超声测量视神经鞘直径与颅内压的相关性研究

Correlation analysis between intracranial pressure and optic nerve sheath diameter measured with ultrasonography

目的研究视神经鞘直径(ONSD)与颅内压(ICP)的相关性,探讨无创ICP监测的可行性。方法选择41例放置脑室型ICP探头的病人,通过超声测量ONSD值并记录对应的ICP值,根据ICP值分为3组:ICP <15 mm Hg组19例,15~25 mm Hg组13例,>25 mm Hg组9例,统计比较各组ONSD的差异,并预测提示ICP增高的ONSD最佳阈值。结果在不同体位及甘露醇使用前后,3组间ONSD差异均具有统计学意义(P<0.001),ONSD随ICP增高而增大。平卧位与30°头高位ONSD组内比较均差异显著(P<0.05);甘露醇使用前30 min与使用后30 min ONSD组内比较,差异亦均具有统计学意义(P<0.05)。Pearson相关性分析提示:ONSD与ICP之间存在正相关关系(r=0.896,P<0.001)。ROC曲线提示:ONSD=5.55mm是诊断ICP>20 mm Hg的最佳阈值,曲线下面积(AUC)=0.921 (95%CI:0.816-1.000;P<0.001);敏感度为86.7%,特异度为92.0%。结论超声测量ONSD是一种安全、有效的无创颅内压监测方法,结果可信度高,可于临床推广使用。

Objective To investigate the correlation between optic nerve sheath diameter(ONSD) and intracranial pressure(ICP), and analyze the possibility of using non-invasive ICP monitoring. Methods Forty-one patients with ventricular ICP probe implantation were selected in the study, and the ONSD of these patients were measured with ultrasonography at different points and the ICP recorded at the same time. Then, the patients were divided into 3 groups according to the ICP: less than 15 mm Hg group(n=19),15 to25 mm Hg group(n=13) and more than 25 mm Hg group(n=9). The differences of ONSD were compared statistically between the 3 groups, and the best threshold value of ONSD indicating ICP increase was predicted. Results There were significant differences in ONSD between the 3 groups in the different body positions and before and after using mannitol(P<0.001), and the ONSD increased with the increase of the ICP. Significant differences in ONSD of the same group were found between horizontal position and 30°reverse trendelenburg position(P<0.05), and significant differences were also found between before and after using mannitol in the same group(P<0.05). Pearson correlation analysis showed there was a positive correlation relationship between ONSD and ICP(r =0.896, P<0.001). Receiver operating characteristic(ROC) curve showed the best threshold value of ONSD was equal to 5.55 mm, and the area under the curve(AUC) was 0.921(95%CI: 0.816-1.000, P<0.001), with the sensitivity of 86.7% and the specificity of 92.0%.Conclusions ONSD measurement with ultrasonography is a safe, effective and non-invasive method for ICP monitoring. Its result is of high reliability, and can be widely used in clinic.