经颅多普勒超声及超声测量视神经鞘直径与脑炎患者颅内压增高的相关性

Association between potential intracranial pressure and optic nerve sheath diameter evaluated by transcranial Doppler and ultrasonographic measurement in encephalitis patients

目的探讨经颅多普勒超声(TCD)及超声测量视神经鞘直径(ONSD)与脑炎患者颅内压增高的相关性。方法连续回顾性纳入2019年10月至2020年1月吉林大学第一医院神经内科和神经医学中心脑炎需行腰椎穿刺术的住院患者17例,均行ONSD和(或)TCD检查。行腰椎穿刺术,并记录颅内压的初压,将初压>200 mmH 2O定义为颅内压增高,初压为80~200 mmH 2O为颅内压正常。根据颅内压结果,将17例脑炎患者分为颅内压增高组(10例)和颅内压正常组(7例)。比较颅内压正常组及颅内压增高组患者基线资料、ONSD及TCD参数[收缩期峰值流速(PSV)、舒张期末流速(EDV)、平均血流速度(MV)和血管搏动指数],并分析ONSD与颅内压的相关性。结果(1)颅内压正常组与增高组患者性别、年龄、体质量指数、收缩压、舒张压的差异均无统计学意义(均P>0.05);颅内压正常组ONSD值低于颅内压增高组,组间差异有统计学意义[(4.2±0.4)mm比(4.9±0.4)mm,t=-3.873,P=0.002]。(2)两组患者双侧大脑中动脉PSV、EDV、MV和搏动指数的组间差异均无统计学意义(均P>0.05)。(3)相关性分析结果显示,颅内压与ONSD之间存在较好的相关性(r=0.87,P<0.01)。结论初步分析显示,超声测量ONSD可反映脑炎患者的颅内压增高。

Objective To explore the association between potential intracranial pressure(ICP)and optic nerve sheath diameter(ONSD)evaluated by transcranial Doppler(TCD)and ultrasonographic measurement in encephalitis patients.Methods A total of 17 patients with encephalitis received lumbar puncture were enrolled continuously in the Department of Neurology and Neuroscience of the First Hospital of Jilin University from October 2019 to January 2020.The ONSD and TCD examinations were performed before the operation of lumbar puncture,and the relevant data were recorded.All patients were divided into the elevated ICP group(more than 200 mmH 2O)(n=10),the normal ICP group(80-200 mmH 2O)(n=7)according to the results of the initial ICP.The difference of baseline data,ONSD,and the parameters of TCD such as peak systolic velocity(PSV),end-diastolic velocity(EDV),mean blood flow velocity(MV),and pulse index(PI),were compared between the two groups.Moreover,the correlation between ICP and ONSD was analyzed.Results(1)The difference of gender,age,body mass index,systolic blood pressure,and diastolic blood pressure was not statistically different between the normal and the elevated ICP groups(all P>0.05).The ONSD was significantly lower in the normal ICP group compared with that in the elevated ICP group([4.2±0.4]mm vs.[4.9±0.4]mm,t=-3.873,P=0.002).(2)TCD related parameters(PSV,EDV,MV and PI)were not significantly different between the elevated ICP group and the normal ICP group(all P>0.05).(3)Univariate analyses revealed that ICP was significantly associated with ONSD(r=0.87,P<0.01).Conclusion Results of the study indicate that ONSD is a predictive index for elevated ICP in encephalitis patients.