脑出血患者静息状态下不同头位抬高角度对颅内压和脑血流量的影响

Effect of different head elevation angle on intracranial pressure and cerebral blood flow of patients with hypertensive cerebral hemorrhage in a resting state

目的探讨床头抬高角度与高血压性脑出血患者颅内压和脑血流量的影响,为患者体位护理提供参考。方法选取72例高血压性脑出血患者,在静息状态下将患者床头抬高0°、5°、10°、15°、20°、25°、30°7个体位,每种体位保持5 min,记录患者颅内压、脑灌注压、脑氧饱和度、血压、心率和脉搏血氧饱和度等指标。结果床头抬高0°、5°、10°、15°、20°、25°、30°时患者颅内压为(12.39±3.32)、(10.64±3.19)、(9.84±2.58)、(9.09±1.76)、(8.33±2.51)、(7.13±1.81)、(6.81±1.67)mmHg(1 mmHg=0.133 kPa),平均动脉压为(106.06±10.17)、(104.45±10.77)、(105.87±6.73)、(106.82±10.36)、(105.78±10.27)、(106.77±6.15)、(100.30±10.92)mmHg,脑灌注压为(93.67±10.36)、(93.82±10.81)、(96.03±7.26)、(97.73±10.63)、(97.45±10.38)、(99.65±6.62)、(93.49±10.99)mmHg,脑氧饱和度为0.659±0.067、0.669±0.052、0.671±0.080、0.693±0.133、0.693±0.085、0.689±0.098、0.661±0.068。颅内压随床头角度的增加呈降低趋势,且各角度时颅内压比较差异有统计学意义(F值为45.380,P<0.01)。平均动脉压在30°时呈显著降低趋势,30°时与0°、5°、10°、15°、20°、25°时比较差异有统计学意义(t值为2.331~2.997,P<0.05)。脑灌注压和脑氧饱和度先呈上升趋势,在30°时显著降低;15°、20°、25°时脑灌注压、脑氧饱和度明显高于0°和30°时(t值为2.554~3.331和2.378~3.091,P<0.05),但15°与20°、25°两两间差异无统计学意义(P>0.05)。各角度时患者收缩压、舒张压、心率、脉搏血氧饱和度等生命体征比较差异均无统计学意义(P>0.05)。结论仰卧位床头抬高15°~25°是高血压性脑出血患者的最佳体位。

Objective To explore the effect of different head elevation angle on intracranial pressure and cerebral blood flow of patients with hypertensive cerebral hemorrhage in a resting state,to provide scientific basis for nursing development.Methods A total of 72 hypertensive cerebral hemorrhage patients were selected as research subject,at the resting state,head elevation was raised up with 0°,5°,10°,15°,20°,25°,30°in the supine position with 5 minutes interval between different positions.The levels of intracranial pressure,cerebral perfusion pressure,regional oxygen saturation,blood pressure,heart rate,pulse oxygen saturation were recorded.Results With head elevation from 0°to 5°,10°,15°,20°,25°,30°,the levels of intracranial pressure were(12.39±3.32),(10.64±3.19),(9.84±2.58),(9.09±1.76),(8.33±2.51),(7.13±1.81),(6.81±1.67)mmHg(1 mmHg=0.133 kPa);mean arterial pressure were(106.06±10.17),(104.45±10.77),(105.87±6.73),(106.82±10.36),(105.78±10.27),(106.77±6.15),(100.30±10.92)mmHg;cerebral perfusion pressure were(93.67±10.36),(93.82±10.81),(96.03±7.26),(97.73±10.63),(97.45±10.38),(99.65±6.62),(93.49±10.99)mmHg;regional oxygen saturation were(65.91±6.70)%,(66.89±6.52)%,(67.12±8.04)%,(69.33±13.26)%,(69.31±8.47)%,(68.94±9.82)%,(66.12±6.78)%.Intracranial pressure was increased gradually with head elevation from 0°to 5°,10°,15°,20°,25°,30°,the difference was statistically significant(F value was 45.380,P<0.01).Mean arterial pressure was significantly decreased at 30°head elevation compared to the 0°,5°,10°,15°,20°,25°head elevation(t values were 2.331-2.997,P<0.05).Cerebral perfusion pressure and regional oxygen saturation showed an increased trend,however,those index was decreased at 30°head elevation,the levels of cerebral perfusion pressure and regional oxygen saturation was significantly increased at 15°,20°,25°head elevation compared to the 0°and 30°head elevation(t values were 2.554-3.331 and 2.378-3.091,P<0.05).However,there was no significant difference between 0°,5°,10°,15°,20°,25°,30°head elevation in systolic pressure,diastolic pressure,heart rate,pulse oxygen saturation(P>0.05).Conclusions 15°-25°head elevation is a relatively appropriate position in patients with hypertensive cerebral hemorrhage.