多模态无创评估颅内高压：一项观察性研究。
Multimodal non-invasive assessment of intracranial hypertension: an observational study.
机构信息
Policlinico San Martino, IRCCS For Oncology and Neuroscience, Department of Integrated Surgical and Diagnostic Science, University of Genova, Genova, Italy.
Neurosciences Critical Care Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
出版信息
Crit Care. 2020 Jun 26;24(1):379. doi: 10.1186/s13054-020-03105-z.
BACKGROUND
Although placement of an intra-cerebral catheter remains the gold standard method for measuring intracranial pressure (ICP), several non-invasive techniques can provide useful estimates. The aim of this study was to compare the accuracy of four non-invasive methods to assess intracranial hypertension.
METHODS
We reviewed prospectively collected data on adult intensive care unit (ICU) patients with traumatic brain injury (TBI), subarachnoid hemorrhage (SAH), or intracerebral hemorrhage (ICH) in whom invasive ICP monitoring had been initiated and estimates had been simultaneously collected from the following non-invasive indices: optic nerve sheath diameter (ONSD), pulsatility index (PI), estimated ICP (eICP) using transcranial Doppler, and the neurological pupil index (NPI) measured using automated pupillometry. Intracranial hypertension was defined as an invasively measured ICP > 20 mmHg.
RESULTS
We studied 100 patients (TBI = 30; SAH = 47; ICH = 23) with a median age of 52 years. The median invasively measured ICP was 17 [12-25] mmHg and intracranial hypertension was present in 37 patients. Median values from the non-invasive techniques were ONSD 5.2 [4.8-5.8] mm, PI 1.1 [0.9-1.4], eICP 21 [14-29] mmHg, and NPI 4.2 [3.8-4.6]. There was a significant correlation between all the non-invasive techniques and invasive ICP (ONSD, r = 0.54; PI, r = 0.50; eICP, r = 0.61; NPI, r = - 0.41-p < 0.001 for all). The area under the curve (AUC) to estimate intracranial hypertension was 0.78 [CIs = 0.68-0.88] for ONSD, 0.85 [95% CIs 0.77-0.93] for PI, 0.86 [95% CIs 0.77-0.93] for eICP, and 0.71 [95% CIs 0.60-0.82] for NPI. When the various techniques were combined, the highest AUC (0.91 [0.84-0.97]) was obtained with the combination of ONSD with eICP.
CONCLUSIONS
Non-invasive techniques are correlated with ICP and have an acceptable accuracy to estimate intracranial hypertension. The multimodal combination of ONSD and eICP may increase the accuracy to estimate the occurrence of intracranial hypertension.
背景
尽管脑内导管放置仍然是测量颅内压（ICP）的金标准方法，但几种非侵入性技术也可以提供有用的估计。本研究的目的是比较四种非侵入性方法评估颅内高压的准确性。
方法
我们前瞻性地回顾了在创伤性脑损伤（TBI）、蛛网膜下腔出血（SAH）或脑内出血（ICH）患者中接受颅内压监测的成年重症监护病房（ICU）患者的数据，同时从以下非侵入性指标中收集了估计值：视神经鞘直径（ONSD）、搏动指数（PI）、经颅多普勒测量的估计 ICP（eICP）和使用自动瞳孔测量法测量的神经瞳孔指数（NPI）。颅内高压定义为经测量的 ICP>20mmHg。
结果
我们研究了 100 名患者（TBI=30；SAH=47；ICH=23），中位年龄为 52 岁。中位经测量的 ICP 为 17[12-25]mmHg，37 名患者存在颅内高压。非侵入性技术的中位值分别为 ONSD 5.2[4.8-5.8]mm、PI 1.1[0.9-1.4]、eICP 21[14-29]mmHg 和 NPI 4.2[3.8-4.6]。所有非侵入性技术与侵入性 ICP 均呈显著相关性（ONSD，r=0.54；PI，r=0.50；eICP，r=0.61；NPI，r=-0.41，p<0.001）。ONSD 的曲线下面积（AUC）为 0.78[95%置信区间（CI）0.68-0.88]，PI 的 AUC 为 0.85[95%CI 0.77-0.93]，eICP 的 AUC 为 0.86[95%CI 0.77-0.93]，NPI 的 AUC 为 0.71[95%CI 0.60-0.82]。当各种技术联合使用时，ONSD 与 eICP 的组合获得了最高的 AUC（0.91[0.84-0.97]）。
结论
非侵入性技术与 ICP 相关，具有评估颅内高压的可接受准确性。ONSD 与 eICP 的多模态组合可能会提高评估颅内高压发生的准确性。
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