Clinical Study On The Correlation Between Intracranial Pressure And Optic Nerve Sheath Diameter In Patients With Craniocerebral Diseases In Xining Area

Objective To explore the correlation between Optic nerve sheath diameter（ONSD）and Intracranial pressure（ICP）in patients with craniocerebral diseases in Xining area.To evaluate whether ultrasound measurement of ONSD can be used as a convenient,repeatable,and bedside examination for ICP monitoring in patients with craniocerebral diseases.To provide a possible ONSD critical point for evaluating ICP elevation in patients with craniocerebral diseases in Xining area;The possible influencing factors and reference range of ONSD in patients with non-craniocerebral diseases were analyzed.Method Patients with craniocerebral diseases who were admitted to the Intensive Care Unit（ICU）of our hospital for lumbar puncture within 24 hours of onset from November 2019 to December 2020 were collected,and ONSD was measured by physicians with experience in ultrasound using the high-frequency linearly vibration probe of the Philips CX50 ultrasound system.The ONSD measured in the left eye and right eye were recorded respectively.Lumbar puncture and intracranial pressure were performed on the patients by the physician in charge,without the knowledge of either of them.According to the measured intracranial pressure,the patients were divided into high intracranial pressure group（n=63）and non-high intracranial pressure group（n=36）,and the ONSD and ICP of the two groups were compared.Result 1、A total of 99 patients with craniocerebral diseases who were to undergo lumbar puncture were collected,including 63 patients in the high intracranial pressure group and 36 patients in the non-high intracranial pressure group,the patients’measuring position,age,BMI,APACHE II score on admission to hospital,head circumference,ETD,MAP,presence of endotracheal intubation and past history of chronic diseases such as general data statistical analysis,there was no statistically significant difference（P>0.05）,comparable.The ONSDs of the left and right eyes in the high ICP group were（5.69±0.34）mm and（5.62±0.36）mm,respectively,and the mean values of the two eyes were（5.66±0.33）mm,which were higher than those in the non-high ICP group.The mean values of the left and right eyes in the high ICP group were（5.00±0.54）mm and（4.96±0.58）mm,respectively,and the mean values of the two eyes were（4.98±0.54）mm,respectively,and the difference was statistically significant（P<0.05）.The ICP of the high intracranial pressure group was 290.00（240,330）mm H₂O,and the ICP of the non-high intracranial pressure group was 141.67（120,180）mm H₂O,with statistical significance（P<0.05）.According to ROC analysis,the area under the curve of the mean value of binocular ONSD to evaluate the increase in intracranial pressure was 0.847,and the sensitivity and specificity of the mean value of binocular ONSD to evaluate the increase in intracranial pressure were 90.47%and 77.77%,respectively,when the mean value of binocular ONSD was 5.35mm,according to cut-off point analysis.2、A total of 136 patients with non-craniocerebral diseases were collected.Unary linear regression analysis showed that ONSD was not correlated with age,BMI,head circumference,MAP,gender,ethnicity,etc.The ONSD range for patients without craniocerebral disease was（4.11-5.46）mm,and the mean ONSD was（4.67±0.25）mm,with a 95%confidence interval of（4.62,4.75）.Conclusion Xining region cerebral disease in patients with ICP and ONSD has obvious relevance,about ONSD to evaluate the critical value of elevated ICP,non ONSD patients with craniocerebral disease and its influencing factors,the average of the research is still disputed,the future still need to consider altitude,the asymmetry of the geographical,eyes,etc.,to further expand the sample size and multicenter clinical study in-depth discussion.