microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2019-18-4-4-10microcirculation-639Research ArticleОБЗОРЫREVIEWSО взаимосвязи внутричерепного давления и кровотока при позиционировании у больных с острым повреждением головного мозгаAbout interrelation of intracranial pressure and cerebral blood flow when positioning at patients with acute brain damageГорбачёвВ. И.GorbachevV. I.

д-р мед. наук, профессор, зав. кафедрой анестезиологии и реаниматологии

Doctor of Medical Sciences, Professor, Head of the department of anesthesiology and reanimatology

gorbachevvi@yandex.ruБрагинаН. В.BraginaN. V.

канд. мед. наук, доцент кафедры анестезиологии и реаниматологии

Candidate of Medical Sciences, docent of the department of anesthesiology and reanimatology

likholetova.nat@yandex.ruГорбачёвС. В.GorbachevS. V.

канд. мед. наук, ассистент кафедры анестезиологии и реаниматологии

Candidate of Medical Sciences, associate of the department of anesthesiology and reanimatology

gorbatiy-irk@yandex.ruИркутская государственная медицинская академия последипломного образования – филиал Федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияIrkutsk State Medical Academy of Postgraduate Education – Branch Campus of the FSBEI of FPE «Russian Medical Academy of Continuing Professional EducationRussian Federation201930122019184410Copyright © Горбачёв В.И., Брагина Н.В., Горбачёв С.В., 20192019Горбачёв В.И., Брагина Н.В., Горбачёв С.В.Gorbachev V.I., Bragina N.V., Gorbachev S.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/639

Изменение угла наклона головного конца кровати является рутинным методом позиционирования пациента для коррекции внутричерепной гипертензии. В отделениях реанимации и интенсивной терапии положения головного конца кровати варьируют от 0 до 60°, при этом не существует единого мнения о том, какое из них наиболее эффективно. В статье представлен обзор важнейших современных публикаций в отечественной и зарубежной литературе по проблеме взаимосвязи позиционирования с изменениями внутричерепного давления, системной и церебральной гемодинамики у пациентов нейрореанимационного профиля, в том числе по базам данных eLibrary, PubMed по ключевым словам «позиционирование», «смена положения», «угол наклона головного конца кровати», «внутричерепное давление», «церебральное перфузионное давление», «мозговой кровоток», «острое церебральное повреждение» и их комбинациям. Для большинства пациентов с острым церебральным повреждением, независимо от этиологического фактора, предпочтительным является положение 15–30°. Однако в ряде случаев манипуляции с головным концом кровати могут приводить к необратимым ишемическим повреждениям вследствие снижения системного и перфузионного давления, а также мозгового кровотока. Таким образом, выбор положения оптимального угла наклона головного конца при церебральной патологии остается обсуждаемым вопросом. Таким образом, индивидуальная тактика позиционирования у пациентов с острым повреждением головного мозга позволяет выбрать правильную тактику интенсивной терапии и повысить качество результатов лечения.

Changing of «head – of – the bed» position is a routine method of positioning the patient to correct intracranial hypertension. In intensive care units, the «head – of – the bed» position vary from 0 to 60 °, and there is no consensus on which of them is most effective. The review of the major publications in the domestic and foreign literature about the problem of interrelation between positioning and changes of intracranial pressure, system and cerebral hemodynamic in patients with brain damage including databases eLibrary, PubMed, with the key words «hyperthermia», « positioning», «slope angle of the head of bed», «intracranial pressure», «cerebral perfusion pressure», «cerebral blood flow», «brain damage», and their combination. It is believed that the majority of patients with cerebral damage, regardless of the etiological factor, is preferable to 15–30° «head – of – the bed» position. In some cases manipulation of the head of the bed can lead to irreversible ischemic damage, due to the reduction of system and perfusion pressure, and cerebral blood flow. Thus, the selection of the optimal body position in acute cerebral pathology remains a debated issue. In this way, individual tactics of positioning in patients with cerebral damage allows choosing the correct intensive care and improving the treatment results.

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The authors declare that there are no conflicts of interest present.