超声测量视神经鞘面积评估颅脑外伤患者颅内压的价值

Value of optic nerve sheath area determined by ultrasound in assessing intracranial pressure of craniocerebral trauma patients

目的探讨超声测量视神经鞘面积对颅脑外伤患者颅内压评估的有效性和可行性。方法采用前瞻性临床试验,选取2015年6月至2018年6月收住常熟市第一人民医院重症监护病房并植入有创颅内压探头的颅脑外伤患者36例为研究对象。于术后1、3、5 d行床旁超声经眼眶测量眼球后3 mm视神经鞘直径,分别于横轴位和矢状位测量其长轴和纵轴直径,根据长纵轴直径计算视神经鞘面积,同时记录监测的颅内压数值。结果超声测量视神经鞘长纵轴直径、面积均与颅内压有显著相关性(r=0.493、0.507、0.551,P=0.000、0.000、0.000)。视神经鞘面积与颅内压的相关性高于长纵轴直径。视神经鞘长轴直径5.60 mm、纵轴直径5.75 mm、面积26.52 mm^2为颅内压增高(>20 mmHg,1 mmHg=0.133 kPa)的临界值,其诊断的敏感性分别为73.7%、73.7%、73.7%,特异度分别为86.5%、91.1%、92.1%。结论超声测量视神经鞘长纵轴直径、面积均与颅内压有较好的相关性,均对颅内压增高有较高的预测价值,视神经鞘面积较长纵轴直径与颅内压有更好的相关性,具有临床应用价值。

Objective To investigate the validity and feasibility of optic nerve sheath area (ONSA) determined by ultrasound in evaluating intracranial pressure (ICP) of craniocerebral trauma patients. Methods This was a prospective clinical trial. Thirty-six patients with craniocerebral trauma who were hospitalized in intensive care unit (ICU) of Changshu No.1 People’s Hospital from June 2015 to June 2018 were selected as research objects. On 1, 3 and 5 days postoperatively, bedside ultrasound was used to measure diameter of the optic nerve sheath 3 mm behind the eyeball. The optic nerve sheath long diameter (ONSLD) and optic nerve sheath vertical diameter (ONSVD) were measured in the horizontal axis and the sagittal position, respectively. The ONSA was calculated according to ONSLD and ONSVD. At the same time, ICP values were monitored. Results ONSLD, ONSVD and ONSA determined by ultrasound were significantly correlated with ICP (r=0.493, 0.507, 0.551;P=0.000, 0.000, 0.000). The correlation between ONSA and ICP was higher than ONSLD and ONSVD. Optimal cut-off values of ONSLD, ONSVD and ONSA for detection of elevated ICP(>20 mmHg, 1 mmHg=0.133 kPa)were 5.6 mm, 5.75 mm, 26.52 mm^2, with sensitivity of 73.7%, 73.7%, 73.7%, specificity of 86.5%, 91.1%, 92.1%. Conclusions ONSLD, ONSVD and ONSA have good correlations with ICP and higher predictive value for increased intracranial. But ONSA has a closer correlation with ICP and has clinical application value.