Feasibility of Optic Nerve Sheath Diameter to Guide the Treatment of Dehydration in Patients Undergoing Glioma Surgery
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摘要:
目的 探讨超声测量视神经鞘直径（ONSD）对神经胶质瘤手术患者颅高压（ICH）脱水治疗效果的可行性。 方法 选取择期行额部神经胶质瘤切除术的颅高压患者共40例，随机分为2组（n = 20）。在气管插管10 min后，甘露醇组（M组）予20%甘露醇0.5 g/kg在15 min内静脉滴注完毕，对照组（C组）予等量生理盐水在15 min内静脉滴注完毕。测量麻醉诱导前（T0）、气管插管后即刻（T1）、药物开始滴注时（T2）、药物滴注完毕后30 min（T3）、手术结束即刻（T4）、术后24 h（T5）双眼的ONSD值。检测各时刻血清中VEGF-A、MMP-9和ET-1水平。记录打开硬脑膜时的大脑松弛评分（BRS）。 结果 T3、T4、T5时刻，M组患者的ONSD值、血清中VEGF-A 、MMP-9、ET-1的浓度明显低于C组患者（P < 0.05）；M组患者的BRS评分明显低于C组患者（P < 0.05）。 结论 对术前存在颅内高压的神经胶质瘤患者，在视神经鞘直径的指导下提前给予脱水治疗，可有效减轻脑水肿。 Abstract:Objective To investigate the feasibility of ultrasonic measurement of optic nerve sheath diameter （ONSD） in the treatment of dehydration of intracranial hypertension （ICH） in patients undergoing glioma surgery. Methods A total of 40 patients with cranial hypertension who underwent elective frontal glioma resection were randomly divided into 2 groups （n = 20）. After 10 minutes of endotracheal intubation, Group M was given 20% mannitol 0.5 g/kg intravenously within 15 minute; Group C was given the same amount of normal saline intravenously within 15 minutes. ONSD values of both eyes were measured before anesthesia induction （T0）, immediately after endotracheal intubation （T1）, at the beginning of drug infusion （T2）, 30 min after drug infusion （T3）, immediately after surgery （T4）, and 24 h after surgery （T5）. The levels of VEGF-A, MMP-9 and ET-1 in serum at each time were detected. Cerebral relaxation score （BRS） was recorded when the dura was opened. Results At T3, T4 and T5, the ONSD value and serum concentrations of VEGF-A, MMP-9 and ET-1 in group M were significantly lower than those in group C （P < 0.05）. BRS score in M group was significantly lower than that in C group （P < 0.05）. Conclusion For glioma patients with intracranial hypertension before operation, dehydration treatment in advance under the guidance of optic nerve sheath diameter can effectively reduce cerebral edema. -
Key words:
- Optic nerve sheath diameter /
- Glioma /
- Intracranial pressure /
- Dehydration
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图 1 T0-T6各时刻视神经鞘直径的超声图像
Figure 1. Ultrasonic image of optic nerve sheath diameter at each time from T0 to T6
表 1 2组患者一般情况的比较（
$\bar x \pm s $ ，n = 20）Table 1. Comparison of general conditions between two groups of patients（
$\bar {\boldsymbol{x}} \pm {\boldsymbol{s}}$ ，n = 20）组别 年龄
（岁）性别
男/女（n）BMI
（kg/m2）ASAI/II
（n）肿瘤位置
左/右（n）肿瘤体积
（cm3）C组 41.7 ± 9.8 8/12 21.9 ± 1.1 10/10 11/9 44.5 ± 2.7 M组 41.4 ± 10.1 11/9 22.0 ± 1.0 11/9 13/7 45.6 ± 2.4 t/χ2 0.006 0.902 0.121 0.100 0.417 1.935 P 0.937 0.342 0.730 0.752 0.519 0.172 
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表 2 2组患者在不同时刻双侧ONSD值的比较（
$\bar x \pm s $ ，n = 20，mm）Table 2. Comparison of bilateral ONSD values between two groups at different time（
$\bar {\boldsymbol{x}} \pm {\boldsymbol{s}}$ ，n = 20，mm）部位 组别 T0 T1 T2 T3 T4 T5 左侧 C组 6.31 ± 0.28 7.18 ± 0.35* 6.31 ± 0.28 6.29 ± 0.30 4.99 ± 0.18* 5.51 ± 0.16* M组 6.43 ± 0.29 7.26 ± 0.37* 6.43 ± 0.28 6.00 ± 0.24*# 4.46 ± 0.19*# 5.10 ± 0.20*# F 2.410 0.729 2.128 14.948 128.119 78.090 P 0.137 0.404 0.161 < 0.01# < 0.01# < 0.01# 右侧 C组 6.22 ± 0.21 7.00 ± 0.23* 6.21 ± 0.18 6.18 ± 0.12 4.82 ± 0.10* 5.38 ± 0.08* M组 6.24 ± 0.22 7.03 ± 0.16* 6.25 ± 0.20 5.89 ± 0.19*# 4.41 ± 0.19*# 4.93 ± 0.20*# F 0.416 0.222 1.976 60.181 105.733 90.717 P 0.527 0.643 0.176 < 0.01# < 0.01# < 0.01# 与T0时刻比较，*P < 0.05；与C组比较，#P < 0.05
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表 3 2组患者BRS评分的比较（
$\bar x \pm s$ ，n = 20，分）Table 3. Comparison of BRS score between two groups（
$\bar {\boldsymbol{x}} \pm{\boldsymbol{ s}}$ ，n = 20，Points）组别 BRS评分 C组 3.0 ± 0.6 M组 1.7 ± 0.5# t 5.814 P < 0.01# 与C组比较，#P < 0.05。
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表 4 2组患者在不同时刻血清VEGF-A、MMP-9、ET-1浓度的比较（
$\bar x \pm s $ ，n = 20，pg/mL）Table 4. Comparison of serum VEGF-A, MMP-9 and ET-1 concentrations between 2 groups at different time points（
$\bar {\boldsymbol{x}} \pm {\boldsymbol{s}}$ ，n = 20，pg/mL）指标 组别 T0 T3 T4 T5 VEGF-A C组 162.11 ± 9.60 161.56 ± 9.52 143.29 ± 10.33* 158.15 ± 10.05* M组 160.59 ± 11.61 149.14 ± 11.32*# 123.01 ± 11.44*# 130.18 ± 10.10*# F 1.084 59.675 102.747 90.252 P 0.311 < 0.01# < 0.01# < 0.01# MMP-9 C组 23.28 ± 2.72 23.53 ± 2.51 19.15 ± 2.59* 20.71 ± 2.07* M组 23.41 ± 2.78 19.70 ± 2.43*# 15.52 ± 2.16*# 17.38 ± 1.94*# F 0.459 285.752 280.944 126.377 P 0.506 < 0.01# < 0.01# < 0.01# ET-1 C组 86.74 ± 8.30 86.34 ± 7.79 67.68 ± 8.87* 73.89 ± 8.54* M组 86.40 ± 9.14 80.08 ± 7.35*# 52.52 ± 8.70*# 64.20 ± 8.05*# F 0.245 63.927 515.625 171.555 P 0.626 < 0.01# < 0.01# < 0.01# 与T0时刻比较，*P < 0.05；与C组比较，#P < 0.05。
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