Page 78 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第43卷第12期
·1694 · Journal of Nanjing Medical University（Natural Sciences） 2023年12月

·临床研究·

神经重症患者术后视神经鞘直径与有创颅内压相关性研究

王彬彬，岳 震 *
南京医科大学第一附属医院神经外科，江苏 南京 210029

［摘 要］ 目的：依靠超声测量视神经鞘直径（optic nerve sheath diameter，ONSD）在神经重症患者术后建立有效预测颅内压
（intracranial pressure，ICP）的方法。方法：连续监测52例神经重症患者术后有创ICP，使用经眼眶超声测量视神经鞘在垂直和
水平方向上直径的平均值，采用受试者工作特征（receiver operating characteristic，ROC）曲线分析ONSD诊断颅内高压的效能，
并评估该方法的灵敏度和特异度。结果：所有患者的双眼平均ONSD［（5.27±0.47）mm］和有创ICP［（11.77±6.18）mmHg］相关性
良好（r=0.79，P<0.01）。ROC 曲线得到 ONSD 诊断颅内高压（ICP≥20 mmHg）的最佳临界值为 5.625 mm，诊断的灵敏度为
74.3%，特异度为90.4%。同时获得ICP为5、10、15、25 mmHg对应的ONSD临界值为5.175、5.325、5.375、5.825 mm。结论：床旁
超声经眼眶测量ONSD可以判断ICP变化，尤其在神经重症患者有创ICP或影像学检查受限的情况下，可以动态、快捷、无创地
评估ICP，具有显著的临床应用价值，值得推广。
［关键词］ 颅内压；视神经鞘直径；神经重症；超声
［中图分类号］ R651.11 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）12⁃1694⁃05
doi：10.7655/NYDXBNS20231212

The correlation between optic nerve sheath diameter and traumatic intracranial pressure
in patients with severe neurological disease

WANG Binbin，YUE Zhen *
Department of Neurosurgery，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：To establish an effective method for predicting intracranial pressure（ICP）by measuring optic sheath diameter
（ONSD）using ultrasonography. Methods：52 patients with severe neurological conditions were continuously monitored for
postoperative invasive ICP. The mean diameter of the optic nerve sheath in vertical and horizontal directions was measured by
transorbital ultrasound. The diagnostic efficacy of ONSD in intracranial hypertension was analyzed by receiver operating characteristic
（ROC）curve，and the sensitivity and specificity of the method were evaluated. Results：The mean binocular ONSD（5.27±0.47）mm
was well correlated with invasive ICP（11.77±6.18）mmHg in all patients（r=0.79，P < 0.01）. ROC curve showed that the ONSD cutoff
for detecting intracranial hypertension（ICP≥20 mmHg）was 5.625 mm，with a sensitivity of 74.3% and a specificity of 90.4% .
Meanwhile，the ONSD cutoff corresponding to ICP 5，10，15 and 25 mmHg were 5.175，5.325，5.375 and 5.825 mm. Conclusions：
Bedside ultrasound measurements of ONSD through orbit can determine changes of ICP，especially in the case of invasive ICP or
limited imaging examinatior in patients with severe neurological conditions . The ICP can be evaluated dynamically，quickly and non⁃
invasively，which has significant clinical application value and is worthy of promotion.
［Key words］ intracranial pressure；optic nerve sheath diameter；neurological severe disease；ultrasound
［J Nanjing Med Univ，2023，43（12）：1694⁃1698］

颅内压（intracranial pressure，ICP）增高是颅脑
损伤的一种严重并发症，特别是在神经重症患者中
［基金项目］ 国家自然科学基金（82203767）
尤为严重。颅高压与颅脑损伤的不良预后密切相
∗
通信作者（Corresponding author），E⁃mail：yzicu5336@njmu.edu.
cn 关，早期发现和及时处理颅高压会进一步降低脑损