CAJ | 학술논문

目的：探讨超声测量视神经鞘直径(ONSD)对急诊成年颅脑损伤患者颅内压(ICP)增高的预测准确性和实用性。方法对101例急诊科颅脑损伤的成年患者(>18岁)行床旁ONSD的超声测量，然后进行头颅CT检查；对患者临床表现及CT检查进行ICP增高评分，按总评分将患者分为三组，比较各组之间ONSD值的差异。分别以ONSD≥5.0 mm及ONSD≥5.3 mm为阈值判断患者ICP是否升高，并将该方法所得结果与临床/CT评分法相比较。结果三组之间ONSD值差异有统计学意义(P<0.01)。以0分及≥2分两组患者对ONSD法判断ICP升高的准确性进行评价。取ONSD≥5.0 mm为阈值，敏感度为100%(25/25)、特异度为80.5%(33/41)、准确度为89.4%(59/66)、阳性预测值为78.1%(25/32)、阴性预测值为100%(34/34)；取ONSD≥5.3 mm为阈值，敏感度为100%(25/25)、特异度为90.2%(37/41)、准确度为93.9%(62/66)、阳性预测值为86.2%(25/29)、阴性预测值为100%(37/37)。结论超声测量ONSD能够较好预测颅脑损伤患者ICP水平，在颅脑损伤患者的急救方面有较高的应用价值。
목적：탐토초성측량시신경초직경(ONSD)대급진성년로뇌손상환자로내압(ICP)증고적예측준학성화실용성。방법대101례급진과로뇌손상적성년환자(>18세)행상방ONSD적초성측량，연후진행두로CT검사；대환자림상표현급CT검사진행ICP증고평분，안총평분장환자분위삼조，비교각조지간ONSD치적차이。분별이ONSD≥5.0 mm급ONSD≥5.3 mm위역치판단환자ICP시부승고，병장해방법소득결과여림상/CT평분법상비교。결과삼조지간ONSD치차이유통계학의의(P<0.01)。이0분급≥2분량조환자대ONSD법판단ICP승고적준학성진행평개。취ONSD≥5.0 mm위역치，민감도위100%(25/25)、특이도위80.5%(33/41)、준학도위89.4%(59/66)、양성예측치위78.1%(25/32)、음성예측치위100%(34/34)；취ONSD≥5.3 mm위역치，민감도위100%(25/25)、특이도위90.2%(37/41)、준학도위93.9%(62/66)、양성예측치위86.2%(25/29)、음성예측치위100%(37/37)。결론초성측량ONSD능구교호예측로뇌손상환자ICP수평，재로뇌손상환자적급구방면유교고적응용개치。
Objective To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath Diame-ter (ONSD) for assessment of intracranial hypertension in patients with traumatic brain injury. Methods A 6-month prospective blinded observational study was performed. One hundred and one adult patients (>18 years old) in the De-partment of Emergency with traumatic brain injury underwent bedside ultrasound for measuring optic nerve sheath di-ameter. Then, CT scans were performed for signs of raised intracranial pressure (ICP) and signs of acute pathology. The patients were graded to three groups according to clinical manifestations and CT results. Optic nerve sheath diam-eter among the three groups was compared. ONSD≥5.0 mm and ONSD≥5.3 mm were taken as positive to predict the presence of raised ICP respectively. Clinical manifestations and CT results scores were used to evaluate the accura-cy of ONSD. Results ONSD of three groups were significantly different (P<0.01). The accuracy of ONSD was eval-uated in patients with scores of 0 and those with scores≥2. Taking ONSD≥5.0 mm as the efficacy evaluation, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value were 100% (25/25), 80.5%(34/41), 89.4%(59/66), 78.1%(25/32) and 100%(34/34), respectively. Taking ONSD≥5.3 mm as the efficacy evaluation, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value were 100%(25/25), 90.2%(37/41), 93.9%(62/66), 86.2%(25/29) and 100%(37/37), respectively. Conclusion ONSD can predict the level of intra-cranial pressure. Bedside ultrasound for measuring ONSD is a sensitive test for evaluating ICP in adult head injury.