Study On Temporal Lag Of Estimate Intracranial Pressure By Measure Optic Nerve Sheath Diameter

Elevated intracranial pressure(ICP)is a common complication in patients with traumatic brain injury.And the increase of ICP is the main cause of disability and death in critically ill patients.All patients with craniocerebral injury before the tube phase and the postoperative monitoring period had sudden fluctuations may need ICP,ICP monitoring technology to dynamic real-time monitoring of ICP,in order to detect the early changes of patients and guide the formulation of antihypertensive drugs administered to adjust dehydration time,dose,frequency,type etc..However,as a measure of ICP is relatively reliable and can real-time dynamic monitoring of invasive intracranial pressure monitoring technology for complications,technical level is higher,high cost and other factors lead to the popularization and application of the technology is hindered.The relative safety non-invasive intracranial pressure monitoring technology also has the technical requirements of high equipment,low accuracy,can not quantify,interference factors and other defects.In recent years,studies at home and abroad show that ICP levels can be determined by measuring the optic nerve sheaths diameter(ONSD).A variety of external or clinical studies have confirmed that ONSD and ICP have a good correlation.In recent years,a number of domestic scholars have shown that measuring ONSD has important clinical value for early diagnosis of elevated ICP,and the normal range of ONSD in healthy adults is estimated by statistical methods.[Objective] The purpose of this study is clear: The measurement of ONSD said ICP changes the noninvasive monitoring technology and the current as the “gold standard intraventricular probe type intracranial pressure monitoring technology” whether there is a difference ? Can the change of ONSD value reflect the change of ICP value in real time?Whether there is a lag in time? This research is based on this problem.[Methods] 61 critically ill patients with traumatic brain injury requiring invasive ICP monitoring from from April 2017 tu September 2017 in our ICU were selected,and the subjects were selected according to the design criteria and exclusion criteria.Each patient recorded the ICP value of 20% mannitol before and after intravenous infusion of 125 ml,and received two bedside ultrasound measurements of ONSD values before and after ICP change,10 minutes after change,and 30 minutes after change.(1)each patient was matched by two sets of ONSD values measured by two different physicians to determine whether the ONSD consistency of the same patient measured by the different physicians was good.(2)the 4 time points measured ONSD values were divided into 4 groups of 22 paired difference analysis,3 groups of ONSD 3 time points that ICP after the change of the measured value,which point ONSD value difference and ICP change of ONSD value before.(3)correlation analysis between ONSD change value and ICP change value was carried out,and compared with the domestic and foreign research.[Results] the ONSD value of the same patient measured by the same time point of the same doctor was better,and the ONSD value measured by bedside ultrasound was good.The ONSD value of the immediate measurements after ICP decline was not significantly different from that of the ONSD prior to ICP decline.The difference between the ONSD value measured at 10 minutes after ICP decline and the pre ONSD value of ICP decreased significantly.However,the difference in ONSD values between 10 and 30 minutes after ICP decline was not statistically significant.The correlation coefficients between the two groups of ONSD and ICP were 0.758 and 0.711,respectively,and the correlation coefficients between ONSD and ICP were similar.[Conclusion] ONSD reflects the lag time of ICP changes within 10 minutes,but the ONSD values measured in the 20 minutes after 10 ICP to 30 minutes can better reflect the current ICP value.