超声下视神经鞘直径对重型颅脑外伤继发脑心综合征的预测价值

The predictive value of optic nerve sheath diameter in cerebrocardiac syndrome secondary to severe traumatic brain injury under ultrasound

目的重症超声在颅内压、心脏收舒功能评估上优势明显。文中探讨超声下视神经鞘直径(ONSD)对重型颅脑外伤继发脑心综合征的预测价值。方法回顾性分析2021年1月至2021年9月于福建省立医院就诊的sTBI患者171例,根据是否继发CCS分为CCS组(n=83)和非CCS组(n=88)。比较两组患者年龄、性别、基础病、头颅CT影像学表现、电解质、血糖、CRP、NSE、心肌酶、颅内压(ICP)、ONSD、心脏彩超、APACHE II评分、GCS评分等临床资料。采用多因素Logistics回归分析CCS发生的独立危险因素。绘制ROC曲线,评估CCS各独立危险因素对sTBI继发CCS的预测价值,并通过C-statistics评估ONSD和APACHE II评分联合用于预测sTBI继发CCS的价值。结果本组患者中,48.5%sTBI患者继发CCS。NSE(OR=5.665,95%CI:1.057~30.351,P=0.043)、ONSD(OR=4.979,95%CI:2.0754~11.949,P<0.001)、右心Tei指数(OR=2.375,95%CI:1.071~5.267,P=0.033)、GCS评分(OR=3.871,95%CI:1.624~9.229,P=0.002)为sTBI患者继发CCS的独立危险因素。ONSD的受试者工作特征(ROC)曲线下面积(AUC=0.701)高于NSE、右心Tei指数、GCS(分别为0.656、0.591、0.643),且ONSD有助于提高APACHE II评分对sTBI是否继发CCS的区分度。结论sTBI患者继发CCS的发生率较高。NSE、ONSD、右心Tei指数、GCS评分与sTBI患者继发CCS独立相关。ONSD是临床预测sTBI继发CCS的理想指标。

Objective Severe ultrasound has obvious advantages in the evaluation of intracranial pressure and cardiac systolic function.To investigate predictive value of optic nerve sheath diameter(ONSD)in cerebrocardiac syndrome(CCS)secondary to severe traumatic brain injury(sTBI)under ultrasound.Methods 171 sTBI patients admitted to Fujian Medical University Provincial Hospital from January 2021 to September 2021 were retrospectively analyzedand divided into CCS group(n=83)and non-CCS group(n=88)according to whether CCS is secondary.The clinical data of the two groups were compared,including age,gender,underlying diseases,head CT imaging manifestations,electrolytes,blood glucose,CRP,NSE,myocardial enzyme,ICP,ONSD,color doppler echocardiography,APACHE II score,GCS score,etc.Multi-factor Logistics regression was used to analyze the independent risk factors of CCS.ROC curves were drawn to evaluate the predictive value of independent CCS risk factors for secondary CCS of sTBI,and the value of ONSD and APACHE II scores combined to predict secondary CCS of sTBI was evaluated by C-statistics.Results In this group of patients,48.5%patients with sTBI developed secondary CCS.NSE(OR=5.665,95%CI:1.057-30.351,P=0.043),nerve sheath diameter(ONSD,OR=4.979,95%CI:2.0754-11.949,P<0.001),right heart Tei index(OR=2.375,95%CI:1.071-5.267,P=0.033)and GCS score(OR=3.871,95%CI:1.624-9.229,P=0.002)were independent risk factors for secondary CCS in sTBI patients.The area under receiver operating characteristic(ROC)curve of ONSD(AUC=0.701)was higher than that of NSE,RIGHT heart Tei index and GCS(0.656,0.591 and 0.643,respectively),and ONSD was helpful to improve the differentiation of APACHE II score for secondary CCS of sTBI.Conclusion Patients with sTBI have a high incidence of secondary CCS.NSE,ONSD,right heart Tei index and GCS score were independently correlated with secondary CCS in sTBI patients.ONSD is an ideal indicator for clinical prediction of CCS secondary to sTBI.