뇌손상 환자에게 적용되는 관절운동이 두개강 내압에 미치는 영향

현미숙; 한미라; 홍성현; 송동현; 남명선; 조선옥; 송선옥; 김영주

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자료유형: 전문잡지

저자정보: 현미숙 (아산재단 서울중앙병원 신경외과 중환자실) 한미라 (아산재단 서울중앙병원 신경외과 중환자실) 홍성현 (아산재단 서울중앙병원 신경외과 중환자실) 송동현 (아산재단 서울중앙병원 신경외과 중환자실) 남명선 (아산재단 서울중앙병원 신경외과 중환자실) 조선옥 (아산재단 서울중앙병원 신경외과 중환자실) 송선옥 (아산재단 서울중앙병원 신경외과 중환자실) 김영주 (아산재단 서울중앙병원 신경외과 중환자실)

저널정보: 대한간호협회 대한간호 대한간호 제39권 제1호

발행연도: 2000.1

수록면: 59 - 69 (11page)

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Purpose: The study was. relating to the increase of intracranial pressure of patients in ICU with acute and subacute brain damage. carried out to determine if the ICP could be influenced by passive ROM exercise which is provided early after the operation in order to prevent articular contracture and muscle atrophy from regular ROM exercise for poor exercising ability. Method : Among the patients in Neurosurgical Intensive Care Unit(ICU) who got operation on brain damage, 19 ones whose ICP could be measured through extraventricular drainage system or Camino ICP catherer were selected. Each patient's intracarinial pressure, systolic blood pressure, mean arterial pressure, heart rate and respiration rate were checked six times, before and 1. 2, 3. 4, 5 minutes after the ROM exercise. From this, the cerebral perfusion pressure was calculated and the maximum increase of ICP during the ROM exercise was measured. Details of the passive ROM exercise : As for upper limb, the exercise was in the order of flexion & extension of shoulder and arms, adduction & abduction, shoulder rotation, supination & pronation of elbow, and flexion & extension of wrist. For lower limb, the order was flexion &. extension of hip and knee. adduction & abduction of hip, flexion & extension of hip, and flexion & extension of ankle. Each exercise was tried 10 times and proceed to the next region. Results : As a result of consecutive exercises, six exercise for upper limb and 4 for lower limb, the pressure was slightly increased, as compared with resting one, by average 0.89mmHg(p= .0002) in the flexion & extension of shoulder and arm. O.64mmHg(p= .02) in the flexion & extension of hip and knee. As for the same condition of exercise times. that is. the data(before and 1. 2. 3, 4. 5 minutes after the exercise) of the first day only showed that every parameters like intracranial pressure, systolic blood pressure. heart rate. and mean arterial pressure had no change before and after the exercise. The last. the exercise was repeated 1. 2, and 3 days to measure the influence of repeated exercise. The result showed that there was little change in cerebral perfusion pressure. systolic blood pressure. heart rate. and resp. rate but faint change in intracrainal pressure. The intracranial pressure was affected slightly on POD(p=.0358. f=4.74) and exercise day(p=.0452, f=4.23); decreased by about 1.15 mmHg with every 1 day after the brain surgery and increased by about 1.32 mmHg with every 1 exercise day. Discussion : The results showed that the stimulus of ROM exercise for a given time didn't affect on intracranial pressure and cerebral perfusion pressure. Also, the repeated exercise for 3 days decreased intracranial pressure down to almost stable pressure with the postoperation days. This tells that the influence of ROM exercise reduce as patient's condition after brain damage get away from the acute period. That is, the increase of intracranial pressure due to ROM exercise is slight as long as patient's condition after brain damage become more serious no longer.

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