Relationship between the optic nerve sheath diameter measured by point-of-care ultrasonography and postoperative intracranial pressure in patients with severe craniocerebral injury
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摘要: 目的 探讨床旁即时超声测量视神经鞘直径(ONSD)与重型颅脑损伤患者术后颅内压(ICP)增高的关系。方法 选取兰溪市人民医院急诊科2018年6月-2021年6月收治的重型颅脑损伤患者62例，均行手术治疗，将其按照患者术后ICP值分为3组。ICP值＞25 mmHg组：13例，15~25 mmHg组：20例，＜15 mmHg组：29例。应用床旁即时超声测量各组ONSD值，比较3组ONSD值的差异，使用Pearson分析ONSD和ICP间的关系，并通过ROC曲线分析ONSD评估术后ICP增高的准确性。结果 ICP值＞25 mmHg组和15~25 mmHg组的ICP值、ONSD值均显著高于ICP值＜15 mmHg组，差异均有统计学意义(P＜0.05)；ICP值>25 mmHg组ICP值、ONSD值显著高于15~25 mmHg组，差异均有统计学意义(P＜0.05)；且3组30°头高位ONSD值均低于平卧位，3组使用甘露醇后30 min ONSD值均低于使用甘露醇前，差异均有统计学意义(P＜0.05)。通过Pearson分析相关性显示，床旁即时超声测量ONSD随着重型颅脑损伤患者术后ICP增高而增大，二者间呈正相关(r=0.875，P＜0.01)。通过ROC曲线分析显示，ONSD评估重型颅脑损伤患者术后ICP增高(ICP值>20 mmHg)最佳临界值为5.45 mm，95%CI：0.870~0.992，AUC值为0.931，特异度为92.50%，灵敏度为81.82%。结论 ONSD可随着重型颅脑损伤患者术后ICP增高而增大，床旁即时超声测量ONSD作为无创、便捷的ICP监测方式，可良好地反映ICP增高水平，值得应用。Abstract: Objective To investigate the relationship between optic nerve sheath diameter(ONSD) measured by point-of-care ultrasound and postoperative intracranial pressure(ICP) in patients with severe traumatic brain injury.Methods A total of 62 patients with severe craniocerebral injury who were treated in our hospital from June 2018 to June 2021 were selected, all of them received surgical treatment, and they were divided into: ICP value>25 mmHg group(13 cases), In the 15 to 25 mmHg group(20 cases) and the < 15 mmHg group(29 cases). The ONSD value of each group was measured by point-of-care ultrasound, and the difference in ONSD value among the three groups was compared. The relationship between ONSD and ICP was analyzed by Pearson, and the accuracy of ONSD in assessing postoperative ICP increase was analyzed by ROC curve.Results In ICP value > 25 mmHg group and 15 to 25 mmHg group, ICP value and ONSD value were significantly higher than those in < 15 mmHg group; ICP value and ONSD value in ICP value > 25 mmHg group were significantly higher than those in 15 to 25 mmHg group, and the ONSD values of the three groups 30° head high were lower than those in the supine position, and the ONSD values 30 minutes after the use of mannitol in the three groups were lower than those before the use of mannitol, and the difference was significant (P < 0.05). The correlation analysis by Pearson showed that the ONSD measured by point-of-care ultrasound increased with the increase of postoperative ICP in patients with severe traumatic brain injury, and there was a positive correlation between the two (r=0.875, P < 0.01). The ROC curve analysis showed that the optimal critical value of ONSD to evaluate postoperative ICP increase in patients with severe craniocerebral injury (ICP value greater than 20 mmHg) was 5.45 mm, the 95%CI value was 0.870-0.992, and the AUC value was 0.931, with 92.50% specificity and 81.82% sensitivity respectively.Conclusion ONSD can increase with the increase of postoperative ICP in patients with severe craniocerebral injury. As a non-invasive and convenient ICP monitoring method, the bedside real-time ultrasound measurement of ONSD can well reflect the increased level of ICP and is worthy of application.
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表 1 两组基本资料比较
例，X±S 组别 例数 性别 年龄/岁 损伤部位 男 女 额颞顶部 颞顶部 额颞部 ＞25 mmHg组 13 7 6 42.51±4.46 4 6 3 15~25 mmHg组 20 12 8 42.32±4.27 6 10 4 ＜15 mmHg组 29 16 13 42.09±4.52 8 15 6 P 0.800 0.549 0.719 
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表 2 3组患者ONSD值与ICP值比较
X±S 组别 ICP值>25 mmHg组 15~25 mmHg组 ＜15 mmHg组 例数 13例 20例 29例 ICP值/mmHg 42.32±4.78 19.31±2.45 10.07±2.05 ONSD值/cm 30°头高位 0.62±0.051) 0.54±0.041) 0.45±0.031) 平卧位 0.67±0.04 0.56±0.05 0.48±0.04 使用甘露醇前30 min 0.68±0.05 0.58±0.06 0.50±0.04 使用甘露醇后30 min 0.60±0.062) 0.52±0.052) 0.47±0.052) 与平卧位比较，1)P＜0.05；与甘露醇使用前30 min比较，2)P＜0.05。
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