视神经鞘直径与眼球横径比值在脑水肿患者颅内压监测的应用

Application of ratio of optic nerve sheath diameter to transverse diameter of eyeball in monitoring intracranial pressure in patients with cerebral edema

目的探讨视神经鞘直径(ONSD)与眼球横径(ETD)比值在脑水肿患者颅内压(ICP)监测的应用价值。方法回顾性分析2022年1月至2023年10月福建省漳州市医院收治的50例脑水肿患者临床资料,所有患者均采用超声测定ONSD、ETD,并计算其比值;依据有创颅内压监测数值将患者分为ICP升高组(n=31,≥200 mmHg)及ICP正常组(n=19,80~200 mmHg),以单因素及多因素logistic回归分析脑水肿患者ICP升高的影响因素,采用ROC曲线分析ONSD、ETD、ONSD/ETD对脑水肿患者ICP升高的预测价值,以Pearson相关性分析ONSD、ONSD/ETD与脑水肿患者ICP升高之间的关系。结果单因素分析结果显示,两组ONSD、ONSD/ETD比值、GCS评分、NIHSS评分、APACHEⅡ评分比较,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,ONSD(β=0.778,OR=2.177,95%CI=1.275~3.718)、ONSD/ETD比值(β=0.826,OR=2.284,95%CI=1.218~4.285)为脑水肿患者ICP升高的独立危险因素,差异有统计学意义(P<0.05)。ROC曲线结果显示,ONSD/ETD比值预测脑水肿患者ICP升高的AUC、特异度、灵敏度分别为0.952、96.80%、78.90%,预测效能高于ONSD,差异有统计学意义(P<0.05);ONSD/ETD比值与ICP呈正相关,差异有统计学意义(r=0.523,P<0.001)。结论ONSD/ETD比值是脑水肿患者ICP升高的危险因素,对脑水肿患者ICP升高具有较好的预测价值。

Objective To investigate the value of the ratio of optic nerve sheath diameter(ONSD)to eyeball transverse diameter(ETD)in monitoring intracranial pressure(ICP)in patients with cerebral edema.Methods Clinical data of 50 patients with cerebral edema admitted to Zhangzhou Municipal Hospital of Fujian Province from January 2022 to October 2023 were retrospectively analyzed.ONSD and ETD were measured by ultrasound in all patients,and their ratios were calculated.According to the invasive ICP monitoring values,the patients were divided into the increased ICP group(n=31,≥200 mmHg)and the normal ICP group(n=19,80-200 mmHg).Univariate and multivariate Logistic regression were used to analyze the influencing factors of increased ICP in patients with cerebral edema.ROC curve was used to analyze the predictive value of ONSD,ETD and ONSD/ETD on ICP increase in patients with brain edema,and Pearson correlation was used to analyze the relationship between ONSD,ONSD/ETD and ICP increase in patients with brain edema.Results Univariate analysis showed that there were significant differences in ONSD,ONSD/ETD ratio,GCS score,NIHSS score and APACHEⅡscore between the two groups(P<0.05).Multivariate logistic regression analysis showed that ONSD(β=0.778,OR=2.177,95%CI=1.275-3.718),ONSD/ETD ratio(β=0.826,OR=2.284,95%CI=1.218-4.285)were independent risk factor for increased ICP in patients with cerebral edema,and the difference was statistically significant(P<0.05).ROC curve results showed that the ratio of ONSD/ETD predicted the AUC,specificity and sensitivity of ICP increase in patients with cerebral edema were 0.952,96.80%and 78.90%,respectively,and the prediction efficiency was higher than ONSD,the difference was statistically significant(P<0.05).ONSD/ETD ratio was positively correlated with ICP,and the difference was statistically significant(r=0.523,P<0.001).Conclusion The ratio of ONSD/ETD is a risk factor for the increase of ICP in patients with cerebral edema,and has a good predictive value for the increase of ICP in patients with cerebral edema.