颅脑损伤患者颅内压判断的新方法

The new method of estimation on intracranial pressure of patients with brain injury

目的 探讨用超声检查视神经鞘直径（ONSD）判断颅脑损伤患者颅内压的可行性.方法 2008年7月至201 1年12月,选择颅脑损伤患者90例,按入院时格拉斯哥昏迷量表（GCS）评分,60例轻、中型颅脑损伤患者（GCS评分9～15分）作为试验组1,30例重型颅脑损伤患者（GCS评分3～8分）作为试验组2;另选择同期体检健康者50例及神经外科门诊志愿者50例作为对照组.入院后不同时间用超声经眼眶检查各组眼球后3 mm处ONSD,超声检查后0.5～ 1.0 h腰椎穿刺测定颅内压,进行统计分析.结果 入院后1,3,7,14 d,试验组1检查ONSD分别为（4.49±0.31）、（4.45±0.28）、（4.41±0.32）、（4.43±0.25） mm,颅内压分别为（78±16）、（83±17）、（90±15）、（82±14） mmH2O（1 mmH2O=0.0098 kPa）;试验组2检查ONSD分别为（5.69±0.32）、（6.30±0.47）、（5.71±0.26）、（4.77±0.36） mm,颅内压分别为（230±22）、（269±21）、（228±13）、（147±22） mmH2O,对照组检查当天ONSD为（4.58±0.41） mm,颅内压为（88±10） mmH2O.入院后1,3,7,14 d,试验组1与对照组ONSD、颅内压比较差异无统计学意义（P＞0.05）,试验组2与试验组1、对照组ONSD、颅内压比较差异有统计学意义（P＜0.05）.结论 轻、中型颅脑损伤患者ONSD及颅内压无明显变化;重型颅脑损伤患者伤后不同时间颅内压变化不同,ONSD随颅内压的升高而增大,超声检查ONSD能反映颅内压的变化,是评估颅内压的新方法,有一定应用价值.

Objective To discuss the feasibility of estimation on intracranial pressure of patients withbrain injury by measuring optic nerve sheath diameter （ONSD） with uhrasonography.Methods From July 2008 to December 2011,90 patients with brain injury were selected.According to the admission Glasgow Coma Scale （GCS）,they were divided into experimental group 1 （60 cases with light and medium brain injury,GCS 9-15 scores） and experimental group 2 （30 cases with severe brain injury,G CS 3-8 scores）.The conventional physical examination 50 cases and volunteers 50 cases in neural surgical outpatient were selected as control group.ONSD of all groups were measured 3 mm behind the globe through orbital by ultrasonography with different time after admission.The intracranial pressure was measured at 0.5-1.0 h after ultrasonography by lumbar vertebra puncturing in different groups and analyzed statistically.Results After admission 1,3,7,14 d; ONSD in experimental group 1 respectively was （4.49 ± 0.31）,（4.45 ±0.28）,（4.41 ±0.32）,（4A3 ±0.25） mm;ONSD in experimental group 2 respectively was （5.69 ±0.32）,（6.30 ± 0.47）,（5.71 ± 0.26）,（4.77 ± 0.36） mm.After admission 1,3,7,14 d ;the intracranial pressure in experimental group 1 respectively was （78 ± 16）,（83 ± 17）,（90 ± 15）,（82 ± 14） mmH2O （1 mmH2O =0.0098 kPa） ;the intracranial pressure in experimental group 2 respectively was （230 ± 22）,（269 ± 21）,（228 ± 13）,（147 ± 22） mumH2O.ONSD and the intracranial pressure was （4.58 ± 0.41）mm and（88 ± 10） mmH2O in control group.ONSD and the intracranial in Experimental group 1 and control group had no difference （P ＞0.05）; those of control group and experimental group 2,experimental group 1 and experimental group 2 had difference （P＜ 0.05）.Conclusions ONSD and the intracranial pressure in light,medium brain injury patients have no change.In patients with severe brain injury after different time,the intracranial pressure change differently,ONSD enlargement with the intracranial pressure rising,examination of ONSD by ultrasonography can reflect the changes of the intracranial pressure,it is a new method to evaluate the intracranial pressure,has the certain application value.