超声检查评估视神经鞘直径及视网膜中央动脉在颅内高压患者中的应用价值  

Evaluation of ONSD and central retinal artery by bedside ultrasound in patients with intracranial hypertension

作　　者：陆静 王洲[1] 陈飞[1] 任永凤[1] 李健[1] 刘芳欣[1] LU Jing;WANG Zhou;CHEN Fei;REN Yongfeng;LI Jian;LIU Fangxin(Department of Ultrasound, Bozhou People's Hospital, Bozhou 236800, China)

机构地区：[1]安徽省亳州市人民医院超声科,安徽亳州236800

出　　处：《医学影像学杂志》2022年第3期404-408,共5页Journal of Medical Imaging

基　　金：安徽理工大学校级资助项目(自然科学类)(编号:QN2019137);安徽省亳州市人民医院科研孵化计划(编号:By202006)。

摘　　要：目的探讨床旁超声检测视神经鞘直径(optic nerve sheath diameter,ONSD)、视网膜中央动脉(central retinal artery,CRA)血流参数对评估颅内高压的临床应用价值。方法选取2018年7月~2019年12月我院神经外科收治的住院患者及健康志愿者为观察对象,经颅脑CT检查和临床诊断的颅内高压患者45例(颅内高压组),健康对照组40例,两组均接受床旁超声测量ONSD及CRA血流参数(包括:收缩期峰值速度PSV、舒张末期速度EDV、搏动指数PI)。采用t检验分别比较颅内高压组与对照组之间、颅内高压组治疗前与治疗后ONSD及CRA血流参数的差异,采用受试者工作特征(ROC)曲线分析超声测量ONSD、PSV分别及联合诊断颅内高压的诊断效能,并评估该方法的敏感度和特异度。结果颅内高压组ONSD值(5.04±0.20)mm大于对照组(4.61±0.31)mm,差异有统计学意义(P<0.01)。颅内高压组PSV值(12.08±1.62)cm/s大于对照组(11.07±2.13)cm/s,差异有统计学意义(P<0.05);EDV及PI两组比较差异无统计学意义。颅内高压组治疗前ONSD值(5.04±0.20)mm大于治疗后(4.58±0.31)mm,差异有统计学意义(P<0.01)。颅内高压组治疗前PSV值(12.08±1.62)cm/s大于治疗后(11.06±2.01)cm/s,差异有统计学意义(P<0.05)。ROC曲线得到ONSD诊断颅内高压的最佳临界值为4.86 mm,诊断的敏感度为86.7%,特异度为80.0%。PSV值诊断颅内高压最佳截断值为11.63 cm/s,诊断的敏感度为66.7%,特异度为70.0%。两者联合诊断颅内高压的敏感度为93.3%,特异度为92.5%。结论床旁超声检查通过测量球后ONSD、PSV及两者联合可以间接判断颅内高压变化及进展情况,其中两者联合效能最佳,尤其在有创颅内压监测或其他影像学检查受限的情况下,可以作为一种有效的替代评估方法,具有方便、快捷、无创、价廉等显著的临床应用价值。Objective To evaluate the clinical value of bedside ultrasound in evaluating intracranial hypertension by detecting the optical nerve sheath diameter(ONSD)and central retinal artery(CRA)blood flow parameters.Methods From July 2018 to December 2019,hospitalized patients and healthy volunteers in the Department of Neurosurgery of our hospital were selected as the objects of observation.45 patients with intracranial hypertension were examined by brain CT and clinically diagnosed,and 40 healthy controls were selected.The ONSD and CRA blood flow parameters(including peak systolic velocity PSV,end diastolic velocity EDV and pulsatility index PI)were measured by bedside ultrasound in both groups.T test was used to compare the blood flow parameters of ONSD and CRA between the intracranial hypertension group and the normal intracranial pressure group,and before and after treatment in the intracranial hypertension group.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of ONSD and PSV in the diagnosis of intracranial hypertension.Results The ONSD value of intracranial hypertension group(5.04±0.20)mm was higher than that of normal intracranial pressure group(4.61±0.31)mm,the difference was statistically significant(P<0.01).PSV value of intracranial hypertension group(12.08±1.62)cm/s was higher than that of normal intracranial pressure group(11.07±2.13)cm/s,the difference was statistically significant(P<0.05);there was no significant difference in EDV and PI between the two groups.The ONSD value of intracranial hypertension group before treatment was(5.04±0.20)mm,which was significantly higher than that after treatment(4.58±0.31)mm(P<0.01).The PSV value of intracranial hypertension group before treatment(12.08±1.62)cm/s was higher than that after treatment(11.06±2.01)cm/s,the difference was statistically significant(P<0.05).The ROC curve showed that the optimal thresh-old value of ONSD in the diagnosis of intracranial hypertension was 4.86 mm,the sensitivity was 86.7%,and the spe

关 键 词：超声检查 视神经鞘直径 视网膜中央动脉 颅内高压 

分 类 号：R445.1[医药卫生—影像医学与核医学] R774.6[医药卫生—诊断学]