[1]吴环立,马现启,赵海洋. 重度颅脑损伤病人开颅术后视神经鞘直径与颅内压及预后关系[J].青岛大学学报(医学版),2018,54(04):423-426.[doi:10.11712/jms201804011]
 WU Huanli,MA Xianqi,ZHAO Haiyang.RELATIONSHIP OF OPTIC NERVE SHEATH DIAMETER WITH INTRACRANIAL PRESSURE AND PROGNOSIS IN PATIENTS WITH SEVERE CRANIOCEREBRAL INJURY AFTER CRANIOTOMY[J].JOURNAL OF QINGDAO UNIVERSITY (MEDICAL SCIENCES),2018,54(04):423-426.[doi:10.11712/jms201804011]
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 重度颅脑损伤病人开颅术后视神经鞘直径与颅内压及预后关系()
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《青岛大学学报(医学版)》[ISSN:2096-5532/CN:37-1217/R]

卷:
第54卷
期数:
2018年04期
页码:
423-426
栏目:
出版日期:
2018-07-05

文章信息/Info

Title:
RELATIONSHIP OF OPTIC NERVE SHEATH DIAMETER WITH INTRACRANIAL PRESSURE AND PROGNOSIS IN PATIENTS WITH SEVERE CRANIOCEREBRAL INJURY AFTER CRANIOTOMY
文章编号:
2096-5532(2018)04-0423-04
作者:
吴环立马现启赵海洋
(南阳市第二人民医院神经外科,河南 南阳 473000)
Author(s):
WU Huanli MA Xianqi ZHAO Haiyang
(Department of Neurosurgery, Nanyang Second General Hospital, Nanyang 473000, China)
关键词:
颅脑损伤视神经鞘颅内压预后
Keywords:
craniocerebral trauma optic nerve sheath intracranial pressure prognosis
分类号:
R651
DOI:
10.11712/jms201804011
文献标志码:
A
摘要:
目的 探讨重度颅脑损伤病人开颅手术后视神经鞘直径(ONSD)与术后颅内压(ICP)变化及病人预后的关系。
方法 选取在我院接受开颅手术的重度颅脑损伤病人28例,术后持续监测ICP,每1 h检测1次;术后持续监测ONSD,每12 h检测1次。以12 h为1周期,每个ONSD值对应12个ICP值,将该时间段内超过2.7 kPa的ICP差值累加,得到ICP的时间累加值(PTD-ICP)。应用受试者工作特征曲线(ROC)评估ONSD对预测PTD-ICP>0的效能,获得ONSD的最佳截断值(ONSD-cut)。采用Spearman线性相关分析评估ONSD值与PTD-ICP值的相关性。统计病人6个月时预后,对比预后良好组及预后不良组ONSD值≥ONSD-cut频次。
结果 共获得6组、186对数据。ONSD范围3.2~5.8 mm,中值4.8 mm(4.1~5.0 mm);PTD-ICP范围0~28.6 kPa/h,排除81个为0的检测值后,范围0.2~28.6 kPa/h,中值3.0 kPa/h(1.6~7.7 kPa/h)。ONSD预测PTD-ICP>0的ROC曲线下面积0.922,ONSD-cut=4.8 mm。当ONSD≥ONSD-cut时,ONSD与PTD-ICP呈显著正相关(r=0.687,P<0.001),且能够建立线性方程:PTD-ICP=12.902×ONSD-60.687(调整R2=0.326)。预后良好组(n=13)病人的ONSD≥ONSD-cut频次明显低于预后不良组(n=15),差异有统计学意义(Z=-3.951,P<0.05)。
结论 重度颅脑损伤病人开颅术后ONSD与ICP有一定相关性,ONSD能够预测未来12 h内ICP超过2.7 kPa的PTD-ICP,且最佳截断值为4.8 mm;ONSD≥4.8 mm的检出频次越高,病人预后越差。
Abstract:
Objective To investigate the relationship of optic nerve sheath diameter (ONSD) with postoperative intracranial pressure (ICP) and prognosis in patients with severe craniocerebral injury after craniotomy.
Methods Twenty-eight patients with severe craniocerebral injury undergoing craniotomy in our hospital were enrolled as subjects. Postoperative ICP was recorded every hour and postoperative ONSD was determined once every 12 h. In a period of 12 h, each ONSD value corresponded to 12 ICP values. The ICP values above 2.7 kPa were summed every 12 h to obtain the pressure-time dose of ICP (PTD-ICP). The receiver operating characteristic (ROC) curve was used to evaluate the effectiveness of ONSD in predicting PTD-ICP>0, and the optimal cutoff value of ONSD (ONSD-cut) was obtained. The Spearman linear correlation analysis was used to evaluate the correlation between ONSD and PTD-ICP. All the patients were followed up at least 6 months. The frequency of ONSD ≥ONSD-cut was compared between patients with satisfactory prognosis and poor prognosis.
Results A total of 6 groups and 186 pairs of data were obtained. ONSD ranged from 3.2 to 5.8 mm with a median value of 4.8 mm (4.1-5.0 mm). PTD-ICP ranged from 0 to 28.6 kPa/h. When 81 values of zero were excluded, PTD-ICP ranged from 0.2 to 28.6 kPa/h with a median value of 3.0 kPa/h (1.6-7.7 kPa/h). In prediction of PTD-ICP>0 by ONSD, the area under the ROC curve was 0.922 with an ONSD-cut of 4.8 mm. When ONSD was no less than ONSD-cut, ONSD was positively correlated with PTD-ICP (r=0.687,P<0.001), and a linear equation could be established: PTD-ICP=12.902×ONSD-60.687 (adjusted R2=0.326). Patients with satisfactory prognosis (n=13) had a significantly lower frequency of ONSD ≥ONSD-cut than those with poor prognosis (n=15) (Z=-3.951,P<0.05).
Conclusion For patients with severe craniocerebral injury after craniotomy, ONSD has a certain correlation with ICP; ONSD can predict PTD-ICP resulting from ICP values above 2.7 kPa within 12 h, and the optimal cutoff value of ONSD is 4.8 mm. The more frequently ONSD ≥4.8 mm occurs, the worse prognosis patients have.
更新日期/Last Update: 2018-07-08