关键词 / KeyWords：
高血压脑出血,视神经鞘宽度,鹿特丹 CT 评分,闪光视觉诱发电位,无创颅内压
闪光视觉诱发电位无创颅内压监测指导治疗高血压脑出血的作用评估
何英超 田雪涛 贾 松 林 燕 牛苗苗 吴 萍
保定市第二中心医院，河北 保定 072750
通信作者：何英超
【摘要】 目的 探讨视神经鞘直径（ONSD）联合鹿特丹CT评分评估闪光视觉诱发电位（FVEP）无创颅内压（ICP）监测指导治疗高血压脑出血（HICH）患者的价值。方法 选取2020-05—2021-05保定市第二中心医院应用FVEP无创ICP监测指导治疗的59例HICH患者，其中治愈组49例，残疾组10例，分析2组患者治疗前后 ONSD、鹿特丹 CT 评分，采用受试者工作特征曲线（ROC）分析 ONSD、鹿特丹 CT 评分对疗效的评估价值。结果 治疗前治愈组与残疾组患者 ICP 值［（196.40±16.11）mmHg、（201.33±20.13）mmHg］及住院时间［（7.13±1.35）d、（7.86±1.23）d］比较差异无统计学意义（P>0.05），治愈组患者出血量［（24.83±1.27）mL］低于残疾组［（26.49±3.18）mL］，治疗后出院时2组ICP值均明显降低，且治愈组［（154.94±13.50）mmHg］低于残疾组［（173.04±13.36）mmHg］（P<0.05）。治疗前治愈组与残疾组患者的 ONSD［（5.34±0.55）mm、（5.11±0.74）mm］、鹿特丹 CT 评分［（4.73±0.19）分、（4.81±0.13）分］比较差异无统计学意义（P>0.05），治疗后两项指标均明显降低，且治愈组［（2.97±0.36）分］低于残疾组［（4.01±0.44）分］（P<0.05）。Pearson相关分析显示，治疗后 ONSD、鹿特丹 CT 评分与出院时 ICP 值均呈正相关（r=0.569、0.588，P<0.05）。ROC 曲线分析显示，治疗后 ONSD、鹿特丹 CT 评分单独及联合检测评估疗效的 AUC 分别为 0.790、0.714、0.816（P<0.05）。结论 ONSD联合鹿特丹CT评分对FEVP无创ICP监测指导治疗HICH的效果有较好的评估价值。
【关键词】 高血压脑出血；视神经鞘宽度；鹿特丹 CT 评分；闪光视觉诱发电位；无创颅内压
【中图分类号】 R743.34 【文献标识码】 A 【文章编号】 1673-5110 （2022） 04-0448-05
DOI：10.12083/SYSJ.220163
Evaluation on the curative effect of FVEP non-invasive ICP monitoring in patients with hypertensive intracerebral hemorrhage
HE Yingchao，TIAN Xuetao，JIA Song，LIN Yan，NIU Miaomiao，WU Ping
The Second Central Hospital of Baoding，Baoding 072750，China
Corresponding author: HE Yingchao
【Abstract】 Objective To explore the value of optic nerve sheath diameter （ONSD
） combined with Rotterdam CT score in evaluating the curative effect of flash visual evoked potential （FVEP） non-invasive intracranial pressure （ICP） monitoring in patients with hypertensive intracerebral hemorrhage （HICH）. Methods A retrospective selection was performed on the 59 patients with HICH treated under the guidance of FVEP non-invasive ICP monitoring in the Second Central Hospital of Baoding between May 2020 and May 2021. According to clinical curative effect，they were divided into healing group（49 cases）and disability group（10 cases）. ONSD and Rotterdam CT scores before and after treatment between the two groups were compared. The evaluation value of ONSD and Rotterdam CT score for curative effect was analyzed by receiver operating characteristic（ROC）curves. Results Before treatment，there was no significant difference in ICP（（196.40±16.11）mmHg vs（201.33±20.13）mmHg）or hospitalization time（（7.13±1.35）d vs （7.86±1.23）d）between healing group and disability group（P>0.05）. The blood loss in healing group was less than that in disability group （（24.83±1.27） mL vs （26.49±3.18） mL）. After treatment，ICP in both both groups was significantly reduced，which was lower in healing group than disability group（（154.94±13.50）mmHg vs （173.04±13.36） mmHg）（P<0.05）. Before treatment，there was no significant difference in ONSD（（5.34±0.55）mm vs （5.11±0.74）mm）or Rotterdam CT score（（4.73±0.19）points vs （4.81±0.13）points）between healing group and disability group （P>0.05）. After treatment，ONSD or Rotterdam CT score in both groups were significantly decreased，which were lower in healing group than disability group（（2.97±0.36）points vs （4.01±0.44）points） （P<0.05）. The results of Pearson correlation analysis showed that ONSD and Rotterdam CT score after treatment were positively correlated with ICP at discharge（r=0.569，0.588，P<0.05）. The results of ROC curve analysis showed that AUC values of ONSD，Rotterdam CT score and combined detection for evaluating curative effect were 0.790，0.714 and 0.816，respectively（P<0.05）. Conclusion The combined detection of ONSD and Rotterdam CT score is of good evaluation value for curative effect of FEVP non-invasive ICP monitoring on HICH.
【Key words】 Hypertensive intracerebral hemorrhage；Optic nerve sheath diameter；Rotterdam CT score；Flash visual evoked potential；Non-invasive intracranial pressure
