超声测量视神经鞘直径评估俯卧位通气时颅内压的变化

Ultrasonic measurement of optic nerve sheath diameter evaluation prone position ventilation intracranial pressure change of observational studies

目的通过超声测量视神经鞘直径(ONSD),评估在俯卧位通气时颅内压变化,为颅内压增高患者行俯卧位通气提供依据。方法采用前瞻性临床研究,选取2016年5月至2017年5月在武汉市第一医重症医学科机械通气的58例患者资料,在不同的呼吸末正压(PEEP)和不同的体位(仰卧位和俯卧位)时,使用床旁超声经眼眶检测眼球后3 mm处ONSD。通过ONSD的变化,使用配对的t检验方法处理数据,发现颅内压增高的原因。结果俯卧位可对患者颅内压增高产生明显影响,PEEP可对患者的MAP、Ppeak、Pplat产生明显影响,但对颅内压增高无影响。结论俯卧位通气对ONSD改变较大,颅内高压的患者行俯卧位通气需权衡利弊。

Objective To measure the diameter of optic nerve sheath by ultrasonography to evaluate thechange of intracranial pressure（ICP）in prone position ventilation,and to provide basis for prone position ventila-tion in patients with increased intracranial pressure（ICH）. Methods A total of 58 patients with mechanicalventilation were treated with prospective clinical study from 2016.05.01 to 2017.05.01. The patients were treatedwith different PEEP and different positions（supine position and prone position）,and detected optic nerve sheathdiameter（ONSD）behind 3 mm of eye 3 mm by bedside ultrasound. The cause inducing increase of ICP was stud-ied through the changes of ONSD and the data was analyzed by the paired t test. Results Prone position had a sig-nificant effect on patients with increased intracranial pressure. PEEP had a significant effect on MAP,Ppeak,Pplat,but had no effect on increased intracranial pressure. Conclusions Prone position ventilation significantlyaffect the ONSD. Therefore,it weighs the pros and cons when patients with intracranial hypertension were re-ceived prone position ventilation.