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題 名 | 開顱手術病患行氣管抽吸對血壓、腦壓及動脈壓頻譜之影響=Alternation of Systemic Blood Pressure, Intracranial Pressure and Power Spectrum of Blood Pressure after Tracheal Suction in Patients Receiving Craniotomy |
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作 者 | 蘇泉發; 郭博昭; 張玉麟; 駱子文; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 4:2 2002.04[民91.04] |
頁 次 | 頁81-88 |
分類號 | 416.29 |
關鍵詞 | 血壓; 顱內壓; 動力頻譜分析; 自主神經系統; Blood pressure; Intracranial pressure; Power spectral analysis; Autonomic nervous system; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:腦手術患者,因意識不清、呼吸、循環不穩定,術後常住加護中心照顧,本文擬探討常見之護理照護中,病患之抽痰動作對患者腦壓、血壓及代表自主神經變化之動脈壓頻譜所受之影嚮,藉以深入瞭解病患所受之生理變化衝擊。 病人與方法:研究對象以本科開顱手術案例12例為主,分別為頭部外傷6例、腦中風出血5例、腦膜瘤1例,其中男性8例,女性4例,而平均年齡為52歲,當患者接受開顱手術時,吾人依病情所需安置硬腦膜下腦壓監測器,耐導線經腦壓監測器後,可再轉出接至一般加護病房之惠普監測系統上。另外,橈動脈插管訊號也接至惠普監測儀,而惠普監測儀之銀幕訊號經安置一訊號輸出卡均可輸出,再經類比至數位轉換後,儲存於個人電腦中以做離線分析。 當病患手術後,安置妥當,則患者可行全天24小時之記錄,吾人取每一病患之最平穩之時,才行氣管抽吸動作,觀察抽吸前後血壓、腦壓及動脈壓頻譜之變化,做數據之擷取。 結果:當患者受氣管抽吸刺激時,顱內壓加加97.8%,而血壓之上升為8.4%,至於動脈壓頻譜之增加率,高頻、低頻及極低頻部分分別為5.8倍、4.7倍及3.1倍。 結論:神經外科開顱病患,當行氣管抽吸時,可引發強烈之自主神經之應,其中代表心臟之感神經作用之高頻動脈壓頻譜及代表血管運動之交感神經低頻、極低頻動脈壓頻譜,均成3至5倍之增加,而腦壓也呈倍數之增高,但血壓雖然呈現些微改變,卻未成比例之增高,實驗結果顯示動脈壓頻譜也許更能反應患者受刺激後交感神經系統變化之生理反應,而此反應未必能完全表現在臨床上之血壓變化上。 |
英文摘要 | Objective: Patients who received cranial surgery are usually cared in the intensive care unit (ICU) because of the unconsciousness and unstable homodynamic status. In this circumstance, suction of trachea to keep the airway clean are frequently done, however this procedure does induce the increase of the blood pressure and intracranial pressure (ICP) which may cause the secondary insult to the brain. We used the power spectral analysis of systemic arterial pressure (SAP) signals to evaluate the mechanism of increasing autonomic activity after tracheal suction. Methods: Twelve patients who received the brain surgery with the placement of ICP monitor were chosen for the study. These comprised 6 patients with head injury, 5 patients with spontaneous intracranial hemorrhage and one patient with meningioma. Eight patients are male and the average of age is 52 years. The ICP monitoring was performed by seeing the sensor at the subdural space then the signals were connected to the HP monitor. The cannulation of the radial artery can provide the signal of the SAP. All signals shown at the HP monitor could be transferred out and digitized by the analog-digital converter interfaced to a personal computer for analysis. Experimental data were then collected and saved in the computer continuously. Data showing stable physical sings before tracheal suction were chosen for off-line analysis. Results: After tracheal suction, the SAP increased for 8.4% and ICP 97.8%. As to the power spectral analysis, the increasing rates were 5.8 folds for the high frequency components, 4.7 folds for the low frequency and 3.1 folds for the very low frequency. Conclusion: The tracheal suction can induce vigorous autonomic nervous response in patients cared in the ICU. The high frequency components of SAP power spectrum which indicates the cardiac sympathetic activity and the low frequency and very low frequency power components which represents the vasomotor activity of sympathetic drive are highly increased. In addition, the ICP was doubly increased, however, the change of the blood pressure did not correlate with the expression of power spectral density of the SAP. Results of the study reveals that the power spectral analysis of SAP may be more efficient in the monitoring of the physiological status than the regular vital signs such as SAP or heart rates. |
本系統中英文摘要資訊取自各篇刊載內容。