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研究生:楊瑞琳
研究生(外文):YANG JUI LING
論文名稱:床頭抬高角度對於腦部手術後病患腦血流速度之影響
論文名稱(外文):Effect of head elevation on cerebral blood flow velocity in post-cerebral operation patients
指導教授:王桂芸
指導教授(外文):Wang Kwua Yun
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:80
中文關鍵詞:腦部手術後病患腦血流速度床頭抬高角度
外文關鍵詞:post-cerebral operation patientscerebral blood flow velocityhead elevation
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本研究的目的在探討床頭抬高角度對腦部手術後病患腦血流速度之影響,以及顱內壓和腦血流之相關性。本研究為類實驗研究法,採立意取樣的方式,由北部一所醫學中心之神經加護中心收集20位病患;以腦室外引流管測量顱內壓、經顱杜卜勒超音波測量腦血流速度。以床頭放平的顱內壓、腦血流為基準值,分別以床頭放平與抬高15度、30度或45度的顱內壓、腦血流加以比較。所得資料以平均值、標準差、百分比、相依樣本T檢定、相依樣本單因子變異數分析、皮爾森積差相關進行統計分析。研究結果歸納如下:
1. 參與本研究的病患年齡平均為54歲,以男性病患居多,術前診斷以顱內出血最多,多數病患昏迷指數在3~8T,未用鎮定劑病患居多。動脈血中氧氣分壓平均為114.42mmHg,二氧化碳分壓平均為30.38mmHg,腋溫平均為37℃,血比容平均為34.57﹪。
2. 顱內壓在床頭放平至抬高15度、放平至抬高30度時均有顯著變化,而床頭放平至抬高45度時則無顯著差異存在。床頭從放平至15、30或45度時,腦血流均未有顯著的差異,但是床頭抬高後10秒鐘,腦血流會下降至最低,約在30秒鐘時可恢復至基準值。
3. 床頭放平與床頭抬高15、30或45度比較時,顱內壓和腦血流的變化均無顯著相關性。
4. 床頭放平時顱內壓、腦血流均最高,腦灌注壓最低;隨著床頭抬高角度的增加,顱內壓、腦血流有下降的趨勢,而腦灌注壓則會漸漸上升。
綜言之,腦部手術後病患在床頭放平至抬高15、30度時,顱內壓有顯著變化,而床頭抬高角度改變對腦血流則無顯著影響;不論床頭抬高幾度,顱內壓、腦血流的變化均無顯著相關性。此外,本研究發現抬高30度時顱內壓最低,腦血流會隨著床頭抬高而有下降趨勢,而腦灌注壓則漸漸上升;因此床頭抬高30度可使病患獲得最低的顱內壓,同時維持正常範圍的腦血流及腦灌注壓。針對本研究的結果,在護理實務、護理研究、護理教育三方面,分別提出提昇腦部手術後病患照護品質之建議。

The purpose of this quasi-experimental design study was to investigate the effect of the degree of head elevation on patients, cerebral blood flow (CBF), intracranial pressure (ICP) and the relation were between ICP and CBF. Twenty post-cerebral operation patients are selected from one medical center in Taipei, Taiwan by purposely sampling during a four-month period. The external ventricular drainage will be used for measuring ICP, and the transcranial Doppler will be used for measuring CBF velocity. The ICP and CBF data will be measured at four different head elevation:0°(baseline), 15°, 30° or 45°.A arithmetic mean, standard deviation, percentage, paired-samples T test, repeated measures and Pearsons-r correlation are used to analyze the data. The major findings of this study were summarized as follows:
1. The mean age of patients was 54, 11 patients were male, and the majority of patients were intracranial hemorrhage. Most patients’ GCS coma scale were 3~8T, and 11 patients didn’t use sedation during the study. The means of PaO2, PaCO2, body temperature, and hematocrit(Hct)were 114.42mmHg, 30.38mmHg, 37℃, and 34.57﹪respectively.
2. ICP had significant differences when head elevation form baseline to 15° or 30°. CBF had no significant differences when head elevation from baseline to 15°, 30°, or 45°. The lowest CBF occurred at 10 seconds after head elevation, and CBF might return to the baseline value at 30 seconds after head elevation.
3. With regard to head elevation, the ICP or the CBF were no significant correlations between 0°and 15°, 30° or 45°.
4. The ICP and the CBF were highest when head at elevation 0°. The CBF was gradually decreasing and within normal range with the increasing head elevation. The ICP was lowest when head elevation was at 30°.
In conclusion, patients had the lowest ICP, and within normal range of CBF when head elevation was at 30°.

第一章 緒論 01
第一節 研究動機 01
第二節 問題之重要性 03
第三節 名詞界定 05
第四節 研究目的 06
第五節 研究概念架構 07
第六節 研究問題 08
第七節 研究假設 08
第二章 文獻查證 09
第一節 腦血流之相關概念 09
第二節 改變床頭抬高角度對顱內壓影響之相關研究 20
第三節 改變床頭抬高角度對腦血流影響之相關研究 23
第四節 改變床頭抬高角度時,,顱內壓、腦灌注壓變化之相關
研究 26
第五節 改變床頭抬高角度時,腦血流、顱內壓變化之相關研究 28
第三章 研究方法與過程 29
第一節 研究設計 29
第二節 研究對象與場所 30
第三節 研究工具 32
第四節 研究步驟 35
第五節 資料處理與統計分析方法 37
第四章 研究結果 40
第一節 腦部手術病患基本特性資料 40
第二節 床頭抬高角度不同對顱內壓、腦血流、腦灌注壓之影響 41
第三節 改變床頭抬高角度時,顱內壓、腦血流、腦灌注壓之變化趨勢 41
第四節 改變床頭抬高角度時,顱內壓、腦血流變化之相關性 42
第五節 獲得最低顱內壓並維持正常腦血流的床頭抬高角度 42
第五章 討論 43
第一節 基準值的比較 43
第二節 顱內壓、腦血流在床頭抬高30秒鐘與第9至10分鐘的差異 43
第三節 床頭抬高角度不同對顱內壓之影響 44
第四節 床頭抬高角度不同對腦血流之影響 44
第五節 床頭抬高角度不同對腦灌注壓之影響 45
第六節 改變床頭抬高角度時,顱內壓、腦血流、腦灌注壓之變化趨勢 46
第七節 改變床頭抬高角度時,顱內壓、腦血流變化之相關性 47
第六章 結論與建議 48
第一節 結論 48
第二節 建議 49
第三節 研究限制 51
參考資料 53

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