Clinical Study On The Relationship Between Optic Nerve Sheath And Intracranial Pressure In Children Monitored By Bedside Ultrasound

Objective:Monitoring the optic nerve sheath diamete(ONSD)in children with severe neurological diseases by bedside ultrasound.Analyze the relationship between ONSD and intracranial pressure(ICP)in children with severe neurological diseases.Methods: Children with severe neurological diseases in pediatric intensive care unit of Shengjing Hospital affiliated to China Medical University in 2021 were selected.The cerebrospinal fluid pressure in lumbar cistern was measured by lumbar puncture instead of ICP.ONSD was monitored on the 1st,2nd and 3rd day after lumbar puncture and when the patient was discharged from hospital or his condition was stable.The basic situation,mechanical ventilation,hospitalization time and related scores were collected.According to age and ICP,ONSD was compared among groups.Results: Among the 50 cases,the ONSD in ICP-increased group(6.03±0.64mm)was wider than that in ICP-normal group(5.64±0.66mm)(P<0.05).ONSD in ICPincreased group(6.61±0.50mm)over 4 years old was significantly wider than that in ICP-normal group(5.86±0.41mm)(P< 0.05).There was only one case in ICP-normal group of 1-4 years old,and the ONSD was 4.50 mm,and the ONSD in ICP-increased group was 5.82±0.37mm;ONSD in ICP-increased group(5.47± 0.41mm)under one year old was significantly wider than that in ICP-normal group(4.52±0.53mm)(P<0.05).In ICP-increased group,the larger the age,the wider the ONSD is(P< 0.05),which are 6.61±0.50 mm,5.82±0.37 mm and 5.47±0.41mm;And in the group of >4years old,Spearman correlation analysis showed that ICP was positively correlated with ONSD(r= 0.564,P< 0.05),the optimal critical value was 5.85 mm,and the sensitivity and specificity were 100.00% and 60.00% respectively,the area under receiver operating characteristic curve was 0.880(95% CI: 0.757-1.000,P < 0.05).In ICP-normal group,there was no significant difference in ONSD between 3consecutive days and before discharge or when the condition was stable(F=1.234,P=0.309).In ICP-increased group,there was significant difference in ONSD between3 consecutive days and before discharge or when the condition was stable.(P < 0.05),and the ONSD of children with ICP-increased was significantly narrowed after treatment.Conclusion: Ultrasonic monitoring of ONSD can be used to dynamically evaluate ICP in children with severe neurological diseases.The optimal critical value of ONSD in the diagnosis of ICP increase in children over 4 years old is 5.85 mm,and ONSD can reflect the therapeutic effect of children with severe neurological diseases to some extent.As a real-time,dynamic,simple and repeatable tool,ultrasonic monitoring ONSD can be widely used in intensive care unit.