轴线与非轴线翻身操作对重症高血压脑出血术后病人颅内压及脑灌注压的影响

Influence of axial and non⁃axial turning over on intracranial pressure and cerebral perfusion pressure in patients with severe hypertensive cerebral hemorrhage after operation

目的:探究轴线与非轴线2种翻身操作方式对重症高血压脑出血术后病人颅内压(ICP)及脑灌注压(CPP)的影响。方法:选取2022年6月—2023年4月在唐山市某三级甲等医院神经外科重症监护室带有颅内压监测的37例高血压脑出血病人为研究对象。采用自身前后对照研究,纳入对象均在术后第5天生命体征平稳时于21:00~24:00进行非轴线翻身与轴线翻身操作。记录病人每次翻身操作前、操作中及操作后1、5、10、15、20、30 min的颅内压、平均动脉压和脑灌注压,比较2种翻身操作方式对重症高血压脑出血术后病人的颅内压、平均动脉压及脑灌注压变化。结果:非轴线翻身方式,病人翻身操作前与操作中颅内压、平均动脉压、脑灌注压差异均有统计学意义(P<0.05);翻身操作前与操作中、操作后1 min、操作后5 min颅内压、平均动脉压差异有统计学意义(P<0.05)。轴线翻身方式病人翻身操作前与操作中、操作后1 min颅内压、平均动脉压差异有统计学意义(P<0.05)。翻身操作前与操作后1 min脑灌注压间差异均有统计学意义(P<0.05)。病人2种翻身操作方式颅内压变化幅度比较,翻身操作与操作前、操作后5 min与操作后1 min变化幅度差异有统计学意义(P<0.05)。结论:2种翻身操作方式均会导致高血压脑出血术后病人颅内压、平均动脉压、脑灌注压明显变化。病人轴线翻身比非轴线翻身颅内压上升幅度低,非轴线翻身时脑灌注压下降更明显,提示神经外科重症高血压脑出血术后病人翻身护理操作时,轴线翻身较非轴线翻身更安全。

Objective:To explore the impact of axial and non-axial turning methods on ICP and CPP in postoperative patients with severe hypertensive cerebral hemorrhage.Methods:Patients with hypertensive cerebral hemorrhage who met the inclusion and exclusion criteria and had ICP monitoring in the neurosurgical ICU of a tertiary hospital in Tangshan from June 2022 to April 2023 were selected as study subjects.A self-controlled before-and-after study design was adopted.The subjects underwent non-axial and axial turning operations between 21:00-24:00 on the fifth day post-operation when their vital signs were stable.ICP,MAP,and CPP average values were recorded before,during,and at 1 minute,5 minutes,10 minutes,15 minutes,20 minutes,and 30 minutes after each turning operation.The changes in ICP,MAP,and CPP in postoperative patients with severe hypertensive cerebral hemorrhage were compared between the two turning methods.Results:For the non-axial turning method,there were statistically significant differences in ICP,MAP,and CPP before and during the operation(P<0.05).There were also statistically significant differences in ICP and MAP before and at 1 minute and 5 minutes after the operation(P<0.05).For the axial turning method,there were statistically significant differences in ICP and MAP before and during the operation,and at 1 minute after the operation(P<0.05).There was a statistically significant difference in CPP before and at 1 minute after the operation(P<0.05).When comparing the amplitude of ICP changes between the two turning methods,statistically significant differences were observed in the amplitude of change between during the operation and before the operation,and between 5 minutes and 1 minute after the operation(P<0.05).Conclusion:Both turning methods caused significant changes in ICP,MAP,and CPP in postoperative patients with severe hypertensive cerebral hemorrhage.The rise in ICP is lower with axial turning than with non-axial turning,and the decrease in CPP is more pronounced with non-axial turning,indicating that axial turning is safer than non-axial turning for nursing care of postoperative patients with severe hypertensive cerebral hemorrhage in neurosurgery.This provides a practical basis for clinical nursing work.