动脉瘤性蛛网膜下腔出血术后患者视神经鞘直径与颅内压相关性研究

doi:10.19854/j.cnki.1008-2425.2025.05.0006

摘要/Abstract

摘要： 目的探讨动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)术后患者视神经鞘直径(optic nerve sheath diameter,ONSD)与颅内压(intracranial pressure,ICP)的相关性,从解剖机制与临床实践角度评估ONSD对 ICP 升高的诊断价值,为 aSAH 术后无创 ICP 监测提供依据。方法前瞻性纳入2022年11月至2024年2月于安庆市第一人民医院神经外科接受手术治疗且行有创ICP监测的aSAH患者28例。术后第1、3、5、7天采用床旁超声测量ONSD(眼球后3 mm 处,取双侧6次测量均值),同步记录ICP值。采用Spearman相关分析评估ONSD与ICP的关联,ROC曲线分析ONSD诊断ICP＞21 mmHg 的效能。结果共获取112组配对数据,ONSD 范围5.06~6.60 mm,ICP范围15~45 mmHg。整体分析显示ONSD与 ICP 呈显著正相关(r=0.91,P＜0.01);亚组分析中,Hunt-Hess III 级患者相关性最高(r=0.92,P＜0.01),IV 级(r=0.71,P＜0.01)、V 级(r=0.62,P＜0.01)相关性依次降低;各时间点相关性系数0.86~0.91(均 P＜0.01)。以 ONSD≥5.49 mm诊断 ICP＞21 mmHg 时,灵敏度95.24%、特异度 96.43%、阳性预测值 98.77%、阴性预测值 87.09%,ROC 曲线下面积 0.979。结论 aSAH 术后患者超声测量ONSD与ICP显著正相关,ONSD≥5.49 mm 可作为ICP升高的高效诊断指标;其无创、床旁可重复的优势,尤其适用于aSAH术后重症患者的ICP动态监测。

关键词: 动脉瘤性蛛网膜下腔出血, 视神经鞘直径, 颅内压

Abstract: Objective To investigate the correlation between the optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients after aneurysmal subarachnoid hemorrhage (aSAH) surgery,evaluate the diagnostic value of ONSD for elevated ICP from the perspectives of anatomical mechanism and clinical practice,and provide a basis for non-invasive ICP monitoring after aSAH surgery. Methods A total of 28 aSAH patients who underwent surgical treatment and invasive ICP monitoring in the Department of Neurosurgery,Anqing First People's Hospital from November 2022 to February 2024 were prospectively enrolled.On the 1st,3rd,5th,and 7th days after surgery,bedside ultrasound was used to measure ONSD (3 mm behind the eyeball,with the mean value of 6 bilateral measurements),and the ICP values were recorded simultaneously.Spearman correlation analysis was used to assess the association between ONSD and ICP,and ROC curve analysis was used to evaluate the efficacy of ONSD in diagnosing ICP > 21 mmHg. Results A total of 112 pairs of data were obtained.The ONSD ranged from 5.06 to 6.60 mm,and the ICP ranged from 15 to 45 mmHg.Overall analysis showed a significant positive correlation between ONSD and ICP (r=0.91,P＜0.01).In subgroup analysis,the correlation was the highest in patients with Hunt-Hess Grade III (r=0.92,P＜0.01),followed by Grade IV (r=0.71,P＜0.01) and Grade V (r=0.62,P＜0.01).The correlation coefficients at each time point ranged from 0.86 to 0.91 (all P＜0.01).When ONSD ≥ 5.49 mm was used to diagnose ICP >21 mmHg,the sensitivity was 95.24%,specificity 96.43%,positive predictive value 98.77%,negative predictive value 87.09%,and the area under the ROC curve was 0.979. Conclusion ONSD measured by ultrasound is significantly positively correlated with ICP in patients after aSAH surgery.ONSD ≥ 5.49 mm can be used as a highly effective diagnostic indicator for elevated ICP.Its advantages of non-invasiveness and repeatability at the bedside make it particularly suitable for dynamic ICP monitoring in critically ill patients after aSAH surgery.

Key words: Aneurysmal subarachnoid hemorrhage, Optic nerve sheath diameter, Intracranial pressure

中图分类号:

R743

林斌斌, 王益朋, 张小兵, 刘志, 倪永丰. 动脉瘤性蛛网膜下腔出血术后患者视神经鞘直径与颅内压相关性研究[J]. 立体定向和功能性神经外科杂志, 2025, 38(5): 289-294.

Lin Binbin, Wang Yipeng, Zhang Xiaobing, Liu Zhi, Ni Yongfeng. Correlation Between Optic Nerve Sheath Diameter and Intracranial Pressure in Patients after Surgery for Aneurysmal Subarachnoid Hemorrhage[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(5): 289-294.

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