摘要目的 探讨超声检查视神经鞘直径(Optic Nerve Sheath Diameter,ONSD)在颅脑损伤诊治中的应用价值.方法 选择2008年7月至2011年6月本院颅脑损伤患者90例为观察组,其中入院时GCS评分为轻、中、重型颅脑损伤患者各30例,依次分为A、B、C三组；另招募本院正常体检者50例及神经外科门诊志愿者50例为对照组D组.入院后1、3、7、14 d用彩超经眼眶检查观察组、对照组眼球后3 mm处ONSD大小,每眼检查3次,计算全部受检者ONSD平均值,标准差；彩超检查后0.5h腰穿测不同组别颅内压,计算其平均值,对所有数据进行统计分析.结果 入院后1、3、7、14d,A组ONSD分别为(4.54±0.32)mm、(4.42±0.30)mm、(4.44±0.32)mm、(4.43±0.25)mm；B组ONSD分别为(4.48 ±0.28)mm、(4.52 ±0.24)mm、(4.46 ±0.28)mm、(4.38±0.22)mm；C组ONSD分别为(5.67±0.35)mm、(6.36±0.42)mm、(5.65±0.23)mm、(4.76±0.35)mm.入院后1、3、7、14d,A组颅内压分别是(82±11) mmH2O、(79±12) mmH2O、(90±15) mmH2O、(86±14) mmH2O；B组颅内压分别是(78±15)mmH2O、(85±10) mmH2O、(78±16) mmH2O、(80±11)mmH2O；C组颅内压分别是(225±26) mmH2O、(288±23) mmH2O、(256±23) mmH2O、(122±18) mmH2O；D组ONSD值(4.58±0.41)mm,颅内压值(88±10) mmH2O.A与B、A与D、B与D之间比较差异无统计学意义(P＞0.05)；A与C、B与C、D与C之间比较差异有统计学意义(t=12.24～24.67,P＜0.01).结论 轻、中型颅脑损伤患者ONSD及颅内压无明显变化；重型颅脑损伤患者伤后不同时间颅内压变化不同,ONSD随颅内压的升高而增大,超声检查ONSD在颅脑损伤诊治中具有重要价值,能反应颅内压的升高,是一种非侵袭、操作方便、快速易行的颅高压评估方法.

abstractsObjective To explore the clinic application value of ultrasonography examination of optic nerve sheath diameter(ONSD) in brain injury.Methods From July 2008-June 2011,90 cases of brain injured patients were chosen as experimental group including light (A group),medium (B group),and heavy (C group) brain injured patients according to the admission GCS score ;50 cases of conventional physical examination and 90 cases of volunteers 50 in neurosurgical outpatient were chosen as control group.The ONSD of both groups were measured 3 mm behind the globe through orbital using color sonographic with different time after admission.3 times measurements were carried out for every optic nerve sheath.All client's ONSD mean and standard deviation were calculated.In 0.5 h after color dopplar ultrasound examination,lumbar vertebra puncturing measured intracranial pressure in different groups.Results After admission (1d,3 d,7 d,14 d),the ONSD of A group was (4.54 ±0.32)mm,(4.42 ±0.30)mm,(4.44 ±0.32) m,and (4.43 ± 0.25) mm,respectively; The ONSD of B groups was (4.48 ± 0.28) mm,(4.52 ± 0.24) mm,(4.46 ±0.28)mm,and (4.38 ±0.22)mm,respectively; The ONSD of C group was (5.67 ±0.35)mm,(6.36 ± 0.42) mm,(5.65 ± 0.23) mm,and (4.76 ± 0.35) mm,respectively.After admission (1 d,3 d,7 d,14 d),the intracranial pressure (IP) of A group was (82 ± 11) mmH2O,(79 ± 12) mmH2O,(90 ±15) mmH2O,and (86 ± 14) mmH2O,respectively; The IP of B group was (78 ± 15) mmH2O,(85 ± 10)mmH2O,(78 ± 16) mmH2O,(80 ± 11) mmH2O,The IP of C group was (225 ± 26) mmH2 O,(288 ± 23)mmH2O,(256 ± 23) mmH2O,(122 ± 18) mmH2O,respectively.Group D had the ONSD average of (4.58± 0.41)mm and IP of (88 ± 10)mmH2O after eyeball 3-mm place.No difference was found between A and B,A and D,or B and D (P＞0.05) ; A difference was found between A and C,B and C,or D and C (t =12.24～24.67,P＜0.01).Conclusions The ONSD and IP in light medium brain injured patients had no change.In patients with severe brain injury,IP changed with the time after injury,the ONSD increased with the IP,the ultrasonography examination of ONSD with the important value in the diagnosis and treatment can respond the IP increase,which is a non-invasion,convenient,fast,and feasible method for evaluation of cranial high pressure.