不同体位对高血压脑出血病人颅内压、脑灌注压和生命体征的影响

目的:探讨不同体位对高血压脑出血病人颅内压(ICP)、脑灌注压(CPP)和生命体征的影响.方法:将高血压脑出血病人46例按0°、15°、30°、45°逐渐改变床头抬高角度,监测不同角度下病人ICP、CPP、脑组织血氧饱和度(rSO2)和生命体征变化,并进行相关性分析.结果:随着床头抬高角度增加,病人ICP值逐渐降低,CPP值逐渐升高,组间差异均有统计学意义(P<0.01和P<0.05).不同角度间两两比较显示,床头抬高角度15°、30°、45°病人ICP均较0°明显降低(P<0.01),床头抬高角度30°、45°病人ICP亦均低于15°(P<0.05);床头抬高角度45°病人CPP高于0°(P<0.05).不同床头抬高角度下,病人的rSO2、脉搏血氧饱和度、心率、收缩压、舒张压、平均动脉压和体温差异均无统计学意义(P>0.05).不同床头抬高角度下,高血压脑出血病人rSO2与平均动脉压和ICP均呈正相关关系(P<0.05),与CPP均呈负相关关系(P<0.05).结论:在床头抬高角度15°~30°内,病人能获得最佳护理效果.

Effect of different positions on the ICP,CPP and vital signs in patients with cerebral hemorrhage

Objective:To investigate the effects of different positions on the ICP,CPP and vital signs in patients with cerebral hemorrhage.Methods:The ICP,CPP,cerebral tissue oxygen saturation(rSO2) and vital signs in 46 hypertension patients with cerebral hemorrhage were monitored at 0°,15°,30° and 45° of bed head.Results:With the elevating of bed head angle,the ICP and CPP value of patients gradually decreased,and the difference of those in different groups were statistically significant(P<0.01 and P<0.05). The results of pairwise comparison showed that the ICP value at 15°,30° and 45° of bed head significantly decreased compared with the 0° of bed head,the ICP value at 30° and 45° of bed head was lower than that at 15° of bed head(P<0.05),and the CPP value at 45° of bed head was higher than that at 0° of bed head(P<0.05).The differences of the rSO2,pulse oxygen saturation,heart rate,systolic pressure,diastolic pressure,mean arterial pressure and body temperature between different angles were not statistically significant(P>0.05).At different angles of bed head,the rSO2was positively correlated with mean arterial pressure and ICP(P <0. 05),and negatively correlated with the CPP(P<0.05).Conclusions:Within the 15° to 30° of bed head,the nursing effect of patients is the best.