Department of Anesthesia and Critical Care, Ospedale SS Antonio e Biagio e Cesare Arrigo, via Venezia 16, 15100 Alessandria, Italy.
Neurocrit Care. 2009 Dec;11(3):406-10. doi: 10.1007/s12028-009-9250-8.
The aim of our study is to confirm the reliability of optic nerve ultrasound as a method to detect intracranial hypertension in patients with spontaneous intracranial hemorrhage, to assess the reproducibility of the measurement of the optic nerve sheath diameter (ONSD), and to verify that ONSD changes concurrently with intracranial pressure (ICP) variations.
Sixty-three adult patients with subarachnoid hemorrhage (n = 34) or primary intracerebral hemorrhage (n = 29) requiring sedation and invasive ICP monitoring were enrolled in a 10-bed multivalent ICU. ONSD was measured 3 mm behind the globe through a 7.5-MHz ultrasound probe. Mean binocular ONSD was used for statistical analysis. ICP values were registered simultaneously to ultrasonography. Twenty-eight ONSDs were measured consecutively by two different observers, and interobserver differences were calculated. Twelve coupled measurements were taken before and within 1 min after cerebrospinal fluid (CSF) drainage to control elevated ICP.
Ninety-four ONSD measurements were analyzed. 5.2 mm proved to be the optimal ONSD cut-off point to predict raised ICP (>20 mmHg) with 93.1% sensitivity (95% CI: 77.2-99%) and 73.85% specificity (95% CI: 61.5-84%). ONSD-ICP correlation coefficient was 0.7042 (95% CI for r = 0.5850-0.7936). The median interobserver ONSD difference was 0.25 mm. CSF drainage to control elevated ICP caused a rapid and significant reduction of ONSD (from 5.89 ± 0.61 to 5 ± 0.33 mm, P < 0.01).
Our investigation confirms the reliability of optic nerve ultrasound as a non-invasive method to detect elevated ICP in intracranial hemorrhage patients. ONSD measurements proved to have a good reproducibility. ONSD changes almost concurrently with CSF pressure variations.
本研究旨在证实视神经超声作为一种检测自发性脑出血患者颅内高压的方法的可靠性，评估视神经鞘直径（ONSD）测量的可重复性，并验证 ONSD 变化与颅内压（ICP）变化同步。
我们纳入了 63 名需要镇静和有创 ICP 监测的成年蛛网膜下腔出血（n=34）或原发性脑出血（n=29）患者，这些患者入住了一个有 10 张床位的多科室 ICU。通过 7.5MHz 超声探头在眼球后 3mm 处测量 ONSD。统计分析采用双眼平均 ONSD。同时记录 ICP 值以进行超声检查。由两名不同的观察者连续测量 28 次 ONSD，并计算观察者间差异。在脑脊液（CSF）引流前和引流后 1 分钟内进行了 12 次耦合测量，以控制升高的 ICP。
分析了 94 次 ONSD 测量值。5.2mm 被证明是预测升高的 ICP（>20mmHg）的最佳 ONSD 截断点，具有 93.1%的敏感性（95%CI：77.2-99%）和 73.85%的特异性（95%CI：61.5-84%）。ONSD-ICP 相关系数为 0.7042（r 的 95%CI 为 0.5850-0.7936）。观察者间 ONSD 差异的中位数为 0.25mm。CSF 引流以控制升高的 ICP 导致 ONSD 迅速显著降低（从 5.89±0.61 降至 5±0.33mm，P<0.01）。
我们的研究证实了视神经超声作为一种检测颅内出血患者颅内高压的非侵入性方法的可靠性。ONSD 测量具有良好的可重复性。ONSD 变化几乎与 CSF 压力变化同步。
