EFFECT OF HEAD ELEVATION ON INTRACRANIAL-PRESSURE, CEREBRAL PERFUSION-PRESSURE, AND CEREBRAL BLOOD-FLOW IN HEAD-INJURED PATIENTS
EFFECT OF HEAD ELEVATION ON INTRACRANIAL-PRESSURE, CEREBRAL PERFUSION-PRESSURE, AND CEREBRAL BLOOD-FLOW IN HEAD-INJURED PATIENTS
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DOI：
10.3171/jns.1992.76.2.0207
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发表时间：
1992-02-01
影响因子：
4.1
通讯作者：
GROSSMAN, RG
中科院分区：
文献类型：
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作者：
FELDMAN, Z;KANTER, MJ;GROSSMAN, RG
近年来，抬高头部以降低头部受伤患者的颅内压（ICP）的传统做法受到了挑战。 一些研究者认为，颅内高压患者应采取水平体位，理由是这将增加脑灌注压（CPP），从而改善脑血流量（CBF）。 然而，当患者处于水平位置时，ICP通常显著更高。 本研究的目的是为了阐明头部受伤患者在护理中的最佳头部位置问题。 研究了22例颅脑损伤患者头抬高0度和30度对颅内压（ICP）、脑灌注压（CPP）、脑血流量（CBF）、平均颈动脉压（MAP）以及其他脑和全身生理参数的影响。 当患者头部抬高30度时，平均颈动脉压显著低于0度（84.3 +/- 14.5 mm Hg vs. 89.5 +/- 14.6 mm Hg），平均ICP也是如此（14.1 +/- 6.7 mm Hg vs. 19.7 +/- 8.3 mm Hg）。 CPP、CBF、脑氧代谢率、动静脉乳酸差或脑血管阻力与头位变化无统计学显著性变化。 数据表明，头部抬高30度显著降低了22例患者中大多数患者的ICP，而没有降低CPP或CBF。
The traditional practice of elevating the head in order to lower intracranial pressure (ICP) in head-injured patients has been challenged in recent years. Some investigators argue that patients with intracranial hypertension should be placed in a horizontal position, the rationale being that this will increase the cerebral perfusion pressure (CPP) and thereby improve cerebral blood flow (CBF). However, ICP is generally significantly higher when the patient is in the horizontal position. This study was undertaken to clarify the issue of optimal head position in the care of head-injured patients. The effect of 0-degrees and 30-degrees head elevation on ICP, CPP, CBF, mean carotid pressure, and other cerebral and systemic physiological parameters was studied in 22 head-injured patients. The mean carotid pressure was significantly lower when the patient's head was elevated at 30-degrees than at 0-degrees (84.3 +/- 14.5 mm Hg vs. 89.5 +/- 14.6 mm Hg), as was the mean ICP (14.1 +/- 6.7 mm Hg vs. 19.7 +/- 8.3 mm Hg). There was no statistically significant change in CPP, CBF, cerebral metabolic rate of oxygen, arteriovenous difference of lactate, or cerebrovascular resistance associated with the change in head position. The data indicate that head elevation of 30-degrees significantly reduced ICP in the majority of the 22 patients without reducing CPP or CBF.