超声测量视神经鞘直径在评价儿童颅内压增高中的应用

Ultrasound measurement of optic nerve sheath diameter for assessing increased intracranial pressure in children

目的探讨超声测量视神经鞘直径在评价儿童颅内压(ICP)增高中的应用价值。方法收集2018年11月至2019年11月南方医科大学附属东莞妇幼保健院收治的存在颅内缺血缺氧性改变疾病的患儿82例,入院6 h内腰椎穿刺测量脑脊液压力,多普勒超声监测脑血流间接评价是否出现ICP增高;入院后6、24、48、72 h及1周超声测量视神经鞘直径,分析其诊断ICP增高的价值。结果82例患儿入院后采用腰椎穿刺测量脑脊液压力,显示存在ICP增高(增高组)46例、ICP正常(正常组)36例。入院后6、24、48、72 h及1周增高组患儿视神经鞘直径均显著高于正常组(均P<0.05)。增高组患儿ICP值与超声测量视神经鞘直径呈正相关(r=0.674,P<0.05)。超声测量视神经鞘直径诊断ICP增高的受试者工作特征曲线的曲线下面积最大为0.904(95%CI:0.819~0.958),诊断ICP增高的视神经鞘直径临界值为5.58 mm,诊断敏感度为86.96%,特异度为88.89%,准确度为87.80%。结论超声测量视神经鞘直径可作为动态监测评估儿童ICP增高的无创检查手段,有助于早期识别中重度ICP增高。

Objective To determine the value of ultrasound measurement of optic nerve sheath diameter in assessing increased intracranial pressure(ICP)in children.Methods Included in this study were 82 children with intracranial ischemic-hypoxic disorders admitted to Dongguan Maternal and Children’s Hospital Affiliated to Southern Medical University between November 2018 and November 2019.Within 6 hours after admission,lumbar puncture was performed for measurement of cerebrospinal fluid pressure,and Doppler ultrasonography was used to monitor cerebral blood flow as an indirect assessment of increased ICP.The diameter of the optic nerve sheath was measured by ultrasound at 6,24,48,72 h and 1 week after admission;its value in diagnosing increased ICP was analyzed.Results After admission,82 children underwent lumbar puncture for measurement of cerebrospinal fluid pressure,which showed that ICP was increased in 46 children(ICP increased group)and normal in 36 others(ICP normal group).At 6,24,48,72 h and 1 week after admission,the optic nerve sheath diameter in the ICP increased group was significantly greater than those in the normal group(all P<0.05).In the ICP increased group,the ICP was positively correlated with the optic nerve sheath diameter as measured by ultrasound(r=0.674,P<0.05).The maximum area under the receiver operating characteristic curve for ultrasound measurement of optic nerve sheath diameter in diagnosing increased ICP was 0.904(95%CI:0.819-0.958).Using 5.58 mm as the cut-off value,ultrasound measurement of optic nerve sheath diameter yielded a sensitivity of 86.96%,a specificity of 88.89%,and an accuracy of 87.80%in diagnosing increased ICP.Conclusion Ultrasound measurement of optic nerve sheath diameter can be used as a non-invasive approach for dynamic monitoring and assessment of increased ICP in children,and would help early identification of moderate to severe cases of increased ICP.