经眶超声测量视神经鞘直径在老年ICU神经重症患者颅内压监测中的应用

doi:10.3969/j.issn.1003-9198.2026.05.008

摘要/Abstract

摘要： 目的探讨经眶超声测量视神经鞘直径(optic nerve sheath diameter,ONSD)应用于神经重症患者颅内压(intracranial pressure,ICP)增高早期诊断的有效性和可行性。方法选择 2022年8月至2024年8月江苏省人民医院老年ICU、老年ICU 2病区收治的122例术后行ICP连续监测的神经重症患者,收集患者年龄、性别、原发疾病、格拉斯哥昏迷评分(GCS)等一般资料,根据年龄分为非老年组(＜60 岁,60 例)和老年组(≥60 岁,62 例),根据性别分为男性组(66 例)和女性组(56 例)。所有患者均于术中经侧脑室置入有创ICP监测探头监测ICP,采用经眶超声测量球后 3 mm 处 ONSD,通过ROC曲线分析 ONSD 诊断ICP增高的最佳截断值,并计算灵敏度和特异度。结果 (1)非老年组、老年组患者及所有患者的ONSD与ICP均呈显著正相关(r=0.905、0.909、0.907,P均＜0.01),散点图显示二者呈二次相关,随着ICP水平的升高,ONSD呈现出初始快速增加,随后趋于平缓的非线性增长趋势。(2)不同性别患者ONSD比较,差异有统计学意义(P＜0.01),ROC曲线显示,男性中ONSD诊断ICP增高(ICP≥20 mmHg)的最佳临界值为5.365 mm,灵敏度为0.933,特异度为0.923;女性中ONSD诊断ICP增高的最佳临界值为4.950 mm,灵敏度为0.934,特异度为0.938。结论 ONSD随着ICP的增高而增加,但二者呈二次相关;不同性别患者ONSD诊断ICP增高的最佳临界值存在差异,但与年龄无关。床旁经眶超声测量ONSD能够很好地判断ICP的变化,具有很高的临床应用价值,值得推广。

关键词: 视神经鞘直径, 经眶超声, 颅内压, 相关性

Abstract: Objective To explore the effectiveness and feasibility of transorbital ultrasound measurement of optic nerve sheath diameter (ONSD) in the early diagnosis of increased intracranial pressure (ICP) in elderly patients with critical neurological disease. Methods A total of 122 patients with neurocritical diseases who underwent continuous ICP monitoring after surgery and were admitted to the Geriatric Intensive Care Unit (ICU) and Geriatric ICU 2 ward of Jiangsu Province Hospital from August 2022 to August 2024 were selected. General information such as age, gender, primary disease, and Glasgow Coma Scale (GCS) score of the patients was collected.All the patients were divided into a non-elderly group (＜60 years old, 60 cases) and an elderly group (≥60 years old, 62 cases) by age, and into a male group (66 cases) and a female group (56 cases) by gender. All patients underwent implantation of an invasive ICP monitoring probe via the lateral ventricle during the operation to monitor ICP. ONSD at 3 mm behind the eyeball was measured by transorbital ultrasound. The optimal cut-off value of ONSD for diagnosing increased ICP was analyzed by receiver operating characteristic(ROC) curve, and the sensitivity and specificity were calculated. Results A significant positive correlation was observed between ONSD and ICP in both the non-elderly group, the elderly group, and the overall patient cohort (r=0.905, 0.909, 0.907, respectively, all P<0.01). Additionally, the scatter plot indicated a quadratic relationship between ONSD and ICP. As ICP levels increased, ONSD exhibited a non-linear growth trend characterized by an initial rapid expansion followed by a subsequent plateauing. There was a statistically significant difference in ONSD between male and female patients (P<0.01). ROC curve analysis showed that the optimal cut-off value of ONSD for diagnosing increased ICP (ICP≥20 mmHg) was 5.365 mm in male patients with a sensitivity of 0.933, and a specificity of 0.923; In female patients, the optimal ONSD cut-off value was 4.950 mm, with a sensitivity of 0.934 and a specificity of 0.938. Conclusions ONSD increases with ICP, but their relationship is quadratic; The optimal critical value for diagnosing ICP elevation by ONSD varies among patients of different genders, but it is not related to age. Bedside transorbital ultrasound measurement of ONSD can well determine the changes in ICP and has high clinical application value, which is worthy of promotion.

Key words: optic nerve sheath diameter, bedside ultrasound, intracranial pressure, correlation

中图分类号:

R 445.1

席海明, 田雅丽, 褚敏娟, 徐冠华, 黄培培, 刘辉. 经眶超声测量视神经鞘直径在老年ICU神经重症患者颅内压监测中的应用[J]. 实用老年医学, 2026, 40(5): 474-478.

XI Haiming, TIAN Yali, CHU Minjuan, XU Guanhua, HUANG Peipei, LIU Hui. Application of transorbital ultrasound measurement of optic nerve sheath diameter in monitoring intracranial pressure in elderly patients with critical neurological disease in ICU[J]. Practical Geriatrics, 2026, 40(5): 474-478.

参考文献

[1] 朴莲花, 冉红伟, 申平花, 等. 超声多模式评估脑出血患者颅内压增高的临床价值[J]. 中风与神经疾病杂志, 2022, 39(1): 22-24.
[2] LIN J P, ZHANG S D, HE F F, et al. The status of diagnosis and treatment to intracranial hypotension, including SIH[J]. J Headache Pain, 2017, 18(1): 4.
[3] ÅKERLUND C A, DONNELLY J, ZEILER F A, et al. Impact of duration and magnitude of raised intracranial pressure on outcome after severe traumatic brain injury: a CENTER-TBI high-resolution group study[J]. PLoS One, 2020, 15(12): e0243427.
[4] 薛元峰, 潘榆春, 叶亮亮, 等. 脑室内颅内压监测在老年高血压脑出血病人中的应用研究[J]. 实用老年医学, 2018, 32(12): 1170-1172.
[5] HOHMANN C, KOCH K R, PFISTER R, et al. Sonography of the optic nerve: a new bedside tool in intensive care?[J].Dtsch Med Wochenschr, 2017, 142(24):1858-1861.
[6] 王彬彬, 岳震. 神经重症患者术后视神经鞘直径与有创颅内压相关性研究[J]. 南京医科大学学报(自然科学版), 2023, 43(12): 1694-1698.
[7] LIU D, LI Z, ZHANG X, et al. Assessment of intracranial pressure with ultrasonographic retrobulbar optic nerve sheath diameter measurement[J]. BMC Neurol, 2017, 17(1): 188.
[8] ROBBA C, GOFFI A, GEERAERTS T, et al. Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review[J]. Intensive Care Med, 2019, 45(7): 913-927.
[9] QUARATO C M I, LACEDONIA D, SALVEMINI M, et al. A review on biological effects of ultrasounds: key messages for clinicians[J].Diagnostics: Basel, 2023,13(5):855.
[10] HIRZALLAH M I, LOCHNER P, HAFEEZ M U, et al. Optic nerve sheath diameter point-of-care ultrasonography quality criteria checklist: an international consensus statement on optic nerve sheath diameter imaging and measurement[J]. Crit Care Med, 2024, 52(10): 1543-1556.
[11] 刘芳,王宇娇,曹笑柏,等.成人重症患者颅内压增高防控护理专家共识[J].中华护理杂志,2024,59(21):2606-2610.
[12] 蒋宽, 许文辉, 吴达, 等. 持续颅内压监测对重型颅脑损伤患者病死率的影响[J]. 南京医科大学学报(自然科学版), 2019, 39(12): 1820-1822.
[13] 黄京菊, 吕盛秋, 陈蒙华. 超声测量视神经鞘直径预测颅内压变化的临床研究进展[J]. 中国中西医结合急救杂志, 2022, 29(6): 762-764.
[14] ROBBA C, SANTORI G, CZOSNYKA M, et al. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis[J]. Intensive Care Med, 2018, 44(8): 1284-1294.
[15] MARTÍNEZ-PALACIOS K, VÁSQUEZ-GARCÍA S, FARIYIKE O A, et al. Using optic nerve sheath diameter for intracranial pressure (ICP) monitoring in traumatic brain injury: a scoping review[J]. Neurocrit Care, 2024, 40(3): 1193-1212.
[16] LAUNEY Y, NESSELER N, LE MAGUET P, et al. Effect of osmotherapy on optic nerve sheath diameter in patients with increased intracranial pressure[J]. J Neurotrauma, 2014, 31(10): 984-988.
[17] 肖楚凡, 黄晓玲. 视神经鞘超声检查评估颅内压增高的研究进展[J]. 临床超声医学杂志, 2020, 22(8): 609-611.
[18] 乐元洁, 贲志飞. 床旁超声和CT重建测量视神经鞘直径监测颅内压的比较研究[J]. 浙江医学, 2017, 39(10): 819-823, 830.
[19] 王菊香, 陈斌, 李克, 等. 超声测量视神经鞘直径在诊断去骨瓣减压术后患者颅内压增高中的价值[J]. 医学综述, 2020, 26(1): 153-158.
[20] 李臻, 张旭乡, 杨惠青, 等. 超声测量视神经鞘直径预测颅内压的影响因素研究[J]. 中国超声医学杂志, 2018, 34(11): 961-964.
[21] MORETTI R, PIZZI B. Ultrasonography of the optic nerve in neurocritically ill patients[J]. Acta Anaesthesiol Scand, 2011, 55(6): 644-652.