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床旁即时超声测量视神经鞘直径联合血清基质金属蛋白酶-9、中性粒细胞与淋巴细胞比值对重型颅脑损伤患者术后颅内压增高的评估价值

Value of bedside real-time ultrasound measurement of optic nerve sheath diameter combined with serum matrix metalloproteinase-9 and neutrophil-to-lymphocyte ratio for increased intracranial pressure after surgery in patients with severe craniocerebral injury

    摘要
  • 摘要:
    目的 探讨床旁即时超声测量视神经鞘直径(ONSD)联合血清基质金属蛋白酶-9(MMP-9)、中性粒细胞与淋巴细胞比值(NLR)对重型颅脑损伤患者术后颅内压增高的评估价值。
    方法 选取100例重型颅脑损伤患者作为研究对象。根据术后颅内压情况将患者分为正常组(n=33)与增高组(n=67)。比较2组ONSD、MMP-9和NLR。分析增高组ONSD、血清MMP-9、NLR之间的相关性。分析重型颅脑损伤术后颅内压增高的影响因素。采用受试者工作特征(ROC)曲线分析ONSD联合血清MMP-9、NLR对重型颅脑损伤患者术后颅内压增高的评估价值。
    结果 增高组的ONSD及血清MMP-9、NLR高于正常组，差异有统计学意义(P < 0.05)。ONSD与MMP-9呈正相关(r=0.367、P=0.002), ONSD与NLR呈正相关(r=0.419、P < 0.01), MMP-9与NLR呈正相关(r=0.324、P=0.007)。ONSD、血清MMP-9、NLR升高是重型颅脑损伤术后颅内压增高的危险因素(P < 0.05)。ONSD、血清MMP-9和NLR联合评估重型颅脑损伤患者术后颅内压增高的曲线下面积为0.976(95%CI: 0.952~1.000)、敏感度为91.04%、特异度为93.94%。ONSD、血清MMP-9和NLR联合对重型颅脑损伤患者术后颅内压增高的评估价值更高(Z联合-ONSD=3.453、P=0.001, Z联合-MMP-9=3.637、P < 0.001, Z联合-NLR=2.654、P=0.008)。
    结论 重型颅脑损伤术后颅内压增高患者ONSD及血清MMP-9、NLR水平升高，且三者升高会增加术后颅内压增高的风险。三者联合检测对评估患者术后颅内压增高具有一定价值。

     

    Abstract:
    Objective To evaluate the clinical value of bedside ultrasonographic measurement of optic nerve sheath diameter (ONSD) combined with serum matrix metalloproteinase-9 (MMP-9) and neutrophil-to-lymphocyte ratio (NLR) in assessing postoperative intracranial hypertension in patients with severe traumatic brain injury.
    Methods A total of 100 patients with severe traumatic brain injury were enrolled as study subjects. According to postoperative intracranial pressure status, the patients were divided into normal group (n=33) and elevated group (n=67). ONSD, MMP-9 and NLR levels were compared between the two groups. The correlations among ONSD, serum MMP-9 and NLR in the elevated group were analyzed. The influencing factors of postoperative intracranial hypertension in patients with severe traumatic brain injury were evaluated. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic value of ONSD combined with serum MMP-9 and NLR for postoperative intracranial hypertension.
    Results ONSD, serum MMP-9 and NLR levels were significantly higher in the elevated group than those in the normal group (P < 0.05). ONSD was positively correlated with MMP-9 (r=0.367, P=0.002), ONSD was positively correlated with NLR (r=0.419, P < 0.01), and MMP-9 was positively correlated with NLR (r=0.324, P=0.007). Elevated ONSD, serum MMP-9 and NLR were risk factors for increased intracranial pressure after severe craniocerebral injury surgery (P < 0.05). The area under the curve for evaluation of postoperative intracranial pressure increase in patients with severe craniocerebral injury by combination of ONSD, serum MMP-9 and NLR was 0.976 (95%CI, 0.952 to 1.000), the sensitivity was 91.04%, and the specificity was 93.94%. The combined evaluation value of ONSD, serum MMP-9 and NLR for increased intracranial pressure after surgery in patients with severe craniocerebral injury was higher (Zcombined with-ONSD=3.453, P=0.001, Zcombined with-MMP-9=3.637, P < 0.001, Zcombined with-NLR=2.654, P=0.008).
    Conclusion In patients with increased intracranial pressure after severe craniocerebral injury surgery, their levels of ONSD, serum MMP-9 and NLR increase, and the increase of the three indicators will increase the risk of increased intracranial pressure after surgery. The combined detection of the three indicators has certain value in evaluating the increase of intracranial pressure in patients after surgery.

     

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