CT测量视神经鞘直径评估急性一氧化碳中毒预后的相关研究

Prognostic value of CT measurement of optic nerve sheath diameter in evaluating the prognosis of acute carbon monoxide poisoning

目的评估CT测量视神经鞘直径(ONSD)、ONSD/眼球横径(ETD)与急性一氧化碳中毒(ACOP)预后的关系。方法选择2017年11月至2020年10月于连云港市第一人民医院急诊科就诊的ACOP患者。所有患者均于入院当天行头颅CT检查,测量眼球后3 mm处ONSD和ETD,计算ONSD/ETD比值;同时记录患者基线资料及入院时GCS评分、APACHEⅡ评分、中毒严重度评分(PSS),出院后30 d的脑功能分级(CPC)评分。根据CPC评分将患者分为预后良好组、预后不良组。采用ROC曲线评估各指标对预后的预测价值。采用Logistic回归分析筛选影响患者预后的相关因素。结果最终纳入146例患者,其中预后良好组108例,预后不良组38例。与预后良好组比较,预后不良组ONSD、ONSD/ETD、乳酸、磷酸肌酸激酶(CPK)、神经元特异性烯醇化酶(NSE)、PSS评分、APACHEⅡ评分差异均有统计学意义(P<0.05)。建立ONSD预测不良预后的模型,并绘制对应的ROC曲线,ROC曲线下面积(AUC)为0.925,最佳预测概率临界值为0.36,敏感度为89.5%,特异度为94.4%。同样方法获得ONSD/ETD预测不良预后模型,AUC为0.916,最佳预测概率临界值为0.35,敏感度为89.5%,特异度为92.6%。ONSD和ONSD/ETD与ACOP患者预后明显相关,ONSD>5.68 mm或ONSD/ETD>0.24时预后不良。结论 CT测量ONSD可能会成为评估ACOP患者临床预后的一个简单、快捷的方法。

Objective To evaluate the prognostic value of CT measurement of optic nerve sheath diameter( ONSD) and ONSD/eyeball transverse diameter( ETD) ratio in acute carbon monoxide poisoning( ACOP). Methods Patients with ACOP who visited the emergency department of Lianyungang First People’s Hospital from November 2017 to October 2020 were selected. On the day of admission,all the patients underwent cranial CT examination. ONSD and ETD were measured at 3 mm back of the eyeball,and the ONSD/ETD ratio was calculated. Baseline data,GCS score on admission,APACHEⅡ score,poisoning severity score( PSS) and cerebral performance categories( CPC) score at 30 days after discharge were also recorded. According to CPC score,the patients were divided into the good prognosis group and the poor prognosis group. ROC curve was used to evaluate the prognostic value of each indicator. Logistic regression analysis was used to screen the related factors influencing the prognosis of patients. Results 146 patients were included,108 patients in the good prognosis group and38 patients in the poor prognosis group. Compared with the good prognosis group,the patients in the poor prognosis group had statistically significant differences in ONSD,ONSD/ETD,lactic acid,CPK,NSE,PSS and APACHE Ⅱ scores( P<0. 05). The models of ONSD for predicting poor grognosis were established,and the corresponding ROC curve was drawn. The area under the ROC curve( AUC) was0. 925,the critical value of the best prediction probability was 0. 36,the sensitivity was 89. 5%,and the specificity was 94. 4%. The same method was used to predict the poor prognosis of the ONSD/ETD model. The AUC was 0. 916,the critical value of the best predictive probability was 0. 35,the sensitivity was 89. 5%,and the specificity was 92. 6%. ONSD and ONSD/ETD were significantly correlated with the prognosis of patients with ACOP,and the prognosis was poor when ONSD>5. 68 mm or ONSD/ETD>0. 24. Conclusion CT measurement of ONSD may be a simple and quick method to evaluate the clinical prognosis of patients with ACOP.