视神经鞘直径与脑出血患者颅内压变化的关系

Relationship between optic nerve sheath diameter and the changes of ICP in patients with cerebral hemorrhage

目的探讨超声测量的视神经鞘直径(ONSD)值与脑出血患者颅内压(ICP)变化的相关性。方法选取2018-01—2022-12安徽医科大学附属亳州医院收治的85例脑出血患者为研究对象。所有受试者均行超声和腰椎穿刺检查,根据腰椎穿刺结果将患者分为颅内压正常组和颅内压升高组。采用单因素分析影响脑出血患者颅内压升高的相关因素,Logistic回归分析影响脑出血患者颅内压升高的危险因素。采用Pearson相关分析ONSD值与ICP的相关性。结果颅内压升高组ICP为(245.26±21.36)mmH_(2)O,高于颅内压正常组患者的(141.54±15.48)mmH_(2)O(t=20.518,P<0.001)。颅内压升高组患者性别、手术方式、出血部位、年龄、高血压、糖尿病、冠心病、BMI、吸烟史、饮酒史与颅内压正常组相比差异均无统计学意义(P>0.05)。颅内压升高组患者出血量、NIHSS评分、APACHEⅡ评分、ONSD值均高于颅内压正常组(P<0.05),GCS评分低于颅内压正常组(P<0.05)。Logistic回归分析显示出血量、GCS评分、NIHSS评分、APACHEⅡ评分、ONSD值均是影响脑出血患者ICP升高的危险因素(P<0.05)。Pearson相关分析显示,ONSD值与脑出血患者ICP呈正相关(r=0.612,P<0.05)。结论ONSD值是影响脑出血患者ICP升高的危险因素,且ONSD值与ICP呈正相关,超声测量ONSD值可用于脑出血患者颅内压的评估。

Objective To investigate the correlation between the optic nerve sheath diameter(ONSD)value measured by ultrasound and the changes in intracranial pressure(ICP)in patients with cerebral hemorrhage.Methods A total of 85 patients with cerebral hemorrhage who were admitted to the Bozhou Hospital Affiliated to Anhui Medical University from January 2018 to December 2022 were selected as the research objects.All subjects underwent ultrasonography and lumbar puncture.According to the results of lumbar puncture,the patients were divided into a normal intracranial pressure group and an elevated intracranial pressure group.Univariate analysis was used to analyze the related factors of intracranial pressure increase in patients with cerebral hemorrhage,and Logistic regression was used to analyze the risk factors of intracranial pressure increase in patients with cerebral hemorrhage.Pearson correlation analysis was used to analyze the correlation between ONSD value and ICP.Results The ICP in the elevated intracranial pressure group was(245.26±21.36)mmH_(2)O,which was higher than that in the normal intracranial pressure group(141.54±15.48)mmH_(2)O(t=20.518,P<0.05).There were no significant differences in gender,surgical method,bleeding site,age,hypertension,diabetes,coronary heart disease,BMI,smoking history,drinking history between the elevated intracranial pressure group andthe normal intracranial pressure group (P>0.05). The bleeding volume,NIHSS score,APACHE Ⅱ score andONSD level of the patients in the elevated intracranial pressure group were higher than those in the normalintracranial pressure group(P<0.05),and the GCS score was lower than that in the normal intracranial pressuregroup(P<0.05). Logistic regression analysis showed that bleeding volume,GCS score,NIHSS score,APACHEⅡscore and ONSD value were the risk factors for the increase of ICP in patients with cerebral hemorrhage(P<0.05). Pearson correlation analysis showed that ONSD value was positively correlated with ICP in patients withcerebral hemorrhage(r=0.612,P<0.05). Conclusion The ONSD value is a risk factor affecting the increase ofICP in patients with cerebral hemorrhage,and the ONSD value is positively correlated with ICP. Therefore,theONSD value measured by ultrasound can be used for the evaluation of intracranial pressure in patients withcerebral hemorrhage.