不同吸痰时间对重型颅脑损伤病人颅内压的影响

[目的 ]研究不同吸痰时间对重型颅脑损伤病人颅内压 (ICP)的影响。 [方法 ]将 3 0例重型颅脑损伤病人随机分为 3组 ,观察在吸痰压力为 2 0kPa ,吸痰时间分别为 5s、10s、2 0s时颅内压的变化。 [结果 ]在相同压力下进行吸痰 ,吸痰时间 5s和 10s对颅内压影响作用相似 ,2 0s则可引起颅内压过度升高。 5s与 10s吸痰有效率相似。 [结论 ]在 2 0kPa压力下最佳吸痰时间为 10s。     

重型颅脑损伤病人体位变化对颅内压及脑灌注压的影响

[目的]分析重型颅脑损伤病人体位变化对颅内压(ICP)和脑灌注压(CPP)的影响.[方法]取12种不同体位,统计比较各种体位变化前后ICP、CPP变化.[结果]仰卧位头部抬高45°、仰卧屈膝位30°及45°可使颅内压明显降低,而左侧卧位头部抬高15°、右侧卧位头部抬高15°后颅内压则明显升高.左侧卧位头部抬高30°脑灌注压明显下降.[结论]不同体位可显著影响重型颅脑损伤病人颅内压和脑灌注压的变化.     

两种气管内吸痰方法对重型颅脑损伤患者颅内压的影响

患者气管内吸痰可以改善通气,减少C02潴留,是颅脑损伤患者的重要护理措施之一。颅内压( intracranial pressure,ICP)、脑灌注压(cerebral perfusion pressure,CPP)、平均动脉压(mean artery pressure,MAP)是监护重型颅脑损伤患者病情的重要指标,由于气管内吸痰( endotracheal suction,ETS)刺激气管可引起静脉系统压力升高,可能使重型颅脑伤患者处于颅内高压及脑缺血状态,致残率、致死率高。本研究分别观察开放式吸痰法(open ETS)与密闭式吸痰法(closed ETS)对重型颅脑伤患者的平均动脉压( MAP)、颅内压(ICP)、脑灌注压(CPP)以及血氧饱和度等脑代谢的影响,比较两种气管内吸痰在临床应用的合理性,报道如下。     

护理干预对重型颅脑损伤病人颅内压的影响

[目的]探讨护理干预对重型颅脑损伤病人颅内压(intracranial pressure,ICP)监测数据的影响。[方法]对62例重型颅脑损伤病人进行颅内压监测,均采用Codman ICP监护仪,探头放置在硬膜下、脑室内或者脑实质内。实施监测过程中,颅内压明显升高的病人通过以下措施加强护理,比如镇静、调整体位、保持呼吸道通畅及吸痰、协助排尿排便、防止引流管打折等措施,再观察病人颅内压的变化情况。[结果]共发现216例次ICP升高,其中97例次经过积极护理措施后,病人颅内压明显下降。护理干预前ICP21.42mmHg±4.69mmHg(1mmHg=0.133kPa),护理干预后ICP18.87mmHg±4.79mmHg,以配对样本t检验进行统计分析,差异有统计学意义(P=0.000)。[结论]护理操作可引起颅内压变化,有效恰当的护理干预可以使颅内压监测数据更加准确,为临床诊疗提供更好的依据。     

不同吸痰方式对重型颅脑损伤患者颅内压的影响

目的探讨开放式和密闭式2种不同吸痰方法对重型颅脑损伤患者颅内压的影响。方法42例重型颅脑损伤患者随机分为开放式吸痰组和密闭式吸痰组，分别于每次吸痰前、后5min记录颅内压。结果吸痰后2组颅内压水平均有所升高，但开放式吸痰组升高更为明显（p〈0．05）。2组吸痰有效率相近（p〉0．05）。结论密闭式吸痰法对颅内压影响较小，推荐使用。     

体位对颅脑损伤患者颅内压、脑灌注压的影响

颅内压（ICP）增高是一个复杂的病理生理过程,是重型颅脑损伤的主要并发症。颅内高压如不能及早发现并解除,可引起脑代谢障碍、脑灌注压下降和脑疝形成等严重后果,难以控制的颅内高压病死率达到92％～100％［1-2］。目前脑室内放置 ICP 监测管是临床上常用的方法,被称为ICP 监测的“金标准”［3-4］。颅脑损伤后脑水肿早期,通过实时监测患者的颅内压（ICP）及脑灌注压（CPP）等重要指标,可保证脑组织有足够的血液供应,从而确保脑组织的氧供和糖分需要［5］。研究认为临床护理可影响这些指标的变化,其中患者的体位维持尤为重要［6］。本组选择了复旦大学附属华山医院神经外科急救中心2015年5月至12月期间收治的51例重型颅脑损伤行脑室内 ICP 监测的患者,分别观察其头轴位平卧、头偏位平卧、头轴位床头抬高30°、头偏位床头抬高30°对患者 ICP、CPP 的影响。现报道如下。     

不同吸痰深度对重型颅脑损伤机械通气患者颅内压力的影响

目的 研究不同吸痰深度对重型颅脑损伤机械通气患者颅内压(ICP)和呼吸机相关性肺炎(VAP)发生率的影响.方法 选取重症监护病房58例行机械通气及ICP监护的患者,分为3组,A组、B组、C组分别采取浅吸痰、改良深部吸痰、深部吸痰 3种吸痰方式,分析3组吸痰前后ICP数值变化、吸痰间隔时间和频率;分析机械通气7d内的VAP发生率.结果 A组对ICP影响最小,吸痰间隔最短,吸痰频率最高,VAP发生率60.0％.B组在吸痰瞬间ICP升高,但平均ICP高峰＜20mmHg(1 mmHg=0.133kPa),并在2min内回复基线水平,吸痰间隔较长,吸痰频率较低,VAP发生率为26.3％.C组在吸痰瞬间ICP最高,达(22.63±4.02) mmHg,需5min回复基线水平,吸痰间隔最长,吸痰频率最低,VAP发生率为21.1％.结论 针对重型颅脑损伤患者的气道管理,改良深部吸痰是一种比较安全有效的选择.     

体位变化以及护理干预对重型颅脑损伤病人颅内压和脑灌注压的影响

目的探讨体位变化以及护理干预对重型颅脑损伤病人颅内压和脑灌注压的影响。方法选取本院2015年9月-2017年9月收治的重型颅脑损伤患者73例作为研究对象。采取3种体位,即仰卧位、左侧卧位和右侧卧位,结合头部抬高15°和30°,保持每种姿势15 min后监测颅内压和脑灌注,同时实施护理干预。结果仰卧位和左侧卧位头部抬高15°颅内压升高而脑灌注压下降,但无统计学差异(P0.05);而右侧卧位头部抬高15°颅内压升高和灌注压下降均有统计学差异(P0.05);仰卧位、左侧卧位和右侧卧位头部抬高30°颅内压下降而脑灌注压升高,但无统计学差异(P0.05)。护理干预后不同体位颅内压下降而脑灌注压升高,均有统计学差异(P0.05)。73例患者护理总满意率为97.3%。结论重型颅脑损伤患者不同体位变化颅内压及脑灌注压存在差异,护理干预可降低颅内压和升高脑灌注压,并能提高护理满意度。     

不同吸痰时机对呼吸衰竭机械通气患者排痰的影响

目的:探讨Ⅱ型呼吸衰竭机械通气患者的排痰护理时机。方法:将54例Ⅱ型呼吸衰竭机械通气患者随机分为实验组和观察组。对照组行翻身、叩背等胸部物理治疗后立即吸痰,实验组行翻身、叩背等胸部物理治疗后保持侧卧位8~10min后吸痰,观察两组吸痰效果。结果:两组吸痰效果和吸痰间隔时间比较有显著性差异(P<0.05),实验组明显优于对照组。结论:对呼吸衰竭机械通气患者行翻身、叩背等胸部物理治疗后,保持侧卧位8~10min后吸痰,能明显延长吸痰间隔时间,提高患者对吸痰的耐受性,达到最佳吸痰效果。     

不同吸痰时间对重型颅脑损伤病人颅内压的影响

[目的]研究不同吸痰时间对重型颅脑损伤病人颅内压(1CP)的影响?[方法]将30例重型颅脑损伤病人随机分为3组，观察在吸痰压力为20kPa，吸痰时间分别为5s、10s、20s时颅内压的变化。[结果]在相同压力下进行吸痰，吸痰时间5s和10s对颅内压影响作用相似，20s则可引起颅内压过度升高。5s与10s吸痰有效率相似。[结论]在20kPa压力下最佳吸痰时间为10s。     

早期护理干预对重型颅脑损伤非血肿性高颅压减压手术患者的作用

目的研究早期护理干预对重型颅脑损伤非血肿性高颅压减压手术患者的作用。方法将2009年10月～2011年6月在我院神经外科行减压手术的重型颅脑损伤非血肿性高颅压患者136例随机分为两组,每组各68例。对照组患者接受常规护理方法,观察组患者接受早期护理干预的方法。比较两组患者手术结束时、术后24h、48h和72h的颅内压水平,根据格拉斯哥预后评分进行临床有效性比较以及比较两组家属的护理满意度。结果两组患者术后24h、48h和72h的颅内压水平差异有显著意义(P<0.01);两组患者的临床有效性比较差异有显著意义(P<0.05);两组患者家属的护理满意度得分比较差异有显著意义(P<0.01)。结论早期护理干预对行减压手术的重型颅脑损伤非血肿性高颅压的患者,可促进颅内压降低并提高治疗的临床有效性及护理满意度,值得临床推广。     

颅内压增高患者短时轻度过度通气的观察与护理

目的探讨重型颅脑损伤后的患者使用短时轻度过度通气（HV）的观察与护理。方法2004年5月-2005年12月复旦大学附属华山医院神经外科急救中心收治的重型颅脑外伤的患者31例，使用短期轻度的过度通气治疗，严密观察治疗前后的呼吸指标（PaCO2、PaO2）、颅内压（intracranial pressure，ICP）、平均动脉压（MAP）、脑灌注压（CPP）、意识和瞳孔等动态变化。结果30例患者在使用过度通气1h后，ICP降至20mmHg以下；1例患者出现颅内压反跳性增高，行去骨瓣减压术控制颅内压。31例患者脑灌注压均〉60mmHg。结论 使用短时轻度过度通气可使患者的颅内压下降，通过对呼吸指标、颅内压、脑灌注压的全面仔细观察及护理，有助于保证过度通气的治疗效果，减少因使用过度通气而发生脑缺血加重的并发症。     

急性脑损伤后脑充血

探讨急性颅脑损伤后脑血流动力学改变以及脑充血对颅内压的影响。方法：选用急性颅脑损伤颅内血肿手术后患者２４例,用经颅多普勒超声仪动态监测脑底动脉及颅外颈内动脉的血流变化,通过颅外减压窗观察颅内压的变化。结果：脑充血组１２例中８例同时行颅外减压术,在脑充血期间７例发生颅内压增高,颅内压增高发生率高于无脑充血组（Ｐ〈０．０５）。２例因脑充血死亡。结论：脑充血多为双侧性,可引起较广泛的脑水肿及颅内压增高,     

The effect of nursing interventions on the intracranial pressure in paediatric traumatic brain injury

Aims and objectives: The aim of this research was to investigate the effect of five selected intensive care nursing interventions on the intracranial pressure (ICP) of moderate to severe traumatic brain‐injured children in intensive care. Background: The physiological effects of many nursing interventions in paediatric intensive care (PIC) are not known. This results in the lack of an evidence base for many PIC nursing practices. Design: Prospective observational cohort study conducted over 3 years in a single tertiary referral paediatric intensive care unit (PICU) in the North West of England. Methods: Five selected commonly performed nursing interventions were studied: endotracheal suctioning and manual ventilation (ETSMV), turning via a log‐rolling (LR) approach, eye care, oral care and washing. These were studied in the first 72 h after injury. Results: A total of 25 children with moderate to severe traumatic brain injury and intraparenchymal ICP monitoring in intensive care (aged 2–17 years) were enrolled. Both ETSMV and LR were associated with clinically and statistically significant changes in ICP from baseline to maximal ICP (p = 0·001 ETSMV; p = < 0·001 LR) and from maximal post‐ICP (p = < 0·001 ETSMV; p = < 0.001 LR). Eye care, oral care or washing did not cause any clinically significant change in ICP from baseline. After decompressive craniectomy, none of the interventions caused significant changes in ICP. Conclusions: Only two of the five nursing interventions, endotracheal suctioning and LR, caused intracranial hypertension in moderate to severe traumatic brain‐injured children, and after craniectomy, no care interventions caused any significant change in ICP. Relevance to clinical practice: Knowledge about the physiological effects of many intensive care nursing interventions is lacking and this is magnified in paediatrics. This study provides a significant addition to the evidence base in this area and allows intensive care nurses to plan, implement and evaluate more effectively their nursing care for brain‐injured children.     

两种气管内吸引术在重型颅脑伤患者中的应用比较

目的比较开放式气管内吸引术(Open endotracheal suctioning,Open ETS)与闭合式气管内吸引术(Closed endotracheal suctioning,Closed ETS)对重型颅脑伤患者平均动脉压(MAP)、颅内压(ICP)、脑灌注压(CPP)等方面的影响及其意义。方法将32例重型颅脑伤患者随机分成Open ETS组(n=16)和Closed ETS组(n=16),于吸引前、后动态监测MAP、ICP、CPP变化。结果两组患者吸引后即时MAP均升高,Open ETS组较Closed ETS组明显(P<0.05)。吸引后即时ICP均短暂升高,两组变化趋势基本相同,大多于5min内回落。吸引后即时Open ETS组CPP下降(P<0.01),而Closed ETS组CPP变化无统计学意义。结论颅内高压状态下OpenETS可引起脑缺血、缺氧反应,而Closed ETS不损害脑灌注,并可维持足够脑氧供。因Closed ETS更具合理性,故建议颅脑外伤后可运用Closed ETS。     

Effect of therapeutic hypothermia on the incidence and treatment of intracranial hypertension.

Therapeutic hypothermia initiated immediately after a severe head trauma holds promise for improving outcomes. However, the effect of hypothermia on intracranial pressure (ICP) is not yet known. This study was a secondary analysis, conducted within a National Institutes of Health clinical trial on the efficacy of therapeutic hypothermia, to determine the effects of therapeutic hypothermia on ICP and of interventions (i.e., cerebrospinal fluid drainage and mannitol administration) on intracranial hypertension. There were no significant differences in the overall incidence or treatment of intracranial hypertension between patients who were treated with therapeutic hypothermia and normal controls. Therapeutic hypothermia maintained the ICP at lower levels during the cooling phase, but once patients were rewarmed, the ICP elevated to the levels of normothermic patients.     

Intracranial pressure monitoring in severe hypertensive encephalopathy

Treatment of arterial hypertension in severe hypertensive encephalopathy does not always result in clinical improvement in the patient's central nervous system. In order to elucidate further the status of the brain, the authors have measured intracranial pressure (ICP) and arterial pressure in three cases of severe hypertensive encephalopathy. ICP was elevated in two of the three cases with peak values ranging from 32-70 mm Hg. In these 2 patients, therapy to lower ICP, including hyperventilation, steroids, barbiturates, and furosemide was begun early in the course. Cerebral perfusion pressure (CPP), defined as the difference between mean arterial pressure and ICP, was kept over 50 mm Hg to maintain adequate cerebral blood flow (CBF). These 2 patients survived. In the third case, measures to control ICP were instituted late in the course and the patient died of brain herniation. Intracranial hypertension is a complication of hypertensive encephalopathy and may contribute to cerebral injury. In cases of severe hypertensive encephalopathy, both ICP and arterial pressure should be monitored continuously. Judicious therapy aimed at lowering both ICP and arterial pressure, while maintaining an adequate CPP, should be employed.