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Choi, Jeung-Ok
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Abstract
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Two primary goals for the care of neurosurgical patients are the prevention of secondary brain injury by controlling intracranial pressure, and the prevention of the complications associated with immobility such as pressure necrosis
and/or pulmonary complications.
But, these two goals, accordingly suggest us seemingly conflicting two types of the different care. That is, in these patients, position change, tracheal suctioning, and passive ROM exercise that are essential in the prevention of complications are important factors in the increase of intracranial pressure.
This study is designed to examine the relationship between the degree of neck bending angle and hip joint flexion and the magnitude of increase in intracranial pressure.
Purposes of this study were;
1. To identify the magnitude of increase in intracranial pressure according to four positions.
2. To identify the point at which intracranial pressure goes up to maximum as related to the four positions.
3. To identify the sustaining time of increase in intracranial pressure according to four positions.
The four positions in lateral posture were, (1) the position of hip joint flexion with 45 degree angle and with 15 degree angle of neck bending,
(2) the position of hip joint flexion with 45 degree angle and with neck in horizontal level,
(3) the position of hip joint flexion with 90 degree angle and with 45 degree angle of neck bending, (4) the position of hip joint flexion with 90 degree angle and with neck in horizontal level.
The subjects were selected from the surgical intensive care unit in Seoul National University hospital from June 14, 1986 to Sept. 30, 1986. The number of patients in this study were fifteen and the total number of experimental observational events were thirty.
Data were analyzed as follow;
The one-way analysis of variance was used to identify the relationship between the degreeof neck bending and hip joint flexion and the magnitude of increase, the time at which intracranial pressure goes up to maximum point, sustaining the in intracranial pressure.
A paired t-test was used to determine the level of significance for changes in intracranial pressure during and after neck bending and hip flexion compared with before flexion.
The results of this study were as follows;
1. There was significant difference in magnitude
of increase in intracranial pressure according
to four positions (p<0.01).
2. There was significant difference in the time at which intracranial pressure goes up to maximum point related to four positions (p <0.01).
3. There was not significant difference in sustaining time in intracranial pressure according to four positions.
In summary, it can be said that the hip joint flexion and neck bending increase the intracranial pressure, therefore, adjustment of the degree of neck bending and hip joint flexion
can decrease the magnitude of increase and the a
time at which intracranial pressure goes up to
maximum point.
The result indicates that it is necessary to maintain the hip jointflexibn_ at 45 degree and neck in horizontal level in nursing care of neurosurgery patients whose intracranial pressure is high or who have lost the ability of self compensatory mechanism controlling intracranial pressure.
It is also suggested that since the increase of intracranial pressure usually recover in 10 minutes to the level before flexion, the tracheal-suctioning and passive ROM exercise which is considered to increase intracranial pressure, must be done at least 10 minutes interval. It is especially noticeable that the intracranial pressure goes up to the maximum within the first two
or three minutes. Thus, most care is needed at this time.
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KeyWords
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원문 및 링크아웃 정보
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등재저널 정보
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