心脏术后患者视神经鞘宽度与容量状态的相关性研究

The correlation between optic nerve sheath diameter and volume status in patients after cardiac surgery

目的 通过采用超声测量心脏术后患者视神经鞘宽度（ONSD）,探讨其与容量状态间的关系.方法 选2015年1-8月连续入住北京协和医院重症医学科的心脏术后患者44例,根据标准的目标导向的病因和血流动力学治疗方案接受常规治疗,测中心静脉压（CVP）,记录72 h液体平衡情况.超声测量ONSD和下腔静脉内径（IVC）.结果 44例心脏术后患者基线ONSD为（5.31±1.96） mm,治疗72 h后为（5.07±1.77）mm,△ONSD为（0.22 ±0.21）mm;基线CVP为（11.98±4.09）mmHg（1 mmHg=0.133 kPa）,治疗72 h后为（8.95±4.02） mmHg,△CVP为（2.49±3.00） mmHg;基线IVC为（19.75±4.12）mm,治疗72 h后为（17.11±4.68）mm,△IVC为（1.98±2.61） mm.△ONSD与△CVP相关（r=0.422,P＜0.05,R2=0.1781）,与△IVC相关（r=0.423,P＜0.05,R2=0.178 6）,与72 h累计液体负平衡量相关（r=-0.388,P＜0.05,R2 =0.1508）;△CVP与△IVC相关（r=0.391,P＜0.05,R2 =0.152 9）.结论 心脏术后患者治疗72 h前后ONSD变化与CVP变化、IVC变化和累计液体负平衡量相关.测量ONSD有助于评估脑水肿,且其变化可以动态反映容量状态的变化,有可能用于指导心脏术后患者改善不良预后的治疗.

Objective To investigate the relationship between optic nerve sheath diameter （ONSD）and volume status of patients after cardiac surgery.Methods A total of consecutive 56 patients who were treated in Critical Care Unit in Peking Union Medical College Hospital after open heart surgery from January to August 2015 were screened in this study.Central venous pressure （CVP） and 72 h net fluid balance were monitored.ONSD and diameter of inferior vena cava （IVC） were measured by ultrasound.Results A total of 44 patients were finally included in the study.The postoperative baseline ONSD was （5.31 ± 1.96）mm,compared to （5.07 ± 1.77） mm after 72 h treatment,with △ONSD（0.22 ± 0.21） mm.Baseline and posttreatment at 72 h CVP were （11.98 ± 4.09） mmHg and （8.95 ± 4.02） mmHg respectively.IVC dropped from （19.75 ±4.12） mm to （17.11 ± 4.68） mm.△ONSD and △CVP were significantly correlated （r =0.422,P 〈 0.05）,△ONSD and net fluid balance （NFB） at 72 h were significantly correlated （r =-0.388,P 〈 0.05）.While △ONSD were significantly correlated with △IVC （r =0.423,P 〈 0.05）,△CVP and △IVC were also significantly correlated （r =0.391,P 〈 0.05）.Conclusion The change of ONSD in patients after cardiac surgery is related to the change of volume status.Therefore ONSD is helpful to estimate brain edema,not only could be a potential index to evaluate volume status,but also be used to guide improving prognosis after cardiac surgery.