摘要
目的:探讨床旁超声视神经鞘宽度(ONSD)联合颅内血流测量在心肺复苏术后患者颅内压(ICP)增高评估中的价值。方法:选择我院2016年1月—2019年12月72例急诊科行心肺复苏术后转入ICU的患者作为研究对象,均用床旁超声测量ONSD与颅内血流相关指标,根据复苏术后21 d匹兹堡脑功能(CPC)分级分组,预后良好组(CPC分级1~3级)33例,预后不良组(CPC分级4~5级)39例,比较两组ONSD与颅内血流相关指标,绘制受试者工作特征(ROC)曲线,计算ONSD值与大脑中动脉多普勒参数(MCA-PI)诊断心肺复苏术后患者ICP增高的最佳阈值。结果:预后良好组自主循环恢复24 h、72 h LONSD、RONSD值小于预后不良组,预后良好组自主循环恢复24 h LMCA-PI、RMCA-PI值小于预后不良组,差异均有统计学意义(P<0.05)。两组自主循环恢复72 h LMCA-PI、RMCA-PI值差异无统计学意义(P>0.05)。预后不良组自主循环恢复24 h颅内血流频谱正常、异常、舒张期反向血流构成比例分别为12.24%、65.31%、22.45%;自主循环恢复72 h血流频谱正常、异常、舒张期反向血流构成比例构成比例分别是14.29%、63.27%、22.45%;预后良好组自主循环恢复24 h颅内血流频谱正常、异常、舒张期反向血流构成比例分别为52.17%、47.83%、0.00%,自主循环恢复72 h血流频谱正常、异常、舒张期反向血流构成比例分别为100.00%、0.00%、0.00%,差异均有统计学意义(P<0.05)。绘制ROC曲线,MCA-PI临界值为1.053时,AUC为0.649,敏感性、特异性分别为47.82%、81.63%,对心肺复苏术后患者ICP增高的诊断价值较低;ONSD临界值为5.311时,AUC为0.872,敏感性、特异性分别为73.91%、85.71%,对心肺复苏术后患者ICP增高的诊断价值较高。结论:床旁超声安全无创,测量ONSD值并监测颅内血流可评估心肺复苏术后患者ICP增高值和预后,对治疗措施的制定有指导意义。
Objective:To study the value of bedside ultrasound optic nerve sheath width(ONSD)combined with intracranial blood flow measurement in the evaluation of increased intracranial pressure(ICP)in patients after cardiopulmonary resus-citation.Methods:Seventy-two patients were enrolled,who were transferred to ICU after cardiopulmonary resuscitation in our hospital from January 2016 to December 2019 as the experimental objects.ONSD and intracranial blood flow related indexes were measured by bedside ultrasound according to Pittsburgh brain function classification(CPC).The good prognosis group(CPC grade 1~3)were 33 cases,and the poor prognosis group(CPC grade 4~5)were 39 cases.ONSD and intracranial blood flow related indexes were compared and receiver operating characteristic(ROC)curve was drawn.Results:The LONSD and RONSD values of spontaneous circulation recovered at 24 h and 72 h in the good prognosis group were lower than those in the poor prognosis group.The LMCA-PI and RMCA-PI values of spontaneous circulation recovered at 24 h in the good prognosis group were lower than those in the poor prognosis group.The differences were statistically significant(P<0.05).There was no statistically significant difference in LMCA-PI and RMCA-PI values between the two groups of spontaneous circulation recovery 72 hours(P>0.05).In the poor prognosis group after spontaneous circulation recovering within 24 hours.The proportions of normal,abnormal and inversed intracranial blood flow in diastolic phase were 12.24%,65.31%and 22.45%,respectively.The propor-tions were 14.29%,63.27%and 22.45%,respectively.In the good prognosis group,the proportions within 24 hours were52.17%,47.83 and 0.00%respectively.The proportions within 72 hours,the proportions were 100.00%,0.00%and 0.00%,respectively.The differences were statistically significant(P<0.05).When the ROC curve was drawn,when the MCA-PI cutoff value was 1.053,the AUC was 0.649,and the sensitivity and specificity were 47.82%and 81.63%,respectively.The diagnostic value of increased ICP in patients after cardiopulmonary resuscitation was low.When the ONSD cutoff value was 5.311,the AUC was 0.872,the sensitivity and specificity were 73.91%and 85.71%,respectively.Conclusion:Bedside ultrasound is safe and noninvasive.Measuring ONSD value and monitoring intracranial blood flow can assess the increase in ICP and prognosis of patients after cardiopulmonary resuscitation.
作者
郭慧
许宁
申张顺
赵茜
贾坤
贾阳娟
李红玲
马佳倩
李建国
GUO Hui;XU Ning;SHEN Zhang-shun;ZHAO Qian;JIA Kun;JIA Yang-juan;LI Hong-ling;MA Jia-qian;LI Jian-gao(Hebei General Hospital,Shijiazhuang 050051,China)
出处
《中国临床医学影像杂志》
CAS
CSCD
2021年第7期461-465,共5页
Journal of China Clinic Medical Imaging
基金
河北省2019年度医学科学研究课题(20190202)。
关键词
颅内压
心肺复苏术
超声检查
多普勒
彩色
Intracranial Pressure
Cardiopulmonary Resuscitation
Ultrasonography,Doppler,Color
作者简介
郭慧(1984-),女,河北石家庄人,主治医师。E-mail:guohuinihao@sina.com;通讯作者:李建国,河北省人民医院急诊科,050051。E-mail:lijg65@163.com。
