| Endotracheal suctioning (ETS) is a routine nursing practice for critical patients to reduce pulmonary complications, and as an essential part of the respiratory management, it is important to use ETS in traumatic brain-injured patients. As a result of the increasing pressure in arterial system and venous system caused by ETS stimulation, however, head-injured patients may be in danger of incracranial hypertension and cerebral ischemia. The improvement of monitoring technology has more need for treatment of severe head-injured (SHI) patients. The future managements need further developing targeted therapy in treating SHI, which involves recognizing and understanding the various pathophysiological processes that occur in the injured brain over the acute course of treatment and the responses of these processes to different treatment modalities. Applying effective care modalities, nursing staff should make a correct judgement about the effect of nursing activities on patients, and search for powerful preventable measures for reducing care-induced secondary damage. The use of ETS with TBI patients has always been an emphasis in nursing research. Studies has often focused on routine monitoring about ICP,CPP,MAP, without enough estimation on changes in cerebral oxygen metabolish, and can not discover probable secondary response of cerebral ischemia and hypoxemia. Moreover, in some degree, findings from past studies are difficult to compare and replicate because number of suction sequences have not been controlled. In addition, different degrees of incracranial hypertension (ICH) often come into being after TBI, which increase danger of cerebral ischemia and hypoxemia, and thus, ETS by nurses may induce secondary cerebral damage more easily. Articles, however, about studies on the use of ETS after TBI have not aimed at the condition of ICH.In these studies, we have foused on use of ETS during ICH after TBI by simulating ICH animal model, and using cerebral metabolism monitoring such as SjvO2. Objective: To study the effect of ETS on cerebral oxygenation during ICH, and determine the relationship between routine ETS and secondary cerebral ischemia and hypoxemia damage in order to provide experimental evidences to build up a set of reasonable respiratory management system.Methods: In all three parts of the experiment, the model of acute intracerebral hematoma in rabbits was established by micro-pump injection method, with using a technique of jugular catheterization and analyzing blood gases to monitor changes on cerebral metabolism such as SjvO2. In the first part, Slice preparation and section staining were used to observe the formation of the intracerebral hematoma, and the data of ICP,CPP,MAP,SjvO2 and their relations were continuously monitored during and after blood injection. In the second part, changes on ICP,CPP,MAP,SjvO2,CEO2,AVDO2 were observed during Open ETS procedure with ICH, and the relations of changes between ITP and ICP were surveyed by ITP monitoring. In the third part, changes on ICP,CPP,MAP,SjvO2,CEO2,AVDO2 were investigated respectively during Closed ETS and Open ETS with previously short-duration HV for 1min under ICH.Results: 1. After blood injection into intracranial cavity, ICP was rapidly increased to moderate ICH level (35.1±4.2mmHg), CPP decreased to 72.0±5.8mmHg, SjvO2 remarkably increased to 80.6±4.3% with CEO2,AVDO2 gradually decreasing. There was closely negative correlation between ICP and CPP during the formation of intracerebral hematoma (rICP-CPP = -0.6190, P﹤0.01). SjvO2 was correlated to ICP (rSjvO2-ICP = 0.5545, P﹤0.05), while there was not a correlation between SjvO2 and CPP. Macroscopic slice preparation showed that hematoma was totally located in the left frontal lobe. Blood was not found in the ventricular. Ventricular was compressed obviously and the midline was shifted to right. Light microscopic examinations showed that massive hemorrhage occurred in the brain tissue around the hematoma. Cerebral parenchyma necrosed and the normal neu...
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