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Annales françaises d'anesthésie et de réanimation, v.17 no.2, 1998년, pp.149 - 156
Porchet, F (Service de neurochirurgie, CHU Vaudois, CH-1011 Lausanne, Suisse, France) , Bruder, N (dé) , Boulard, G (partement d'anesthé) , Archer, DP (sie-ré) , Ravussin, P (animation, CHU Timone, F-13385 Marseille, France)
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AbstractThe question as to whether the head and trunk of neurosurgery patients should be elevated remains controversial. This question is particularly important when intracranial hypertension is present. Head up position may have beneficial effects on intracranial pressure (ICP) via changes in mean ...
RésuméL'effet de la position sur la pression intracrânienne (PIC) reste encore un sujet de controverses. La PIC et la pression de perfusion cérébrale (PPC) se modifient lors de changements de position de manière variable, selon des mécanismes non encore entièrement élucidés. Il est donc nécessaire d'adapter le positionnement des patients en fonction d'une situation clinique donnée. Dans tous les cas, une position proclive de plus de 30° est déconseillée. Chez la plupart des patients, l'élévation de la tête jusqu'à 30° permet de diminuer la PIC, sans altérer de manière notable la PPC et le débit sanguin cérébral. Toutefois, une élévation paradoxale de la PIC lors de l'élévation modérée de la tête et du tronc peut être observée dans certains cas. Ceci nécessite un suivi méticuleux de l'évolution de la PPC (et donc de la PIC et de la pression artérielle moyenne) par examen doppler transcrânien et/ou monitorage de la saturation en O2 du sang veineux jugulaire. Une position à plat semble préférable chez tous les patients dont l'état hémodynamique est précaire et lors de toute baisse de la pression artérielle.
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