床旁超声测量眼球横径与视神经鞘直径对脑出血患者预后的诊断价值

Diagnostic value of bedside ultrasound measurement of eyeball diameter and optic nerve sheath diameter on prognosis of patients with cerebral hemorrhage

目的 分析床旁超声测量眼球横径与视神经鞘直径对脑出血患者预后的诊断价值。方法 选择2019年12月至2021年12月接诊的175例脑出血患者,其中男性119例,女性56例;年龄25~79岁,平均年龄64.35岁(标准差7.76岁);根据发病30 d时格拉斯哥预后评分(GOS)分为预后良好组和预后不良组。比较两组基线情况、床旁超声测量眼球横径和视神经鞘直径,使用Pearson相关性分析眼球横径和视神经鞘直径与急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分、美国国立卫生研究院卒中量表(NIHSS)评分、血肿体积的关系,通过使用受试者工作特性(ROC)曲线下面积(AUC)评价眼球横径和视神经鞘直径对预后不良的诊断效能。结果 根据发病30 d时GOS评分分为预后良好组95例和预后不良组80例。预后不良组眼球横径小于预后良好组[(21.53±1.58) mm vs(22.61±1.42) mm],视神经鞘直径大于预后良好组[(5.96±0.67) mm vs (5.61±0.58) mm],差异均有统计学意义(P <0.05)。经Pearson相关性分析,脑出血患者APACHEⅡ评分、NIHSS评分及血肿体积均与眼球横径呈负相关(r=-0.620、-0.534、-0.536,P <0.05),与视神经鞘直径呈正相关(r=0.715、0.827、0.840,P <0.05);经多因素Logistic回归分析,眼球横径、视神经鞘直径、NIHSS评分均是脑出血患者预后不良的独立预测因素(P <0.05);经ROC曲线分析,眼球横径联合视神经鞘直径预测脑出血患者短期预后不良的AUC为0.910,大于NIHSS评分的0.775,差异有统计学意义(P <0.05)。结论 床旁超声测量眼球横径与视神经鞘直径均与脑出血密切相关,判断预后不良的效能较好,值得临床予以重视应用。

Objective To analyze the value of bedside ultrasound measurement of transverse diameter of eyeball and diameter of optic nerve sheath in diagnosing prognosis of patients with cerebral hemorrhage. Methods From December 2019 to December 2021, 175 patients with cerebral hemorrhage were enrolled, which included 119 males and 56 females, aged 25-79 years old with mean age of 64.35 years old(standard deviation 7.76 years old). According to the onset of 30-day Glasgow outcome score(GOS), all of them were divided into good prognosis guoup and poor prognosis group. The baseline conditions and transverse diameter of eyeball and diameter of optic nerve sheath using bedside ultrasound was compared between 2 groups.Pearson correlation analysis was used to analyze the relationship between eye ball transverse diameter and optic nerve sheath diameter and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, National Institutes of health stroke scale(NIHSS) score, and hematoma volume. The area under curve(AUC) of receiver operating characteristic(ROC) was used to evaluate the diagnostic efficacy of eye ball transverse diameter and optic nerve sheath diameter for poor prognosis. Results All of them were divided into good prognosis group(n = 95) and poor prognosis group(n = 80) according to GOS score at 30-day after onset. The transverse diameter of eyeball in poor prognosis group was significantly smaller than that in good prognosis group[(21.53 ± 1.58) mm vs(22.61 ± 1.42) mm], and the diameter of optic nerve sheath was significantly larger than that in good prognosis group[(5.96 ± 0.67) mm vs(5.61 ± 0.58) mm](P<0.05). Pearson correlation analysis showed that APACHE Ⅱ score, NIHSS score and hematoma volume were negatively correlated with eyeball diameter(r =-0.620、-0.534、-0.536, P<0.05), and positively correlated with optic nerve sheath diameter(r = 0.715、0.877、0.840, P<0.05). Multivariate Logistic regression analysis showed that eyeball diameter, optic nerve sheath diameter and NIHSS score were independent predictors of poor prognosis in patients with cerebral hemorrhage(P<0.05). ROC curve analysis showed that AUC of eyeball diameter combined with optic nerve sheath diameter in predicting poor short-term prognosis of patients with intracerebral hemorrhage was 0.910, which was statistically significantly higher than NIHSS score(0.775, P<0.05). Conclusion It is demonstrated that transverse diameter of eyeball and diameter of optic nerve sheath measured by bedside ultrasound are closely related to cerebral hemorrhage, which have good efficacy in judging poor prognosis, and is worthy of clinical application.