Ammons A M
Richland Memorial Hospital, Columbia, South Carolina.
Nurs Clin North Am. 1990 Mar;25(1):23-33.
Cerebral injuries refer to an actual injury to the brain matter. Injuries seen are concussion, contusion, or diffuse axonal injury. Bleeding into any of the meningeal spaces, brain, or ventricles is known as intracranial hemorrhage. Seldom do cerebral injuries appear as distinct entities but rather as a combination of injuries. The neurologic dysfunction is the sum total of the injury. The significance of the initial injury lies in the development of secondary events, such as edema, hemorrhage, and swelling. These events may lead to further deterioration and neurologic dysfunction. Treatment is directed at preservation of brain homeostasis and prevention of secondary injury. Controlled hyperventilation is the mainstay in the treatment of increased ICP. Other therapies include barbiturate coma and the use of corticosteroids to reduce ICP. Nursing interventions focus on methods to promote cerebral perfusion and support other body systems affected by immobility and altered level of consciousness. Planning nursing care and activities to the patient's ICP and CPP responses is indicated.
脑损伤是指脑实质的实际损伤。所见损伤包括脑震荡、脑挫伤或弥漫性轴索损伤。血液进入任何脑膜间隙、脑或脑室被称为颅内出血。脑损伤很少以单一形式出现，而是多种损伤的组合。神经功能障碍是损伤的综合表现。初始损伤的重要性在于继发事件的发生，如水肿、出血和肿胀。这些事件可能导致病情进一步恶化和神经功能障碍。治疗旨在维持脑内环境稳定并预防继发性损伤。控制性过度通气是治疗颅内压升高的主要手段。其他治疗方法包括巴比妥类药物昏迷疗法以及使用皮质类固醇降低颅内压。护理干预重点在于促进脑灌注的方法以及支持因活动受限和意识水平改变而受影响的其他身体系统。根据患者的颅内压和脑灌注压反应来规划护理和活动是必要的。
