视神经鞘直径对颅脑损伤术后迟发性颅内血肿的临床意义  

Clinical significance of optic nerve sheath diameter on delayed intracranial hematoma after craniocerebral injury

作　　者：耿炯 尤金芳 GENG Jiong;YOU Jinfang(Emergency Department,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi Jiangsu 214032,China)

机构地区：[1]南京医科大学附属无锡人民医院急诊科,江苏无锡214032

出　　处：《中国急救复苏与灾害医学杂志》2022年第7期898-900,906,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生健康委科研立项项目(编号:Z2019033)。

摘　　要：目的 探究视神经鞘直径(ONSD)对颅脑损伤术后迟发性颅内血肿(DIH)的预测价值。方法 选取2017年2月—2021年3月无锡市人民医院收治的143例行手术治疗的颅脑损伤患者为研究对象。统计术后颅脑损伤患者DIH发生情况,并依据是否发生DIH分为发生组和未发生组。对比发生组和未发生组患者的临床资料。分析影响颅脑损伤患者术后发生DIH的危险因素。制作受试者工作特征曲(ROC),以曲线下面积(AUC)分析ONSD对颅脑损伤术后DIH的预测价值。结果 本研究中143例颅脑损伤患者术后DIH的发生率为19.58%。发生组格拉斯哥昏迷量表(GCS)评分、纤维蛋白原水平均低于未发生组(P<0.05);发生组颅骨骨折占比、基底池受压占比、巴彬斯基(Babinski)征阳性占比及ONSD则均高于未发生组(P<0.05)。Logistic回归分析显示,颅骨骨折、Babinski征为阳性及ONSD均为影响颅脑损伤患者术后发生DIH的危险因素(OR=2.875、3.370、3.133,P<0.05)。ROC分析显示,ONSD对颅脑损伤术后发生DIH预测的最佳截断点为6.08 mm,灵敏度、特异度分别为75.00%,87.83%,AUC为0.879。结论 ONSD对颅脑损伤术后DIH的预测价值较高,可作为临床预测颅脑损伤患者术后DIH是否发生的重要参考指标。Objective To explore the early warning value of optic nerve sheath diameter(ONSD) for delayed intracranial hematoma(DIH) after craniocerebral injury.Methods A total of 143 patients with craniocerebral injury underwent emergency operation.Ultrasonic unit was put above the upper left and right eyelids within 1 hour after the operation to examine the ONSD.Relevant clinical data were collected.Seven days later the incidence of DIH was counted,Multivariate logistic regression analysis was used to identify the risk factors for postoperative DIH.Receiver operating characteristic curve(ROC) was made,and the area under the curve(AUC) was used to analyze the early warning value of ONSD for DIH after craniocerebral injury.Results DIH occurred in 28 patients with an incidence rate of 19.58%.The Glasgow Coma Scale(GCS) score and fibrinogen level of the DIH group were significantly lower than those of the non-DIH group(both P<0.05),and the proportions of skull fracture,basal cistern compression,and positive Babinski sign,and the level of ONSD of the DIH group were all significantly higher than those of the non-DIH group(all P<0.05) Multivariate logistic regression analysis showed that skull fracture,positive Babinski sign,and ONSD were all risk factors affecting the development of DIH in patients with brain injury(OR=2.875,3.370,3.133,P<0.05).ROC analysis showed that the best cut-off point of ONSD for predicting DIH after craniocerebral injury was 6.08 mm,the sensitivity and specificity were 75.00% and 87.83% respectively,and the AUC was 0.879.Conclusion ONSD has a high early warning value for DIH after craniocerebral injury,and can be used as an important reference index for clinical prediction of DIH after craniocerebral injury.

关 键 词：视神经鞘直径 颅脑损伤 迟发性颅内血肿 预测价值 

分 类 号：R651.1[医药卫生—外科学]