超声测量视神经鞘直径评估鞘内灌注化疗对非小细胞肺癌软脑膜转移患者颅内压的影响  

Effects of intrathecal infusion chemotherapy on intracranial pressure in non-small cell lung cancer patients with leptomeningeal metastases by ultrasound measurement of optic nerve sheath diameter

作　　者：谢宇[1] 蒋澄 黄明敏[1] 郭爱斌[1] 尹震宇[1] 林永娟[1] Xie Yu;Jiang Cheng;Huang Mingmin;Guo Aibin;Yin Zhenyu;Lin Yongjuan(Department of Geriatric Oncology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院老年肿瘤科,南京210008

出　　处：《国际肿瘤学杂志》2023年第9期532-539,共8页Journal of International Oncology

基　　金：江苏省老年健康科研项目(LKZ2023013);江苏省干部保健科研课题(BJ18006、BJ19001);南京市医学重点科技发展项目(ZKX18014);希思科-豪森肿瘤研究基金(Y-HS2019-5)。

摘　　要：目的应用床旁视神经超声检查测量视神经鞘直径(ONSD)评估鞘内灌注化疗对非小细胞肺癌(NSCLC)软脑膜转移(LM)患者颅内压(ICP)的影响。方法选取2021年6月10日至2022年12月25日于南京大学医学院附属鼓楼医院行鞘内灌注化疗的31例NSCLC-LM患者为研究对象。床旁视神经超声检查测量首次腰椎穿刺引流脑脊液前、后ONSD值,并于鞘内灌注化疗前30 min(T0),化疗后30 min(T1)、1 h(T2)、2 h(T3)、4 h(T4)、6 h(T5)、24 h(T6)动态测量ONSD值,根据公式计算ICP_(ONSD),比较ICPLP与ICP_(ONSD)的差异及不同时间点ONSD、ICPONSD的差异。分别于T0、T1、T2、T3、T4、T5、T6对平均动脉压(MAP)、心率及头痛评分进行评估并比较。采用Spearman相关性分析神经肿瘤反应评价(RANO)评分与ICP的相关性。结果NSCLC-LM患者首次腰椎穿刺引流脑脊液前ICPLP为(218.55±63.83)mmH_(2)O,左眼、右眼、双眼ICPONSD分别为(217.28±57.17)mmH_(2)O、(223.64±51.13)mmH_(2)O、(220.46±52.50)mmH_(2)O,差异无统计学意义(F=0.77,P=0.463)。患者首次腰椎穿刺引流脑脊液后ICPLP为(214.68±58.01)mmH_(2)O,左眼、右眼、双眼ICPONSD分别为(216.71±48.96)mmH_(2)O、(216.62±47.18)mmH_(2)O、(216.67±47.86)mmH_(2)O,差异无统计学意义(F=0.12,P=0.757)。鞘内灌注化疗T0、T1、T2、T3、T4、T5、T6患者MAP分别为89.80(83.40,93.67)mmHg、95.00(80.83,99.37)mmHg、91.86(79.88,100.14)mmHg、90.15(79.04,100.55)mmHg、105.14(88.55,114.74)mmHg、98.96(81.72,111.81)mmHg、89.29(85.45,100.38)mmHg,差异有统计学意义(χ^(2)=16.11,P=0.013);心率分别为80.00(75.00,84.50)次/min、80.00(72.50,87.50)次/min、74.00(66.00,87.50)次/min、82.00(72.00,90.00)次/min、80.00(70.50,90.00)次/min、77.00(68.00,91.00)次/min、77.00(71.50,88.50)次/min,差异无统计学意义(χ^(2)=2.18,P=0.902);头痛评分分别为2.00(0.50,3.00)分、2.00(1.00,3.00)分、2.00(2.00,3.00)分、2.00(1.00,3.00)分、2.00(1.00,2.00)分、2.00(1.00,2.00)分、2.00(0.00,2.00)分,差异无统计Objective To evaluate the effects of intrathecal infusion chemotherapy on intracranial pressure(ICP)in non-small cell lung cancer(NSCLC)patients with leptomeningeal metastases(LM)by ultrasound measurement of the optic nerve beside the bed of optic nerve sheath diameter(ONSD).Methods A total of 31 NSCLC-LM patients who underwent intrathecal infusion chemotherapy at Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School from June 10,2021 to December 25,2022 were collected.The ONSD values were measured before and after the first lumbar puncture by bedside optic nerve ultrasound,and measured dynamically 30 min before intrathecal infusion chemotherapy(T0),30 min(T1),1 h(T2),2 h(T3),4 h(T4),6 h(T5),and 24 h(T6)after intrathecal infusion chemotherapy.ICPONSD was calculated,with differences between ICPLP and ICPONSD,and differences between ONSD and ICPONSD series at different time being compared separately.Mean arterial pressure(MAP),heart rate,and headache score were assessed and compared respectively at T0,T1,T2,T3,T4,T5 and T6.Spearman analysis was used to evaluate the correlation between the response assessment in neuro-oncology(RANO)score and ICP.Results Before the first lumbar puncture for cerebrospinal fluid drainage,ICPLP was(218.55±63.83)mmH_(2)O,left eye,right eye,and binocular eyes ICPONSD were(217.28±57.17)mmH_(2)O,(223.64±51.13)mmH_(2)O,and(220.46±52.50)mmH_(2)O respectively,in NSCLC-LM patients,with no statistically significant difference(F=0.77,P=0.463).After first lumbar puncture for cerebrospinal fluid drainage,ICPLP was(214.68±58.01)mmH_(2)O,left eye,right eye,and binocular eyes ICPONSD were(216.71±48.96)mmH_(2)O,(216.62±47.18)mmH_(2)O,and(216.67±47.86)mmH_(2)O respectively,with no statistically significant difference(F=0.12,P=0.757).At T0,T1,T2,T3,T4,T5,and T6,the MAP during intrathecal infusion chemotherapy was 89.80(83.40,93.67)mmHg,95.00(80.83,99.37)mmHg,91.86(79.88,100.14)mmHg,90.15(79.04,100.55)mmHg,105.14(88.55,114.74)mmHg,98.96(81.72,111.81)mmHg,and 89.29(85

关 键 词：癌 非小细胞肺 脑膜肿瘤 颅内压 超声检查 视神经鞘直径 

分 类 号：R445.1[医药卫生—影像医学与核医学] R734.2[医药卫生—诊断学]