动态超声测量视神经鞘直径指导院前创伤性脑外伤应用甘露醇的价值  

The value of dynamic ultrasound measurement of optic nerve sheath diameter in guiding the application of mannitol in pre hospital traumatic brain injury

作　　者：姜辉 杨柳[1] 谢志惠[1] 王慧婷 JIANG Hui;YANG Liu;XIE Zhihui;WANG Huiting(Emergency Center,the First People's Hospital of Changde,Changde,Hunan,415000,China;Department of Emergency,the First People's Hospital of Changde,Changde,Hunan,415000,China)

机构地区：[1]常德市第一人民医院120急救中心,湖南常德415000 [2]常德市第一人民医院急诊科

出　　处：《临床急诊杂志》2024年第4期164-169,共6页Journal of Clinical Emergency

基　　金：常德市科技局科技创新指导性计划项目(No:2022ZD37)。

摘　　要：目的:通过超声测量视神经鞘直径(optic nerve sheath diameter,ONSD)监测颅内压,以指导院前创伤性脑外伤患者甘露醇的应用。方法:选取2022年12月至2023年7月院前接诊的160例创伤性颅脑外伤患者为研究对象。在120救护车上测量第0、60和120分钟ONSD,根据患者临床结局、是否使用甘露醇及意识水平改变情况进行分组,回顾性收集患者年龄、性别、头部CT结果、发病后第0、60和120分钟ONSD结果、同期格拉斯哥昏迷量表、意识水平改变、是否应用甘露醇降颅压和死亡率等相关数据。评估不同时间段(第0、60和120分钟)ONSD水平与临床结局、是否使用甘露醇、意识水平改变的关系。以ONSD≥5 mm定义为存在高颅压情况,采用Kaplan-Meier曲线分析ONSD≥5 mm的患者是否使用甘露醇与30 d死亡率的相关性。结果:共有160例创伤性脑外伤患者纳入本研究,其中存活患者150例,死亡患者10例。死亡患者的ONSD值在第120分钟为6.79(4.19,8.87)mm,较第0分钟与第60分钟显著增加(P<0.001)。未接受甘露醇治疗患者的ONSD值在第120分钟为6.51(4.09,8.71)mm,较第0分钟与第60分钟显著增加(P=0.002)。意识障碍加重患者的ONSD值在第120分钟为6.61(4.11,8.83)mm,较第0分钟与第60分钟显著增加(P<0.001),而意识障碍改善患者的ONSD值在第120分钟为5.91(3.99,8.02)mm,较第0分钟与第60分钟显著降低(P=0.003)。通过生存分析发现,对于ONSD增高(ONSD≥5 mm)的创伤性脑外伤患者,接受甘露醇治疗较未接受甘露醇治疗30 d生存率显著提高(P<0.01)。结论:院前ONSD动态观察有助于指导创伤性脑外伤患者甘露醇的应用。Objective To monitor the intracranial pressure by measuring the optical nerve sheath diameter(ONSD)using ultrasound,in order to guide the application of mannitol in pre hospital patients with traumatic brain injury.Methods A total of 160 patients with traumatic brain injury who were admitted from December 2022 to July 2023 were selected as the study subjects.The ONSD at 0,60,and 120 minutes were measured on the 120 ambulances.Patients were grouped based on their clinical outcomes,whether mannitol was used,and changes in consciousness levels.Relevant data including age,gender,head CT results,ONSD results at 0,60,and 120 minutes after onset,Glasgow Coma Scale during the same period,changes in consciousness,use of mannitol to reduce intracranial pressure,and mortality were retrospectively collected.The relationship between ONSD levels and clinical outcomes,use of mannitol,and changes in consciousness levels at different time periods(0,60,and 120 minutes)were evaluated.Defining ONSD≥5 mm as the presence of high intracranial pressure,Kaplan-Meier curves were used to analyze the correlation between mannitol use and mortality within 30 days in patients with ONSD≥5 mm.Results A total of 160 patients with traumatic brain injury were included in this study,of which 150 cases survived and 10 cases died.Among the patients with death,the ONSD value at 120 minutes was 6.79(4.19,8.87)mm,which was significantly increased compared to those at 0 and 60 minutes(P<0.001).For patients who did not receive mannitol treatment,the ONSD value at 120 minutes was 6.51(4.09,8.71)mm,which was significantly increased compared to those at 0 and 60 minutes(P=0.002).The ONSD value in patients with worsening consciousness disorders at 120 minutes was 6.61(4.11,8.83)mm,which was significantly increased compared to those at 0 and 60 minutes(P<0.001),while the ONSD value in patients with improved consciousness disorders at 120 minutes was 5.91(3.99,8.02)mm,which was significantly decreased compared to those at 0 and 60 minutes(P=0.003).Through su

关 键 词：颅脑外伤 视神经鞘直径 甘露醇 生存率 

分 类 号：R651.1[医药卫生—外科学]