Zhongguo cuzhong zazhi (Jul 2023)

自发性脑出血患者视神经鞘直径与颅内压相关性研究 Association between Optic Nerve Sheath Diameter and Intracranial Pressure in Patients with Spontaneous Intracerebral Hemorrhage

  • 陈必耀，陈征，雷燕妮，徐玢，单凯

DOI
https://doi.org/10.3969/j.issn.1673-5765.2023.07.009
Journal volume & issue
Vol. 18, no. 7
pp. 799 – 804

Abstract

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目的 探究自发性脑出血（spontaneous intracerebral hemorrhage，sICH）患者视神经鞘直径（optic nerve sheath diameter，ONSD）与颅内压（intracranial pressure，ICP）的相关性，评估ONSD对ICP升高的诊断效能。 方法 连续纳入2021年12月—2022年5月在首都医科大学附属北京天坛医院急诊科住院治疗并接受有创ICP监测的sICH患者。在入抢救室0 h、4 h、8 h、12 h、24 h、48 h分别通过床旁超声测量ONSD并记录同时刻ICP数值。采用Spearman相关分析评估ONSD与ICP关系。采用ROC曲线评估ONSD对ICP＞20 mmHg（1 mmHg=0.133 kPa）的诊断效能。 结果 共纳入12例患者，年龄59（42～76）岁，共计采集72对ONSD和ICP数据。ONSD与ICP间相关系数为0.768（95%CI 0.578～0.886，P＜0.001）。应用ONSD诊断ICP＞20 mmHg的ROC曲线下面积为0.841（95%CI 0.727～0.921，P=0.007）。以ONSD≥5.35 mm为阈值诊断ICP＞20 mmHg的灵敏度为0.947，特异度为0.796，阳性预测值为0.667，阴性预测值为0.972。 结论 在sICH患者中，超声测量的ONSD与ICP呈正相关，ONSD≥5.35 mm可以诊断ICP增高。 Abstract: Objective To investigate the association between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with spontaneous intracerebral hemorrhage (sICH), and to evaluate the performance of ONSD in diagnosis ICP elevation. Methods Patients with sICH admitted to the emergency department of Beijing Tiantan Hospital, Capital Medical University from December 2021 to May 2022 and receiving invasive ICP monitoring were consecutively included. ONSD was measured by bedside ultrasound and ICP was recorded at 0 h, 4 h, 8 h, 12 h, 24 h, 48 h after admission. Spearman correlation analysis was used to evaluate the relationship between ONSD and ICP. ROC was used to evaluate the diagnostic efficacy of ONSD in the diagnosis of ICP >20 mmHg. Results A total of 12 patients, aged 59(42-76) years were enrolled, of which a total of 72 pairs of ONSD and ICP data were collected. Spearman rank correlation coefficient of ONSD and ICP was 0.768 (95%CI 0.578-0.886, P20 mmHg was 0.841 (95%CI 0.727-0.921, P=0.007). Using ONSD 5.35 mm as the threshold for diagnosing ICP>20 mmHg, its sensitivity was 0.947, specificity was 0.796, positive predictive value was 0.667, and negative predictive value was 0.972. Conclusions In patients with sICH, Ultrasound measurement of ONSD is positively correlated with ICP, and increased ICP can be diagnosed when ONSD≥5.35 mm.

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