重度颅脑损伤病人开颅术后视神经鞘直径与颅内压及预后关系  

RELATIONSHIP OF OPTIC NERVE SHEATH DIAMETER WITH INTRACRANIAL PRESSURE AND PROGNOSIS IN PATIENTS WITH SEVERE CRANIOCEREBRAL INJURY AFTER CRANIOTOMY

作　　者：吴环立[1] 马现启[1] 赵海洋[1] WU Huanli;MA Xianqi;ZHAO Haiyang(Department of Neurosurgery,Nanyang Second General Hospital,Nanyang 473000,Chin)

机构地区：[1]南阳市第二人民医院神经外科,河南南阳473000

出　　处：《青岛大学学报（医学版）》2018年第4期423-426,共4页Journal of Qingdao University(Medical Sciences)

摘　　要：目的探讨重度颅脑损伤病人开颅手术后视神经鞘直径(ONSD)与术后颅内压(ICP)变化及病人预后的关系。方法选取在我院接受开颅手术的重度颅脑损伤病人28例,术后持续监测ICP,每1h检测1次;术后持续监测ONSD,每12h检测1次。以12h为1周期,每个ONSD值对应12个ICP值,将该时间段内超过2.7kPa的ICP差值累加,得到ICP的时间累加值(PTD-ICP)。应用受试者工作特征曲线(ROC)评估ONSD对预测PTDICP>0的效能,获得ONSD的最佳截断值(ONSD-cut)。采用Spearman线性相关分析评估ONSD值与PTD-ICP值的相关性。统计病人6个月时预后,对比预后良好组及预后不良组ONSD值≥ONSD-cut频次。结果共获得6组、186对数据。ONSD范围3.2~5.8mm,中值4.8 mm(4.1~5.0 mm);PTD-ICP范围0~28.6kPa/h,排除81个为0的检测值后,范围0.2~28.6kPa/h,中值3.0kPa/h(1.6~7.7kPa/h)。ONSD预测PTD-ICP>0的ROC曲线下面积0.922,ONSD-cut=4.8mm。当ONSD≥ONSD-cut时,ONSD与PTD-ICP呈显著正相关(r=0.687,P<0.001),且能够建立线性方程:PTD-ICP=12.902×ONSD-60.687(调整R2=0.326)。预后良好组(n=13)病人的ONSD≥ONSD-cut频次明显低于预后不良组(n=15),差异有统计学意义(Z=-3.951,P<0.05)。结论重度颅脑损伤病人开颅术后ONSD与ICP有一定相关性,ONSD能够预测未来12h内ICP超过2.7kPa的PTD-ICP,且最佳截断值为4.8mm;ONSD≥4.8mm的检出频次越高,病人预后越差。Objective To investigate the relationship of optic nerve sheath diameter（ONSD）with postoperative intracranial pressure（ICP）and prognosis in patients with severe craniocerebral injury after craniotomy. Methods Twenty-eight patients with severe craniocerebral injury undergoing craniotomy in our hospital were enrolled as subjects.Postoperative ICP was recorded every hour and postoperative ONSD was determined once every 12 h.In a period of 12 h,each ONSD value corresponded to 12 ICP values.The ICP values above 2.7 kPa were summed every 12 hto obtain the pressure-time dose of ICP（PTD-ICP）.The receiver operating characteristic（ROC）curve was used to evaluate the effectiveness of ONSD in predicting PTD-ICP〉0,and the optimal cutoff value of ONSD（ONSD-cut）was obtained.The Spearman linear correlation analysis was used to evaluate the correlation between ONSD and PTD-ICP.All the patients were followed up at least 6 months.The frequency of ONSD ≥ONSD-cut was compared between patients with satisfactory prognosis and poor prognosis. Results A total of 6 groups and 186 pairs of data were obtained.ONSD ranged from 3.2 to 5.8 mm with a median value of 4.8 mm（4.1-5.0 mm）.PTD-ICP ranged from 0 to 28.6 kPa/h.When 81 values of zero were excluded,PTD-ICP ranged from 0.2 to 28.6 kPa/h with a median value of 3.0 kPa/h（1.6-7.7 kPa/h）.In prediction of PTD-ICP〈0 by ONSD,the area under the ROC curve was 0.922 with an ONSD-cut of 4.8 mm.When ONSD was no less than ONSD-cut,ONSD was positively correlated with PTD-ICP（r=0.687,P〈0.001）,and a linear equation could be established：PTD-ICP=12.902×ONSD-60.687（adjusted R2=0.326）.Patients with satisfactory prognosis（n=13）had a significantly lower frequency of ONSD ≥ ONSD-cut than those with poor prognosis（n =15）（Z =-3.951,P〈 0.05）.Conclusion For patients with severe craniocerebral injury after craniotomy,ONSD has a certain correlation with ICP;ONSD can predict PTD-ICP resulting from ICP values above 2.7 kPa within 12 h,and the optimal cutoff

关 键 词：颅脑损伤 视神经鞘 颅内压 预后 

分 类 号：R651[医药卫生—外科学]