超声测量视神经鞘直径在颅脑外伤患者中的应用价值

Application value of ultrasonic measurement of optic nerve sheath diameter in patients with craniocerebral trauma

  • 摘要:
    目的 探讨超声测量视神经鞘直径(ONSD)在颅脑外伤患者中的应用价值。
    方法 选取100例颅脑外伤患者作为研究对象,随机分为对照组和研究组,每组50例。对照组患者接受有创颅内压(ICP)监测,研究组患者接受有创ICP监测联合ONSD超声测量,且2组患者均根据实际情况接受治疗。观察2组患者的一般资料、治疗情况。比较研究组不同ICP患者的一般资料、ICP监测结果和ONSD超声测量结果,分析颅脑外伤患者ONSD与ICP的相关性,并分析ONSD对颅脑外伤患者ICP升高的诊断效能。
    结果 治疗后28 d时,研究组患者的平均动脉压高于对照组,心率、呼吸频率低于对照组,差异有统计学意义(P < 0.05);研究组患者机械通气时间、入住ICU时间短于对照组,甘露醇使用量少于对照组,治疗后ICP、28 d病死率低于对照组,差异有统计学意义(P < 0.05)。ICP≥22 mmHg患者的ICP高于ICP < 22 mmHg患者,不同体位、甘露醇使用前后的ONSD大于ICP < 22 mmHg组,差异有统计学意义(P < 0.05)。颅脑外伤患者ONSD与ICP呈显著正相关(r=0.723, P < 0.001);受试者工作特征曲线分析结果显示, ONSD诊断ICP升高的最佳临界值为5.25 mm, 曲线下面积为0.879。
    结论 将ICP监测联合超声测量ONSD应用于颅脑外伤患者的治疗中,可有效改善患者体征,缩短机械通气时间、入住ICU时间,减少甘露醇使用量,降低28 d病死率。颅脑外伤患者ONSD与ICP呈显著正相关,且ONSD对ICP升高具有较高的诊断效能。

     

    Abstract:
    Objective To investigate the application value of ultrasonic measurement of optic nerve sheath diameter (ONSD) in patients with craniocerebral trauma.
    Methods A total of 100 patients with craniocerebral trauma were selected as research subjects and randomly divided into control group and study group, with 50 patients in each group. Patients in the control group received invasive intracranial pressure (ICP) monitoring, while patients in the study group received invasive ICP monitoring combined with ultrasonic measurement of ONSD. Both groups were treated according to their actual conditions. The general information and treatment status of the two groups were observed, and the general information, ICP monitoring results, and ONSD ultrasonic measurement results of different ICP patients in the study group were compared. The correlation between ONSD and ICP in patients with craniocerebral trauma was analyzed, and the diagnostic efficacy of ONSD for ICP elevation in patients with craniocerebral trauma was also analyzed.
    Results At 28 days after treatment, the mean arterial pressure of the study group was higher than that of the control group, while the heart rate and respiratory rate were lower than those of the control group(P < 0.05). The mechanical ventilation time and ICU stay of the study group were shorter than those of the control group, the amount of mannitol used was less than that of the control group, and the ICP and 28-day mortality rate after treatment were lower than those of the control group (P < 0.05). Patients with ICP≥22 mmHg had higher ICP than those with ICP < 22 mmHg, and ONSD before and after the use of mannitol in different positions was greater than that in the ICP < 22 mmHg group (P < 0.05). There was a significant positive correlation between ONSD and ICP in patients with craniocerebral trauma (r=0.723, P < 0.001). The results of receiver operating characteristic curve analysis showed that the optimal cutoff value of ONSD for diagnosing ICP elevation was 5.25 mm, and the area under the curve was 0.879.
    Conclusion The combination of ICP monitoring and ultrasonic measurement of ONSD in the treatment of patients with craniocerebral trauma can effectively improve patients' vital signs, shorten the duration of mechanical ventilation and ICU stay, reduce the amount of mannitol used, and reduce the 28-day mortality rate. There is a significant positive correlation between ONSD and ICP in patients with craniocerebral trauma, and ONSD has a high diagnostic efficacy for ICP elevation.

     

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