Herbowski L
Kliniki Neurochirurgii Instytutu Neurologii i Psychiatrii, Pomorskiej Akademii Medycznej.
Ann Acad Med Stetin. 1991;37:121-35.
The determination of the best body position in patients after cranio-cerebral injuries was the main subject of the undertaken studies. This optimal body position should ensure the intracranial pressure drop on condition that the cerebral blood flow and cerebral elasticity are not disturbed. To accomplish this task a biophysical model of the positional changes of the cerebro-spinal fluid pressure was elaborated. I took the activity of the gravitation and adhesive forces as well as contraction phenomenon into consideration, while preparing the model. The verification of the biophysical model was carried out by clinical examination of 15 patients, which confirmed its correctness. The positional changes of the intracranial pressure and cerebral perfusion pressure as well as cerebral elasticity were analyzed in 11 patients after cranio-cerebral injuries. I disclosed the intracranial pressure normalization and cerebral blood flow improvement by elevation of the body to the position of 30 degrees. Moreover, it appears that the shift of the cerebral midline structures causes an essential diminution of the positional intracranial pressure drop by the body elevation. The retrospective studies in 157 patients after cranio-cerebral injuries permitted me to compare the results of the classical treatment and the positioning one. I have ascertained that the applying of the trunk and head elevation to the position of 30 degrees improves the results of the medical treatment.
颅脑损伤患者最佳体位的确定是所开展研究的主要课题。这种最佳体位应在不干扰脑血流量和脑弹性的情况下确保颅内压下降。为完成此任务,精心构建了脑脊液压力位置变化的生物物理模型。在构建模型时,我考虑了重力、黏附力的作用以及收缩现象。通过对15例患者的临床检查对生物物理模型进行了验证,证实了其正确性。对11例颅脑损伤患者的颅内压、脑灌注压以及脑弹性的位置变化进行了分析。我发现将身体抬高至30度可使颅内压恢复正常并改善脑血流量。此外,似乎脑中线结构的移位会导致因身体抬高而引起的位置性颅内压下降显著减少。对157例颅脑损伤患者的回顾性研究使我能够比较传统治疗和体位治疗的结果。我已确定将躯干和头部抬高至30度可改善治疗效果。