不同高度头位对重度颅脑损伤患者颅内压及脑氧饱和度的影响

中华养生保健 ›› 2022, Vol. 40 ›› Issue (17): 4-6.

不同高度头位对重度颅脑损伤患者颅内压及脑氧饱和度的影响

支艳玲, 王忠^*

内蒙古自治区人民医院神经外科,内蒙古呼和浩特,010017

出版日期:2022-09-01 发布日期:2022-08-26
通讯作者: ^* 王忠,E-mail：wz1971@163.com。
作者简介:支艳玲（1982.5-）,女,汉族,籍贯：内蒙古自治区呼和浩特市,本科,主管护师,研究方向：神经外科重症监护。
基金资助:
内蒙古卫健委资助项目（基金编号201701009）; 内蒙古自治区关键技术攻关计划项目（项目编号2019GG051）

Effects of Different Height Head Positions on Intracranial Pressure and Cerebral Oxygen Saturation in Patients with Severe Craniocerebral Injury

ZHI Yan-ling, WANG Zhong

Department of Neurosurgery, People's Hospital of Inner Mongolia Autonomous Region, Huhehaote Inner Mongolia, 010017,China

Online:2022-09-01 Published:2022-08-26

摘要/Abstract

摘要： 目的探讨不同高度头位对重度颅脑损伤（severe traumatic brain injury,sTBI）患者颅内压（intracranial pressure,ICP）及局部脑氧饱和度（regional cerebral oxygen saturation,rScO₂）的影响。方法回顾性分析2019年4月~2021年8月内蒙古自治区人民医院神经外科神经重症监护病房（neurosurgical intensive care unit,NSICU）收治的40例sTBI患者的临床资料,给予颅内压监测及脑氧饱和度监测,观察床头抬高0°、30°、60°时,颅内压及脑氧饱和度的变化。结果 40例患者完成ICP及rScO₂监测,床头抬高不同度数时,颅内压及脑氧饱和度发生变化,其中头位抬高在0°时,其颅内压最高,脑氧饱和度最低,将患者的头位抬高30°及60°时,其颅内压下降明显,脑氧饱和度明显升高,三组比较,差异有统计学意义（P<0.05）。结论在sTBI患者中通过应用ICP联合rScO₂监测脑组织氧代谢,可以及时发现颅内压及脑氧饱和度的变化,患者头部抬高可以降低颅内压及提高脑氧饱和度。

关键词: 重度颅脑损伤, 颅内压, 局部脑氧饱和度, 监测, 头位

Abstract: Objective To investigate the effects of ICP and cerebral oxygen saturation of severe traumatic brain injury (sTBI) patients on different head position. Methods The clinical data of 40 patients with severe craniocerebral injury admitted to Neurosurgical Intensive Care Unit (NSICU) of The People's Hospital of Inner Mongolia Autonomous Region from April 2019 to August 2021 were selected. Intracranial pressure monitoring and cerebral oxygen saturation monitoring were given to observe the changes of intracranial pressure and cerebral oxygen saturation when the head position was raised 0°, 30° and 60°. Results In our group of 40 patients who completed ICP and rScO₂ monitoring, intracranial pressure and cerebral oxygen saturation changed when the head of the bed was elevated at different degrees, with the highest intracranial pressure and lowest cerebral oxygen saturation when the head was elevated at 0°. When the patient's head was elevated at 30° and 60°, the intracranial pressure decreased significantly and the cerebral oxygen saturation increased significantly. The difference between the three groups was statistically significant（P<0.05）. Conclusion The application of ICP combined with rScO₂ monitoring in patients with severe traumatic brain injury can detect the changes of intracranial pressure and brain oxygen saturation in time, and head position elevation can reduce intracranial pressure and improve brain oxygen saturation.

Key words: severe traumatic brain injury, intracranial pressure, regional cerebral oxygen saturation, monitoring, head position

中图分类号:

R651

支艳玲, 王忠. 不同高度头位对重度颅脑损伤患者颅内压及脑氧饱和度的影响[J]. 中华养生保健, 2022, 40(17): 4-6.

ZHI Yan-ling, WANG Zhong. Effects of Different Height Head Positions on Intracranial Pressure and Cerebral Oxygen Saturation in Patients with Severe Craniocerebral Injury[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(17): 4-6.

参考文献

[1] Oddo M, Bösel J.Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring. Monitoring of brain and systemic oxygenation in neurocritical care patients.[J].Neurocrit Care,2014,21(Suppl 2):S103-20.
[2] Ishiyama T, Kotoda M, Asano N, et al.Effects of hyperventilation on cerebral oxygen saturation estimated using near-infrared spectroscopy: A randomised comparison between propofol and sevoflurane anaesthesia[J].Eur J Anaesthesiol,2016,33(12):929-935.
[3] 中华医学会神经外科学分会颅脑创伤专业组,中华医学会创伤学分会神经损伤专业组.颅脑创伤患者脑监测技术中国专家共识[J].中华神经外科杂志,2020,36(12):1189-1194.
[4] Rivera Lara L, Püttgen H A.Multimodality Monitoring in the Neurocritical Care Unit.[J].Continuum (Minneap Minn).2018,24(6):1776-1788.
[5] 周晓芬,陈晗,于荣国,等.神经重症患者术后多模态监测技术的应用研究[J].中华危重病急救医学,2020,32(8):960-964.
[6] Bratton S I, Chesnut R M, Ghajar J, et al.Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring.[J].J Neurotrauma,2007,24(Suppl 1):S37-S44.
[7] 王忠,张瑞剑,韩志桐,等.动态颅内压监测联合脑氧饱和度监测目标导向治疗在重型颅脑损伤中的应用[J].临床神经外科杂志,2021,18(6):648-652.
[8] Gagnon A, Laroche M, Williamson D, et al.Incidence and characteristics of cerebral hypoxia after craniectomy in brain-injured patients: a cohort study.[J].J Neurosurg,2020,6(11):1-8.
[9] Padhy S K, Ajayan N, Hrishi A P, et al.Novel application of near-infrared spectroscopy in detecting iatrogenic vasospasm during interventional neuroradiological procedures[J].Brain Circ,2019,5(2):90-93.
[10] 王忠,张瑞剑,韩志桐,等.局部脑氧饱和度监测目标导向治疗在重度颅脑损伤中的应用[J].华南国防医学杂志,2020,34(12):850-852,882.
[11] Hussein K, Rabino G, Feder O, et al.Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study[J].Acta Neurochir (Wien),2019,161(3):517-524.
[12] Liu X, Zimmermann L L, Ho N, et al.Evaluation of a new catheter for simultaneous intracranial pressure monitoring and cerebral spinal fluid drainage: a pilot study[J].Neurocrit Care,2019,30(3):617-625.
[13] 石庆芬,梁玉桃,沈合春,等.浅论为手术后的颅脑损伤患者采取不同的头位卧床对其颅内压和脑氧饱和度的影响[J].当代医药论丛, 2017,15(21):98-99.
[14] 江燕,袁萍,张燕茹,等.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[J].中国实用护理杂志,2020,36(22): 1700-1704.
[15] Wood M D, Jacobson J A, Maslove D M, et al.The physiological determinants of near-infrared spectroscopy-derived regional cerebral oxygenation in critically ill adults[J].Intensive Care Med Exp,2019,7(1):23.
[16] 卢维新,侯博儒,王登峰,等.重度脑外伤后动态监测局部脑氧饱和度的临床意义[J].中国康复理论与实践,2020,26(1):106-109.