视神经鞘超声联合经颅彩色多普勒超声评估恶性大脑中动脉梗死的临床研究  

The evaluation of malignant middle cerebral artery infarction by optic nerve sheath ultrasound combined with transcranial color-code doppler ultrasound

作　　者：韩转宁 张静芳[1] 潘奇[2] Han Zhuanning;Zhang Jingfang;Pan Qi(Department of Ultrasound,Second Affiliated Hospital of Xi'an Medical University,Xi'an 710038,China;Department of Imagingthe,Second Affiliated Hospital of Xi'an Medical University,Xi'an 710038,China)

机构地区：[1]西安医学院第二附属医院超声科,710038 [2]西安医学院第二附属医院影像科,710038

出　　处：《中华脑血管病杂志(电子版)》2024年第6期521-527,共7页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：陕西省卫生健康科研项目(2022E029);陕西省2021年科技计划项目(2021SF-271)。

摘　　要：目的探讨视神经鞘超声联合经颅彩色多普勒(TCCD)超声对恶性大脑中动脉梗死(MMI)的临床预测价值。方法回顾性分析2021年6月至2023年4月西安医学院第二附属医院收治的大脑半球大面积脑梗死且符合研究纳入和排除标准的102例患者,均行床旁超声测量视神经鞘直径(ONSD)及TCCD检查。根据是否发生MMI分为MMI组(44例)和非MMI组(58例)。采用独立样本t检验比较2组双侧ONSD值及TCCD参数[收缩期血流速度(Vs)、舒张期血流速度(Vd)、平均血流速度(Vm)及搏动指数(PI)]的差异;采用Pearson相关分析ONSD及TCCD参数与MMI患者入院格拉斯哥昏迷量表(GCS)评分、美国国立卫生研究院卒中量表(NIHSS)评分及脑梗死体积的相关性;绘制受试者操作特征(ROC)曲线,分析并评估ONSD、TCCD参数单独及各指标联合预测MMI的效能。结果MMI组ONSD平均值及患侧PI值明显高于非MMI组[(5.53±0.39)mm vs(4.97±0.35)mm;0.89±0.16 vs 0.72±0.18],患侧Vd、Vs、Vm值则明显低于非MMI组[(20.58±9.54)cm/s vs(32.12±9.87)cm/s;(57.50±10.59)cm/s vs(72.58±11.35)cm/s;(30.85±10.23)cm/s vs(51.72±12.33)cm/s],差异具有统计学意义(t=7.617、4.953、-5.933、-6.839、-9.098,P均<0.001)。ONSD平均值、患侧PI值分别与GCS评分呈负相关(r=-0.568、-0.539,P均<0.05),与入院NIHSS评分(r=0.606、0.549,P均<0.05)和脑梗死体积(r=0.637、0.561,P均<0.05)呈正相关;患侧Vd、Vs、Vm值分别与GCS评分(r=0.512、0.501、0.522,P均<0.05)呈正相关,与NIHSS评分(r=-0.554、-0.534、-0.529,P均<0.05)和脑梗死体积(r=-0.567、-0.545、-0.537,P均<0.05)呈负相关。ONSD联合TCCD各参数共同预测MMI发生的ROC曲线下面积为0.926,优于各指标单独预测(0.796~0.871),预测价值明显提高。结论超声测量ONSD及TCCD参数可作为临床识别MMI发生的预测因子,与患者入院GCS评分、NIHSS评分及脑梗死体积显著相关。ONSD联合TCCD各参数共同预测MMI发生的价值明显高于各指标单独预测,利�Objective To investigate the clinical predictive value of optic nerve sheath ultrasound combined with transcranial color-code Doppler(TCCD)ultrasound for malignant middle cerebral artery infarction(MMI).Methods A retrospective analysis was performed on 102 patients with large cerebral infarction in the cerebral hemisphere,admitted to the Second Affiliated Hospital of Xi&apos;an Medical University from June 2021 to April 2023,who met the inclusion and exclusion criteria of the study.Bedside ultrasound measurements of optic nerve sheath diameter(ONSD)and TCCD were performed.The enrolled patients were categorized into MMI(n=44)and non-MMI(n=58)groups according to MMI occurrence.Independent sample t tests were used to compare the differences of bilateral ONSD values and TCCD parameters[systolic velocity(Vs),diastolic velocity(Vd),mean velocity(Vm),and pulsatility index(PI)]between the two groups.Pearson correlation was used to assess the correlation between ONSD and TCCD parameters with the Glasgow coma scale(GCS),National Institute of Health stroke scale(NIHSS)scores,and cerebral infarction volume in MMI patients.Receiver Operating characteristic(ROC)curves were plotted to evaluate the predictive efficacy of ONSD and TCCD,individually and in combination,for MMI.Results MMI patients exhibited significantly higher mean ONSD and PI values on the affected side compared to the non-MMI group[(5.53±0.39)mm vs(4.97±0.35)mm;0.89±0.16 vs 0.72±0.18],while Vd,Vs,and Vm on the affected side were significantly lower than those in the non-MMI group[(20.58±9.54)cm/s vs(32.12±9.87)cm/s;(57.50±10.59)cm/s vs(72.58±11.35)cm/s;(30.85±10.2)cm/s vs(51.72±12.33)cm/s],all with statistical significance(t=7.617,4.953,-5.933,-6.839,-9.098,all P<0.05).ONSD and PI on the affected side were negatively correlated with GCS score(r=-0.568,-0.539,all P<0.05),and positively correlated with NIHSS score(r=0.606,0.549,all P<0.05)and cerebral infarction volume(r=0.637,0.561,all P<0.05),respectively.Vd,Vs,and Vm on the affected side were positive

关 键 词：视神经鞘直径 经颅彩色多普勒超声 恶性大脑中动脉梗死 

分 类 号：R743.33[医药卫生—神经病学与精神病学]