摘要
目的 探讨超声视神经鞘直径与眼球横径(ONSD/ETD)比值对颅脑外伤(TBI)患者颅内压(ICP)的预测价值及其相关性分析。方法 90例TBI患者纳入研究,根据侧脑室置管测量ICP结果将患者分为ICP升高组(ICP>200 mmH2O,n=32)和ICP正常组(ICP≤200 mmH2O,n=58),根据格拉斯哥预后分级量表(GOS)随访后将4~5分患者纳入预后良好组(n=38),1~3分患者纳入预后不良组(n=52),比较两组患者ICP、ONSD、ETD和ONSD/ETD比值等指标的水平差异。超声ONSD、ONSD/ETD比值和ICP间的相关性分析行Spearman相关性分析;超声ONSD和ONSD/ETD比值对ICP升高预测的准确性比较采用受试者工作特征曲线(ROC)。结果 术后第1天、第3天和第7天,两组患者GCS评分逐渐升高,ICP升高组GCS评分低于ICP正常组,组间和组内比较均具有统计学意义(P<0.05);而两组患者ICP、ONSD和ONSD/ETD比值水平逐渐降低,ICP升高组高于ICP正常组,组间和组内比较均具有统计学意义(P<0.05)。预后不良组GOS评分低于预后良好组,而ICP、ONSD和ONSD/ETD比值高于预后良好组(P<0.05)。Spearman相关性分析发现,TBI患者超声ONSD、ONSD/ETD比值和ICP间呈正相关性(r=0.593和0.621,P<0.001)。绘制ROC曲线发现,超声ONSD和ONSD/ETD比值预测ICP升高的曲线下面积分别是0.884和0.923,敏感性分别是82.50%和90.00%,特异性分别是80.00%和83.50%,最佳阈值分别是5.15 mm和0.25。Kappa一致性检验发现,超声ONSD和ONSD/ETD比值对ICP升高的预测效果与脑室内测压具有一致性(Kappa=0.612和0.725,P<0.05),超声ONSD和ONSD/ETD比值的预测效果一致性较好(Kappa=0.812,P<0.001)。结论 超声ONSD/ETD比值预测ICP升高的效果较超声下ONSD测量更佳,且诊断敏感性和特异性较高,具有临床应用前景。
Objective To investigate the predictive value of the ratio of ultrasonic optic nerve sheath diameter to eyeball transverse diameter(ONSD/ETD) for intracranial pressure(ICP) in patients with traumatic brain injury(TBI) and its correlation analysis. Methods 90 TBI patients according to the ICP results measured by lateral ventriculectomy were divided into ICP elevated group(ICP>200 mmH2O, n=32) and ICP normal group(ICP≤200 mmH2O, n=58), while 90 TBI patients according to Glasgow Outcome Scale(GOS) were included in the good prognosis group(the patients with 4-5 scores, n=38) and in the poor prognosis group(the patients with 1-3 scores, n=52). The differences of ICP, ONSD, ETD and ONSD/ETD were compared between the two groups. GCS scores, ICP, ONSD, ETD and ONSD/ETD were compared between the two groups. The correlation between ONSD,ONSD/ETD under ultrasound and ICP was analyzed by Spearman correlation analysis,where the receiver operator characteristic curve( ROC) was used to compare the accuracy of ONSD and ONSD/ETD under ultrasound in predicting ICP rise. Results On the 1st,3rd and 7th day after operation,the GCS score of the two groups increased gradually,and the GCS score of the ICP elevated group was lower than that of the ICP normal group,where the comparison between the two groups and within the group was statistically significant( P < 0. 05). The levels of ICP,ONSD and ONSD/ETD ratio of the two groups decreased gradually and the level of ICP increased group was higher than that of ICP normal group,where the comparison between groups and within groups was statistically significant( P < 0. 05). The GCS score of poor prognosis group was lower than that of good prognosis group,while ICP,ONSD and ONSD/ETD under ultrasound in poor prognosis group were higher than those in good prognosis group( P < 0. 05). Spearman correlation analysis showed that there were a positive correlation between ONSD,ONSD/ETD under ultrasound and ICP( r = 0. 593 and 0. 621,P < 0. 001). The ROC curve showed that the area under the curve of
作者
汪林锋
张楚蕾
於佳飞
李婷
庞昕
张定元
张雪锋
WANG Lin-feng;ZHANG Chu-lei;YU Jia-fei;ZHANG Xue-feng(Department of Intensive Care Unit,Haiyan People's Hospital,Jiaxing 314300,China;不详)
出处
《临床神经外科杂志》
2023年第1期74-79,共6页
Journal of Clinical Neurosurgery
基金
海盐县人民医院2019年科学研究基金项目(2019-YJ-15A)。
