【摘要】 目的探讨床旁超声测量视神经鞘宽度(ONSD)在诊断重型颅脑损伤患者颅内压增高(ICH)中的临床应用价值。方法采用前瞻性研究方法,选取30例由神经外科行开颅血肿清除+去骨瓣减压术+侧脑室探头植入术后转入重症医学科的重型颅脑损伤男性患者。转入后30 min内,应用床旁超声仪测量每位患者眼球后8 mm的ONSD值,同时采用双盲法,记录其当时对应的颅内压(ICP)。采用SPSS 22.0软件,对ONSD值与ICP值采用双变量非参数Pearson相关性分析;绘制出关于ONSD值与ICP值的受试者工作特征(ROC)曲线,计算使用ONSD值诊断ICH的最佳阈值。结果 30例研究对象ICP的平均值为(36.8±26.0)mmHg,ONSD的平均值为(5.3±1.3)mm,ONSD值与ICP值呈正相关(r=0.836,P<0.01)。构建ONSD值的ROC曲线,曲线下面积(AUC)为0.898,95%的可信区间为0.780～1.000;以ONSD≥5.2 mm作为判断ICP增高的最佳阈值,其诊断的灵敏度为88.9%(16/18),特异度为83.3%(10/12),Youden指数为72.2%,阳性预测值为88.9%(16/18),阴性预测值为85.7%(12/14),准确度为86.7%(26/30)。结论应用床旁超声仪测量ONSD值及监测其动态变化可用于判断重型颅脑损伤患者是否存在ICH和指导脱水降颅压的精确治疗,同时可用于早期评估预后,值得推广应用。更多还原

【Abstract】 Objective To explore the clinical value of bedside ultrasound measurement of optic nerve sheath diameter(ONSD) in the diagnosis of intracranial hypertension(ICH) in patients with severe craniocerebral injury.Methods A prospective study was conducted to select 30 male patients with severe craniocerebral injury who were transferred to ICU after the clearance of hematoma by craniotomy+decompressive craniectomy+lateral ventricle probe implantation in neurosurgery department.Within 30 minutes after transfer,the ONSD value at 8 mm behind the eyeball of each patient was measured by bedside ultrasound,and the corresponding intracranial pressure(ICP) was recorded by double blind method.SPSS 22.0 software was applied,and bivariate non-parametric Pearson correlation analysis was carried out on the correlation between ONSD value and ICP value.Receiver operating characteristic(ROC) curve about ONSD value and ICP value was drawn,and the optimum threshold value of ONSD value for ICH diagnosis was calculated.Results The mean ICP and ONSD of 30 subjects in this study was(36.8±26.0) mmHg and(5.3±1.3) mm,respectively,and the ONSD value was positively correlated with ICP value(r=0.836,P<0.01).The ROC curve of ONSD value was constructed,the area under the curve(AUC) was 0.898,and the 95% confidence interval was(0.780～1.000).When ONSD≥5.2 mm was used as the optimum threshold for judging the increase of ICP,the sensitivity,specificity,Youden index,positive predictive value,negative predictive value and accuracy of which was 88.9%(16/18),83.3%(10/12),72.2%,88.9%(16/18),85.7%(12/14) and 86.7%(26/30),respectively.Conclusion Measurement of ONSD value by bedside ultrasound and monitoring of its dynamic changes can be used to determine whether ICH exists in patients with severe craniocerebral injury and to guide the precise treatment of lowering intracranial pressure by dehydration.At the same time,it can be used to evaluate the prognosis in early stage,which is worth popularizing and applying.更多还原