An Empirical Research On The Optimal Head Position In Patients With Traumatic Brain Injury

Objective:To observe the effects and explore the influence for different angles of the head levels on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe traumatic brain injuries:, seek the optimum level of head elevation exists severe patients with TBI among the acute phase after injury, and establish a standardized procedure for therapeutic position intervention, in order to provide evidence-based basis for Standard clinical emergency nursing measures with severe traumatic brain injury.Method:A prospective self-controlled study was used. All clinical data of 43 consecutive patients with severe traumatic brain injuries who underwent treatment in Jiangsu Provincial Traditional Chinese Medicine Hospital emergency department between Oct 2013 and Nov 2014 were analyzed. Cerebral blood flow parameters and mean arterial pressure (MABP) were measured on 43 patients with severe craniocerebral injuries within 2 hours after admission by bedside TCD (Transcranial Doppler TCD) examination. Cerebral blood flow parameters and the mean arterial pressure (MABP) was measured at 10 degrees,20 degrees and 30 degrees respectively. The changes of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were calculated according to the formula.Results:As the angles of head of bed in patients with severe traumatic brain injuries was up from 0 °to、10°、20°and 30°, the intracranial pressure and the mean arterial blood pressure gradually reduced and the difference was statistically significant when 0° was up to 20°and 30°(P<0.05), with elevation of the head from 0°to 10°、20°and 30°, the cerebral perfusion pressure (CPP) reduced slightly, but the difference was not statistically significant (P>0.05). For ICP<25mmHg group, with elevation of the head from 0°to 20°and 30°, mean arterial blood pressure decrease gradually and the difference was statistically significant (P< 0.05), from 0 °、 10°、20°to 30°, intracranial pressure decreased gradually and the difference was statistically significant (P< 0.05);No significant change in cerebral perfusion pressure with elevation of the head from 0°to 20°and 30°, there was no statistically significant difference (P> 0.05). For ICP>25mmHg group, with elevation of the head from 0 °、10°、20°to 30°, mean arterial pressure reduce gradually, from 0° up to 30° the difference was statistically significant (P< 0.05), intracranial pressure decreased gradually for 0 ° up to 20°and 30° and the difference was statistically significant(P< 0.05),and cerebral perfusion pressure reduced significantly, from 0° up to 30° the difference was statistically significant (P<0.05).Conclusions:In the study,it was found that elevating the head of bed to 30 degrees can rapidly reduce the intracranial pressure and ensuring adequate cerebral perfusion when ICP monitoring is not performed. It is a safe、effective and worth promoting therapeutic position for emergency rescue and nursing with severe traumatic brain injury patients; For Severe TBI patients with ICP monitoring, when the intracranial pressure was mild increase (ICP< 25mmHg), to elevate the head of the bed 30 degrees to reduce intracranial pressure and ensure the cerebral perfusion; However, for the patients with moderated intracranial hypertension (ICP >25mmHg),with elevation the head up to 30 degrees intracranial pressure and cerebral perfusion decreased, and had the risk of brain perfusion shortage, however elevation the head up to 20 degrees can reduce the adverse effects of intracranial pressure adaptability shortage and the cerebral hypoperfusion, increase cerebral blood supply, improve the safety of nursing care, reduce the risk of secondary brain injury and improve the prognosis of the patient.