床旁经颅多普勒超声评估儿童神经危重症患者颅内压的临床价值

Clinical value of bedside transcranial doppler ultrasound in assessing intracranial pressure in critically ill pediatric patients with nervous system disease

目的 研究床旁经颅多普勒超声(transcranial doppler,TCD)在评估儿童重症监护病房(pediatric intensive care unit,PICU)神经危重症患儿颅内压(intracranial pressure,ICP)水平中的应用价值。方法 前瞻性纳入2020年11月至2021年11月入住中国医科大学附属盛京医院PICU的神经危重症患儿进行研究。纳入病例行床旁TCD检查,计算搏动指数(pulsatility index,PI);之后行床旁腰椎穿刺术,测量ICP。采用Pearson相关分析法行PI值与ICP值的相关性分析。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价PI诊断ICP增高(≥20 mm Hg)的价值。结果 56例儿童神经危重症患儿纳入研究。颅内感染(24例,43%)、颅脑创伤(11例,20%)及脑血管疾病(5例,9%)的占比居原发病前3位。Pearson相关分析显示,PI和ICP呈显著正相关(r=0.536,P<0.001)。按原发病分组研究,显示颅脑创伤组PI与ICP呈显著正相关(r=0.655,P=0.029),而颅内感染组PI与ICP无显著相关性(r=0.324,P=0.122)。ROC曲线分析显示,PI预测神经危重症患儿ICP是否≥20 mm Hg的曲线下面积为0.828 (95%CI:0.677~0.979);PI=1.255为最佳临界值,预测ICP≥20 mm Hg的灵敏度为83.3%,特异度为79.5%。结论 TCD监测ICP技术可以用来预测神经危重症患儿ICP变化情况,以指导临床治疗和预后评估。

Objective To study the value of bedside transcranial doppler(TCD) in evaluating the level of intracranial pressure(ICP) in critically ill pediatric patients with nervous system disease in the pediatric intensive care unit(PICU). Methods A prospective analysis was performed on the critically ill pediatric patients with nervous system disease who were admitted to the PICU of Shengjing Hospital, China Medical University, from November 2020 to November 2021. Bedside TCD was performed on all patients, and pulsatility index(PI) was calculated. Bedside lumbar puncture was performed to measure ICP. A Pearson correlation analysis was used to assess the correlation between PI and ICP. The receiver operating characteristic(ROC) curve was used to assess the value of PI in the diagnosis of elevated ICP(≥20 mm Hg). Results A total of 56 children were included in the study. The top three primary diseases were intracranial infection(24 children, 43%), traumatic brain injury(TBI)(11 children, 20%), and cerebrovascular disease(5 children, 9%). The Pearson correlation analysis showed that PI was positively correlated with ICP(r=0.536, P<0.001).The subgroup analysis based on primary disease showed that in the TBI group, PI was positively correlated with ICP(r=0.655, P=0.029), while no significant correlation between PI and ICP was observed in the intracranial infection group(r=0.324, P=0.122). The ROC curve analysis showed that PI had an area under the curve of 0.828(95%CI: 0.677-0.979)in predicting ICP≥20 mm Hg, with a sensitivity of 83.3% and a specificity of 79.5% at the optimal cut-off value of 1.255.Conclusions TCD technology for ICP monitoring can predict the change in ICP in critically ill pediatric patients with nervous system disease, suggesting it is useful for treatment options and prognosis evaluation.