Estimation of elevated intracranial pressure in infants with hydroce-phalus by using transcranial Doppler velocimetry with fontanel compression.
Estimation of elevated intracranial pressure in infants with hydroce-phalus by using transcranial Doppler velocimetry with fontanel compression.
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DOI：
10.1038/s41598-018-30274-3
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发表时间：
2018-08-07
影响因子：
4.6
通讯作者：
Iwata O
中科院分区：
文献类型：
--
作者：
Yoshizuka T;Kinoshita M;Iwata S;Tsuda K;Kato T;Saikusa M;Shindou R;Hara N;Harada E;Takashima S;Takeshige N;Saitoh S;Yamashita Y;Iwata O
对于急性进行性脑积水的婴儿，脑脊液(CSF)的有创性引流直到能够插入脑室-腹膜分流管为止。颅内压替代标志物(ICP)可能有助于优化侵入性手术的时机。为了评估RI是否有助于区分正常(<；5 cmH2O)、轻度(5-11 cmH2O)和中度(>；11 cmH2O)颅内压升高的婴儿，我们评估了去除脑脊液前后74项颅内压测量和148项相关的大脑中动脉多普勒测量。较高的阻力指数与颧骨受压、颅内压升高及其相互作用有关(均p <； 0.001)。在无压迫的情况下，RI在正常和中度之间(p <； 0.001)和轻度和中度颅内压升高之间(p = 0.033)之间有差异。在受压的情况下，正常、轻度和中度颅内压升高之间的所有成对比较的RI都有差异(均p <； 0.001)。在没有压缩的情况下，受试者操作特征曲线下预测轻度和中度颅内压升高的面积分别为0.664(95%可信区间，0.538-0.791；p = 0.020)和0.727(95%可信区间，0.582-0.872；p = 0.004)，提高到0.806(95%可信区间，0.703-0.910；p <； )和0.814(95%可信区间，0.707-0.921；p <； 0.001)，并进行压缩。对于无、轻度和中度颅内压升高的婴幼儿，采用颧骨加压的RI可改善其辨别能力。
For infants with acute progressive hydrocephalus, invasive drainage of cerebrospinal fluid (CSF) is performed until a ventriculo-peritoneal shunt can be inserted. Surrogate markers of intracranial pressure (ICP) may help optimise the timing of invasive procedures. To assess whether RI with/without fontanel compression helps distinguish between infants with normal (<5 cmH2O), mild (5–11 cmH2O), and moderate (>11 cmH2O) ICP elevation, 74 ICP measures before/after CSF removal and 148 related Doppler measures of the middle cerebral artery were assessed. Higher RI was associated with fontanel compression, elevated ICP, and their interaction (all p < 0.001). Without compression, differences in RI were observed between normal and moderate (p < 0.001) and between mild and moderate ICP elevation (p = 0.033). With compression, differences in RI were observed for all pairwise comparisons among normal, mild, and moderate ICP elevation (all p < 0.001). Without compression, areas under the receiver-operating characteristic curve for prediction of mild and moderate ICP elevation were 0.664 (95% confidence interval (CI), 0.538–0.791; p = 0.020) and 0.727 (95% CI, 0.582–0.872; p = 0.004), respectively, which improved to 0.806 (95% CI, 0.703–0.910; p < 0.001) and 0.814 (95% CI, 0.707–0.921; p < 0.001), respectively, with compression. RI with fontanel compression provides improved discrimination of infants with absent, mild, and moderate ICP elevation.
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影响因子：
19.7
作者：
TAYLOR, GA;PHILLIPS, MD;JAMES, CS
通讯作者：
JAMES, CS
影响因子：
4.2
作者：
Cardim, Danilo;Robba, Chiara;Czosnyka, Marek
通讯作者：
Czosnyka, Marek
影响因子：
8
作者：
Adams-Chapman, Ira;Hansen, Nellie I.;Higgins, Rose
通讯作者：
Higgins, Rose
影响因子：
8
作者：
Rintoul, NE;Sutton, LN;Adzick, NS
通讯作者：
Adzick, NS
影响因子：
2.3
作者：
Nishimaki, S;Iwasaki, Y;Akamatsu, H
通讯作者：
Akamatsu, H