Value of ultrasonic measurement of the ratio of optic nerve sheath diameter to eyeball transverse diameter in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma
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目的 评价超声测量视神经鞘直径（ONSD）与眼球横径（ETD）比值对颅脑外伤患者颅内高压的诊断和预后评估价值。 方法 前瞻性选取2021年12月至2023年1月华北医疗健康集团邢台总医院收治的120例颅脑外伤患者，根据颅内压测量结果分为颅内压正常组（73例）和颅内高压组（47例），颅内高压组再根据随访预后情况分为预后良好组（20例）和预后不良组（27例）。比较各组ONSD、ETD及ONSD/ETD，采用受试者工作特征（ROC）曲线分析ONSD、ONSD/ETD对颅内高压诊断及预后评估的效能，采用Kaplan-Meier法评估患者6个月不良预后风险，并通过Log-rank检验进行比较。 结果 颅内压正常组颅内压、ONSD、ONSD/ETD低于颅内高压组[（130.73 ± 23.63）mmH2O（1 mmH2O = 0.009 8 kPa）比（270.11 ± 35.78）mmH2O、（5.47 ± 0.29）mm比（5.78 ± 0.44）mm、0.246 ± 0.018比0.263 ± 0.018]，差异有统计学意义（P<0.05）。预后良好组入院时格拉斯哥昏迷量表（GCS）评分、颅内压、ONSD、ONSD/ETD低于预后不良组[（5.50 ± 1.24）分比（6.41 ± 1.34）分、（256.15 ± 30.23）mmH2O比（280.44 ± 36.56）mmH2O、（5.62 ± 0.40）mm比（5.90 ± 0.44）mm、0.254 ± 0.014比0.270 ± 0.017]，差异有统计学意义（P<0.05）。ROC曲线分析结果显示，ONSD、ONSD/ETD诊断颅脑外伤患者颅内高压的曲线下面积（AUC）分别为0.718和0.765，临界值分别为5.87 mm和0.263；ONSD、ONSD/ETD预测颅内高压患者预后的AUC分别为0.677和0.763，临界值分别为5.90 mm和0.267。以ONSD/ETD预测颅内高压预后的临界值（0.267）分组，ONSD/ETD>0.267组不良预后发生率高于ONSD/ETD≤0.267组，差异有统计学意义（P<0.05）。 结论 ONSD/ETD可作为颅脑外伤患者颅内高压诊断和预后评估的指标。 Objective To investigate the value of ultrasonic measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter(ETD) in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma. Methods A total of 120 patients with craniocerebral trauma treated in the Xingtai General Hospital of North China Medical and Health Group from December 2021 to January 2023 were perspectively selected, and they were divided into normal intracranial pressure group (73 cases) and intracranial hypertension group (47 cases) according to the results of intracranial pressure measurements, and the intracranial hypertension group was divided into good prognosis group (20 cases) and poor prognosis group (27 cases) according to the follow-up prognosis. The efficacy of ONSD, ETD and ONSD/ETD in intracranial hypertension diagnosis and prognosis assessment were analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to evaluate the 6-month risk of adverse prognosis of patients, and the comparison was made by Log-rank test. Results The levels of intracranial pressure, ONSD, ONSD/ETD in the normal intracranial pressure group were lower than those in the intracranial hypertension group: (130.73 ± 23.63) mmH2O (1 mmH2O = 0.009 8 kPa) vs. (270.11 ± 35.78) mmH2O, (5.47 ± 0.29) mm vs. (5.78 ± 0.44) mm, 0.246 ± 0.018 vs. 0.263 ± 0.018, there were statistical differences (P<0.05). The scores of Glasgow Coma Scale (GCS), intracranial pressure, ONSD, ONSD/ETD in the good prognosis group were lower than those in the poor prognosis group: (5.50 ± 1.24) scores vs. (6.41 ± 1.34) scores, (256.15 ± 30.23) mmH2O vs. (280.44 ± 36.56) mmH2O, (5.62 ± 0.40) mm vs. (5.90 ± 0.44) mm, 0.254 ± 0.014 vs. 0.270 ± 0.017, there were statistical differences (P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of ONSD and ONSD/ETD for diagnosing intracranial hypertension in patients with craniocerebral trauma were 0.718 and 0.765, respectively, and the critical values were 5.87 mm and 0.263, respectively. The AUC of ONSD and ONSD/ETD predicting prognosis of intracranial hypertension patients was 0.677 and 0.763, respectively, and the critical values were 5.90 mm and 0.267, respectively. Grouped by the threshold of ONSD/ETD for the prognosis of intracranial hypertension (0.267), the incidence of adverse prognosis in ONSD/ETD > 0.267 group was higher than that in the ONSD/ETD≤0.267 group, there was statistical difference (P<0.05). Conclusions ONSD/ETD can be used as an index for diagnosis and prognosis of intracranial hypertension.
Objective To investigate the value of ultrasonic measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter(ETD) in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma. Methods A total of 120 patients with craniocerebral trauma treated in the Xingtai General Hospital of North China Medical and Health Group from December 2021 to January 2023 were perspectively selected, and they were divided into normal intracranial pressure group (73 cases) and intracranial hypertension group (47 cases) according to the results of intracranial pressure measurements, and the intracranial hypertension group was divided into good prognosis group (20 cases) and poor prognosis group (27 cases) according to the follow-up prognosis. The efficacy of ONSD, ETD and ONSD/ETD in intracranial hypertension diagnosis and prognosis assessment were analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to evaluate the 6-month risk of adverse prognosis of patients, and the comparison was made by Log-rank test. Results The levels of intracranial pressure, ONSD, ONSD/ETD in the normal intracranial pressure group were lower than those in the intracranial hypertension group: (130.73 ± 23.63) mmH2O (1 mmH2O = 0.009 8 kPa) vs. (270.11 ± 35.78) mmH2O, (5.47 ± 0.29) mm vs. (5.78 ± 0.44) mm, 0.246 ± 0.018 vs. 0.263 ± 0.018, there were statistical differences (P<0.05). The scores of Glasgow Coma Scale (GCS), intracranial pressure, ONSD, ONSD/ETD in the good prognosis group were lower than those in the poor prognosis group: (5.50 ± 1.24) scores vs. (6.41 ± 1.34) scores, (256.15 ± 30.23) mmH2O vs. (280.44 ± 36.56) mmH2O, (5.62 ± 0.40) mm vs. (5.90 ± 0.44) mm, 0.254 ± 0.014 vs. 0.270 ± 0.017, there were statistical differences (P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of ONSD and ONSD/ETD for diagnosing intracranial hypertension in patients with craniocerebral trauma were 0.718 and 0.765, respectively, and the critical values were 5.87 mm and 0.263, respectively. The AUC of ONSD and ONSD/ETD predicting prognosis of intracranial hypertension patients was 0.677 and 0.763, respectively, and the critical values were 5.90 mm and 0.267, respectively. Grouped by the threshold of ONSD/ETD for the prognosis of intracranial hypertension (0.267), the incidence of adverse prognosis in ONSD/ETD > 0.267 group was higher than that in the ONSD/ETD≤0.267 group, there was statistical difference (P<0.05). Conclusions ONSD/ETD can be used as an index for diagnosis and prognosis of intracranial hypertension.
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