Multimodality Monitoring Application Research In Neurocritical Care Nursing Of Body Position In Patients With Hypertensive Cerebral Hemorrhage

Background and ObjectivesDeformity and mortality rate of hypertensive cerebral hemorrhage(HICH) rank first in cerebrovascular disease.The high mortality is highly concerned with the secondary brain injury beyond the surrounding tissue microcirculation dysfunction due to hematoma oppression. vascular hyporeactivity,and the automatically adjusting dysfunction of blood vessels and hemodynamic change after hemorrhage, which increases ICP, reduces CPP and CBF, eventually leads to the brain ischemia hypoxia which is the important cause of illness aggravated or death.Therefore,how to reduce the ICP availably, maintain the reasonable CPP and brain tissue oxygen saturation(rSO2)has become a research hotspot. Adjusting the head elevation as a treatment of reducing ICP and improving the CPP absolutely can yet be regarded as a good gentle way.Our study mainly includes two parts based on Mulimodality Monitoring.Part one:Measure r SO2 using near infrared spectroscopy(NIRS) and explore its correlation with ICP,CPP.and preliminaryly discusse the clinical value of multimodality monitoring which includes r SO2,ICP,CPP and other hemodynamic targets.Part two:find the tendency of the ICP,CPP and rSO2 at different postures in neurosurgery postoperative patients with HICH,and screen the best head elevation, to provide certain scientific basis for clinical nursing development.Subjects and MethodsResearch subjects were selected among the patients who were diagnosed with HICH and hospitalized in neurosurgery Institute First Hospital Affiliated to the Third Military Medical University during May 2014 and January 2015. According to the inclusion criteria and exclusive criteria, qualified subjects were truly choosed.and the patients or relatives signed their informed consent. Totally,34 subjects were enrolled.At the resting state, head elevation was raised up with 0°-15°-30°-45°-0° in the supine position with 5 minutes interval between different positions,then we wrote down the monitoring indexes 5 minutes later when each position was stable. Ventricle drainage bottle also need to move synchronously in the process of changing positions,and ensure that the open position of drainage bottle are higher 15~20 cm than that of the puncture point,and ICP monitoring pressure sensors are tied to the bed. Monitor brain tissue oxygen saturation with NIRS noninvasively,besidely and continuously;monitor ICP continuously using intracranial pressure monitoring. Meanwhile,All of the patients were monitored heart rate,blood pressure and pulse oxygen saturation by ECG monitor,then we calculated mean arterial pressure and cerebral perfusion pressure and detected SaO2,PaO2 and Pa CO2 with the portable blood gas analyzer,finally.Results1. rSO2 was increased gradually with head elevation from 0° to 15°、30°、45°(P = 0.018);but there was no significant difference between15° and 30°,30° and 45°,15° and 45° head elevation(P>0.05).2. ICP was significantly lower at 15°、30° and 45°than at 0° of head elevation(P = 0.000);CPP was slightly higher at 15°、30°and 45°than at 0°(P = 0.000).but there was no significant difference between 30° and 45° head elevation(P>0.05).MAP、HR、SPO2 remained relatively unchanged between 0°、15°、30°、45°head elevation(P>0.05).3. There was no correlation between r SO2 at 0° with ICP、CPP、SPO2(P>0.05),but a relationship between SaO2、Pa O2、MAP(P<0.05);rSO2 of the male patients were slightly higher than the female(67.84±6.17% vs 63.20±3.14%,P<0.05);rSO2 of the patients with tracheotomy were lower than without tracheotomy(63.32±4.46%vs 67.98±5.87%,P>0.05).Conclusions1. To postoperative patients with HICH in supine position,15°、30°、45° head elevation could effectively reduce the ICP, and increase the CPP, but it cannot continue to rise when head elevation raised up more than 30°; increase r SO2,but there was no significant difference between 15° and 30°,30° and 45°,15° and 45° head elevation;In addition, HR,SPO2 and MAP were not affected significantly by head elevation.2. There was no correlation between r SO2 at 0° with ICP、CPP 、SPO2,but had a relationship between Sa O2、PaO2、MAP and Gender. r SO2 of the male patients were slightly higher than the female;rSO2 of the patients with tracheotomy were lower than without tracheotomy.3. the postoperative NICH patients with GCS of 5~12 points, 15° to 30° head elevation is relatively appropriate position in Multimodality Monitoring;It is necessary to monitor rSO2 noninvasively by NIRS for the HICH patients with tracheotomy;Use Multimodality Monitoring to ensure SaO2、PaO2、MAP、ICP、CPP、r SO2 within the normal range,help to choose the most beneficial treatment measures to prevent brain ischemia hypoxia,and provide a more comprehensive and reliable data support,which has a certain clinical value...