超声检测视神经鞘直径在急性颅内压增高患者诊断与治疗的临床价值研究

目的 探讨超声检测视神经鞘直径(ONSD)在急性颅内压(ICP)增高患者诊断与治疗的临床价值。方法 选择2020年3月至2023年3月在本院治疗的急性ICP增高患者180例,收集患者术前(T0)、麻醉后(T1)、手术开始(T2)、术后即刻(T3)、术后清醒时刻(T4)的ONSD以及ICP,分析各时刻ONSD与ICP的关系。并参考格拉斯哥预后评分(GOS)进行预后评估,分为预后良好组(157例)和预后不良组(23例),比较两组术前、术后即刻ONSD,并分析ONSD与GOS的相关性,采用受试者工作特征(ROC)曲线分析ONSD对围术期急性ICH患者预后的预测价值。结果 T0～T2时刻患者ONSD、ICP无明显变化,T3～T4时刻患者ONSD、ICP明显降低,差异均有统计学意义(P<0.05)。Pearson相关性结果发现,T0～T4时刻ONSD均与ICP呈正相关(P<0.05)。预后良好组与预后不良组术后ONSD、ICP水平均降低,且预后良好组术后ONSD、ICP水平更低,差异均有统计学意义(P<0.05)。Spearman相关性结果发现,术后即刻ONSD、ICP均与GOS呈负相关(P<0.05)。ROC曲线分析结果显示,术后即刻ONSD、ICP预测患者预后不良的的AUC分别为0.886、0.782,均有较好的预测价值(P<0.05)。结论 超声检测ONSD可有效评估急性ICP增高患者的ICP情况,且对患者预后有一定的预测价值。

Clinical value of optic nerve sheath diameter by ultrasonic detection in the diagnosis and treatment of patients with acute increased intracranial pressure

Objective To explore the clinical value of optic nerve sheath diameter (ONSD) by ultrasonic detection in the diagnosis and treatment of patients with acute increased intracranial pressure (ICP). Methods A total of 180 patients with acute increased ICP in the hospital were enrolled between March 2020 and March 2023. ONSD and ICP were collected before surgery (T0), after anesthesia (T1), at the beginning of surgery (T2), immediately after surgery (T3) and immediately after awaking (T4). The relationship between ONSD and ICP at different time points was analyzed. According to scores of Glasgow Outcome Scale (GOS), they were divided into good prognosis group (157 cases) and poor prognosis group (23 cases). ONSD in the two groups was compared before surgery and immediately after surgery. The correlation between ONSD and GOS score was analyzed. The predictive value of ONSD for prognosis in patients with perioperative acute increased ICH was analyzed by receiver operating characteristic (ROC) curves. Results From T0-T2, there was no significant change in ONSD or ICP, but which were significantly decreased from T3-T4 (P<0.05). The results of Pearson correlation analysis showed that ONSD was positively correlated with ICP from T0-T4 (P<0.05). After surgery, levels of ONSD and ICP were decreased in both groups, which were lower in good prognosis group than poor prognosis group (P<0.05). The results of Spearman correlation analysis showed that ONSD and ICP were negatively correlated with GOS score immediately after surgery (P<0.05). The results of ROC curves analysis showed that AUC values of ONSD and ICP for predicting poor prognosis immediately after surgery were 0.886 and 0.782, which were of good predictive value (P<0.05). Conclusion ONSD by ultrasonic detection can effectively evaluate ICP in patients with acute increased ICP, which also has certain prognostic value.