超声ONSD联合TCCD脑中线移位为基础的无创多模态颅内压监测在大面积脑梗死救治中的应用价值  

Application of non-invasive multimodal intracranial pressure monitoring based on ultrasonic ONSD combined with TCCD midline shift in the treatment of massive cerebral infarction

作　　者：吴云鹰 韩韬[2] 赵倩 陆海波 王东升 皋九鑫 程言博 WU Yunying;HAN Tao;ZHAO Qian;LU Haibo;WANG Dongsheng;GAO Jiuxin;CHENG Yanbo(Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Critical Care Medicine,Suqian Zhongwu Hospital,Suqian,Jiangsu 223800;Department of Neurology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002)

机构地区：[1]徐州医科大学研究生院,江苏徐州221004 [2]宿迁市钟吾医院重症医学科,江苏宿迁223800 [3]徐州医科大学附属医院神经内科,江苏徐州221002

出　　处：《徐州医科大学学报》2024年第9期698-702,共5页Journal of Xuzhou Medical University

基　　金：国家卫生健康委脑卒中防治技术研究项目(WKZX2023CZ0143);宿迁市群英计划青年项目[(2022)QNXM-0048]。

摘　　要：目的 探讨超声视神经鞘直径(ONSD)联合经颅彩色多普勒超声(TCCD)脑中线移位为基础的无创多模态颅内压监测在大面积脑梗死患者救治中的应用价值。方法 选取2021年3月—2023年3月宿迁市钟吾医院确诊的大脑半球大面积脑梗死患者80例,随机分为对照组(n=40,常规监测)和研究组(n=40,常规监测+超声多模态监测)。对比2组患者一般资料、行去骨瓣减压术比例和术后6个月格拉斯哥预后评分(GOS)。多因素logistic回归分析ONSD、TCCD脑中线移位监测值与去骨瓣减压术的关系。用受试者工作特征(ROC)曲线分析预测价值。结果 2组行去骨瓣减压术比例差异无统计学意义(P>0.05),研究组患者术前住院时间明显少于对照组,术后6个月GOS评分明显高于对照组(P<0.05);研究组行去骨瓣减压术患者超声ONSD、TCCD脑中线移位值高于保守治疗患者(P<0.05);超声ONSD、TCCD脑中线移位、二者联合预测大面积脑梗死患者行去骨瓣减压术的曲线下面积(AUC)分别为0.854、0.748、0.891。结论 以超声ONSD、TCCD为基础的无创多模态颅内压监测可以较为准确地预测大面积脑梗死患者行去骨瓣减压术,测量结果可信度较高,有助于改善预后,值得在临床推广使用。Objective To explore the application of non-invasive multimodal intracranial pressure monitoring based on optic nerve sheath diameter(ONSD)combined with transcranial color Doppler ultrasound(TCCD)midline shift in the treatment of patients with massive cerebral infarction.Methods A total of 80 patients diagnosed with massive cerebral infarction at Suqian Zhongwu Hospital from March 2021 to March 2023 were selected.According to the random number table method,they were divided into two groups(n=40):a control group(conventional monitoring)and a study group(conventional monitoring+multimodal ultrasound monitoring).Both groups were compared for general data,the proportion of patients undergoing decompressive craniectomy,and Glasgow Outcome Scale(GOS)scores at post-operation 6 months.Multivariate logistic regression analysis was conducted to explore the relationship between ONSD and TCCD midline shift monitoring values and decompressive craniectomy.The predictive value was analyzed using the ROC curve.Results There was no statistical difference in the proportion of decompressive craniectomy between the two groups(P>0.05).However,the study group showed significantly shorter length of preoperative hospitalization stay,and higher GOS scores at post-operation 6 months than the control group(P<0.05).The ONSD and TCCD midline shift values in patients undergoing decompressive craniectomy in the study group were higher than those receiving conservative therapy(P<0.05).The area under the curve(AUC)for predicting decompressive craniectomy in patients with massive cerebral infarction using ultrasound ONSD,TCCD midline shift,and their combination were 0.854,0.748,and 0.891,respectively.Conclusions Non-invasive multimodal intracranial pressure monitoring based on ultrasound ONSD and TCCD can accurately predict decompressive craniectomy in patients with massive cerebral infarction.The measurement results have high reliability,which helps improve prognosis and is worthy of clinical promotion and application.

关 键 词：视神经鞘直径 颅内压监测 经颅彩色多普勒超声 大面积脑梗死 去骨瓣减压 

分 类 号：R651.12[医药卫生—外科学]