1、临床超声医学杂志2023年8月第25卷第8期J Clin Ultrasound in Med，August 2023，Vol.25，No.8 临床研究 超声测量视神经鞘直径联合闪光视觉诱发电位监测颅脑损伤患者颅内压的临床价值贾松吴萍何英超牛苗苗摘要目的应用超声测量颅脑损伤患者视神经鞘直径（ONSD），探讨其联合闪光视觉诱发电位（FVEP）在颅脑损伤患者颅内压监测中的临床价值。方法选取我院重症医学科收治的100例颅脑损伤患者，其中仅采用FVEP指导临床治疗者43例（对照组），FVEP联合ONSD指导临床治疗者57例（联合组），比较两组中颅内压升高者ONSD、颅内压的差异；分析ONSD、颅内压与颅
2、内压升高的相关性。比较两组甘露醇使用时间及总量、急性肾损伤例数、住院费用、抗菌药物使用强度、住院时间、机械通气时间。结果对照组与联合组中出现颅内压升高者分别为29例和22例，两组颅内压升高者颅内压比较差异无统计学意义；联合组和对照组中颅内压升高者ONSD均显著高于颅内压正常者，差异均有统计学意义（均P0.05）。相关性分析显示，联合组ONSD、颅内压与颅内压升高均呈正相关（r=0.739、0.981，均P0.05）；且ONSD与颅内压呈正相关（r=0.752，P0.05）。联合组甘露醇使用时间、住院时间、机械通气时间均短于对照组，甘露醇使用总量、急性肾损伤占比、住院费用、抗菌药物使用强度均少于
3、对照组，差异均有统计学意义（均P0.05）。结论ONSD联合FVEP在颅脑损伤患者颅内压监测中具有重要意义，可用于指导临床用药。关键词超声检查；视神经鞘直径；闪光视觉诱发电位；颅脑损伤；颅内压中图法分类号R445.1文献标识码 AClinical value of optic nerve sheath diameter measured by ultrasound combined withflash visual evoked potential in monitoring intracranial pressure inpatients with craniocerebral injury
4、JIA Song，WU Ping，HE Yingchao，NIU MiaomiaoDepartment of Critical Care Medicine，the Second Central Hospital of Baoding，Hebei 072750，ChinaABSTRACTObjectiveTo measure the optic nerve sheath diameter（ONSD）by ultrasound，and to investigate theclinical value of ONSD combined with flash visual evoked potenti
5、al（FVEP）in monitoring intracranial pressure in patients withcraniocerebral injury.MethodsA total of 100 patients with craniocerebral injury admitted to the department of critical caremedicine in our hospital were selected.Among them，43 patients underwent FVEP-guided clinical treatment（control group）
6、，and 57 patients underwent FVEP combined with ONSD（combination group）.ONSD and intracranial pressure of patients withincreased intracranial pressure were compared between the two groups.The correlation of ONSD，intracranial pressure andincreased intracranial pressure were analyzed.The usage time and
7、total amount of mannitol，the proportion of patients with acutekidney injury，hospitalization cost，antibiotic usage intensity，hospital stay and mechanical ventilation time were comparedbetween the two groups.ResultsThere were 29 patients and 22 patients with increased intracranial pressure in the cont
8、rolgroup and the combination group，respectively.There was no statistically significant difference in intracranial pressure in patientswith increased intracranial pressure between the two groups.In both groups，patients with increased intracranial pressure hadhigher ONSD than that in patients with nor
9、mal intracranial pressure，with statistically significant differences（both P0.05）.Correlation analysis showed that ONSD and intracranial pressure were positively correlated with increased intracranial pressure（r=0.739，0.981，both P0.05），and ONSD was positively correlated with intracranial pressure（r=0
10、.752，P0.05）.The usagetime of mannitol，hospital stay and mechanical ventilation time in the combination group were significantly shorter than those inthe control group，and the total amount of mannitol，proportion of patients with acute kidney injury，the hospitalization cost andantibiotic usage intensi
11、ty were less than those in the control group，the differences were statistically significant（all P300 mm H2O时，静脉滴注250 ml甘露醇；颅内压在220300 mm H2O时，维持原治疗方案；颅内压在180220 mm H2O时，静脉滴注125 ml甘露醇，每隔12 h给药1次；当颅内压300 mm H2O 时，静脉滴注 250 ml 甘露醇；颅内压在 220300 mm H2O 时，维持原治疗方案；颅内压在180220 mm H2O时，且ONSD5 mm，静脉滴注 125 ml 甘露醇
12、，每隔 12 h 给药 1 次；当颅内压180 mm H2O，ONSD5 mm，停用甘露醇。4.观察指标：常规收集两组基线资料，包括性别、年龄、致伤原因、损伤类型、基础疾病、吸烟史、饮酒史、GCS评分、白蛋白、乳酸、平均动脉压、急性生理与慢性健康评分。观察并记录入院后1 h颅内压升高例数，比较两组中颅内压升高者ONSD；分析ONSD、颅内压与颅内压升高的相关性；记录并比较两组治疗后肾功能及甘露醇使用情况，以及一般住院资料，包括住院费ConclusionONSD combined with FVEP is of great significance in monitoring intracran
13、ial pressure in patients withcraniocerebral injury，which could be used to guide clinical medication.KEY WORDSUltrasonography；Optic nerve sheath diameter；Flash visual evoked potential；Craniocerebral injury；Intracranial pressure 646临床超声医学杂志2023年8月第25卷第8期J Clin Ultrasound in Med，August 2023，Vol.25，No.8
14、用、抗菌药物使用强度、住院时间、机械通气时间。三、统计学处理应用SPSS 20.0统计软件，计量资料以xs表示，两组比较采用独立样本t检验；计数资料以例或率表示，两组比较采用2检验。联合组ONSD与颅内压的相关性分析采用Pearson相关性分析法；联合组ONSD、颅内压与颅内压升高的相关性分析采用Spearman相关性分析法。P0.05为差异有统计学意义。结果一、两组基线资料比较两组基线资料比较差异均无统计学意义。见表1。表1两组基线资料比较组别联合组（57）对照组（43）2/t值P值男/女（例）38/1927/160.1620.687年龄（岁）62.337.4161.297.840.6770
15、.500致伤原因（例）交通事故32230.1840.912坠落伤1511意外砸伤109损伤类型（例）颅内血肿20170.3340.954脑挫裂伤1511硬膜下出血129蛛网膜下腔血肿106基础疾病（例）糖尿病120.7070.401高血压760.0610.805冠心病330.1280.721脑卒中230.6210.431组别联合组（57）对照组（43）2/t值P值吸烟史（例）28220.0410.667饮酒史（例）23160.1020.750GCS评分（分）5.360.575.410.580.4310.667白蛋白（g/L）33.264.1732.694.570.6490.518乳酸（mmol
16、/L）2.140.252.170.280.5640.574平均动脉压（mm Hg）83.699.4184.578.730.4770.634急性生理与慢性健康评分（分）16.212.3416.352.570.2840.777GCS评分：格拉斯哥昏迷评分。1 mm Hg=0.133 kPa二、两组颅内压及ONSD比较100例颅脑损伤患者中有颅内压升高 51 例，颅内压正常 49 例。联合组中 29 例出现颅内压升高，ONSD为（5.980.61）mm，颅内压为（295.3331.35）mm H2O；28例颅内压正常，ONSD 为（4.730.49）mm，颅内压为（93.6710.25）mm H2O；联合组中颅内压升高者ONSD、颅内压均高于颅内压正常者，差异均有统计学意义（均 P0.05）。对照组中颅内压升高 22 例，颅内压为（289.6431.27）mm H2O；25 例颅 内 压 正 常，颅 内 压 为（96.5811.36）mm H2O；对照组中颅内压升高者颅内压高于颅内压正常者,差异有统计学意义（P0.05）。两组颅内压比较差异无统计学意义。见图1，2。三、相关性分析相关性分析显
