视神经鞘直径与小儿神经危重症患者的颅内压无关。
Optic nerve sheath diameter does not correlate with intracranial pressure in pediatric neurocritical care patients.
机构信息
Division of Pediatric Critical Care, Medical University of South Carolina, Charleston, SC, USA.
Division of Critical Care, Nationwide Children's Hospital, Columbus, OH, USA.
出版信息
Childs Nerv Syst. 2021 Mar;37(3):951-957. doi: 10.1007/s00381-020-04910-1. Epub 2020 Oct 3.
PURPOSE
Intracranial pressure (ICP) > 20 mmHg is associated with worse outcomes in children. The gold standard for monitoring ICP is invasive, has complications such as bleeding and infection, and may not be available in resource limited areas. Ultrasound of the optic nerve sheath diameter (ONSD) has been studied as a noninvasive way to evaluate for elevated ICP in adults. Its utility in pediatrics remains unclear.
METHODS
A prospective study was performed in a pediatric intensive care unit in children ≤ 18 years old. ONSD ultrasound was performed using a 13-6 MHz linear probe with the patient's invasively measured ICP simultaneously recorded. Linear mixed effects models were used to evaluate the association between ONSD and ICP.
RESULTS
One hundred thirty-six measurements were obtained from 16 patients. ONSD was not significantly associated with ICP (p = 0.51). A ROC curve assessing ONSD to determine elevated ICP > 20 mmHg had an area under the curve of 0.52 (95%CI = 0.32-0.72). There was no difference in measurements obtained between the left and right ONSD at the same time (p = 0.82).
CONCLUSIONS
In conclusion, this study demonstrated no association between ONSD measurement and invasively monitored ICP in critically ill children.
目的
颅内压（ICP）>20mmHg 与儿童预后不良相关。监测 ICP 的金标准是有创的，存在出血和感染等并发症，并且在资源有限的地区可能无法获得。视神经鞘直径（ONSD）的超声检查已被研究作为一种评估成人 ICP 升高的非侵入性方法。但其在儿科中的应用尚不清楚。
方法
在儿童重症监护病房进行了一项前瞻性研究，纳入年龄≤18 岁的患儿。使用 13-6MHz 线性探头进行 ONSD 超声检查，同时记录患者有创测量的 ICP。线性混合效应模型用于评估 ONSD 与 ICP 之间的关联。
结果
从 16 名患者中获得了 136 次测量。ONSD 与 ICP 无显著相关性（p=0.51）。评估 ONSD 以确定 ICP>20mmHg 的升高的 ROC 曲线下面积为 0.52（95%CI=0.32-0.72）。同时测量的左右 ONSD 之间无差异（p=0.82）。
结论
总之，本研究表明，在危重症儿童中，ONSD 测量与有创监测的 ICP 之间无关联。
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