超声动态监测神经鞘直径变化对急性高原脑水肿早期诊断的初步探讨  

Preliminary exploration of ultrasonic dynamic monitoring of optic nerve sheath diameter changes for early diagnosis of acute high altitude cerebral edema

作　　者：张建波 张芸芸 白红民 魏林节 Zhang Jianbo;Zhang Yunyun;Bai Hongmin;Wei Linjie(Department of Neurosurgery,General Hospital of Southern Theater Command,Guangzhou,Guangdong 510010,China;Department of Ultrasonic Diagnosis,925th Hospital of Joint Logistics Support Force,Guiyang,Guizhou 550006,China;Department of Neurosurgery,956th Hospital of the PLA Army/Key Clinical specialty of the PLA Army,Linzhi,Xizang 860000,China)

机构地区：[1]南部战区总医院神经外科,广东广州510010 [2]联勤保障部队第九二五医院超声诊断科,贵州贵阳550006 [3]陆军第九五六医院神经外科陆军临床重点培育专科,西藏林芝860000

出　　处：《中国微侵袭神经外科杂志》2024年第7期392-395,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：西藏自治区科技计划项目(中央引导地方项目,编号:XZ202201YD0028C)。

摘　　要：目的探讨超声监测视神经鞘直径(optic nerve sheath diameter,ONSD)指导治疗急性高原脑水肿(high altitude cerebral edema,HACE)可行性。方法对短时间进驻高原的40名健康成年男性(对照组)及3例急性HACE患者(HACE组),利用超声测定ONSD。以其阈值大于5.2mm诊断颅内压升高,在治疗过程中与出院1周后,动态监测ONSD。结果对照组双眼平均ONSD为(5.05±0.04)mm。HACE患者急诊就诊即刻双眼平均ONSD为(5.62±0.06)mm,经治疗出院时双眼平均ONSD为(5.00±0.17)mm,随访时双眼平均ONSD为(5.01±0.10)mm。与对照组比较,HACE患者急诊就诊即刻双眼平均ONSD差异具有统计学意义(P<0.01),出院时、随访时双眼ONSD差异无显著统计学意义(P>0.05)。HACE患者出院时、随访时双眼平均ONSD,小于急诊就诊即刻ONSD,差异具有统计学意义(P<0.05)。结论超声监测ONSD增宽是确诊急性HACE的一种便捷、简单且无创的方法,对急性HACE救治具有重要临床意义。Objective To investigate the feasibility of using ultrasonic monitoring of optic nerve sheath diameter(ONSD)to guide the treatment of acute high altitude cerebral edema(HACE).Methods ONSD was measured by ultrasound in 40 healthy adult males who had recently arrived at high altitudes(control group)and 3 patients with acute HACE(HACE group).An ONSD threshold greater than 5.2 mm was used to diagnose increased intracranial pressure.ONSD was dynamically monitored during treatment and one week after discharge.Results The mean binocular ONSD in control group was(5.05±0.04)mm.The mean binocular ONSD in HACE group at the time of emergency consultation was(5.62±0.06)mm,(5.00±0.17)mm at the time of discharge after treatment,and(5.01±0.10)mm during follow-up after discharge.Compared with the control group,the mean ONSD in HACE patients at the time of emergency consultation was statistically significant(P<0.01),while there was no significant statistical difference in ONSD at the time of discharge and follow-up(P>0.05).The mean ONSD in HACE patients at the time of discharge and follow-up was significantly lower than that at the time of emergency consultation,with a statistically significant difference(P<0.05).Conclusions Ultrasonic monitoring of increased ONSD is a convenient,simple,and noninvasive method for diagnosing acute HACE,which has important clinical significance for the treatment of acute HACE.

关 键 词：脑水肿 急性 视神经鞘 高原 超声动态监测 

分 类 号：R594.3[医药卫生—内科学]