床头抬高角度对重型颅脑损伤患者ICP、MAP、CPP的影响

The influence of bed elevation angle on ICP,MAP and CPP in patients with severe craniocerebral injury

目的:探讨床头抬高不同角度与重型颅脑损伤患者ICP、MAP、CPP的关系,进而确立合适的床头抬高角度。方法:收治重型颅脑损伤患者64例,均采取持续颅内压监测,并通过心电监护仪测出平均动脉压,灌注压通过平均动脉压减颅内压获得。将所有患者的床头分别抬高0°、15°、30°、45°进行观察并收集数据。结果:颅内压、灌注压、平均动脉压与床头抬高0°~45°呈负相关(P<0.05);床头抬高0°~30°时灌注压没有明显变化,但抬高45°时灌注压明显下降,颅内压、平均动脉压也显著降低(P<0.05)。结论:重型颅脑损伤患者床头抬高30°时既可以显著降低颅内压,又可以维持有效灌注压水平,是此类患者较合适的床头抬高角度。

Objective:To investigate the relationship between bed elevation angle and ICP,MAP and CPP in patients with severe craniocerebral injury and to establish a suitable bed elevation angle.Methods:64patients with severe craniocerebral injury were selected.They were all received continuous intracranial pressure monitoring.The mean arterial pressure was measured by ECG monitor.Perfusion pressure was obtained by mean intracranial pressure reduction of intracranial pressure.All patients bedside were raised0°、15°、30°、45°.We observed and collected the data.Results:The intracranial pressure,perfusion pressure,mean arterial pressure and bedside elevation0°～45°was negatively correlated(P<0.05).There was no significant change in perfusion pressure when the bed was elevated0°～30°,but when evaluated45°,the perfusion pressure decreased significantly,and the intracranial pressure and mean arterial pressure were also significantly reduced(P<0.05).Conclusion:Severe craniocerebral injury in patients with bedside elevation of30°can not only significantly reduce intracranial pressure,but also maintain the level of effective perfusion pressure,which is a more appropriate bed elevation angle.