视神经鞘直径与眼球横径比值变化量对俯卧位脊柱手术患者眼部并发症的预测价值  

Predictive value of the ratio change of optic nerve sheath diameter to eyeball transverse diameter for ocular complications in prone spinal surgery patients

作　　者：高兴悦 凌云志 谢亚琼 章迪 王竹 张凯 刘婉钰 李博文 陈珂 张雍兴 Gao Xingyue;Ling Yunzhi;Xie Yaqiong;Zhang Di;Wang Zhu;Zhang Kai;Liu Wanyu;Li Bowen;Chen Ke;Zhang Yongxing(Department of Anesthesiology,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233004,China;Graduate School of Bengbu Medical University,Bengbu 233030,China;Clinical Medical College of Bengbu Medical University,Bengbu 233030,China)

机构地区：[1]蚌埠医科大学第一附属医院麻醉科,蚌埠233004 [2]蚌埠医科大学研究生院,蚌埠233030 [3]蚌埠医科大学临床医学院,蚌埠233030

出　　处：《中华解剖与临床杂志》2024年第5期311-315,共5页Chinese Journal of Anatomy and Clinics

基　　金：安徽高校自然科学研究项目(KJ2021A0705);国家级大学生创新创业训练计划(202310367025);蚌埠医学院研究生科研创新计划(Byycxz22070)。

摘　　要：目的探讨视神经鞘直径(ONSD)与眼球横径(ETD)比值(ONSD/ETD)的变化量对俯卧位脊柱手术患者眼部并发症的预测价值。方法病例对照研究。纳入2022年10月—2023年6月蚌埠医科大学第一附属医院行择期俯卧位脊柱手术患者62例,其中男17例、女45例,年龄50~75(63.7±6.0)岁。根据脊柱手术后是否发生眼部并发症分为2组:眼部并发症组17例,其中男5例、女12例,年龄53~74(65.1±7.5)岁;眼部正常组45例,其中男12例,女33例,年龄52~75(63.2±5.4)岁。对2组患者的性别、年龄、合并高血压/糖尿病、俯卧位时长、体质量指数、ONSD/ETD变化量、失血量、术中输液量等进行单因素分析,将差异有统计学意义(P<0.05)的指标进行多因素logistic回归分析,采用受试者操作特征(ROC)曲线检验ONSD/ETD变化量对脊柱术后发生眼部并发症的预测效能。结果单因素分析结果显示,俯卧位时长、ONSD/ETD变化量是脊柱术后眼部并发症的影响因素,差异有统计学意义(Z=2.612、t=4.011,P值均<0.05)。多因素logistic回归分析显示,ONSD/ETD变化量是脊柱术后眼部并发症的独立危险因素[OR(95%CI)为2.159(1.142~4.083)]。ROC曲线显示,ONSD/ETD变化量的最佳截断值为0.514,曲线下面积(95%CI)为0.783(0.644~0.923),灵敏度0.688,特异度0.826。结论ONSD/ETD变化量是脊柱手术后眼部并发症的独立危险因素,对脊柱手术后眼部并发症有一定的预测价值。Objective This study aimed to explore the predictive value of the ratio of optic nerve sheath diameter to eyeball transverse diameter(ONSD/ETD)for ocular complications of prone spinal surgery patients.Methods A case control design was adopted.A total of 62 patients underwent elective prone spinal surgery in the First Affiliated Hospital of Bengbu Medical University from October 2022 to June 2023 were included.The patients consisted of 17 males and 45 females,aged 50-75(63.7±6.0)years.The patients were divided into two groups according to whether they had complications after the spinal surgery.In the eye complication group,17 patients were diagnosed,including 5 males and 12 females aged 53-74(65.1±7.5)years.The normal eye group had 45 patients including 12 males and 33 females,aged 52-75(63.2±5.4)years.Univariate analysis was performed on the clinical data(gender,hypertension,diabetes,age,prone position duration,body mass index,ONSD/ETD changes,blood loss,intraoperative infusion volume)of the two groups of patients.Multivariate logistic regression analysis was performed on indicators with statistical significance(P<0.05).Receiver operating characteristic(ROC)curve was used to examine the predictive efficacy of ONSD/ETD changes in the occurrence of postoperative ocular complications after spinal surgery.Results The results of univariate analysis showed that prone position duration and ONSD/ETD changes influenced postoperative ocular complications after spinal surgery,and the differences were statistically significant(Z=2.612,t=4.011,all P values<0.05).Multivariate logistic regression analysis showed that ONSD/ETD variation was an independent risk factor for ocular complications after spinal surgery(OR=2.159,95%CI:1.142-4.083).The ROC curve showed that the best cut-off value of ONSD/ETD variation was 0.514,the area under the curve(95%CI)was 0.783(0.644-0.923),the sensitivity was 0.688,and the specificity was 0.826.Conclusion The variation in ONSD/ETD is an independent risk factor for ocular complications after sp

关 键 词：俯卧位 脊柱手术 视神经鞘直径 眼球横径 眼部并发症 影响因素 

分 类 号：R687.3[医药卫生—骨科学]