Kerr M E, Brucia J
University of Pittsburgh School of Nursing, PA 15261.
Heart Lung. 1993 Nov-Dec;22(6):516-22.
Mortality and poor functional outcomes remain major problems in patients who experience a severe head injury. Cerebral injury from high intracranial pressure contributes to the head injury. A basic postulate in the care of the head-injured patient is the prevention of secondary cerebral damage through the management and prevention of high intracranial pressure. Hyperventilation, once an established intervention in the treatment and control of intracranial hypertension in patients with severe neurologic injury, has become increasingly controversial. This article reviews (1) the normal physiology of the brain, (2) the pathophysiologic changes that occur during head injury, and (3) the theoretical rationale of hyperventilation and its interaction with nursing care. A case study is presented to highlight how the patient's response to a routine nursing procedure, endotracheal suctioning, may change as a result of hyperventilation.
对于重度颅脑损伤患者而言，死亡率和功能预后不良仍是主要问题。高颅内压导致的脑损伤会加重颅脑损伤。颅脑损伤患者护理的一个基本假设是通过管理和预防高颅内压来预防继发性脑损伤。过度通气曾是治疗和控制重度神经损伤患者颅内高压的既定干预措施，但如今争议越来越大。本文回顾了：（1）大脑的正常生理功能；（2）颅脑损伤期间发生的病理生理变化；（3）过度通气的理论依据及其与护理的相互作用。文中呈现了一个案例研究，以突出过度通气可能如何改变患者对常规护理操作——气管内吸痰的反应。
