脑出血术后体位护理对ICP稳定性影响的研究

Effect of postural nursing on ICP stability after cerebral hemorrhage operation bruce bowen

目的探讨脑出血术后体位护理对ICP稳定性的重要性。方法选取2015年10月~2016年6月本院收治的脑出血术后患者60例,通过ICP监测仪,记录床头抬高0°、15°、30°和45°时的ICP值。比较床头抬高不同角度对ICP的影响。结果床头抬高15°时的ICP值(12.92±3.45)mm Hg处于正常范围内,抬高15°时ICP值明显高于抬高30°、45°时ICP值,且明显低于平卧时ICP值,差异有统计学意义(P <0.05)。随着床头抬高角度增加,患者ICP值逐渐降低,差异有统计学意义(P <0.05)。Pearson相关性分析结果显示,床头抬高15°的ICP值与患者的性别、年龄、出血部位/诊断及手术方式不存在相关关系(P> 0.05)。2015年1~9月本院未行ICP监测时,术前GCS与术后2周GCS评分差值为(2.07±0.56)分,本研究60例患者床头抬高15°时,术前GCS与术后2周GCS评分差值为(5.33±0.89)分,两者比较,差异有统计学意义(F=4.706,P=0.000)。结论考虑压疮及ICP等因素,与床头抬高0°、30°及45°比较,床头抬高15°更有利于维持脑出血术后患者ICP在正常范围内的稳定性。

Objective To investigate the importance of postural nursing on ICP stability after cerebral hemorrhage operation. Methods Sixty patients with cerebral hemorrhage treated in our hospital were selected from October 2015 to June 2016. ICP values were recorded by ICP monitor at the height of 0° , 15° , 30° and 45° . The influences of different angles on the ICP were compared. Results When the head was raised 15° , the ICP value was （12.92 ± 3.45） mm Hg in normal range. The ICP value was significantly higher at elevating 15° than the ICP value at elevating 30° and 45° , while it was significantly lower than the ICP value of supine position, and the differences were statistically signifieant（P 〈 0.05）. With the increase of head elevation, the ICP value of patients gradually decreased, and the difference was statistically signifieant（P 〈 0.05）. The results of Pearson correlation analysis showed that the ICP value of the head elevation of 15° was not related to the patient＇ s sexual distinction, age, bleeding site or diagnosis and operation mode（P 〉 0.05）. From January 2015 to September 2015, when ICP monitoring was not performed in our hospital, the difference of GCS score between preoperative and postoperative 2 weeks was （2.07 ± 0.56） score. But the difference of GCS score between preoperative and postoperative 2 weeks was （5.33 ± 0.89） score, and the difference was statistically significant（F=4.706, P=0.000）. Conclusion Considering the factors such as pressure sore and ICP, compared with the head elevation of 0° , 30° and 45° , the head elevation of 15° is more favorable to maintain the stability of ICP in the normal range after the operation of cerebral hemorrhage.