COMPARISON OF CSF DRAINAGE PROTOCOLS IN ICP MANAGEMENT

颅内高压是头颅继发性损伤的主要原因 受伤患者和以患者为目标的主要预后指标 有死亡和不良功能结局的风险。脑脊液 脑脊液引流是治疗颅内高压的一种医疗干预措施 护士对颅脑创伤患者的压力监测 独立决策，包括脑脊液注射的时间、频率和数量 排水系统。由于缺乏经验数据，脑脊液引流的标准是 不一致，因此护士对此没有科学的理由 练习一下。本研究的目的是确定脑脊液引流 降低颅脑损伤患者的颅内压，改善脑血流灌注。 这项研究是调查员在一个广泛的计划内进行的第二项研究 探讨护理干预在颅脑损伤患者中的作用 对大脑功能的影响。这项研究将比较脑血管 颅脑损伤患者对三种脑脊液引流方案的反应 传统和先进的神经生理学方法均可用于护理 以评估临床医生的反应。研究的问题是：1)是否 脑脊液引流可改善颅内压和脑血流灌注 灌流压(CPP)、脑血流速度(VMAC)和血氧 颈静脉球部张力(PjO2)？2)变化有区别吗？ 脑脊液引流量(1、2、3)对颅内压和脑灌注量的影响 Ml)？3)血流动力学反应有差异吗？ 治疗前后的动脉压(SAP)和心率(HR)] 排水？这项研究的次要目的是比较后 临床连续监测传统方法的分析 脑血管反应(ICP和CPP)的评估区域 先进的神经生理学方法(VMAC和PjO2)和识别 年龄、脑脊液引流总量和频率对脑脊液引流效果的影响 在开始脑脊液引流方案之前，基线动脉血碳 二氧化碳水平、药物、体温和头部损伤类型 脑脊液引流的疗效。 这一受试者内重复测量设计将使3个方案随机化 60例颅脑损伤患者脑脊液引流。自变量为 脑脊液引流1、2、3毫升。同步实时数据打开 生理参数(SAP、ICP、HR、SpO2、VMAC、P/ET CO2)为 在脑脊液检查前、中、后持续采集和记录 排水方案。使用压力传感器测量SAP和ICP值 连接到古尔德放大器，并对照水银柱进行校准。 心率是通过将EKG肢体导联连接到古尔德放大器来采集的。VMAC 通过连接古尔德放大器的经颅多谱勒进行测量。 PjO2和SpO2通过血气进行验证。放大器传输模拟信号 计算机古尔德数据采集和系统分析程序的数据 用于模拟到数字的转换和分析。多变量和 重复测量方差分析将确定最有效的 脑脊液引流法降低颅内压，保护脑血流灌注。

Intracranial hypertension is a primary cause of secondary injury in head injured patients and a major prognostic indicator targeting patients at risk for mortality and poor functional outcomes. Cerebrospinal fluid (CSF) drainage is a medical intervention for elevated intracranial pressure (ICP) in patients with head trauma that nurses initiate and make independent decisions including the timing, frequency, and amount of CSF drainage. With the lack of empirical data, standards for CSF drainage are inconsistent thus leaving nurses with no scientific rationale for this practice. The purpose of this study is to determine if CSF drainage decreases ICP and improves cerebral perfusion in head injured patients. This study is the investigator's second study within a broad plan to ascertain the effects of nursing interventions in head injured patients on cerebral function. This study will compare the cerebrovascular responses of head injured patients to three CSF drainage protocols using both traditional and advanced neurophysiologic methods available to nurse clinicians to evaluate the response. The research questions are: 1) Does CSF drainage improve ICP and cerebral perfusion [as measured by cerebral perfusion pressure (CPP), cerebral blood flow velocity (Vmac) and oxygen tension in the jugular bulb (PjO2]? 2)Is there a difference in the change in ICP and cerebral perfusion by the amount of CSF drainage (1,2 and 3 mL)? and 3) Is there a difference in the hemodynamic responses [system arterial pressure (SAP) and heart rate (HR)] before and after CSF drainage? Secondary aims of this study are to compare in post hoc analysis the traditional methods monitored continuously in the clinical area for assessment of cerebrovascular responses (ICP and CPP) with advanced neurophysiologic methods (Vmac and PjO2) and to identify any moderating effects from age, total volume and frequency of CSF drainage prior to initiation of CSF drainage protocol, baseline arterial carbon dioxide levels, medications, temperature and type of head injury on the efficacy of CSF drainage. This within-subject, repeated measures design will randomize 3 protocols of CSF drainage in 60 head injured patients. The independent variable is the CSF drainage (1 mL, 2 mL, 3 mL). Simultaneous real time data on physiologic parameters (SAP, ICP, HR, SpO2, Vmac, P/ET CO2) are continuously acquired and recorded before, during and following the CSF drainage protocols. SAP and ICP are measured using pressure transducers connected to Gould amplifiers and calibrated against a column of mercury. HR is collected by connecting EKG limb leads to a Gould amplifier. Vmac is measured using a transcranial doppler attached to a Gould amplifier. PjO2 and SpO2 are validated by blood gases. Amplifiers transmit analogue data to a computerized Gould Data Acquisition and System Analysis program for analogue to digital transformation and analysis. Multivariate and repeated measure analysis of variance will determine the most effective CSF drainage method for decreasing ICP and preserving cerebral perfusion.