连翘养荣汤联合负压引流技术对四期压疮的辅助治疗效果及其对炎性因子的影响

目的:探讨连翘养荣汤联合负压引流技术(VSD)对四期压疮的辅助治疗效果及对炎性因子的影响。方法:选取2017年1月—2019年1月我院收治的四期压疮患者120例,依据随机数字表分为A组和B组,每组60例,A组给予VSD治疗,B组在此基础上给予连翘养荣汤治疗,比较两组炎性因子[C-反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)]、疼痛[视觉模拟评分(VAS)]、创面愈合情况。结果:A组和B组治疗后CRP、IL-6、TNF-α明显低于治疗前,B组治疗后CRP、IL-6、TNF-α明显低于A组,差异有统计学意义(P<0.05);A组和B组治疗7、14 d后VAS评分明显低于治疗前,B组治疗7、14 d后VAS评分明显低于A组,差异有统计学意义(P<0.05);B组治疗有效率明显高于A组,B组换药次数、创面愈合时间、治疗费用明显低于A组,差异有统计学意义(P<0.05)。结论:连翘养荣汤联合VSD可有效减少四期压疮患者炎性因子及疼痛,有利于提高患者治疗效果,值得临床推广。     

负压封闭引流联合牛碱性成纤维细胞生长因子对四肢深Ⅱ度烧伤创面治疗效果研究

目的:研究负压封闭引流(Vacuum sealing drainage,VSD)联合牛碱性成纤维细胞生长因子(Basic fibroblast growth factor,bFGF)对四肢深Ⅱ度烧伤创面的治疗效果。方法:选择2018年4月-2019年3月笔者医院收治的80例四肢深Ⅱ度烧伤患者,分别采用常规治疗(对照组,n=20),负压封闭引流治疗(治疗组A,n=20),牛碱性成纤维细胞生长因子治疗(治疗组B,n=20)和负压封闭引流联合牛碱性成纤维细胞生长因子治疗(治疗组C,n=20)。观察比较四组患者创面大体情况、创面愈合时间、创面愈合率、创面分泌物细菌培养情况和瘢痕增生情况。结果:经不同处理10d和21d后,治疗组A、B和C创面改善情况明显优于对照组,且治疗组C情况改善最好;治疗组A、B和C创面愈合时间均明显低于对照组,治疗组C愈合时间最短,差异均具有统计学意义(P0.05)。10d、14d和21d后,治疗组A、B和C创面愈合率明显高于对照组,且10d、14d后治疗组C创面愈合率最高(P0.05),但21d后治疗组A、B和C创面愈合率无差别(P0.05)。治疗组A、B和C患者愈后1个月、2个月、4个月瘢痕颜色评分明显低于对照组,治疗组A、B和C患者愈后2个月、4个月瘢痕厚度、血管分布及柔软度评分均明显低于对照组,且C组愈后4个月的各指标评分均明显低于治疗组A和B(P0.05)。所有患者治疗后1d均无细菌感染,但治疗10d、14d和21d后,治疗组A、B和C组细菌培养阳性病例数比例均明显低于对照组,治疗组C细菌培养阳性病例数最低(P0.05)。结论:负压封闭引流联合bFGF可有效加快四肢深Ⅱ度烧伤创面的愈合,改善愈后的瘢痕生长,减少创面病原菌感染率,具有临床推广使用价值。     

自制皮肤牵张器与负压技术联合应用对大面积皮肤缺损的疗效观察

目的探讨自制的皮肤牵张器与负压技术联合应用对大面积皮肤缺损创面的治疗效果。方法回顾性分析自2016年1月至2018年6月收治的90例大面积皮肤缺损创面患者的临床资料,根据治疗方法分为A、B、C组,每组30例。A组采用自制皮肤牵张器治疗;B组采用负压技术治疗;C组采用皮肤牵张器与负压技术联合治疗;比较3组治疗效果。结果C组患者治疗后的创面分泌物细菌计数明显低于A、B组(P<0.05),HA、VECF水平明显高于A、B组(P<0.05)。C组患者治疗后的创面色泽(2.78±0.59)、血管分布(2.25±0.30)、厚度(1.92±0.21)、柔软度(1.87±0.17)评分均明显高于A、B组;3组组间比较差异具有统计学意义(P<0.05)。结论采用自制的皮肤牵张器与负压技术联合治疗大面积皮肤缺损可降低创面分泌物的细菌计数,促进血管内皮生长因子分泌和创面愈合。     

生肌止痛膏纱条对肛周脓肿术后创面愈合及生长因子的临床疗效研究

目的 观察生肌止痛膏纱条对肛周脓肿术后创面愈合的影响,总结临床疗效。方法:将80例肛周脓肿术后患者随机均分为治疗组和对照组。治疗组予生肌止痛膏纱条换药、静滴抗生素、痔疮Ⅱ洗剂坐浴;对照组予雷夫诺尔纱条换药、静滴抗生素、痔疮Ⅱ洗剂坐浴。测量并比较两组的疼痛程度、创面减小率、创面完全愈合期、C-反应蛋白(CRP)、血管内皮生长因子(VEGF)、成纤维细胞生长因子(FGF)和血小板衍生生长因子(PDGF)含量。结果:两组肛周脓肿术后相比,治疗组疼痛轻于对照组,差异有统计学意义(P<0.05);两组创面减小率比较,术后7 d、14 d治疗组创面减小率均大于对照组,差异有统计学意义(P<0.05);两组创面完全愈合期比较,治疗组创面完全愈合期小于对照组,差异有统计学意义(P<0.05);两组CRP含量比较,术后7 d治疗组CRP含量小于对照组,差异有统计学意义(P<0.05);两组VEGF、PDGF、FGF含量比较,治疗组术后7 d、14 d、21 d创面VEGF、PDGF、FGF含量大于对照组,差异有统计学意义(P<0.05)。结论:生肌止痛膏纱条能够明显减轻肛周脓肿术后创面疼痛,促进生长因子的分泌,加快创面愈合。     

藻酸盐敷料与mEGF联合应用对难愈性创面bFGF影响的随机对照试验

目的:探讨联合应用藻酸盐敷料(alginate dressing)与冻干鼠表皮生长因子(mouse epidermal growth fac-tor,mEGF)对难愈性创面碱性成纤维细胞生长因子(basic fibroblast grow thfactor,bFGF)表达的影响,评价其疗效。方法:采用前瞻性、随机、对照设计方法,选择经常规换药抗炎治疗1个月创面仍未愈合的18例患者,年龄18～61岁,平均36.4岁;男12例,女6例;足部11例,小腿3例,手4例。随机分成3组:藻酸盐敷料与mEGF联合治疗组(A组)、mEGF治疗组(B组)、常规治疗组(C组),每组6例。治疗7、14、21、28d后评价其创面愈合指数,7d和14d时行活组织检查常规病理学观察,免疫组织化学SP法评定bFGF表达阳性细胞数目。结果:A、B组创面愈合均明显,A组较B组突出(P<0.05)。病理学检查显示:A组创面修复细胞增殖明显,表皮增厚,上皮化活跃;B组虽也有类似改变,但不如A组显著。免疫组织化学SP染色显示:3组bFGF表达均有上调,但以A组最为显著(P<0.05)。结论:藻酸盐敷料与mEGF联合应用治疗难愈性创面,能协同两者优势,较单用mEGF疗效更佳。     

高通量透析改善老年血液透析患者微炎症状态的临床研究

目的:探讨高通量透析对老年维持性血液透析患者微炎症状态的影响。方法:将常规血液透析老年患者80例,随机分为高通量组及常规透析组。检测各组患者治疗前后的血清超敏C反应蛋白、白细胞介素6、肿瘤坏死因子α、同型半胱氨酸、丙二醛、白蛋白、转铁蛋白、血红蛋白、全段甲状旁腺素等,治疗观察时间为3个月。结果:高通量透析组(A组)和常规透析组(B组)患者治疗前后血清学CRP、IL-6、TNF-α、Hcy、MDA、iPTH水平比较,A组治疗3月后各项指标较治疗前明显下降(P<0.05),而B组治疗后各项指标下降不明显,治疗3月时A、B两组间各项指标差异有统计学意义(P<0.05);MHD组患者CRP与IL-6、TNF-α、Hcy、MDA、iPTH呈显著正相关(分别为r=0.526,P<0.01;r=0.511,P<0.01;r=0.269,P<0.05;r=0.302,P<0.05;r=0.712,P<0.01)。结论:高通量血液透析可以改善血透患者微炎症状态。     

纳米银敷料在修复Ⅱ度烧伤创面的应用研究

目的观察纳米银敷料在Ⅱ度烧伤创面的防治感染作用及对创面愈合时间的影响。方法将Ⅱ度(深、浅)烧伤创面患者随机分为纳米银敷料组(A组,65例),1%磺胺嘧啶银霜组(B组,63例)和凡士林油纱组(C组,63例)。创面敷料或用药每天更换1次,使用前后进行创面细菌培养,观察创面愈合时间并进行统计学比较。结果在防治创面细菌定植方面,治疗后创面细菌培养阳性率A组(0%)与B组(1·6%)相似,均较治疗前下降,而C组治疗后细菌培养阳性率(14·3%)较治疗前(4·8%)明显增加。A组浅Ⅱ度创面愈合时间为(9·6±1·6)d,与B、C两组比较均明显提前(P<0·01);A组深Ⅱ度创面愈合时间为(19·1±2·6)d,与C组比较差异具有统计学意义(P<0·01),与B组比较差异无统计学意义(P>0·05)。结论Ⅱ度烧伤创面应用纳米银敷料,可以降低患者创面感染的风险,缩短创面愈合时间。     

三种疝修补术治疗老年腹股沟疝患者的临床疗效比较

目的探究疝环充填手术、Lichtenstein修补术与腹腔镜经腹腹膜前修补术对老年腹股沟疝患者临床疗效情况。 方法选取2018年1月至2020年2月在东南大学附属中大医院溧水分院进行治疗的150例老年腹股沟疝患者，随机分为A组（50例）、B组（50例）及C组（50例）。A组采用疝环充填修补术、B组采用Lichtenstein修补术、C组采用腹腔镜经腹膜前修补术，观察并记录3组患者的手术时间、术后下床活动时间、术后疼痛持续时间以及术后住院时间；分别于术后1 d、7 d，采用视觉模拟评分对患者进行疼痛评估；检测术前及术后3组患者炎性因子水平：C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）以及白细胞介素-6（IL-6）水平；记录患者术后6个月内并发症发生情况。 结果3组患者手术时间比较，差异无统计学意义（P>0.05）；C组术后下床活动时间、术后疼痛持续时间及术后住院时间显著低于A组和B组（P<0.01），B组在术后疼痛持续时间上低于C组（P<0.05）；术后1 d、7 d，C组VAS评分低于A组及B组，A组VAS评分低于B组（P<0.05）；3组术后CRP、TNF-α以及IL-6水平均较术前显著升高，C组炎性因子水平均显著低于A组和B组（P<0.05），B组术后IL-6水平低于A（P<0.05）；3组在术后6个月均未出现疝复发情况，A组并发症总发生率低于B组和C组（P<0.05），B组术后发生神经感觉异常症状高于A组（P<0.05），B组和C组并发症总发生率差异无统计学意义（P>0.05）。 结论腹腔镜经腹腹膜前修补术治疗老年腹股沟疝患者疗效较开放式无张力疝修补术更好，对老年患者损伤更小，使其术后恢复更快，安全性更高。     

两种不同术式治疗多发性肋骨骨折对患者呼吸功能及炎症反应的影响

目的 探讨两种不同术式治疗多发性肋骨骨折患者对呼吸功能及炎症反应的影响。方法 回顾性分析2018年1月至2022年12月本院收治的80例多发性肋骨骨折患者，根据不同治疗方案分为A组43例和B组37例。A组进行钛镍记忆合金肋骨环抱器内固定术治疗，B组进行胸部护板外固定术治疗。比较两组疗效、临床指标、呼吸功能、炎症指标、疼痛、并发症。结果 治疗7 d后，A组优良率为90.70%，高于B组的70.27%(P<0.05)。A组患者呼吸困难改善时间、镇痛药应用时间、住院时间、骨折愈合时间均短于B组（P<0.05）。A组治疗7 d后的呼吸频率低于B组，血氧饱和度、最大通气量、潮气量高于B组（P<0.05）。A组治疗7 d后的血清C反应蛋白（CRP）、白细胞介素-6(IL-6)水平低于B组（P<0.05）。A组治疗7 d后的疼痛视觉模拟评分（VAS）低于B组（P<0.05）。两组患者并发症发生率比较差异无统计学意义（P>0.05）。结论 相比胸部护板外固定术，钛镍记忆合金肋骨环抱器内固定术治疗多发性肋骨骨折更能改善呼吸功能，减轻炎症反应，更快促进骨折愈合。     

物理治疗促进坐骨神经损伤再生的实验研究

目的周围神经损伤是临床常见疾病,评估物理治疗对坐骨神经损伤后功能恢复的影响,为临床治疗提供一定参考。方法雌性Wistar大鼠64只,体重252～365g,随机分为A、B、C、D4组,每组16只。各组分离右侧坐骨神经后,B、C、D组钳夹坐骨神经造成损伤模型,A组不进行钳夹作为对照。术后第2天,B组未治疗,C组采用单纯电刺激治疗,D组采用电刺激、分米波和红外线综合治疗。分别于治疗后0、7、14、30d行坐骨神经功能指数(sciatic nerve function index,SFI)、神经传导速度(motor nerve conduction velocity,MNCV)检测,并取材行组织形态学观察和透射电镜观察,取治疗后30d切片行轴突图像分析。结果治疗后0、7d,B、C、D组SFI显著高于A组(P<0.05),B、C、D组间差异无统计学意义(P>0.05);治疗后14、30d,D组SFI显著降低,30d时与A组比较差异无统计学意义(P>0.05),B、C组SFI有所降低,但与A组比较差异仍有统计学意义(P<0.05)。治疗后0、7、14d,B、C、D组MNCV显著低于A组(P<0.05),C、D组与B组比较差异有统计学意义(P<0.05),14d时D组高于C组(P<0.05);治疗后30d,B、C组仍显著低于A组(P<0.05),但D组与A组比较差异无统计学意义(P>0.05)。治疗后0、7d,透射电镜观察各组仅见胶原蛋白和脂质成分;治疗后14、30d,B、C、D组可见大量雪旺细胞和再生神经纤维,D组最显著。治疗30d时轴突图像分析示,D组有髓神经纤维数、轴突直径及髓鞘厚度与A组比较差异均无统计学意义(P<0.05),有髓神经纤维数量和轴突直径显著高于B、C组(P<0.05),髓鞘厚度与C组比较差异无统计学意义(P>0.05)。结论物理治疗有促进大鼠损伤周围神经再生的作用。     

股静脉测压法和膀胱测压法在危重患者腹内压监测中的比较

目的：比较股静脉测压法和膀胱测压法在危重患者腹内压（IAP）监测中的应用价值.方法：对2013年1-6月住院治疗的20例ICU重症患者,分别使用两种测压方法进行IAP监测,均每8 h 1次,连续测定3 d,每次随机选择两种方法的测量顺序,共测量720次,比较两种测压法在读数精准性、测压数值、操作时间、并发症和医护人员满意度等方面的异同.结果：股静脉测压法所测压力数值与膀胱测压法相近[（14.14±4.33）mmHg比（12.91±4.75）mmHg,P〉0.05];但是股静脉测压法的操作时间[（57.94±19.00）s]较膀胱测压法更短[（112.49±27.07）s,P〈0.05];股静脉测压法读数精准率（84.44%）较膀胱测压法（49.44%）高（P〈0.01）,操作并发症低至1.1%（4例次）,远低于膀胱测压法的5.3%（19例次,P〈0.05）;医护人员满意度达（3.90±0.26）分,优于膀胱测压法[（2.48±0.19）分,P〈0.01].结论：相对于膀胱测压法而言,股静脉测压法具有测压值相似、操作时间短、读数精准度高、操作并发症少、接纳度高等优点,值得在危重患者IAP监测中推广.     

间歇正压通气和呼气末正压通气对犬眼内压的影响

目的 探讨间歇正压通气(IPPV)和呼气末正压通气(PEEP)对犬眼内压(10P)的影响.方法 实验犬8只,麻醉后分别监测基础条件下和各种机械通气条件下的IOP、CVP、MAP.结果 实施20 ml/kg和30 ml/kg两种不同潮气量的IPPV时IOP差异无统计学意义.实施10、15、20cm H20三种不同压力值的PEEP时IOP均显著升高(P<0.01).结论 IPPV对IOP影响不大,PEEP可使IOP显著升高.     

Intra-abdominal pressure measurement: validation of intragastric pressure as a measure of intra-abdominal pressure

Background: The diagnosis of abdominal compartment syndrome depends uponthe demonstration of an elevated intra-abdominal pressure (IAP).Direct measures of IAP are impractical in the critical careunit; intravesical pressure (IVP) and intragastric pressure(IGP) should represent acceptable surrogate measures. IVP isthe preferred measure of IAP in critical care. We consideredthat IGP represents a practical alternative. The objective ofthis preliminary study was to observe the relationship betweenIGP and IAP. Methods: After Institutional Ethics Board approval, 29 patients havingelective laparoscopic surgery were recruited. IAP was measureddirectly via the abdominal trochar. This was compared with IGPmeasured via a commercial balloon catheter placed into the stomach. Results: Measured IGP was always more positive than IAP; both showedlinear correlation (r²>0.9). When IGP was calibrated againstIAP, an estimated difference between the IGP and IAP of ±2.5 mm Hg for 95% of the measurements was seen. Conclusions: The study demonstrates the strength of the relationship betweenIGP and IAP in normal individuals. Application of IGP measurementin the critical care patient is necessary to demonstrate itssuitability for continuous IAP assessment.     

Iliac venous pressure estimates central venous pressure after laparotomy

Background

Central venous pressure (CVP) is traditionally obtained through subclavian or internal jugular central catheters; however, many patients who could benefit from CVP monitoring have only femoral lines. The accuracy of illiac venous pressure (IVP) as a measure of CVP is unknown, particularly following laparotomy.

Methods

This was a prospective, observational study. Patients who had both internal jugular or subclavian lines and femoral lines already in place were eligible for the study. Pressure measurements were taken from both lines in addition to measurement of bladder pressure, mean arterial pressure, and peak airway pressure. Data were evaluated using paired t-test, Bland-Altman analysis, and linear regression.

Results

Measurements were obtained from 40 patients, 26 of which had laparotomy. The mean difference between measurements was 2.2 mm Hg. There were no significant differences between patients who had laparotomy and nonsurgical patients (P = 0.93). Bland-Altman analysis revealed a bias of 1.63 ± 2.44 mm Hg. There was no correlation between IVP accuracy and bladder pressure, mean arterial pressure, or peak airway pressure.

Conclusions

IVP is an adequate measure of CVP, even in surgical patients who have had recent laparotomy. Measurement of IVP to guide resuscitation is encouraged in patients who have only femoral venous catheter access.     

Changes in intracranial pulse pressure amplitudes after shunt implantation and adjustment of shunt valve opening pressure in normal pressure hydrocephalus

Summary Background  We have previously reported that the intracranial pulse pressure amplitudes were elevated in idiopathic normal pressure hydrocephalus (NPH) patients responding to shunt surgery. Whether or not shunt implantation or adjustment of the shunt valve opening pressure modifies the intracranial pulse pressure amplitudes in NPH patients remains to be established. This report summarises our observations. Patients and methods  Thirteen patients with NPH (idiopathic in nine and secondary in four) are presented in whom continuous intracranial pressure (ICP) monitoring was done before and after shunt implantation. In two, ICP monitoring was also done during adjustment of shunt valve opening pressure. The mean ICP and mean ICP wave amplitude (i.e. pulse pressure amplitudes) were determined in 6-s time windows. Results  After shunt implantation there was a fall in both mean ICP and mean ICP wave amplitude; the reduction in the two ICP parameters correlated significantly. However, mean ICP in the supine position was normal (i.e. <15 mmHg) in 12 of 13 patients before shunt placement, and remained normal after shunting. According to our criteria, the mean ICP wave amplitudes were elevated before shunting in 12 of 13 patients and became “normalised” the day after shunting in nine patients. The reduction in mean ICP wave amplitude after shunt was highly significant at the group level. Moreover, adjustment of shunt valve opening pressure modified the levels of mean ICP wave amplitudes. Conclusions  The present observations in 13 NPH patients indicate that shunt implantation reduces mean ICP wave amplitudes. Moreover, the level of reduction can be tailored by adjustment of the shunt valve opening pressure.     

Telemetric recording of intrapleural pressure

BACKGROUND: Monitoring of intrapleural pressure (IPP) is used for evaluation of lung function in a number of pathophysiological conditions. We describe a telemetric method of non-invasive monitoring of the IPP in conscious animals intermittently or continuously for a prolonged period of time. MATERIALS AND METHODS: After IACUC approval, six mongrel dogs were used for the study. After sedation, each dog was intubated and anesthetized using 0.5% Isoflurane. A telemetric implant model TL11M2-D70-PCT from Data Science International was secured subcutaneously. The pressure sensor tip of the catheter from the implant was inserted into the pleural space, and the catheter was secured with sutures. The IPP signals were recorded at a sampling rate of 100 points/second for 30 to 60 min daily for 4 days. From these recordings, the total mean negative IPP (mmHg), and the total mean negative IPP for a standard time of 30 min were calculated. In addition, the actual inspiratory and expiratory pressures were also measured from stable recording of the IPP waveforms. RESULTS: In six dogs, the total mean +/- SD negative IPP was -10.8 +/- 10.6 mmHg. After normalizing with respect to acquisition time it was -13.2 +/- 11.2 mmHg/min. The actual inspiratory pressure was -19.7 +/- 15.3, and the expiratory pressure was -11.0 +/- 12.9. CONCLUSIONS: Our study demonstrates that telemetric monitoring of IPP can be performed reliably and non-invasively in conscious experimental animals. The values for IPP in our study are compatible with the results of other investigators who used different methods of IPP measurement. Further work may show this method to be helpful in understanding the pathophysiology of various breathing disorders.     

Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries

In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.     

异丙酚和普鲁卡因对颅内压及脑灌注压的影响

目的观察异丙酚、普鲁卡因对颅内压(ICP)和脑灌注压(CPP)的影响。方法25例脑肿瘤病人随机分成异丙酚组(D组)和普鲁卡因组(P组)。局麻下钻孔于颅骨及脑膜间安置SP-2000型颅内压监护仪，连续监测ICP，同时用Colin508连续监测MAP、HR及PETCO2。静注异丙酚2mg／kg后，输注异丙酚100～150pg·kg     

Clinical evaluation of a simple epidural pressure sensor

Summary The Plastimed^® epidural pressure sensor was evaluated in 35 patients, twenty-eight of whom were suffering from head injury. In seven patients simultaneous intraventricular pressure measurements were obtained. The epidural pressure sensor was only functioning satisfactorily in approximately 2/3 of the patients, while it was malfunctioning or not functioning in the remainder. In seven comparable IVP/EDP studies significant differences up to 25 mm Hg were noted. In three patients IVP was greater than EDP. In two patients the opposite was true. No significant complications were observed.These unsatisfactory results have made us abandon the technique and resort to intraventricular or subarachnoidal pressure measurements.     

体位变化对脑室引流术患者颅内压和平均动脉压及脑灌注压的影响

目的 探讨脑室引流患者的体位变化对平均动脉压、颅内压和脑灌注压的影响.方法 对60例接受过脑室穿刺术并留置脑室引流管患者,监测其抬高床头0°、15°、30°、45°时的颅内压(ICP)和平均动脉压(MAP),再计算出脑灌注压(CPP),比较不同体位状态下患者的MAP、ICP和CPP.结果 ICP随着床头的抬高而显著降低...