颅脑损伤患者视神经鞘直径与头颅CT计分的相关性

Correlation of optic nerve sheath diameter and head CT score in patients with craniocerebral injury

目的:探讨超声测量颅脑损伤患者视神经鞘直径与Rotterdam CT评分的相关性,为快速诊断颅内压及判断病情提供快速、简单的诊断工具。方法:选择2016年6月至2017年9月在ICU住院治疗的急性颅脑损伤患者72例,发病6 h内行头颅CT(computed tomography,CT)扫描,同时行超声测量视神经鞘直径(optic nerve sheath diameter,ONSD),并根据Rotterdam CT计分(RCT)进行分组,即RCT计分<4分为轻度脑损伤组38例,RCT计分≥4分为重度脑损伤组34例。结果:(1)72例患者,轻型脑损伤患者的平均ONSD为(4.74±0.55)mm,重型脑损伤患者的平均ONSD为(6.79±0.75)mm,随着RCT计分的增加,ONSD也在随之增加,且两个指标之间存在正关联(r=0.905,P<0.05);(2)ROC曲线分析结果显示,RCT评分≥4分,ONSD的截断值为5.15 mm,诊断的灵敏度为94.1%,特异度为78.9%,AUC为0.930,[(P=0.000,渐进95%可信区间为0.871-0.989)]。结论:患者RCT评分与ONSD之间存在正相关,当ONSD>5.15 mm可以作为区别轻度和重度脑损伤的临界值,故ONSD可作为急救部门的颅脑损伤患者的初始分类工具及方法。

Objective:To investigate the correlation between optic nerve sheath diameter(ONSD)and Rotterdam CT(RCT)score by ultrasonography in patients with traumatic brain injury so as to provide a rapid and simple diagnostic tool for rapid bedside diagnosis of intracranial pressure and diagnosis of disease.Methods:72 patients with acute craniocerebral injury were selected between June 2016 and September 2017.The head CT scan was performed within 6 hours after the onset of the disease,and ONSD was measured by ultrasound.According to RCT score,38 patients(CT score<4)were divided into mild brain injury group,and 34 patients(CT score>=4)were divided into severe brain injury group.SPSS18.0 software was used for statistical analysis.Results:①Among 72 patients,the average ONSD of patients with mild brain injury was(4.74±0.55)mm,and the average ONSD of patients with severe brain injury was(6.79±0.75)mm.With the increase of evaluation score of RCT in patients with mild or severe brain injury,ONSD increased accordingly.The two indexes in the score of RCT and ONSD were positively correlated(r=0.905,P<0.05).②ROC curve analysis showed that RCT was equal to and greater than 4,the cutoff value of ONSD was 5.15mm,the sensitivity of the diagnosis was 94.1%,the specificity was 78.9%,AUC was 0.930,(P=0.000,gradual 95%confidence interval was 0.871-0.989).Conclusion:The score of RCT in patients with mild or severe brain injury and ONSD were positively correlated.When ONSD is greater than 5.150 mm,it can be used as a threshold to distinguish between mild and severe brain injury.Therefore,ONSD can be used as a tool and method for initial classification of first aid departments.