Parsons L C, Wilson M M
Nurs Res. 1984 Mar-Apr;33(2):68-75.
Nursing care of the severe closed head injured patient has two primary goals: (1) the prevention of secondary brain injury associated with intracranial hypertension, and (2) the prevention of complications associated with immobility. This study examined the effects of six body position changes, performed as part of routine nursing care interventions, on the cerebrovascular status of 18 severely head injured patients. These changes included turning and positioning in bed, head rotation, range of motion exercises, and raising and lowering of the head of the bed. All subjects had baseline mean intracranial pressures of less than or equal to 15 mm/Hg, and cerebral perfusion pressures of greater than or equal to 50 mm/Hg. Over 200 observations of the effects of position changes on heart rate (HR), mean arterial blood pressure (MABP), mean intracranial pressure (MICP), and cerebral perfusion pressure (CPP) were recorded and analyzed. With the exception of the intervention raising the head of the bed, all position changes produced increases in HR, MABP, MICP, and CPP. Typically, the physiologic changes were transient and showed recovery toward baseline values in one-minute postintervention measurements. The results of this study suggest that passive position changes may be performed safely upon severe closed head injured patients with baseline MICPs less than or equal to 15 mm/Hg, provided CPPs are maintained above 50 mm/Hg throughout each position change and provided multiple fractures do not preclude these position changes.
（1）预防与颅内高压相关的继发性脑损伤；（2）预防与活动受限相关的并发症。本研究考察了作为常规护理干预措施一部分的六种体位改变对18例重症颅脑损伤患者脑血管状况的影响。这些改变包括在床上翻身和摆放体位、头部转动、关节活动度练习以及床头的升降。所有受试者的基线平均颅内压均小于或等于15 mmHg，脑灌注压均大于或等于50 mmHg。记录并分析了200多次关于体位改变对心率（HR）、平均动脉血压（MABP）、平均颅内压（MICP）和脑灌注压（CPP）影响的观察结果。除了抬高床头的干预措施外，所有体位改变均使HR、MABP、MICP和CPP升高。通常，这些生理变化是短暂的，在干预后一分钟的测量中显示出向基线值恢复的趋势。本研究结果表明，对于基线MICP小于或等于15 mmHg的重症闭合性颅脑损伤患者，只要在每次体位改变过程中CPP维持在50 mmHg以上，且多处骨折不排除这些体位改变，被动体位改变可以安全地进行。
