摘要
目的 探讨超声测量视神经鞘直径(ONSD)早期评估心搏骤停后昏迷病人神经功能预后的价值。方法 采用前瞻性队列研究方法,选择2019年3月至2021年2月佛山复星禅诚医院心搏骤停复苏成功后转入重症医学科的昏迷病人[格拉斯哥昏迷量表(GCS)评分≤8分]为研究对象,记录入组病人第1、2、3天的中枢神经特异蛋白(S100-β)、神经元特异性烯醇化酶(NSE)、GCS评分、ONSD;记录病人治疗后3个月的格拉斯哥-匹兹堡脑功能评分(CPC)以评定神经功能预后,比较预后良好组(CPC 1~2分)和预后不良者组(CPC 3~5分)在S-100β蛋白、NSE、GCS评分、ONSD的差异;评估ONSD与S-100β蛋白、NSE、GCS相关性,使用受试者操作特征曲线(ROC曲线)评价ONSD预测昏迷病人预后的有效性。结果 该研究共纳入病人38例。预后不良组(27例)心搏骤停后ONSD第1天(5.11±0.70)mm、第2天(4.99±0.74)mm、第3天(5.01±0.70)mm显著高于预后良好组(11例)ONSD第1天(4.35±0.59)mm、第2天(4.23±0.57)mm、第3天(4.03±0.53)mm(P<0.05),ONSD与NSE水平呈正相关性(r=0.58,P<0.05);ONSD与GCS评分呈负相关性(r=-0.63,P<0.05);ONSD预测不良预后的ROC曲线下面积为0.82,以ONSD≥4.85mm为最佳截断值,灵敏度为0.72,特异度为0.78。结论 床边超声测量ONSD可作为心搏骤停后昏迷病人神经功能预后判断的工具。
Objective To investigate the prognostic value of optic nerve sheath diameter(ONSD) measurement by ultrasound in early assessment of neurological function prognosis in patients with cardiac arrest.Methods A prospective observational cohort study was conducted to select coma patients [Glasgow Coma Scale(GCS)≤8] who were transferred to Department of Intensive Care Unit of Foshan Fosun Chancheng Hospital after resuscitation of cardiac arrest from March 2019 to February 2021. The CNS-specific protein(S100-β), neuron-specific enolase(NSE), GCS and ONSD were recorded on the first, second and third days of the enrolled patients. The cerebral performance category(CPC) was recorded 3 months after treatment to assess the prognosis of neurological function. The differences in S100-β, NSE, GCS and ONSD were compared between the good prognostic group(CPC1-2) and the poor prognostic group(CPC3-5).The correlation between ONSD and S100-β, NSE, and GCS was evaluated. Receivers operating characteristic curve(ROC) was used to evaluate the values of ONSD in predicting the prognosis of comatose patients.Results A total of 38 patients were included in the study. The first(5.11±0.70) mm, second(4.99±0.74) mm and third days(5.01±0.70) mm ONSD in patients with poor outcomes(n=27)were significantly higher than the first(4.35±0.59) mm, second(4.23±0.57) mm and third days(4.03±0.53) mm ONSD in patients with good outcomes(n=11), ONSD measurements were strongly negatively correlated with GCS(r=-0.63, P<0.05) and NES(r=0.58, P<0.05). The area under the ROC curve for predicting poor prognosis of ONSD was 0.82, with ONSD≥4.85 mm as the best cut-off value,sensitivity was 0.72, and specificity was 0.78.Conclusion The measurement of ONSD by bedside ultrasound can be used as a tool for assessing the prognosis of neurological outcome in comatose post-cardiac arrest patients.
作者
陶飞
娄侠儒
许洁
吴晓弟
黄响玲
TAO Fei;LOU Xiaru;XU jie;WU Xiaodi;HUANG Xiangling(Intensive Care Unit,Foshan Fosun Chancheng Hospital,Foshan,Guangdong 528031,China)
出处
《安徽医药》
CAS
2023年第3期588-591,共4页
Anhui Medical and Pharmaceutical Journal
关键词
心脏停搏
昏迷
视神经鞘直径
超声检查
预后
Heart arrest
Coma
Optic nerve sheath diameter
Ultrasonography
Prognostic
