Schott Christopher K, Hirzallah Mohammad I, Heyman Rock, Lesky Daniel N, Brant Emily B, Callaway Clifton W
VA Pittsburgh Health Care Systems * Critical Care Service Line (124U), University Drive, Pittsburgh, PA, 15240, USA.
Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, and University of Pittsburgh Medical Center (UPMC), 3550 Terrace Street Scaife Hall, Suite 600, Pittsburgh, PA, 15213, USA.
Ultrasound J. 2020 May 13;12(1):26. doi: 10.1186/s13089-020-00173-8.
To test the hypothesis that optic nerve sheath diameter (ONSD) correlates with real-time changes in intracranial pressure, we performed ultrasound measurements of the ONSD in ambulatory patients undergoing elective lumbar puncture (LP). We conducted a prospective cohort study, including adult patients undergoing LP in a non-emergent setting. We measured ONSD perpendicular to the optic nerve at 3 mm behind the globe in both eyes in the traverse and sagittal planes, with the patient supine. The primary outcome was change in ONSD from pre-LP to post-LP. We calculated association of opening and closing LP pressures with changes in the pre- and post-LP ONSD measurements.
The mean patient age was 49.0 years (SD = 37-61, range 19-67) with 21 females (72.4%) and 26 (89.7%) white American (not Hispanic or Latino). The average opening pressure and closing pressures were 20.4 cm and 13.5 cm with a difference of 6.9 cm, (95% CI 3.9-10.0 cm). Pressures between the participants with baseline ONSD measurement > 5 mm (average opening pressure = 21.3 cm) to those < 5 mm (20.2 cm) differed by 1.1 cm (95% CI - 5.7 to 8.0). Linear regression revealed no association between the sagittal, transverse, average, and change in ONSD measurements with the observed LP opening pressure, change in LP pressure, or volume of cerebral spinal fluid (CSF) drained.
In this study of ambulatory patients undergoing rapid decreases in ICP via elective LP, we detected no acute changes in ultrasonographic measurement of the ONSD.
为验证视神经鞘直径（ONSD）与颅内压实时变化相关的假说，我们对接受择期腰椎穿刺（LP）的非卧床患者进行了ONSD的超声测量。我们开展了一项前瞻性队列研究，纳入在非急诊情况下接受LP的成年患者。患者仰卧位，在双眼眼球后3毫米处的横切面和矢状面测量垂直于视神经的ONSD。主要结局是LP前至LP后的ONSD变化。我们计算了LP开放压和关闭压与LP前后ONSD测量值变化之间的关联。
患者平均年龄为49.0岁（标准差=37 - 61，范围19 - 67岁），其中女性21名（72.4%），26名（89.7%）为美国白人（非西班牙裔或拉丁裔）。平均开放压和关闭压分别为20.4厘米和13.5厘米，差值为6.9厘米（95%可信区间3.9 - 10.0厘米）。基线ONSD测量值>5毫米的参与者（平均开放压=21.3厘米）与测量值<5毫米的参与者（20.2厘米）之间的压力差值为1.1厘米（95%可信区间 - 5.7至8.0）。线性回归显示，矢状面、横断面、平均ONSD测量值及其变化与观察到的LP开放压、LP压力变化或引流的脑脊液（CSF）量之间无关联。
在这项对通过择期LP使颅内压快速下降的非卧床患者的研究中，我们未检测到ONSD超声测量值的急性变化。
