视神经鞘直径联合相对α变异性对儿童颅脑损伤预后的价值分析

Predictive value of optic nerve sheath diameter combined with relative alpha variability for the prognosis of craniocerebral injury in children

摘要:

目的 探究视神经鞘直径（ONSD）联合相对α变异性（RAV）对儿童创伤性颅脑损伤预后的价值。方法 选取2022年9月—2023年12月内蒙古医科大学附属医院收治的80例创伤性颅脑损伤患儿作为观察对象。患儿入院72 h时行超声检查和床旁量化脑电图检测，同时行生命体征监测和常规治疗，每日行意识状态评估，根据患儿入院28 d的颅脑损伤预后情况分为良好组和不良组。比较不同预后患儿ONSD、RAV指标，分析患儿ONSD、RAV指标与改良儿童格拉斯哥昏迷评分（MPGCS）、急性生理和慢性健康状况评分（APACHE）Ⅱ系统评分的相关性，采用受试者工作特征（ROC）曲线评估患儿颅脑损伤预后的价值。结果 预后良好组重度患儿占比、入院72 h时APACHE Ⅱ评分均低于预后不良组（P <0.05），入院72 h时MPGCS评分高于预后不良组（P <0.05）。两组患儿性别构成、年龄、体质量指数比较，差异均无统计学意义（P >0.05）。预后良好组入院24 h与72 h时ONSD的差值高于预后不良组（P <0.05），RAV的差值低于不良组（P <0.05）。患儿入院72 h时ONSD水平与APACHE Ⅱ评分呈正相关（r =0.376，P <0.05），与MPGCS评分呈负相关（r =-0.442，P <0.05）。患儿入院24 h时ONSD水平与APACHE Ⅱ评分呈负相关（r =-0.401，P <0.05），与MPGCS评分呈正相关（r =0.398，P <0.05）。患儿入院72 h时RAV水平与APACHE Ⅱ评分呈负相关（r =-0.421，P <0.05），与MPGCS评分呈正相关（r =0.413，P <0.05）。ROC曲线分析结果显示，患儿入院72 h时MPGCS评分、ONSD水平和RAV水平曲线下面积分别为0.753、0.673、0.793。入院72 h时ONSD、RAV水平联合预测效能最高，敏感性和特异性分别为88.2%（95% CI：0.695，0.974）、85.7%（95% CI：0.684，0.971）。结论 ONSD、RAV指标对颅脑损伤患儿有一定的预后价值，且于入院72 h时联合预测效能最佳。

Abstract:

Objective To explore the predictive value of optic nerve sheath diameter (ONSD) combined with relative alpha variability (RAV) for the prognosis of craniocerebral injury in children.Methods Eighty children with traumatic craniocerebral injury admitted to our hospital from September 2022 to December 2023 were selected, and children were subjected to bedside ultrasonography and quantitative electroencephalography at 72 h of admission, as well as the monitoring of vital signs, routine treatment, and daily assessment of their state of consciousness. Children were categorized into the good group and the poor group based on the prognosis at 28 days of admission. ONSD and RAV were compared between the two groups, and their correlations with the Modified Pediatric Glasgow Coma Scale (MPGCS) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were analyzed. The receiver operating characteristic (ROC) curve was plotted to determine the predictive value of ONSD and RAV for the prognosis of children with craniocerebral injury.Results The proportion of severe cases and the APACHE II scores at 72 h of admission in the good group were lower than those in the poor group (P < 0.05), while the MPGCS scores at 72 h of admission in the good group were higher than those in the poor group (P < 0.05). There was no significant difference in sex, age and BMI between the two groups as assessed by the Chi-square test or t-test (P > 0.05). The difference of ONSD in the good group was higher than that in the poor group (P < 0.05), whereas the difference of RAV in the good group was lower than that in the poor group (P < 0.05). The ONSD at 72 h of admission was positively correlated with the APACHE II scores (r = 0.376, P < 0.05), and negatively correlated with the MPGCS scores (r = -0.442, P < 0.05). The ONSD at 24 h of admission was negatively correlated with the APACHE II scores (r = -0.401, P < 0.05), and positively correlated with the MPGCS scores (r = 0.398, P <0.05). The RAV at 72 h of admission was negatively correlated with the APACHE II scores (r = -0.421, P < 0.05), and positively correlated with the MPGCS scores (r = 0.413, P < 0.05). The ROC curve analysis revealed that all of the MPGCS scores, ONSD and RAV at 72 h of admission could predict the prognosis of children, with the areas under the ROC curves being 0.753, 0.673 and 0.793, respectively. The combination of ONSD and RAV at 72 h of admission had the highest predictive efficacy, with a sensitivity of 88.2% (95% CI: 0.695, 0.974) and a specificity of 87.3% (95% CI: 0.684, 0.971).Conclusions ONSD and PAV are of certain predictive value for the prognosis of children with craniocerebral injury, and their combined detection at 72 h of admission yields the optimal predictive efficacy.