Pulmonary complications associated with severe head injury.
Pulmonary complications associated with severe head injury.
复制标题
与严重头部损伤相关的肺部并发症。
DOI：
10.1097/01376517-198308000-00004
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发表时间：
1983
期刊：
影响因子：
--
通讯作者：
Warren,JB
中科院分区：
文献类型：
--
作者：
Warren,JB
严重头部损伤（HI）后的肺功能障碍是所有护理创伤患者的护士都常见的问题。无论何种病理生理过程导致原本完整的整个呼吸系统功能障碍，对于严重颅脑外伤患者来说，最终结果是脑氧合受损。初始评估和管理计划必须从对 HI 相关潜在并发症的了解发展到整合脑源和呼吸源性呼吸异常的概念。有鉴于此，重要的是要注意这样一个原理：脑缺氧不仅会减慢大脑活动，如果不治疗或治疗不当还会造成不可逆的损伤。”HI 后立即发生的急性呼吸衰竭的重要性与其对已经受伤的大脑的影响有关。多项研究表明，至少 30% 的 HI 患者在进入急诊室时会出现缺氧。** 急性呼吸衰竭一般很难定义，因为 病因的多样性、症状的多样性以及不同的临床方向。本质上，在头部受伤的患者中，先前通气控制完好且肺部健康的个体存在低氧血症。具体相关原因可能是脑干损伤的神经源性改变、误吸导致肺泡水平气体交换严重受损或肺水肿。与颅脑损伤相关的呼吸衰竭的主要指标是 在不补充氧气的情况下，患者无法维持正常的 PaO2。本文将描述严重头部受伤后常见的肺部并发症，并定义
Pulmonary dysfunction after severe head injury (HI) is a problem commonly seen by all nurses who care for trauma patients. Whatever the pathophysiol-ogical process that renders the otherwise intact total respiratory system dysfunctional, the ultimate result for the patient with severe craniocerebral trauma is impaired cerebral oxygenation. The initial assessment and plan of management must progress from a knowledge of potential complications associated with HI to integration of the concept of respiratory abnormalities from both cerebral and respiratory origin. In this light, it is important to note the principle that cerebral hypoxia not only slows brain activity, but also causes irreversible damage if untreated or treated poorly." Acute respiratory failure directly after HI takes on significance related to its effect on an already injured brain. Several studies have indicated that hypoxia upon admission to the emergency room is found in at least 30 percent of all HI patients.** Acute respiratory failure in general is difficult to define due to the multiplicity of causes, varieties of symptomatologies, and different clinical orientations. Essentially, in head-injured patients, there is hypoxemia in individ-uals with previously intact ventilatory control and healthy lungs. Specific related causes may be due to neurogenic changes of brainstem damage, severe impairment of gas exchange at the alveolar level due to aspiration, or pulmonary edema. The cardinal indicator of respiratory failure associated with head injury is the inability of the patient to maintain normal PaO, without supplemental oxygen. This article will describe pulmonary complications commonly seen after severe head injury and define the