床旁超声测量视神经鞘直径对颅脑损伤患者颅内压增高的诊断价值  

Diagnosis Value of Optic Nerve Sheath Diameter Measured by Bedside Ultrasound for Increased Intracranial Pressure in Patients with Traumatic Brain Injury

作　　者：张锐[1] 宋苏云[1] 王丰[1] 陈刚[1] 张雪珍[1] 肖芳[1] 唐熙[1] 吴辉云[1] 

机构地区：[1]湖南省怀化市第一人民医院超声科,湖南怀化418000

出　　处：《医学临床研究》2012年第4期707-709,713,共4页Journal of Clinical Research

摘　　要：[目的]探讨利用床旁超声测量视神经鞘直径在颅脑损伤患者中检出颅内压（ICP）增高者的应用价值.[方法]35例颅脑损伤（ICP正常22例,ICP增高13例）患者及10名健康志愿者行床旁超声检查测量视神经鞘直径,并对颅脑损伤患者进行ICP测定.比较三组之间视神经鞘直径,计算视神经鞘直径与ICP的相关性,利用ROC曲线探究预测ICP增高的最佳阈值及准确性.[结果]ICP增高组视神经鞘直径显著高于ICP正常组及对照组（P〈0.05）,ICP正常组视神经鞘直径与对照组差异无统计学意义（P〉0.05）,视神经鞘直径与ICP之间存在正相关关系（r=0.733,P〈0.01）.ROC曲线显示视神经鞘直径≥5.0 mm作为判断标准效果最佳,此时敏感度86.4%（19/22）、特异度84.6%（11/13）、准确度85.7%（30/35）、阳性预测值90.5%（19/21）、阴性预测值78.9%（11/14）.[结论]床旁超声测量视神经鞘直径能够较好预测ICP水平,当视神经鞘直径≥5.0mm提示ICP增高.[Objective] To explore the diagnosis value of bedside ultrasound for measuring optic nerve sheath diameter in increased intracranial pressure of patients with traumatic brain injury. [Methods]Thirtyfive patients with traumatic brain injury and ten healthy volunteer underwent bedside ultrasound for measuring optic nerve sheath diameter. Intracranial pressure of patients with traumatic brain injury was measured. Optic nerve sheath diameter among three groups was compared. The association between optic nerve sheath diameter and intracranial pressure was assessed. Receiver operating curve（ROC） was used to predict the best threshold of increased intracranial pressure and accuracy. [Results]Optic nerve sheath diameter in increased intracranial pressure group was significantly higher than that on normal intracranial pressure group and control group（ P 〈0.05）, but there was no significant difference between normal intracranial pressure group and control group （ P 〉0.05）. Optic nerve sheath diameter was positively correlated with intracranial pressure（r=0. 733, P 0.01）. ROC showed that optic nerve sheath diameter≥5.0mm as the efficacy evaluation was the best, and its sensitivity, specificity, accuracy and positive and negative predictive value were 84.4% （19/22）, 84.6% （11/ 13）, 85.7%（30/35）, 90.5%（19/21） and 78.9%（11/14）, respectively. [Conclusion] Bedside ultrasound for measuring optic nerve sheath diameter can better predict the level of intracranial pressure. Optic nerve sheath diameter≥5.0mm indicates increased intracranial pressure.

关 键 词：脑损伤/超声检查 颅内压 

分 类 号：R651.1[医药卫生—外科学]