超声测量视神经鞘直径及视网膜中央动脉血流参数对儿童创伤性损伤致颅内高压的评估价值

Evaluation Value of Ultrasonic Measurement of Optic Nerve Sheath Diameter and Central Retinal Artery in Intracranial Hypertension Caused by Traumatic Injury in Children

目的:探讨超声测量视神经鞘直径(optic nerve sheath diameter,ONSD)及视网膜中央动脉(central retinal artery,CRA)血流参数对儿童创伤性损伤致颅内高压的诊断价值。方法:选取厦门市儿童医院2019年7月—2021年12月收治的重症颅脑创伤(traumatic brain injury,TBI)术后颅内压(intracranial pressure,ICP)≥15 mmHg的患儿59例为试验组,同期于本院体检的健康儿童41例为对照组。两组通过超声测量ONSD及CRA血流参数。比较试验组与对照组各参数的差异,并通过受试者操作特征(receiver operator characteristic,ROC)曲线分析各参数诊断颅内高压的效能及多参数联合诊断颅内高压的效能。结果:试验组双侧ONSD均显著大于对照组,差异均有统计学意义(P<0.05)。试验组双侧舒张期末血流速度(end diastolic velocity,EDV)均小于对照组,双侧收缩期峰值血流速度/EDV(S/D)均大于对照组,双侧阻力指数(resistance index,RI)均高于对照组,差异均有统计学意义(P<0.05)。ROC曲线显示,ONSD诊断颅内高压的最佳临界值为4.9 mm,敏感度为83.05%,特异度为92.68%,AUC为0.938。EDV诊断颅内高压的最佳临界值为3.48 cm/s,敏感度为77.97%,特异度为60.98%,AUC为0.719。S/D诊断颅内高压的最佳临界值为2.92,敏感度为67.80%,特异度为85.40%,AUC为0.786。RI诊断颅内高压的最佳临界值为0.65,敏感度为72.88%,特异度为82.93%,AUC为0.835。RI与ONSD两者联合诊断颅内高压的敏感度为93.20%,特异度为78.05%,AUC为0.955。结论:通过超声测量ONSD、RI可以间接判断颅内压增高情况,两者联合具有较高的诊断效能,需要连续无创监测的情况下可以作为一种有效的评估方法。

Objective:To investigate the diagnostic value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and central retinal artery(CRA)blood flow parameters for intracranial hypertension caused by traumatic injury in children.Method:A total of 59 children with intracranial pressure(ICP)≥15 mmHg after severe traumatic brain injury(TBI)surgery admitted to Xiamen Children's Hospital from July 2019 to December 2021 were selected as the experimental group,41 healthy children who underwent physical examination in our hospital at the same time served as the control group.The ONSD and blood flow parameters of CRA were measured by ultrasound.The difference of parameters between the experimental group and the control group were compared,and the efficacy of each parameter in diagnosing intracranial hypertension and the multi-parameter combination in diagnosing intracranial hypertension were analyzed by receiver operator characteristic(ROC)curve.Result:The bilateral ONSD of the experimental group were significantly larger than those of the control group,the differences were statistically significant(P<0.05).The bilateral end diastolic velocity(EDV)of the experimental group were smaller than those of the control group,the bilateral peak systolic velocity/EDV(S/D)of the experimental group were larger than those of the control group,and bilateral resistance index(RI)were higher than those of the control group,the differences were all statistically significant(P<0.05).ROC curve showed that the optimal critical value of ONSD for diagnosing intracranial hypertension was 4.9 mm,sensitivity was 83.05%,specificity was 92.68%,and AUC was 0.938.The optimal critical value of EDV for diagnosing intracranial hypertension was 3.48 cm/s,the sensitivity was 77.97%,the specificity was 60.98%,and the AUC was 0.719.The optimal critical value of S/D for diagnosing intracranial hypertension was 2.92,sensitivity was 67.80%,specificity was 85.40%,and AUC was 0.786.The optimal critical value of RI for diagnosing intracranial hypertension was 0.65,sensitivity was 72.88%,specificity was 82.93%,and AUC was 0.835.The sensitivity,specificity and AUC of RI and ONSD in the diagnosis of intracranial hypertension were 93.20%,78.05%and 0.955,respectively.Conclusion:The increase of intracranial pressure can be indirectly judged by ultrasonic measurement of ONSD and RI.The combination of ONSD and RI has high diagnostic efficiency and can be used as an effective evaluation method when continuous non-invasive monitoring is needed.