动脉瘤性蛛网膜下腔出血患者视神经鞘直径与颅内压的相关性

doi:10.3969/j.issn.1006-7795.2024.02.006

首都医科大学学报 ›› 2024, Vol. 45 ›› Issue (2): 207-212.doi: 10.3969/j.issn.1006-7795.2024.02.006

• 重症医学诊疗技术与进展 • 上一篇下一篇

动脉瘤性蛛网膜下腔出血患者视神经鞘直径与颅内压的相关性

刘帅¹, 王淑雅¹, 徐珊珊¹, 田莹¹, 陈晓霖², 张琳琳^1*#, 石广志^1*#, 周建新³

1.首都医科大学附属北京天坛医院重症医学科，北京100070；2.首都医科大学附属北京天坛医院神经外科，北京 100070；3.首都医科大学附属北京世纪坛医院重症医学科，北京100038

收稿日期:2023-12-19 出版日期:2024-04-21 发布日期:2024-04-25
通讯作者: 张琳琳, 石广志 E-mail:abluelemon@163.com，shigzh@aliyun.com
基金资助:
首都临床诊疗技术研究及转化应用项目（Z201100005520050）。

Correlation between optic nerve sheath diameter and intracranial pressure in patients with aneurysmal subarachnoid hemorrhage

Liu Shuai¹, Wang Shuya¹, Xu Shanshan¹, Tian Ying¹, Chen Xiaolin², Zhang Linlin^1*#, Shi Guangzhi^1*#, Zhou Jianxin³

1.Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 2.Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; 3.Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China

Received:2023-12-19 Online:2024-04-21 Published:2024-04-25
Supported by:
This study was supported by Capital Clinical Diagnosis and Therapy Technology Research and Translational Application (Z201100005520050).

摘要/Abstract

摘要： 目的探索动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）患者术后视神经鞘直径（optic nerve sheath diameter， ONSD）与颅内压（intracranial pressure， ICP）的相关性。方法纳入2019年12月1日至2022年6月1日收治在首都医科大学附属北京天坛医院重症医学科的aSAH术后且行ICP监测及头颅电子计算机断层扫描（computed tomography, CT）检查患者，通过CT测量ONSD并记录ICP数值，利用组内相关系数（intraclass correlation coefficient, ICC）评价3名研究者测量ONSD的一致性，采用Spearman相关系数评价ONSD与ICP的相关性。结果纳入184名aSAH术后患者共282例次ONSD数值以及对应的ICP，ICP的中位数是12（9，18）mmHg（1 mmHg=0.133 kPa）；ONSD的中位数是5.59（5.26，5.99）mm。3名不同研究者测量双侧ONSD的ICC分别为0.895（0.872~0.915，P<0.001）、0.869（0.841~0.894，P<0.001）。ONSD和ICP呈正相关（r=0.273，95% CI：0.158~0.381，P<0.001）。ONSD预测ICP ＞ 22 mmHg的曲线下面积为0.753（95％CI：0.670~0.836，P<0.001），cutoff值为5.61 mm，灵敏度、特异度分别为85.2%、55.3%。结论应用CT测量ONSD具有可重复性，其与有创ICP数值显著相关。

关键词: 颅内动脉瘤, 蛛网膜下腔出血, 视神经鞘直径, 颅内压, 神经重症

Abstract: Objective To evaluate the correlation between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods All patients were diagnosed with aSAH and received microsurgery clipping at the Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University from December 1, 2019 to June 1, 2022. The patients received head computed tomography (CT) and subdural ICP monitoring devices were kept to monitor the ICP. The ONSD were measured with CT and ICP was recorded. The agreement among the three observers was evaluated with intraclass correlation coefficient (ICC), and the regression of ONSD and ICP was evaluated with Spearman's correlation coefficient. Results A total of 184 patients were included, with 282 data of ONSD and ICP recorded. The median ICP was 12 (9, 18) mmHg (1 mmHg=0.133 kPa)， and the median ONSD was 5.59 (5.26, 5.99) mm. The ICC of left and right ONSD measured by three observers was 0.895 (0.872-0.915, P<0.001) and 0.869 (0.841-0.894, P<0.001), respectively. There was a significant positive correlation between ONSD and ICP (r=0.273，95% CI: 0.158-0.381, P<0.001). The area under the receiver operating characteristics curve of ONSD to predict ICP>22 mmHg was 0.753 (95% CI: 0.670-0.836, P<0.001), The cutoff point was 5.61 mm, with 85.2% sensitivity and 55.3% specificity. Conclusion Measurement of ONSD by CT is repeatable, and it significantly correlates by ICP.

Key words: intracranial aneurysms, subarachnoid hemorrhage, optic nerve sheath diameter, intracranial pressure, neurocritical care

中图分类号:

刘帅, 王淑雅, 徐珊珊, 田莹, 陈晓霖, 张琳琳, 石广志, 周建新. 动脉瘤性蛛网膜下腔出血患者视神经鞘直径与颅内压的相关性[J]. 首都医科大学学报, 2024, 45(2): 207-212.

Liu Shuai, Wang Shuya, Xu Shanshan, Tian Ying, Chen Xiaolin, Zhang Linlin, Shi Guangzhi, Zhou Jianxin. Correlation between optic nerve sheath diameter and intracranial pressure in patients with aneurysmal subarachnoid hemorrhage[J]. Journal of Capital Medical University, 2024, 45(2): 207-212.

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动脉瘤性蛛网膜下腔出血患者视神经鞘直径与颅内压的相关性

Correlation between optic nerve sheath diameter and intracranial pressure in patients with aneurysmal subarachnoid hemorrhage

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