头颅CT视神经鞘直径测定对成人心搏骤停后昏迷患者预后的判断价值  

The prognostic value of optic nerve sheath diameter on computed tomography of brain in adult comatose cardiac arrest survivors

作　　者：王淦楠[1] 陈科 陈旭锋[1] 乔莉[1] 孙娜娜[3] 许晓泉[3] 沈斌[2] 张劲松[1] WANG Gannan;CHEN Ke;CHEN Xufeng;QIAO Li;SU Nana;XU Xiaoquan;SHEN Bin;ZHANG Jinsong(Department of Emergency Center,the First Affiliated Hospital of Nanjing Medical Universi ty,Nanjing,210029,China;Department of Emergency,Liyang Branch,Jiangsu Province Hospital;Department of Radiology,the First Affiliated Hospital of Nanjing Medical University)

机构地区：[1]南京医科大学第一附属医院急诊中心,南京210029 [2]江苏省人民医院溧阳分院急诊科 [3]南京医科大学第一附属医院放射科

出　　处：《临床急诊杂志》2019年第1期25-29,共5页Journal of Clinical Emergency

基　　金：江苏省医学创新团队(No:CXTDA2017007)

摘　　要：目的:探讨头颅CT视神经鞘直径(ONSD)对中国成人心搏骤停(CA)后昏迷患者神经功能预后的判断价值。方法:回顾性分析了2015-01—2018-06期间南京医科大学第一附属医院95例复苏后72h内行头颅CT检查的成人CA患者,测定其ONSD及灰质/白质比例(GWR),同时评价各指标对神经功能不良预后(CPC评分3～5分)的预测价值。结果:与预后良好组相比较,预后不良组ONSD显著增加(P<0.01)。预后不良组基底节、大脑、平均及简化GWR均显著低于预后良好组(均P<0.05)。ONSD>4.30mm预测神经功能不良预后的敏感度为77.8%,特异度为74.5%(P<0.01)。与单一指标相比较,ONSD联合GWR评估可显著提高不良预后的判断价值(GWR基底节加ONSD,敏感度72.5%,特异度94.4%,P<0.01)。结论:CA后昏迷患者头颅CT提示ONSD增加与神经功能不良预后相关,ONSD与GWR联合评估可有效提升CA后昏迷患者不良预后的判断价值。Objective:To evaluate the association between optic nerve sheath diameter(ONSD)and the outcomes in adult comatose cardiac arrest(CA)survivors in China.Method:Ninty-five CA patients who received CT scans within 72 hours of resuscitation between January 2015 and June 2018 were included in this single-center retrospective study.The ONSD was measured,and gray-white matter ratio(GWR)was calculated according to previous studies.The prognostic values of the ONSD and GWR in predicting poor outcomes(Cerebral Performance Category 3-5)were analyzed.Result:The ONSD was significantly higher in patients with good outcomes than that with poor outcomes(P<0.01).GWRs were significantly higher in good outcome group than in poor outcome group(P<0.05).ONSD>4.30 mm predicted poor outcomes with a sensitivity and specificity of 77.8%and 74.5%respectively(P<0.01).The combination of ONSD and GWR significantly improved prognostic performance in predicting poor neurologic outcomes rather than ONSD or GWR alone(P<0.01).Conclusion:ONSD can be used as a promising tool to assess outcome in adult comatose CA survivors.The combination of ONSD and GWR improved prognostic value for predicting poor neurologic outcomes in post-CA patients.

关 键 词：心搏骤停 视神经鞘直径 昏迷 CT 预后 

分 类 号：R459.7[医药卫生—急诊医学]