床旁超声与CT重建测量视神经鞘直径与颅内压的关系

The Relationship Between the Optic Nerve Sheath Diameter and Intracranial Pressure Measured by Bedside Ultrasound and CT Reconstruction

目的分析床旁超声与CT重建测量视神经鞘直径ONSD与颅内压(ICP)的关系。方法将2014年1月-2019年1月在本院接受床旁超声与CT重建测量ONSD及无创ICP监测的88例神经外科重症患者纳入研究范围,Pearson相关性分析床旁超声、CT重建所得ONSD与ICP的关系,并绘制受试者工作特征曲线(ROC)分析ONSD对颅内高压的预测价值。结果88例患者平均ICP为(21.26±8.14)mmHg,其中41例ICP>20mmHg;47例ICP≤20mmHg;Pearson相关性分析显示,床旁超声及CT重建所得ONSD与ICP、床旁超声所测得ONSD与CT重建所得ONSD均显著正相关(r=0.727、0.462、0.480,均P<0.05);ROC曲线显示,床旁超声、CT重建所得ONSD曲线下面积值(AUC)为0.719、0.717,cut-off分别为0.480cm、0.595cm,敏感度63.00%、74.10%,特异度为78.80%、66.70%;联合预测时AUC值为0.743,敏感度及特异度为66.70%、75.80%。结论床旁超声、CT重建所得ONSD值与颅内压水平显著正相关,且均对颅内高压有一定预测价值,值得临床重视。

Objective To analyze the relationship between the optic nerve sheath diameter(ONSD)and intracranial pressure(ICP)measured by bedside ultrasound and CT reconstruction.Methods A total of 88 patients in neurosurgery department who underwent bedside ultrasound and CT reconstruction to measure ONSD and non-invasive ICP in the hospital from January 2014 to January 2019 were enrolled in the study.Pearson correlation analysis was performed to analyze the relationship between ONSD measured by bedside ultrasound and CT reconstruction and ICP.The predictive value of ONSD for intracranial hypertension was analyzed by the receiver operating characteristic curve(ROC).Results The average ICP of 88 patients was(21.26±8.14)mmHg.There were 41 cases with ICP>20mmHg and 47 cases with ICP≤20mmHg.Pearson correlation analysis showed that ONSD measured by bedside ultrasound and CT reconstruction,ONSD measured by bedside ultrasound or CT reconstruction alone were significantly positively correlated ICP(r=0.727,0.462,0.480,all P<0.05).The ROC curve showed that the areas under the curve(AUC)of ONSD measured by bedside ultrasound and CT reconstruction were 0.719 and 0.717,respectively.The cut-off values were 0.480 cm and 0.595 cm,sensitivities were 63.00%and 74.10%,specificities were 78.80%and 66.70%,respectively.The AUC,sensitivity and specificity of combined prediction were 0.743,66.70%and 75.80%,respectively.Conclusion The ONSD measured by bedside ultrasound and CT reconstruction is significantly positively correlated with ICP.Both are of certain predictive value for intracranial hypertension.