床旁超声联合颅内血流监测预测心肺复苏患者颅内压升高的效果研究  

Effect of Bedside Ultrasound Combined with Intracranial Blood Flow Monitoring on Predicting Intracranial Pressure Elevation in Patients with Cardiopulmonary Resuscitation

作　　者：谢谦[1] 生娣 廖光冲[1] 张岩鹏[1] 王铁柱 XIE Qian;SHENG Di;LIAO Guang-chong;ZHANG Yan-peng;WANG Tie-zhu(Department of Intensive CareMedicine,The Fourth Affiliated Hospital of XinjiangMedical University,Urumqi,Xinjiang,830011,China)

机构地区：[1]新疆医科大学第四附属医院重症医学科,新疆乌鲁木齐830011

出　　处：《现代生物医学进展》2023年第23期4473-4477,共5页Progress in Modern Biomedicine

基　　金：新疆维吾尔自治区自然科学基金项目(2021D01C230)。

摘　　要：目的:探讨床旁超声联合颅内血流监测预测心肺复苏患者颅内压升高的效果。方法:选择2020年1月至2022年12月在本院重症医学科行心肺复苏治疗的60例患者作为研究对象,于心肺复苏术后采用脑室测压导管测定颅内压,根据颅内压结果将患者分为颅内高压组和正常组。采用酶联免疫吸附法检测两组患者血清脑源性神经营养因子(BDNF)、中枢神经特异性蛋白(S100β)和神经元特异性烯醇化酶(NSE)水平。比较两组患者视神经鞘宽度(ONSD)、大脑中动脉搏动指数(MCA-PI)。采用Pearson分析颅内压、ONSD与MCA-PI之间的相关性。绘制受试者工作特征(ROC)曲线分析患者ONSD、MCA-PI对的心肺复苏术后颅内压升高的预测价值。结果:(1)60例心肺复苏患者中19例出现颅内压升高;(2)颅内高压组患者血清BDNF、S100β和NSE水平均显著高于正常组(P<0.05);(3)颅内高压组患者ONSD和MCA-PI均显著高于正常组(P<0.05);(4)心肺复苏患者ICP与ONSD、MCA-PI均呈显著正相关关系(r=0.872、0.848,P<0.05)。(5)ONSD和MCA-PI预测心肺复苏患者发生颅内压升高的AUC分别为0.875(95%CI:0.739~1.000)、0.841(95%CI:0.735~0.948)。ONSD预测心肺复苏患者颅内压升高的最佳截断值为≥5.69 mm,对应敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为78.95%、100.00%、78.95%、100.00%和91.11%;MCA-PI预测心肺复苏患者颅内压升高的最佳截断值为≥0.945,对应敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为78.95%、80.49%、59.44%、65.22%和89.19%。结论:床旁超声和颅内血流监测均无创安全,ONSD和MCA-PI都可以有效预测心内复苏患者颅内压升高,ONSD预测效能更佳。Objective:To explore the effect of bedside ultrasound combined with intracranial blood flow monitoring in predicting intracranial hypertension in patients with cardiopulmonary resuscitation.Methods:60 patients underwent cardiopulmonary resuscitation in the Department of Critical Medicine of our hospital from January 2020 to December 2022 were selected as the study subjects.After cardiopulmonary resuscitation,intracranial pressure was measured by intraventricular manometry catheter.According to the results of intracranial pressure,the patients were divided into intracranial hypertension group and normal group.Enzyme-linked immunosorbent assay was used to detect serum brain-derived neurotrophic factor(BDNF),central nerve specific protein-100(S100β)and Neuron specific enolase(NSE)levels.The optical nerve sheath diameter(ONSD)and MCA-pulsation index(MCA-PI)were compared between the two groups.Pearson was used to analyze the correlation between intracranial pressure,ONSD and MCA-PI.Draw the receiver operating characteristic(ROC)curve to analyze the predictive value of ONSD and MCA-PI on intracranial pressure rise after cardiopulmonary resuscitation.Results:(1)Among 60 patients with cardiopulmonary resuscitation,19 patients had elevated intracranial pressure;(2)Serum BDNF and S100 in patients with intracranial hypertensionβAnd NSE levels were significantly higher than those in the normal group(P<0.05);(3)The ONSD and MCA-PI of patients with intracranial hypertension were significantly higher than those of the normal group(P<0.05);(4)ICP was positively correlated with ONSD and MCA-PI in patients with cardiopulmonary resuscitation(r=0.872,0.848,P<0.05).(5)The AUC of ONSD and MCA-PI predicting intracranial hypertension in patients with cardiopulmonary resuscitation were 0.875(95%CI:0.739~1.000)and 0.841(95%CI:0.735~0.948),respectively.The best cutoff value of ONSD for predicting intracranial pressure increase in patients with cardiopulmonary resuscitation is≥5.69 mm,and the corresponding sensitivity,specificity,Yoden

关 键 词：心肺复苏 颅内压升高 床旁超声 颅内血流监测 

分 类 号：R541.6[医药卫生—心血管疾病] R741.02[医药卫生—内科学]