重型脑损伤后脑组织氧分压变化的临床观察及护理

Clinical Observation and Nursing of the Variation of Brain Oxygen Pressure After Severe Brain Tnjnrv

对10例重型颅脑损伤病人进行脑组织氧分压(PbrO_2)持续监测,同时监测血氧饱和度(SpO_2)、动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、颅内压(ICP)及脑组织灌注压(CPP)。从伤后平均7h开始连续监测,24～72h,发现有86％病人PbrO_2≤2.67Kpa,其伤后24h PbrO_2逐渐上升,当SpO_2波动在98～100％及PaO_2波动于11.06～14.42Kpa之间时,PbrO_2基本处于正常状态,影响PbrO_2的主要因素为PaO_2和PaCO_2。因此,保持呼吸道通畅及适当的使用呼吸机辅助呼吸,及做好气切及头部导管的护理,有利于PbrO_2保持正常范围。

Ten patients with severe head injury have continuously monitored the brain oxygen pressure (PbrO2), pulse oxygen saturation (SpO2), arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), intracranial pressure (ICP) and cerebral perfusion pressure (CPP), began in an average of 7 hours after injury and went on for 24-72 hours. Eighty-six percent of the patients had a PbrO2 less than 2. 67Kpa, which increased gradually within 24 hours after injury. When SpO2 fluctuated between 98% and 100% and PaO2 fluctuated between 11.06Kpa and 14.42 Kpa, PbrO2 was almost normal. The main factors influencing PbrO2 are PaO2 and PaCO2. Therefore, to keep PbrO2 normal, it is important to keep the respiratory tract unblocked, properly use breathing machine and take care of the tracheotomy cannula and the catheter on the head.