CT测量视神经鞘直径与急性颅脑创伤开颅术后颅内压的相关研究

Correlation between optic nerve sheath diameter on CT and intracranial pressure in patients with acute severe traumatic brain injury after craniotomy

摘要:

目的 探讨急性重型颅脑创伤患者开颅术后视神经鞘直径（ONSD）与颅内压（ICP）的相互关系，评价ONSD推测ICP变化情况的效能。方法 回顾性分析48例急性重型颅脑创伤患者数据，通过重建头部薄层CT来测量球后ONSD，采用有创ICP传感器监测颅内压等临床数据；患者数据按手术类型分类为开颅手术组和单纯ICP组，分别应用线性及Logistic回归分析ONSD与ICP相关性及ONSD的评价效能。结果 48例患者平均ONSD=6.6 mm（SD 0.54），平均ICP=12 mmHg（SD 6.5），ONSD与ICP呈明显线性相关性，其中手术组的线性关系更加明显，AUC=0.964，cutoff=7.1 mm，敏感性=100%，特异性=89%，P<0.001，ONSD用于推测ICP效能较高，有统计学意义；而ICP组两者间无明显线性相关性。结论 急性重症颅脑创伤开颅术后患者ONSD与ICP线性关系明显，可通过ONSD是否大于7.1 mm来推测ICP>20 mmHg，为危急重症患者提供重要的参考意见。

Abstract:

Objective To investigate the correlation between optic nerve sheath diameter (ONSD) on computed tomography (CT) and intracranial pressure (ICP) in patients with acute severe traumatic brain injury after craniotomy, and to assess the performance of ONSD in predicting ICP.Methods A retrospective analysis was performed on the clinical data of 48 patients with acute severe traumatic brain injury. Thin-slice head CT reconstruction was used to measure the retrobulbar ONSD, and ICP was monitored using an invasive ICP sensor. According to the surgical procedure, these patients were divided into craniotomy group and ICP group. Linear and logistic regression methods were used to determine the correlation between ONSD and ICP and the performance of ONSD in predicting ICP.Results The 48 patients had a mean ONSD of 6.6 mm (SD 0.54) and a mean ICP of 12 mmHg (SD 6.5). There was a significant linear correlation between ONSD and ICP in the craniotomy group (P<0.001); ONSD had an area under the receiver operating characteristic curve of 0.964, and with a cut-off value of 7.1 mm, ONSD had a sensitivity of 100% and a specificity of 89%, suggesting that ONSD had a high performance in predicting ICP. But in the ICP group, there was no significant correlation between ONSD and ICP.Conclusions In patients with acute severe traumatic brain injury after craniotomy, ONSD is significantly correlated with ICP; ONSD >7.1 mm is predictive of ICP >20 mmHg, thus providing an important reference for these patients.