颅内压增高性疾病患儿经颅多普勒超声检查的相关参数

Relevant Parameters of Transcranial Doppler in Children with Increased Intracranial Pressure

目的分析颅内压(ICP)增高性疾病患儿经颅多普勒超声(TCD)检查的相关参数。方法将2019年3月至2021年5月河南省儿童医院收治的49例ICP增高性疾病患儿作为研究对象(观察组),并选同期同年龄段健康体检儿童37例作对照组,行TCD监测。比较两组血流动力学参数[收缩期峰血液流速(V_(s))、平均血液流速(V_(m))、舒张期末血液流速(V_(d))、脉动指数(PI)]。比较观察组不同颅内高压及不同预后下V_(s)、V_(d)、V_(m)、PI水平,不同时间点(入院后1、3d)两组视神经鞘直径、视神经鞘直径与ICP的关系。分析TCD检测视神经鞘直径对ICP增高的诊断价值。结果观察组V_(s)、V_(d)、V_(m)水平均较对照组低,PI水平较对照组高(P<0.05);不同颅内高压下V_(s)、V_(d)、V_(m)、PI水平对比,差异有统计学意义,且随着ICP升高,V_(s)、V_(d)、V_(m)水平逐渐降低,PI水平逐渐升高(P<0.05);预后良好患儿V_(s)、V_(d)、V_(m)水平均较预后不良患儿高,PI水平较预后不良患儿低(P<0.05);观察组入院后1、3d视神经鞘直径均较对照组大(P<0.05);相关性分析显示,ICP增高性疾病患儿与TCD监测视神经鞘直径呈正相关(P<0.05);受试者工作特征(ROC)曲线结果显示,曲线下面积临界值为5.60mm,灵敏度为87.76%,特异度为85.71%,95%CI为0.837~0.964。结论对ICP增高性疾病患儿行TCD检测,能有效了解血流动力学、ICP变化、视神经鞘直径水平,有助于临床评估病情、实施治疗,具有应用推广的价值。

Objective To analyze the relevant parameters of the results of transcranial Doppler(TCD)monitoring in children with increased intracranial pressure(ICP)diseases.Methods Forty-nine children with ICP-increased disease in Henan Children's Hospital from March 2019 to May 2021 were selected as the research objects(observation group),and 37 children vith the same age group were selected as the control group.Patients were monitored for TCD.Hemodynamic parameters[peak systolie velocity(V_(s)),mean velocity(V_(m)),end diastolic velocity(V_(d)),pulsation index(PI)]of the two groups were compared,the observation group’s different intracranial hypertension and V_(s)、V_(d)、V_(m),PI levels under different prognosis,different time points(1,3 d after admission)of the two groups of optic nerve sheath diameter,the relationship between the diameter of the optic nerve sheath and ICP were compared.The diagnostie value of TCD in detecting the diameter of optic nerve sheath for ICP elevation was analyzed.Results The levels of V_(s)、V_(d) and V_(m) in the observation group were lower than those in the control group,and the level of PI was higher than that in the control group(P<0.05).The comparison of the levels of V_(s)、V_(d)、V_(m) and PI under dfferent intracranial hypertension showed staistically significant differences,and with the increase of ICP,the levels of V_(s)、V_(d) and V_(m) gradually decrease,and the level of PI gradually increases(P<0.05).The levels of Vs Vd and Vmin children with good prognosis were higher than those with poor prognosis,and the level of PI was lower than those with poor prognosis(P<0.05).The diameter of the optic nerve sheath of the observation group was larger than that of the control group at 1 and 3 days after admission(P<0.05).Correlation analysis found that children with ICP-increased disease were positively correlated with the diameter of the optic nerve sheath monitored by TCD(P<0.05).According to the resuls of the receiver operating characteristie(ROC)curve,the critical value of the area under the curve was 5.60 mm,the sensitivity was 87.76%,the speeifcity was 85.71%,and the 95%CI was 0.837-0.964.Conclusion TCD detection in children with ICP-increased disease can effectively understand hermodynamics,ICP changes,and optic nerve sheath diameter levels,which is helpful for dlinical assessment of the disease and implementation of treatment,and has the value of application and promotion.