Simmons B J
J Neurosci Nurs. 1997 Feb;29(1):44-9. doi: 10.1097/01376517-199702000-00007.
Head elevation is a conventional nursing intervention used to control raised intracranial pressure and avoid complications in patients with neurotrauma or other conditions requiring management of intracranial hemodynamics. This therapy, however, provides a particular dilemma for health care providers. While elevating the head of the bed does decrease intracranial pressure, it may put some patients at risk for intracranial hypertension and cerebral ischemia due to decreases in cerebral perfusion pressure. This article analyzes research on head positioning that provides individual outcome measurements versus group means in adult patients with various conditions. The risk/benefit method of analysis used in this review revealed that in addition to only monitoring and controlling for ICP, we must also monitor and control CPP with a greater emphasis on this particular measurement. This analysis also revealed that optimal head positioning to manage intracranial hemodynamics should be decided upon on an individual basis using both ICP and CPP measurements.
抬高床头是一种传统的护理干预措施，用于控制颅内压升高，并避免神经创伤患者或其他需要管理颅内血流动力学的疾病患者出现并发症。然而，这种治疗方法给医护人员带来了一个特殊的难题。虽然抬高床头确实能降低颅内压，但由于脑灌注压降低，可能会使一些患者面临颅内高压和脑缺血的风险。本文分析了针对不同病情成年患者的头部定位研究，这些研究提供了个体结果测量值与组均值。本综述中使用的风险/效益分析方法表明，除了仅监测和控制颅内压外，我们还必须监测和控制脑灌注压，并且要更加重视这一特定测量值。该分析还表明，应根据颅内压和脑灌注压测量值，针对个体情况确定管理颅内血流动力学的最佳头部位置。
