摘要
目的探讨高血压脑出血术后床头抬高度数选择及其对神经功能、颅内压和脑灌注压的影响。方法前瞻性选定2020年1月至2022年1月在诸暨市人民医院接受血肿清除术治疗的高血压脑出血患者192例作为研究对象。所有患者依次采用不同的床头抬高度数,包括0°、15°、30°、45°,每个体位角度保持10min,分别记录患者生命体征[体温、心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean arterial pressure MAP)、脉搏血氧饱和度(percutaneous arterial oxygen saturation,SpO2)、脑组织血氧饱和度(cerebral tissue oxygen saturation,rSO2)]、颅内压以及脑灌注压的变化情况。不同体位维持1h后检测患者神经功能相关指标情况[神经元特异性烯醇化酶(neuron-specific enolase,NSE)、S100β蛋白、髓鞘碱性蛋白(myelin alkaline protein,MBP)]。结果比较不同床头抬高度数患者的体温、HR、SBP、DBP、MAP、SpO2、rSO2,差异无统计学意义(P>0.05)。抬高度数为0°、15°、30°时患者NSE、S100β蛋白、MBP水平均高于45°,0°、15°时高于30°,0°的颅内压高于15°,差异均有统计学意义(P<0.05)。抬高度数为0°、15°、30°时,患者颅内压均高于45°,脑灌注压水平均低于45°,0°、15°时颅内压均高于30°,脑灌注压水平均低于30°,0°时颅内压高于15°,脑灌注压水平低于15°,差异均有统计学意义(P<0.05)。结论高血压脑出血术后患者床位抬高30°、45°有助于降低颅内压,稳定脑灌注压,改善神经功能。
Objective To investigate the selection of bed head elevation after hypertensive cerebral hemorrhage and its influence on nerve function,intracranial pressure and cerebral perfusion pressure.Methods A total of 192 patients with hypertensive cerebral hemorrhage who received hematoma removal in Zhuji People’s Hospital from January 2020 to January 2022 were prospectively selected as research subjects.All patients were sequentially treated with different bedside elevations,including 0°,15°,30°,and 45°,each position angle was maintained for 10 min,and the patient’s vital signs,including body temperature,heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),percutaneous arterial oxygen saturation(SpO2),cerebral tissue oxygen saturation(rSO2),intracranial pressure,and changes in cerebral perfusion pressure were recorded.Detection of neurologic function-related indicators in patients after different position maintenance for 1h,including neuron-specific enolase(NSE),S100βprotein,myelin alkaline protein(MBP).Results Compared temperature,HR,SBP,DBP,MAP,SpO2and rSO2in patients with different degrees of bedhead elevation,the differences were not statistically significant(P>0.05).NSE,S100βprotein and MBP levels were higher than 45°at 0°,15°and 30°,and higher than 30°at 0°and 15°,and intracranial pressure was higher at 0°than 15°,all with statistically significant differences(P<0.05).Patients had intracranial pressure higher than 45°and cerebral perfusion pressure levels lower than 45°at 0°,15°and 30°of elevation,intracranial pressure higher than 30°and cerebral perfusion pressure levels lower than 30°at 0°and 15°,and intracranial pressure higher than 15°and cerebral perfusion pressure levels lower than 15°at 0°,all with statistically significant differences(P<0.05).Conclusions Bed elevation of 30°and 45°in patients with hypertensive cerebral hemorrhage can help reduce intracranial pressure,stabilize cerebral perfusion pressure,and improve nerve function.
作者
钟玉婷
杨刚
戚佳凤
马佳忠
ZHONG Yuting;YANG Gang;QI Jiafeng;MA Jiazhong(Department of Intensive Care Medicine,Zhuji People's Hospital,Zhuji 311800,Zhejiang,China)
出处
《中国现代医生》
2023年第5期11-14,共4页
China Modern Doctor
基金
浙江省中医药科技计划项目(2019ZA127)。
关键词
高血压脑出血
床头抬高度数
脑灌注压
颅内压
神经功能
Hypertensive cerebral hemorrhage
Number of head-up heights
Cerebral perfusion pressure
Intracranial pressure
Nerve function
