不同床头抬高角度和体位对神经外科患者颅内压及脑灌注压的影响
Effects of Different Head-of-Bed Elevations and Body Positions on Intracranial Pressure and Cerebral Perfusion Pressure in Neurosurgical Patients.
作者信息
Altun Uğraş Gülay, Yüksel Serpil, Temiz Zeynep, Eroğlu Selin, Şirin Keziban, Turan Yüksel
机构信息
Gülay A. Uğraş, PhD, is Assistant Professor, Department of Surgical Nursing, The University of Mersin, Mersin, Turkey. Serpil Yüksel, PhD, is Assistant Professor, Department of Surgical Nursing, The University of Necmettin Erbakan, Konya, Turkey. Zeynep Temiz, PhD, is Assistant Professor, Department of Surgical Nursing, The University of Artvin Çoruh, Artvin, Turkey. Selin Eroğlu, RN, is Nurse, Neurosurgery Intensive Care Unit, Cerrahpaşa Faculty of Medicine, The University of İstanbul, İstanbul, Turkey. Keziban Sirin, RN, is Nurse, Cerrahpaşa Faculty of Medicine, Department of Neurosurgery, The University of Istanbul, İstanbul, Turkey. Yüksel Turan, RN, is Nurse, Neurosurgery Intensive Care Unit, Cerrahpaşa Faculty of Medicine, The University of Istanbul, Istanbul, Turkey.
出版信息
J Neurosci Nurs. 2018 Aug;50(4):247-251. doi: 10.1097/JNN.0000000000000386.
PURPOSE
The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores.
METHODS
This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU). Patients' HOB was elevated (degree of 15,30,45) and the patients were at supine, left lateral and right lateral positions. ICP and CPP were recorded for each patient.
RESULTS
It was found that ICP increased and CPP decreased at supine, left and right lateral positions with different HOB elevations, which, however, did not reach statistical significance. When patients with a GCS score of 3-8 were at degree of 15 right and left lateral positions and 45 right lateral position; and when patients with a GCS score of 13-15 were positioned at degree of 15 left lateral, ICP and CPP changed significantly.
CONCLUSION
The results of this study showed that different positions the patients' HOB (degree of 15,30,45) led to slight insignificant changes in ICP and CPP; and these values were maintained within the ranges established by recent guidelines.
目的
本研究旨在评估不同床头抬高（HOB）角度和体位对颅内压（ICP）和脑灌注压（CPP）的影响，并确定不同格拉斯哥昏迷量表（GCS）评分的神经外科患者的安全体位。
方法
本研究采用准实验性前瞻性重复测量设计，对干预措施进行控制，纳入30例入住神经重症监护病房（NCU）的患者。将患者的床头抬高（15度、30度、45度），并让患者处于仰卧位、左侧卧位和右侧卧位。记录每位患者的ICP和CPP。
结果
发现在不同床头抬高角度下，仰卧位、左侧卧位和右侧卧位时ICP升高而CPP降低，但未达到统计学意义。当GCS评分为3 - 8分的患者处于15度左右侧卧位和45度右侧卧位时；以及当GCS评分为13 - 15分的患者处于15度左侧卧位时，ICP和CPP有显著变化。
结论
本研究结果表明，患者床头不同抬高角度（15度、30度、45度）导致ICP和CPP有轻微的无显著意义的变化；且这些数值保持在近期指南所确定的范围内。
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