Al-Hassani Ammar, Strandvik Gustav, Abayazeed Sheraz, Ahmed Khalid, El-Menyar Ayman, Mahmood Ismail, Arumugam Suresh Kumar, Asim Mohammad, Nabir Syed, Ahmed Nadeem, Ahmed Zahoor, Al-Thani Hassan
Department of Surgery and, Hamad General Hospital, Doha, Qatar.
Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.
J Emerg Trauma Shock. 2020 Jul-Sep;13(3):183-189. doi: 10.4103/JETS.JETS_103_19. Epub 2020 Sep 18.
to study the association between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with moderate-to-severe brain injury.
A retrospective cohort study of traumatic brain injury (TBI) patients was conducted between 2010 and 2014. Data were analyzed and compared according to the ICP monitoring cutoff values. Outcomes included intracranial hypertension (ICH) and mortality.
A total of 167 patients with a mean age of 33 ± 14 years, of them 96 had ICP monitored. ICP values correlated with ONSD measurement ( = 0.21, = 0.04). Patients who developed ICH were more likely to have higher mean ONSD ( = 0.01) and subarachnoid hemorrhage (SAH) ( = 0.004). Receiver operating curve for ONSD showed a cutoff value of 5.6 mm to detect ICH with sensitivity 72.2% and specificity 50%. Age and ICP were independent predictors of inhospital mortality in multivariate model. Another model with same covariates showed ONSD and SAH to be independent predictors of ICH. Simple linear regression showed a significant association of ONSD with increased ICP (β = 0.21, 95% confidence interval 0.25-5.08, = 0.03).
ONSD is a simple noninvasive measurement on initial CT in patients with TBI that could be a surrogate for ICP monitoring. However, further studies are warranted.
研究中重度脑损伤患者视神经鞘直径（ONSD）与颅内压（ICP）之间的关系。
对2010年至2014年间的创伤性脑损伤（TBI）患者进行回顾性队列研究。根据ICP监测临界值对数据进行分析和比较。结果包括颅内高压（ICH）和死亡率。
共167例患者，平均年龄33±14岁，其中96例进行了ICP监测。ICP值与ONSD测量值相关（=0.21，=0.04）。发生ICH的患者更可能有较高的平均ONSD（=0.01）和蛛网膜下腔出血（SAH）（=0.004）。ONSD的受试者工作特征曲线显示，检测ICH的临界值为5.6mm，敏感性为72.2%，特异性为50%。在多变量模型中，年龄和ICP是住院死亡率的独立预测因素。另一个具有相同协变量的模型显示，ONSD和SAH是ICH的独立预测因素。简单线性回归显示ONSD与ICP升高显著相关（β=0.21，95%置信区间0.25 - 5.08，=0.03）。
ONSD是TBI患者初始CT上一种简单的非侵入性测量方法，可作为ICP监测的替代方法。然而，仍需进一步研究。
