课件：神经系统监测.pptVIP

昏迷并不代表无痛觉 适度镇静减轻应激、改善通气、有利于实施低温 不良后果 增加院内肺炎 * 早期建立胃肠营养 胃管的位置 颅底创伤应避免经鼻途径 鼻饲的速度、温度、患者的反应-腹胀 排便 血糖和血电解质监测 * 定时记录出入平衡 对尿液的观察 尿管通畅度的判断 体重监测 * 褥疮 器械相关损伤 气管插管 气管切开 鼻饲管 引流管 * 原因 长期制动 分解代谢 肌松剂 预防 定期更换姿势 被动运动 理疗师 家属参与 * 肺不张 院内感染性肺炎 意外拔管 * 制动 呼吸幅度减浅 疼痛 意识损伤 脑干损伤 高颈髓损伤 * 长时间昏迷卧床 咳嗽反射功能障碍，排痰困难，胃内容返流误吸 大手术、创伤后的ALI和ARDS 呼吸机的长时间使用 * 鼓励深呼吸和咳嗽 翻身扣背 动力治疗 镇痛 * 口腔细菌 制酸剂 误吸 交叉污染 * 1、如何判断患者意识状态？ 2、如何掌握患者的镇静深度？ 3、颅内压增高的表现？ 4、夜间病人主诉头痛加重，出现频繁呕吐，左瞳孔散大，光反应小时，右侧肢体偏瘫，随后意识丧失，请判断病人病情？护士应如何处理？ * * * BIS values range from 0 – 100 and are correlated to level of sedation. 100 = Awake 0 = Isoelectric or Flat line EEG (This does not mean brain dead!) 60 = Low probability of awareness or consciousness The most appropriate level of sedation is dependent upon what the clinicians specific sedation goals are for each patient and clinical situation * * Teaching point. Cerebral perfusion pressure (CPP) = MAP - ICPInadequate CPP (less than 70?mmHg) has been shown to be a major factor in the poor outcome of patients with raised ICP. Assessment of CPP is vital and possible either by measurement of both ICP and MAP (mean arterial pressure - see text) or by measuring MAP and making a reasonable estimate of ICP. During anaesthesia therefore, if ICP is raised a fall in blood pressure must be avoided or treated quickly by volume replacement or catecholamines whichever is relevant. More specifically, when CPP is inadequate the oxygen saturation of jugular venous blood falls (normal range 65%-75%) because of increased oxygen extraction. Does the jugular venous bulb measurement give an indication of the minimum level for CPP? Chan [4] in another study of head-injured patients showed that when CPP was below 70?mmHg, there was a rapid decrease in jugular venous bulb saturation. It was concluded that when CPP was less than 70?mmHg cerebral perfusion was insufficient. In the head injured patient, CPP should not fall below 70?mmHg. * 神经外科术后呼吸道管理 神经外科术后呼吸功能障碍主要由脑神经功能不全、气道保护性反射异常、气道机械性梗阻和中枢呼吸肌无力引起。呼吸道正常反射依赖于三叉