重度创伤性脑损伤患者视神经鞘直径与死亡率之间的关联
Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury.
作者信息
Sekhon Mypinder S, McBeth Paul, Zou Jie, Qiao Lu, Kolmodin Leif, Henderson William R, Reynolds Steve, Griesdale Donald E G
机构信息
Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada,
出版信息
Neurocrit Care. 2014 Oct;21(2):245-52. doi: 10.1007/s12028-014-0003-y.
PURPOSE
Increased intracranial pressure (ICP) is associated with worse outcomes following traumatic brain injury (TBI). Studies have confirmed that ICP is correlated with optic nerve sheath diameter (ONSD) on ultrasound. The aim of our study was to assess the independent relationship between ONSD measured using CT and mortality in a population of patients admitted with severe TBI.
METHODS
We conducted a retrospective cohort study of patients with a TBI requiring ICP monitoring admitted to the ICU between April 2006 and May 2012 to two neurotrauma centers. ONSD was independently measured by two physicians blinded to patient outcomes. Multivariable logistic regression modeling was used to assess an association between ONSD and hospital mortality.
RESULTS
A total of 220 patients were included in the analysis. Overall, the cohort had a mean age of 35 (SD 17) years and 171 of 220 (79 %) were male. The median admission GCS was 6 (IQR 3-8). Intra-class correlation coefficient between raters for ONSD measurements was 0.92 (95 % CI 0.90-0.94, P < 0.0001). On multivariable analysis, each 1 mm increase in ONSD was associated with a twofold increase in hospital mortality (OR 2.0, 95 % CI 1.2-3.2, P = 0.007). Using linear regression, ONSD was independently associated with increased ICP in the first 48 h after admission (β = 4.4, 95 % CI 2.5-6.3, P < 0.0001).
CONCLUSIONS
In patients with TBI, ONSD measured on CT scanning was independently associated with ICP and mortality.
目的
创伤性脑损伤（TBI）后颅内压（ICP）升高与预后较差相关。研究证实，超声检查时ICP与视神经鞘直径（ONSD）相关。我们研究的目的是评估在重度TBI入院患者群体中，使用CT测量的ONSD与死亡率之间的独立关系。
方法
我们对2006年4月至2012年5月期间入住两个神经创伤中心ICU且需要进行ICP监测的TBI患者进行了一项回顾性队列研究。由两名对患者预后不知情的医生独立测量ONSD。采用多变量逻辑回归模型评估ONSD与医院死亡率之间的关联。
结果
共有220例患者纳入分析。总体而言，该队列的平均年龄为35（标准差17）岁，220例中有171例（79%）为男性。入院时格拉斯哥昏迷量表（GCS）中位数为6（四分位间距3 - 8）。评估者之间ONSD测量的组内相关系数为0.92（95%可信区间0.90 - 0.94，P < 0.0001）。多变量分析显示，ONSD每增加1 mm，医院死亡率增加两倍（比值比2.0，95%可信区间1.2 - 3.2，P = 0.007）。采用线性回归分析，入院后48小时内ONSD与ICP升高独立相关（β = 4.4，95%可信区间2.5 - 6.3，P < 0.0001）。
结论
在TBI患者中，CT扫描测量的ONSD与ICP及死亡率独立相关。
Zotero 插件