超声测量视神经鞘直径在颅脑外伤患者中的应用价值

张建波, 丁俊宏, 周立田, 杨平来, 焦磊

张建波, 丁俊宏, 周立田, 杨平来, 焦磊. 超声测量视神经鞘直径在颅脑外伤患者中的应用价值[J]. 实用临床医药杂志, 2024, 28(13): 47-51. DOI: 10.7619/jcmp.20241141
引用本文: 张建波, 丁俊宏, 周立田, 杨平来, 焦磊. 超声测量视神经鞘直径在颅脑外伤患者中的应用价值[J]. 实用临床医药杂志, 2024, 28(13): 47-51. DOI: 10.7619/jcmp.20241141
ZHANG Jianbo, DING Junhong, ZHOU Litian, YANG Pinglai, JIAO Lei. Application value of ultrasonic measurement of optic nerve sheath diameter in patients with craniocerebral trauma[J]. Journal of Clinical Medicine in Practice, 2024, 28(13): 47-51. DOI: 10.7619/jcmp.20241141
Citation: ZHANG Jianbo, DING Junhong, ZHOU Litian, YANG Pinglai, JIAO Lei. Application value of ultrasonic measurement of optic nerve sheath diameter in patients with craniocerebral trauma[J]. Journal of Clinical Medicine in Practice, 2024, 28(13): 47-51. DOI: 10.7619/jcmp.20241141

超声测量视神经鞘直径在颅脑外伤患者中的应用价值

基金项目: 

江苏省南京市卫生科技发展专项基金项目 YKK20176

江苏大学临床医学科技发展基金项目 JLY20180213

详细信息
    通讯作者:

    焦磊, E-mail: jlsu2008@126.com

  • 中图分类号: R743;R651.1;R445.1

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.

  • 图  1   ONSD诊断颅脑外伤患者ICP升高的ROC曲线

    图  2   颅脑外伤患者ONSD与ICP的相关性分析散点图

    表  1   2组患者一般资料比较(x±s)[n(%)]

    指标 分类 对照组(n=50) 研究组(n=50) χ2/t P
    年龄/岁 41.69±3.64 41.39±3.52 0.419 0.676
    性别 28(56.00) 29(58.00) 0.041 0.840
    22(44.00) 21(42.00)
    入院时体征 平均动脉压/mmHg 61.37±5.26 62.35±5.77 -0.888 0.377
    心率/(次/min) 121.25±9.66 123.33±8.95 -1.117 0.267
    呼吸频率/(次/min) 35.89±3.62 35.57±3.79 0.432 0.667
    入院时格拉斯哥昏迷量表评分/分 6.25±1.06 6.37±1.19 -0.532 0.596
    受伤原因 车祸伤 32(64.00) 33(66.00) 0.044 0.834
    跌落伤 11(22.00) 12(24.00)
    其他原因 7(14.00) 5(10.00)
    临床诊断 合并蛛网膜下腔出血 27(54.00) 26(52.00) 0.040 0.841
    硬膜下出血 11(22.00) 12(24.00)
    硬膜外出血 7(14.00) 7(14.00)
    脑挫裂伤 5(10.00) 5(10.00)
    下载: 导出CSV

    表  2   2组患者治疗情况比较(x±s)[n(%)]

    指标 对照组(n=50) 研究组(n=50) χ2/t P
    治疗后28 d时平均动脉压/mmHg 72.13±6.37 86.43±7.65 -10.157 < 0.001
    治疗后28 d时心率/(次/min) 85.39±6.21 77.91±8.15 5.162 < 0.001
    治疗后28 d时呼吸频率/(次/min) 19.33±2.16 17.16±2.33 4.807 < 0.001
    机械通气时间/d 6.37±1.34 3.62±1.01 11.588 < 0.001
    入住重症监护室时间/d 10.35±3.37 7.23±2.04 5.600 < 0.001
    治疗28 d内死亡 11(22.00) 2(4.00) 7.162 0.007
    甘露醇使用量/g 453.85±131.57 165.37±29.85 15.120 < 0.001
    治疗前颅内压/mmHg 19.42±8.25 19.33±8.75 0.053 0.958
    治疗后颅内压/mmHg 17.25±4.12 15.15±3.58 2.721 0.008
    下载: 导出CSV

    表  3   研究组中不同ICP患者的临床资料比较(x±s)[n(%)]

    指标 分类 ICP < 22 mmHg组(n=28) ICP≥22 mmHg组(n=22) χ2/t P
    性别 16(57.14) 13(59.09) 0.019 0.890
    12(42.86) 9(40.91)
    年龄/岁 38.26±2.53 39.53±2.76 -0.684 0.500
    ICP/mmHg 14.25±3.12 27.26±5.31 -10.820 < 0.001
    ONSD/mm 平卧位 5.23±0.47 5.61±0.53 -3.793 < 0.001
    30 °头高位 5.31±0.42 5.86±0.54 -5.685 < 0.001
    甘露醇使用前30 min 5.32±0.46 5.82±0.55 -4.931 < 0.001
    甘露醇使用后30 min 4.47±0.33 4.89±0.39 -5.813 < 0.001
    ICP: 颅内压; ONSD: 视神经鞘直径。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2024-03-17
  • 修回日期:  2024-05-10
  • 网络出版日期:  2024-07-19
  • 刊出日期:  2024-07-14

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