横断面调查超声测量视神经鞘直径在维持性血液透析患者中的分布情况

罗慧嫦; 宋利; 尹燕; 全梓林; 崔冬梅; 赵立艳; 陈诚

doi:10.3969/j.issn.1671-4091.2023.10.008

中国血液净化 >

2023 , Vol. 22 >Issue 10: 754 - 758

DOI: https://doi.org/10.3969/j.issn.1671-4091.2023.10.008

临床研究

横断面调查超声测量视神经鞘直径在维持性血液透析患者中的分布情况

罗慧嫦 ,
宋利 ,
尹燕 ,
全梓林 ,
崔冬梅 ,
赵立艳 ,
陈诚

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523110 东莞，1东莞东华医院肾内科
510080 广州，2南方医科大学附属广东省人民医院(广东省医学科学院)肾内科

收稿日期: 2023-03-20

修回日期: 2023-08-09

网络出版日期: 2023-09-28

基金资助

广东省医学科学技术研究基金项目(A2021260)；广州市科技计划项目(202102080292)

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Cross-sectional survey of the distribution of optic nerve sheath diameter by ultrasound measurement in patients on maintenance hemodialysis

LUO Hui-Chang ,
SONG Li ,
YIN Yan ,
QUAN Zi-Lin ,
CUI Dong-Mei ,
ZHAO Li-Yan ,
CHEN Cheng

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Department of Nephrology, Dongguan Tungwah Hospital, Dongguan 523110, China; 2Department of Nephrology, Guangdong Provincial People's Hospital, Southern Medical University (Guangdong Academy of Medical Sciences), Guangzhou 510080, China; 3Department of Nephrology, Peking University Shenzhen Hospital, Shenzhen 518034, China

Received date: 2023-03-20

Revised date: 2023-08-09

Online published: 2023-09-28

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摘要

目的通过对维持性血液透析(maintenance hemodialysis,MHD)患者横断面调查，应用超声测量其视神经鞘直径(optic nerve sheath diameter,ONSD)的数值分布情况。方法选取2022年9月—10月的MHD患者，由同一检查者采用B型超声分别测量双眼球后3 mm处ONSD，每侧眼球均测量纵切面直径和横切面直径，将2次ONSD平均值作为该眼ONSD。结果共纳入206例患者，平均年龄(60.2±14.3)岁，平均透析时间62.5(26.0,113.0)月。其中女性166例(80.6%)，合并糖尿病71例(34.5%)，合并冠心病40例(19.4%)。MHD患者中男性ONSD平均直径高于女性(t=3.180,P=0.002)；男性患者左眼ONSD平均直径高于女性(t=-3.399,P=0.001)；与非糖尿病患者比较，糖尿病MHD患者左眼和右眼ONSD平均直径均显著增大，差异有统计学意义(t=-3.824,P＜0.001)；与非冠心病患者比较，冠心病MHD患者左眼和右眼ONSD平均直径差异均不显著(t=-1.064,P=0.289)。结论 MHD患者ONSD分布与性别和是否合并糖尿病显著相关。临床中需关注男性、糖尿病患者左眼ONSD。

关键词： 超声测量; 视神经鞘直径; 血液透析; 颅内压

本文引用格式

罗慧嫦 , 宋利 , 尹燕 , 全梓林 , 崔冬梅 , 赵立艳 , 陈诚 . 横断面调查超声测量视神经鞘直径在维持性血液透析患者中的分布情况[J]. 中国血液净化, 2023 , 22(10) : 754 -758 . DOI: 10.3969/j.issn.1671-4091.2023.10.008

Abstract

Objectives This is a cross-sectional survey to observe the distribution of optic nerve sheath diameter (ONSD) by ultrasound measurement in maintenance hemodialysis (MHD) patients. Method The MHD patients treated in the period from September to October 2022 were recruited. Ultrasound examination of both eyes was performed by one examiner. The ONSD of an eye was measured from the longitudinal and transverse eye sections 3mm after the bulb, and the two values were then averaged. Results A total of 206 MHD patients were enrolled, with the mean age of 60.2±14.3 years, the mean dialysis age of 62.5 (26.0～113.0) months, and 80.6% female patients (166 cases). Diabetic nephropathy was found in 71 cases (34.5%), and coronary heart disease was found in 40 cases (19.4%). The average ONSD was higher in males than in females (t=3.180, P=0.002). The average ONSD of left eyes was greater in males than in females (t=-3.399, P=0.001). The average ONSD of both eyes increased significantly in MHD patients with diabetes, as compared with those without diabetes (t=-3.824, P＜0.001). In contrast, the average ONSD of both eyes had no differences between the MHD patients with and without coronary heart disease (t=-1.064, P=0.289). Conclusion The distribution of ONSD is closely related to gender and the diabetic nephropathy in MHD patients. Clinically, the left side ONSD is significantly higher than that of right side in male patients with diabetic nephropathy.

Key words： Ultrasound measurement; Optic nerve sheath diameter; Hemodialysis; Intracranial pressure

参考文献

[1] 王卉,邢海英,刘文宏,等.超声测量视神经鞘直径影响因素的研究[J].中华老年心脑血管病杂志,2018,20(10):1066-1068.
[2]LochnerP,LeoneMA,CoppoL,et al.B-mode transorbital ultrasononography for the diagnosis ofacute optic neuritis.A systematic review[J].Clin Neurophysiol,2016,127(1):803-809.
[3] 向红,亢春苗,穆靓,等.高频超声测量正常成人球后3mm处的视神经鞘直径及其相关因素[J].广西医学,2020,42(09):1065-1068.
[4] HansenHC,LagrezeW,KruegerO,etal.Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure-an experimental ultrasoundstudy[J].Acta Ophthalmol,2011,89(6):e528-e532.
[5] 陈艳,林相彬,陈卫挺,等.超声测量视神经鞘直径在创伤性颅脑损伤中的应用价值[J].浙江临床医学,2018,20(4):611-612,615.
[6] 胡述立,汤浩,范学朋,等.超声测量视神经鞘直径评估俯卧位通气时颅内压的变化[J].实用医学杂志,2018,34(9):1520-1523.
[7]Kamran,Munawar,Muhammad Tariq,Khan,Syed Waqar,Hussain,Aayesha,Qadeer,Zahid Siddique,Shad,Sheher,Bano,Azmat,Abdullah.Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound.[J].Cureus,2019,11(2):e4145-e4145.
[8]Mohd,Raffiz,Jafri M,Abdullah.Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients.[J].The American journal of emergency medicine,2017,35(1):150-153.
[9] Lisandro M,Qian Y,Stephen J B,et al.Mean value of B-mode optic nerve sheath diameter as ani ndicator of increased intracranial pressure: a systematic review and meta-analysis.[J].Theultrasound journal,2021,13(1)：234-236.
[10] 罗俏聪,张龙,李艳雅.中国健康成人视神经鞘直径的超声解剖学研究[J].影像研究与医学应用,2018,2(17):46-48.
[11] Geeraerts T,Newcombe V F,Coles J P,et al.Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure[J].Crit Care,2008,12(5):R114-R144.
[12] Maude R R,Hossain M A,Hassan M U,et al.Transorbital sonographic evaluation of normaloptic nerve sheath diameter in healthy volunteers in Bangladesh[J].PLoS One,2013,8(12):e81013-e81013.
[13] Christoph,Schroeder,Aristeidis H,Katsanos,Daniel,Richter,Georgios,Tsivgoulis,Ralf,Gold,Christos,Krogias.Quantification of Optic Nerve and Sheath Diameter by Transorbital Sonography: A Systematic Review and Metanalysis.[J].Journal of neuroimaging : official journal of the American Society of Neuroimaging,2020,30(2):165-174
[14] 陈焕,王小亭,丁欣,等.心脏术后患者视神经鞘宽度与容量状态的相关性研究[J].中华内科杂志,2016,55(10):779-783.
[15] Lund A,Damholt M B,WiisJ,etal.Intracranial pressure during hemodialysis in patients with acute braininjury.[Z].2019:63,493-499.
[16] 于泽洋,宋晓南,李聪,等.超声测量视盘联合视神经鞘对重症高颅压患者的评估价值[J].中风与神经疾病杂志,2021,38(11):976-979.
[17] 孙爱童,冯德喜,郭丽娜,等.超声测量视神经鞘直径预测颅脑损伤患者颅内压增高可行性[J].疑难病杂志,2022,21(03):263-266.
[18] 陈常兴,洪江,刘毅.超声测量视神经鞘直径在临床中的应用进展[J].中国综合临床,2018,34(02):180-183.
[19] Blaivas M,Thedoro D,Sierzenski P R.Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath[J].Acad Emerg Med,2003,10(4):376-381.
[20] 李臻,张旭乡,杨惠青,等.超声测量视神经鞘直径预测颅内压的影响因素研究[J].中国超声医学杂志,2018,34(11):961-964.
[21] WangL,FengL,YaoY,etal.Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population[J].PLoSOne,2015,10(2):e117939-e117939.
[22] Del S P,Redondo-Gonzalez O,Mateu-MateuA,et al.Sonographic assessment of the optic nerve sheath diameter in the diagnosis of idiopathic intracranial hypertension[J].JNeurolSci,2016,361(1):122-127.
[23] Maissan I M,Dirven P J,Haitsma I K,et al.Ultrasonographic measured optic nerve sheath diameter as an accurate and quick monitor for changes in intracranial pressure[J].JNeurosurg,2015,123(3):743-747.
[24] Wang LJ,YaoY,FengLS,et al.Noninvasive and quantitative intracranial pressure estimation using ultrasonographic measurement of optic nerve sheath diameter[J].SciRep,2017,1(7):42063-42063.
[25] Soliman I,Johnson G,Gillman L M,et al.New Optic Nerve Sonography Quality Criteria in the Diagnostic Evaluation of Traumatic Brain Injury[J].Crit Care ResPract,2018,20(18):358-362.
[26] Munawar K,Khan M T,Hussain S W,et al.Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound[J].Cureus,2019,11(2):e4145-e4145.
[27] Genena K H,Ahmed S,Szerlip H M,et al.Half the V by 120:A practical approach to the prevention of the dialysis disequilibrium syndrome.[Z].2021,25(1),424-432.
[28] Fletcher J J,Bergman K,Carlson G,et al.Continuous renal replacement therapy for refractoryintracranial hypertension[J].JTRAUMA,2010,68(6):1506-1509.
[29] 王蕾,朱保锋,张毅,等.健康成年人视神经鞘直径的影响因素分析[J].广西医学,2017,39(12):1862-1864.
[30] 王丽娟,冯良枢,姚燕,等.超声评估中国健康成年人视神经鞘直径[J].中国卒中杂志,,2016,11(7):556-562
[31] Rohit P,Muhammad A B C,Sarah G,et al.Ultrasound of Optic Nerve Sheath Diameter andStroke Outcomes.[J].Critical care explorations,2021,3(11):234-236.
[32] 高孝蓉.集束化护理干预在视神经鞘B超测量监测患者颅内压中的应用[J].国际护理学杂志,2021,40(11):2043-2046.

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