超声测量视神经鞘直径在创伤性颅脑损伤中的应用价值

目的探讨超声测量视神经鞘直径（ONSD）与通过侧脑室置管直接测量颅内压（ICP）的相关性，同时寻找ONSD测量的阈值来预测ICP增高。方法2016年3月1日至2017年7月1日收入连续创伤性颅脑损伤患者61例，所有患者均在全身麻醉下经侧脑室前角放置颅内压监测探头。转入ICU后30min内由操作者对患者进行ONSD测量。双眼分别测量3次，并取6次测量的平均值。测量ONSD的同时由专门人员记录每次ICP值，同样计算6次ICP的平均值。对ONSD和ICP的采用非参数spearman相关性分析。绘制ONSD和ICP的受试者特征曲线，评价ONSD对诊断ICP增高的最佳阈值。结果61例创伤性颅脑损伤患者中，ONSD的平均值为（5．2±0．6）mm，ICP的平均值为（18．0±9．4）mmHg。采用非参数Spearman相关性分析结果显示，ONSD与ICP有显著的相关性，R=0．842，P〈0．001。以ICP≥20mmHg诊断ICP增高，对oNsD测量方法绘制ROC曲线。ONSD测量方法的曲线下面积为0．946，可信区间是0．894-0．999。当ONSD=5．1mm时，敏感度为95．5％，特异度为79．5％。结论床旁超声测量ONSD能可靠的预测ICP增高，且当ONSD值为5．1mm对诊断ICP增高具有较高的敏感度和特异度。

Ohjctive To investigate the correlation between the diameter of ONSD and the direct t of ICP in the lateral ventricle and to predict the increase of ICP by the threshold of ONSD measurement. Methods From 2016-03-01 to 2017-07-01, 61 cases of continuous traumatic craniocerebral injury were received in the critical medical department of Taizhou traditional Chinese and Western medicine hospital. All patients were placed under the general anesthesia through the lateral ventricles of the anterior horn to locate the intracranial pressure monitoring probe. Aider transferring to ICU, the ONSD was measured by the operator within 30min. The eyes were measured 3 times, and the average of the 6 were taken. While the ONSD was measured, the ICP value was recorded by the special personnel, and the average value of the 6 ICP was calculated as well. The nonparametric Spearman correlation analysis was applied to ONSD and ICP. The receiver and characteristic curves of ONSD and ICP were drawn to evaluate the optimal threshold of ONSD for the diagnosis oflCP. Results In 61 traumatic brain injury patients, the average value of ONSD was （ 5.2 ± 0.6 ） mm, and the average value of ICP was （ 18±9.4 ） mmHg. Using nonparametric Spearman correlation analysis, the results showed that there was a significant correlation between ONSD and ICP, R=0.842, P〈0.001. With ICP=20mmHg diagnosis of ICP increased, the ONSD measurement method of ROC curve, see figure 2. The area tinder the curve of the ONSD method was 0.946, and the confidence interval was 0.894 to 0.999. When ONSD=5.1mm, the sensitivity was 95.5% and specificity was 79.5%. Conclusion Bedside ultrasound measurement of ONSD can reliably predict the increase oflCP, and when the ONSD value is 5.1mm, it has higher sensitivity and specificity for the diagnosis oflCP.