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目的研究并探讨呼气末正压水平对脑出血患者颅内压及脑灌注压的影响。方法选取自2011年9月-2013年8月期间在洛阳市新安县人民医院重症监护室接受机械通气的脑出血患者38例为研究对象,根据对所选患者的呼气末正压水平在0cm H2O时测量的颅内压水平结果,将其分为两组,即颅内压增高组为观察组和颅内压正常组为对照组。两组患者均排除有慢性肺部疾病及心脏、肾脏等疾病,且均经头颅CT检查确诊为基底神经节区出血,两组患者的格拉斯哥昏迷评分及其他一般资料相比均无统计学意义。对两组患者均进行颅脑手术及术后治疗与护理,测量两组患者的呼气末正压在不同水平时的颅内压及脑灌注压。结果呼气末正压水平为0cm H2O时,观察组和对照组的颅内压分别为(19.8±5.3)mmHg和(10.9±2.7)mmHg,脑灌注压分别为(69±7.9)mmHg和(74±13.5)mmHg。观察组患者的颅内压高于对照组,差异有统计学意义(P<0.05);脑灌注压低于对照组。随着呼气末正压水平的增高,两组患者的颅内压均有所增高,但差异无统计学意义(P>0.05)。两组患者的脑灌注压都随着呼气末正压水平的增高而有所降低。因呼气末正压水平升高的程度而表现出不同的结果。结论正压通气可有效改善脑出血患者的氧合需求,随着呼气末正压水平的不同对患者的颅内压及脑灌注压也产生了不同的影响,本研究经过实验得出:呼气末正压水平升高可引起颅内压轻微升高,差异无统计学意义(P>0.05);较高水平的呼气末正压可引起脑灌注压下降。
Objective To study and explore the effect of positive end-expiratory pressure on intracranial pressure and cerebral perfusion pressure in patients with intracerebral hemorrhage. Methods From September 2011 to August 2013 in the Xin’an County People ’s Hospital Intensive Care Unit in Luoyang City, received mechanical ventilation in 38 cases of patients with cerebral hemorrhage as the study object, according to the selected end - 0cm H2O measured when the intracranial pressure level results, will be divided into two groups, namely, increased intracranial pressure group and normal intracranial pressure group as the control group. Two groups of patients were excluded from chronic lung disease and heart, kidney and other diseases, and were diagnosed by head CT examination of basal ganglia hemorrhage, two groups of patients with Glasgow coma score and other general information were not statistically significant. The patients in both groups underwent craniocerebral surgery and postoperative treatment and nursing. The intracranial pressure and cerebral perfusion pressure were measured at different levels of positive end expiratory pressure in both groups. Results When the positive expiratory pressure was 0 cm H2O, the intracranial pressures in the observation group and the control group were (19.8 ± 5.3) mmHg and (10.9 ± 2.7) mmHg, respectively, and the cerebral perfusion pressures were (69 ± 7.9) mmHg and 74 ± 13.5) mmHg. The intracranial pressure in the observation group was significantly higher than that in the control group (P <0.05). The cerebral perfusion pressure was lower than that in the control group. As the positive end-expiratory pressure increased, the intracranial pressure of both groups increased, but the difference was not statistically significant (P> 0.05). Brain perfusion pressure decreased with increasing levels of positive end expiratory pressure in both groups. Due to the level of positive end expiratory pressure showed different results. Conclusions Positive pressure ventilation can effectively improve the oxygenation demand of patients with intracerebral hemorrhage. Different positive end-expiratory pressure levels have different effects on intracranial pressure and cerebral perfusion pressure in patients with cerebral hemorrhage. In this study, we found that: Increased positive airway pressure can cause a slight increase in intracranial pressure, the difference was not statistically significant (P> 0.05); higher levels of positive end-expiratory pressure can cause cerebral perfusion pressure decreased.