The prognostic value of optic nerve sheath diameter on computed tomography of brain in adult comatose cardiac arrest survivors
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摘要: 目的:探讨头颅CT视神经鞘直径 (ONSD) 对中国成人心搏骤停 (CA) 后昏迷患者神经功能预后的判断价值。方法:回顾性分析了2015-01-2018-06期间南京医科大学第一附属医院95例复苏后72h内行头颅CT检查的成人CA患者, 测定其ONSD及灰质/白质比例 (GWR), 同时评价各指标对神经功能不良预后 (CPC评分3~5分) 的预测价值。结果:与预后良好组相比较, 预后不良组ONSD显著增加 (P＜0.01)。预后不良组基底节、大脑、平均及简化GWR均显著低于预后良好组 (均P＜0.05)。ONSD＞4.30mm预测神经功能不良预后的敏感度为77.8%, 特异度为74.5% (P＜0.01)。与单一指标相比较, ONSD联合GWR评估可显著提高不良预后的判断价值 (GWR基底节加ONSD, 敏感度72.5%, 特异度94.4%, P＜0.01)。结论:CA后昏迷患者头颅CT提示ONSD增加与神经功能不良预后相关, ONSD与GWR联合评估可有效提升CA后昏迷患者不良预后的判断价值。Abstract: Objective: To evaluate the association between optic nerve sheath diameter (ONSD) and the outcomes in adult comatose cardiac arrest (CA) survivors in China.Method: Ninty-five CA patients who received CT scans within 72 hours of resuscitation between January 2015 and June 2018 were included in this single-center retrospective study.The ONSD was measured, and gray-white matter ratio (GWR) was calculated according to previous studies.The prognostic values of the ONSD and GWR in predicting poor outcomes (Cerebral Performance Category 3-5) were analyzed.Result: The ONSD was significantly higher in patients with good outcomes than that with poor outcomes (P＜0.01).GWRs were significantly higher in good outcome group than in poor outcome group (P＜0.05).ONSD＞4.30 mm predicted poor outcomes with a sensitivity and specificity of 77.8% and 74.5% respectively (P＜0.01).The combination of ONSD and GWR significantly improved prognostic performance in predicting poor neurologic outcomes rather than ONSD or GWR alone (P＜0.01).Conclusion: ONSD can be used as a promising tool to assess outcome in adult comatose CA survivors.The combination of ONSD and GWR improved prognostic value for predicting poor neurologic outcomes in post-CA patients.
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Key words:
- cardiac arrest /
- optic nerve sheath diameter /
- coma /
- computed tomography /
- prognosis
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