中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2012年
11期
1459-1462
,共4页
赵万%苗雨露%王福明%余少雄%刘春霞%白洪涛%刘泽%尹勇%黄志斌%柳茂成%黄斌%张浚%丁志海
趙萬%苗雨露%王福明%餘少雄%劉春霞%白洪濤%劉澤%尹勇%黃誌斌%柳茂成%黃斌%張浚%丁誌海
조만%묘우로%왕복명%여소웅%류춘하%백홍도%류택%윤용%황지빈%류무성%황빈%장준%정지해
神经鞘/超声检查%视神经%颅脑损伤/诊断%颅脑损伤/治疗
神經鞘/超聲檢查%視神經%顱腦損傷/診斷%顱腦損傷/治療
신경초/초성검사%시신경%로뇌손상/진단%로뇌손상/치료
Neurilemma/ultrasonography%Optic nerve%Craniocerebral trauma/diagnosis%Craniocerebral trauma/therapy
目的 探讨超声检查视神经鞘直径(Optic Nerve Sheath Diameter,ONSD)在颅脑损伤诊治中的应用价值.方法 选择2008年7月至2011年6月本院颅脑损伤患者90例为观察组,其中入院时GCS评分为轻、中、重型颅脑损伤患者各30例,依次分为A、B、C三组；另招募本院正常体检者50例及神经外科门诊志愿者50例为对照组D组.入院后1、3、7、14 d用彩超经眼眶检查观察组、对照组眼球后3 mm处ONSD大小,每眼检查3次,计算全部受检者ONSD平均值,标准差；彩超检查后0.5h腰穿测不同组别颅内压,计算其平均值,对所有数据进行统计分析.结果 入院后1、3、7、14d,A组ONSD分别为(4.54±0.32)mm、(4.42±0.30)mm、(4.44±0.32)mm、(4.43±0.25)mm；B组ONSD分别为(4.48 ±0.28)mm、(4.52 ±0.24)mm、(4.46 ±0.28)mm、(4.38±0.22)mm；C组ONSD分别为(5.67±0.35)mm、(6.36±0.42)mm、(5.65±0.23)mm、(4.76±0.35)mm.入院后1、3、7、14d,A组颅内压分别是(82±11) mmH2O、(79±12) mmH2O、(90±15) mmH2O、(86±14) mmH2O；B组颅内压分别是(78±15)mmH2O、(85±10) mmH2O、(78±16) mmH2O、(80±11)mmH2O；C组颅内压分别是(225±26) mmH2O、(288±23) mmH2O、(256±23) mmH2O、(122±18) mmH2O；D组ONSD值(4.58±0.41)mm,颅内压值(88±10) mmH2O.A与B、A与D、B与D之间比较差异无统计学意义(P＞0.05)；A与C、B与C、D与C之间比较差异有统计学意义(t=12.24～24.67,P＜0.01).结论 轻、中型颅脑损伤患者ONSD及颅内压无明显变化；重型颅脑损伤患者伤后不同时间颅内压变化不同,ONSD随颅内压的升高而增大,超声检查ONSD在颅脑损伤诊治中具有重要价值,能反应颅内压的升高,是一种非侵袭、操作方便、快速易行的颅高压评估方法.
目的 探討超聲檢查視神經鞘直徑(Optic Nerve Sheath Diameter,ONSD)在顱腦損傷診治中的應用價值.方法 選擇2008年7月至2011年6月本院顱腦損傷患者90例為觀察組,其中入院時GCS評分為輕、中、重型顱腦損傷患者各30例,依次分為A、B、C三組；另招募本院正常體檢者50例及神經外科門診誌願者50例為對照組D組.入院後1、3、7、14 d用綵超經眼眶檢查觀察組、對照組眼毬後3 mm處ONSD大小,每眼檢查3次,計算全部受檢者ONSD平均值,標準差；綵超檢查後0.5h腰穿測不同組彆顱內壓,計算其平均值,對所有數據進行統計分析.結果 入院後1、3、7、14d,A組ONSD分彆為(4.54±0.32)mm、(4.42±0.30)mm、(4.44±0.32)mm、(4.43±0.25)mm；B組ONSD分彆為(4.48 ±0.28)mm、(4.52 ±0.24)mm、(4.46 ±0.28)mm、(4.38±0.22)mm；C組ONSD分彆為(5.67±0.35)mm、(6.36±0.42)mm、(5.65±0.23)mm、(4.76±0.35)mm.入院後1、3、7、14d,A組顱內壓分彆是(82±11) mmH2O、(79±12) mmH2O、(90±15) mmH2O、(86±14) mmH2O；B組顱內壓分彆是(78±15)mmH2O、(85±10) mmH2O、(78±16) mmH2O、(80±11)mmH2O；C組顱內壓分彆是(225±26) mmH2O、(288±23) mmH2O、(256±23) mmH2O、(122±18) mmH2O；D組ONSD值(4.58±0.41)mm,顱內壓值(88±10) mmH2O.A與B、A與D、B與D之間比較差異無統計學意義(P＞0.05)；A與C、B與C、D與C之間比較差異有統計學意義(t=12.24～24.67,P＜0.01).結論 輕、中型顱腦損傷患者ONSD及顱內壓無明顯變化；重型顱腦損傷患者傷後不同時間顱內壓變化不同,ONSD隨顱內壓的升高而增大,超聲檢查ONSD在顱腦損傷診治中具有重要價值,能反應顱內壓的升高,是一種非侵襲、操作方便、快速易行的顱高壓評估方法.
목적 탐토초성검사시신경초직경(Optic Nerve Sheath Diameter,ONSD)재로뇌손상진치중적응용개치.방법 선택2008년7월지2011년6월본원로뇌손상환자90례위관찰조,기중입원시GCS평분위경、중、중형로뇌손상환자각30례,의차분위A、B、C삼조；령초모본원정상체검자50례급신경외과문진지원자50례위대조조D조.입원후1、3、7、14 d용채초경안광검사관찰조、대조조안구후3 mm처ONSD대소,매안검사3차,계산전부수검자ONSD평균치,표준차；채초검사후0.5h요천측불동조별로내압,계산기평균치,대소유수거진행통계분석.결과 입원후1、3、7、14d,A조ONSD분별위(4.54±0.32)mm、(4.42±0.30)mm、(4.44±0.32)mm、(4.43±0.25)mm；B조ONSD분별위(4.48 ±0.28)mm、(4.52 ±0.24)mm、(4.46 ±0.28)mm、(4.38±0.22)mm；C조ONSD분별위(5.67±0.35)mm、(6.36±0.42)mm、(5.65±0.23)mm、(4.76±0.35)mm.입원후1、3、7、14d,A조로내압분별시(82±11) mmH2O、(79±12) mmH2O、(90±15) mmH2O、(86±14) mmH2O；B조로내압분별시(78±15)mmH2O、(85±10) mmH2O、(78±16) mmH2O、(80±11)mmH2O；C조로내압분별시(225±26) mmH2O、(288±23) mmH2O、(256±23) mmH2O、(122±18) mmH2O；D조ONSD치(4.58±0.41)mm,로내압치(88±10) mmH2O.A여B、A여D、B여D지간비교차이무통계학의의(P＞0.05)；A여C、B여C、D여C지간비교차이유통계학의의(t=12.24～24.67,P＜0.01).결론 경、중형로뇌손상환자ONSD급로내압무명현변화；중형로뇌손상환자상후불동시간로내압변화불동,ONSD수로내압적승고이증대,초성검사ONSD재로뇌손상진치중구유중요개치,능반응로내압적승고,시일충비침습、조작방편、쾌속역행적로고압평고방법.
Objective To explore the clinic application value of ultrasonography examination of optic nerve sheath diameter(ONSD) in brain injury.Methods From July 2008-June 2011,90 cases of brain injured patients were chosen as experimental group including light (A group),medium (B group),and heavy (C group) brain injured patients according to the admission GCS score ;50 cases of conventional physical examination and 90 cases of volunteers 50 in neurosurgical outpatient were chosen as control group.The ONSD of both groups were measured 3 mm behind the globe through orbital using color sonographic with different time after admission.3 times measurements were carried out for every optic nerve sheath.All client's ONSD mean and standard deviation were calculated.In 0.5 h after color dopplar ultrasound examination,lumbar vertebra puncturing measured intracranial pressure in different groups.Results After admission (1d,3 d,7 d,14 d),the ONSD of A group was (4.54 ±0.32)mm,(4.42 ±0.30)mm,(4.44 ±0.32) m,and (4.43 ± 0.25) mm,respectively; The ONSD of B groups was (4.48 ± 0.28) mm,(4.52 ± 0.24) mm,(4.46 ±0.28)mm,and (4.38 ±0.22)mm,respectively; The ONSD of C group was (5.67 ±0.35)mm,(6.36 ± 0.42) mm,(5.65 ± 0.23) mm,and (4.76 ± 0.35) mm,respectively.After admission (1 d,3 d,7 d,14 d),the intracranial pressure (IP) of A group was (82 ± 11) mmH2O,(79 ± 12) mmH2O,(90 ±15) mmH2O,and (86 ± 14) mmH2O,respectively; The IP of B group was (78 ± 15) mmH2O,(85 ± 10)mmH2O,(78 ± 16) mmH2O,(80 ± 11) mmH2O,The IP of C group was (225 ± 26) mmH2 O,(288 ± 23)mmH2O,(256 ± 23) mmH2O,(122 ± 18) mmH2O,respectively.Group D had the ONSD average of (4.58± 0.41)mm and IP of (88 ± 10)mmH2O after eyeball 3-mm place.No difference was found between A and B,A and D,or B and D (P＞0.05) ; A difference was found between A and C,B and C,or D and C (t =12.24～24.67,P＜0.01).Conclusions The ONSD and IP in light medium brain injured patients had no change.In patients with severe brain injury,IP changed with the time after injury,the ONSD increased with the IP,the ultrasonography examination of ONSD with the important value in the diagnosis and treatment can respond the IP increase,which is a non-invasion,convenient,fast,and feasible method for evaluation of cranial high pressure.
