重度颅脑损伤患者开颅术后视神经鞘直径与颅内压及预后的关系

Relationship among diameter of optic nerve sheath and intracranial pressure and prognosis in patients with severe brain injury after craniotomy

目的:探究重度颅脑损伤患者开颅术后视神经鞘直径与颅内压及预后的关系。方法:2018年3月-2019年5月收治重度颅脑损伤患者70例,监测患者颅内压与视神经鞘直径。结果:70例患者平均视神经鞘直径为4.8 mm,引入ICP时间累加值测量范围在0~29.1 k Pa/h。随访后得知,患者GOS-E评分为(4.51±0.32)分,死亡1例,预后良好36例,预后不良34例。预后良好与预后不良患者视神经鞘直径最佳截断值的频次比较,差异有统计学意义(P<0.05);视神经鞘直径与颅内压呈正相关关系。结论:当视神经鞘直径超过4.8 mm,即可对患者颅内压情况与预后进行预防,视神经鞘直径检出频次越多,患者预后效果越不理想。

Objective:To investigate the relationship among the diameter of optic nerve sheath and intracranial pressure and prognosis in patients with severe brain injury after craniotomy.Methods:From March 2018 to May 2019,70 patients with severe brain injury were enrolled and the diameter of optic nerve sheath and intracranial pressure were monitored.Results:The average diameter of optic nerve sheath in 70 patients was 4.8 mm,the measurement range of the cumulative value of the introduced ICP time was from 0 to 29.1 kPa/h.After follow-up,it was found that the patient's GOS-E score was(4.51±0.32),1 case was death,36 cases were good prognosis and 34 cases were poor prognosis.The optimal truncation of optic nerve sheath diameter in patients with good prognosis and those with poor prognosis was compared,the difference was statistically significant(P<0.05)。The diameter of optic nerve sheath was positively correlated with intracranial pressure.Conclusion:When the diameter of optic nerve sheath exceeds 4.8 mm,the intracranial pressure and prognosis can be prevented,the more frequently the optic nerve sheath diameter is detected,the less prognostic the patient will be。