Anggun Puspita Dewi, Dzulfikar Djalil Lukmanul Hakim, Sri E Rahayuningsih, N. A. Risan, R. Ghrahani, R. Adrizain
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引用次数: 0
摘要
背景 中枢神经系统(CNS)感染会影响大脑,可导致脑水肿、颅内压(ICP)升高、脑疝和死亡。通过超声波测量视神经鞘直径(ONSD)是一种预测 ICP 的新型无创检查方法,具有较高的灵敏度和特异性。 方法 该横断面研究在西爪哇省万隆市 Hasan Sadikin 医院儿科进行。研究对象通过连续抽样的方式选出。我们测量了ONSD,检查了临床表现,并进行了脑脊液(CSF)检查和中枢神经系统感染的影像学检查。数据分析采用配对 T 检验和单因素方差分析,重大变量采用 Tukey 检验。 结果 32 名儿童患有中枢神经系统感染。最常见的临床症状是发热、意识减退和颈部僵硬。双变量分析显示,ONSD与格拉斯哥昏迷量表(GCS)、CSF中蛋白质水平升高和中枢神经系统感染类型之间存在很强的正相关性。 结论 较大的 ONSD 与较低的 GCS、CSF 蛋白水平升高和特定的中枢神经系统感染有明显关联。ONSD 还与结核性脑膜炎 III 级相关,与其他中枢神经系统感染相比,双眼平均 ONSD 较高。因此,ONSD越高,中枢神经系统感染的程度就越严重。
Optic nerve sheath diameter and severity of central nervous infection
Background Central nervous system (CNS) infection affects the brain, and can cause cerebral edema, increased intracranial pressure (ICP), cerebral herniation, and death. Measurement of the optic nerve sheath diameter (ONSD) by ultrasound is a new, non–invasive examination to predict ICP, with high sensitivity and specificity.Objective To analyze for a possible association between ONSD measured by ultrasonographic examination and severity of CNS infection. Methods This cross–sectional study was performed in the Pediatric Department of Hasan Sadikin Hospital, Bandung, West Java. Subjects were chosen by consecutive sampling. We measured ONSD, examined clinical manifestations, as well as performed a cerebrospinal fluid (CSF) study and imaging of CNS infection. Data analysis was done by paired T–test and one–way ANOVA, followed by Tukey test on significant variables. Results Subjects consisted of 32 children with CNS infection. The most common clinical symptoms were fever, decreased consciousness, and nuchal rigidity. Bivariate analysis revealed strong positive associations between ONSD and Glasgow Coma Scale (GCS), increased protein levels in CSF, and type of CNS infection. Conclusion Larger ONSD is significantly associated with lower GCS, increases CSF protein, and particular CNS infections. The ONSD is also associated with meningitis tuberculosis grade III, with a higher mean ONSD of both eyes compares to other CNS infections. Hence, the higher the ONSD, the more severe the degree of CNS infection.