视神经鞘直径和颅内压专家讲座

解剖学基础视神经鞘直径和颅内压专家讲座第1页解剖学基础Pulillaryaperature瞳孔Iris虹膜Cornea角膜Ciliarybody睫状体Lens晶状体Vitreousbody玻璃体Retina视网膜Choroid脉络膜Sclera巩膜视神经鞘直径和颅内压专家讲座第2页视神经鞘直径和颅内压专家讲座第3页眼部结构及超声图像

眼球及眶周结构视神经鞘直径和颅内压专家讲座第4页视神经鞘直径和颅内压专家讲座第5页视路MRI图像视神经：眼内部眶部（ONSD段）管内部颅内部视神经鞘直径和颅内压专家讲座第6页视神经鞘直径和颅内压专家讲座第7页CriticalCare,12:R114ONSD视神经ONSD临界值5.82mmICP>20mmHg视神经鞘直径和颅内压专家讲座第8页共纳入231例敏感性0.90（95%CI0.80-0.95）特异性0.85（95%CI0.73-0.93）IntensiveCareMed()37:1059–1068视神经鞘直径和颅内压专家讲座第9页视神经鞘直径和颅内压专家讲座第10页ConclusionsSonographicmeasurementofONSDmaybeapotentiallyusefultechniqueforassessingIHinabinarymode(present/absent)wheninvasive/monitoringmethodsarenotdesirableoravailable.视神经鞘直径和颅内压专家讲座第11页视神经鞘直径可准确评定颅内压增高？视神经鞘直径和颅内压专家讲座第12页视神经鞘直径和颅内压专家讲座第13页ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP.ONSDexpansioncanpersistevenafterICPcontrol,andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs.Furtherlargersizestudiesareneededtoconfirmthesefindings.视神经鞘直径和颅内压专家讲座第14页影响原因视神经鞘直径和颅内压专家讲座第15页1、

体位EffectsofPronePositionandPositiveEnd-ExpiratoryPressureonNoninvasiveEstimatorsofICP:APilotStudy.Results:ThemeanvaluesofONSD,ICPFVd,andICPPIsignificantlyincreasedafterchangefromsupinetoproneposition.Receiveroperatingcharacteristicanalysesdemonstratedthat,amongthenoninvasivemethods,themeanONSDmeasurehadthegreatestareaunderthecurvesignifyingitisthemosteffectiveindistinguishingahypotheticalchangeinICPbetweensupineandpronepositioning(0.86+/-0.034[0.79to0.92]).Acutoffof0.43cmwasfoundtobeabestseparatorofONSDvaluebetweensupineandpronewithaspecificityof75.0andasensitivityof86.7.Conclusions:NoninvasiveICPestimationmaybeusefulinpatientsatriskofdevelopingintracranialhypertensionwhorequirepronepositioning.JournalofNeurosurgicalAnesthesiology.18March视神经鞘直径和颅内压专家讲座第16页2肥胖、气腹Therewere62subjects,28females(45.2%)and34males(54.8%),withameanageof44.22±10.44years(range23–66).Forty-eightpercentofpatientswerenon-obese,and52%ofpatientswereobese.Themeanbodymassindexwas30.70±7.61kg/m2(range20.0–59.5).ThemeanONSDofnon-obeseandobesepatientswas4.7and5.5mmatbaseline(p=0.01),5.4and6.2mmat15min(p=0.01),5.8and6.6mmat30min(p=0.01),and5.1and5.7mmafterdeflationofpneumoperitoneum

(p=0.03),respectively.SurgicalEndoscopyJune,Volume30,Issue

6,pp2321–2325视神经鞘直径和颅内压专家讲座第17页测量方法视神经鞘直径和颅内压专家讲座第18页探头选择和放置1选择高频线阵探头(7.5MHzorgreater).2无菌贴膜覆盖眼球3充分耦合，防止挤压眼球（以面颊或者额头为受力点）4深度在视网膜下1-2cm视神经鞘直径和颅内压专家讲座第19页视神经鞘直径和颅内压专家讲座第20页测量方法和注意事项1测量位置：位于视网膜和视神经交界处深部3mm2分别测量长轴和短轴视神经鞘直径并求出平均值。3测量对侧视神经鞘直径。视神经鞘直径和颅内压专家讲座第21页视神经鞘是颅内硬脑膜与蛛网膜下腔延续，所以颅内压增高将直接增大视神经鞘直径。测量主要在眼球后3mm处，因为该处随颅内压改变弹性伸缩性最大。

视神经鞘直径和颅内压专家讲座第22页ONSD评定颅内压力测量方法：冠状位测量球后3mm处ONSD,3次均值正常上限值5mm矢状位测量球后3mm处ONSD,3次均值正常上限值5.8mm视神经鞘直径和颅内压专家讲座第23页参考值视神经鞘直径和颅内压专家讲座第24页1、单侧异常ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess,suchasopticneuritisorcompressiveopticneuropathy.Papilledema（视乳头水肿）

mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody.视神经鞘直径和颅内压专家讲座第25页2、双侧异常ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.BasedontheinitialstudyofultrasoundmeasurementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.Tworecentmeta-analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificityof87–90%