TCD两种参数预估去骨瓣减压术后颅内压的准确度分析  

Two parameters derived from transcranial doppler ultrasonography for non-invasive assessment of intracranial pressure in patients post decompressive craniectomy:a retrospective study

作　　者：郑龙龙[1] 杨彦龙[1] 杨阳[2] 常涛[1] 李玉骞[1] 李立宏[1] 

机构地区：[1]第四军医大学唐都医院神经外科,陕西西安710038 [2]解放军第451医院神经外科,陕西西安710054

出　　处：《中华神经外科疾病研究杂志》2017年第3期249-253,共5页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的对比评价经颅多普勒超声(TCD)中基于搏动指数(PI)评估颅内压(nICP_PI)和基于舒张期脑血流流速(FVd)评估颅内压(nICP_FVd)两种参数的准确度。方法回顾性分析44例行去骨瓣减压术患者的一般临床资料及TCD相关参数(55条记录)。结果把每一条TCD记录作为一个独立事件,nICP_FVd显示了与有创颅内压(ICP)更好的相关性与评估能力:r=0.61,P<0.05;偏倚为-2.20 mmHg,95%预测置信区间(CI)=(-23.1 mmHg,18.7 mmHg);曲线下面积(AUC)=0.73,P<0.05。而nICP_PI则与有创ICP无明显相关性:r=0.1,P>0.05;偏倚为2.10 mmHg,95%CI=(-16.0 mmHg,20.1 mmHg);AUC=0.53,P>0.05。结论去骨瓣减压术后基于TCD的参数nICP_FVd与参数nICP_PI相比较,前者能更准确地评估患者颅内压变化,具有更为可靠的参考价值。Objective The relative accuracy of two assessment parameters for intracranial pressure by transcranial doppler ultrasonography （TCD） based on pulsatility index （nICP_PI） and diastolic flow velocity （nICP_ FVd） were compared and analyzed. Methods A total of 55 records of TCD and other clinical data from 44patients post decompressive craniectomy were collected and analyzed by retrospectively analysis. Results Considering every TCD recording as an independent event, nICP_FVd was generally showed to be the best estimator of measured intracranial pressure （ICP） ： r = 0.61, P 〈 0.05 ; Bias = - 2.2 mmHg, 95% confidence interval （CI） = （ - 23.1 mmHg, 18.7 mmHg） ; area under the curve （AUC） =0.73, P 〈0.05, whereas nICP_PI did not show any relationship with measured ICP using any of the above statistical indicators ： r = 0. 1, P 〉 0.05 ; Bias = 2.1 mmHg, 95% CI = （ - 16.0 mmHg, 20.1 mmHg） ; AUC = 0.53, P 〉 0.05. Conclusion The parameter based on diastolic flow velocity （nICP_FVd） has been demonstrated to be the better estimator for measured ICP in patients post decompressive craniectomy in comparison to the parameter based on pulsatility index （nICP_PI） , having more reliable reference value in clinical practices.

关 键 词：颅内压 经颅多普勒超声 去骨瓣减压术 

分 类 号：R651[医药卫生—外科学]