眼部超声与颅内压监测课件

眼部超声与颅内压监测OcularutrasoundGreggL.ChesneyPaulK.MohabirKEYPOINTSMeasurementotheoptcnervesheathdiameterONSD)byocularultrasoundprovdesarapid,noninvasivequanttativemethcdtoassessforelevatedintracranialpressureatthebedside,withameasurementof>5mmconsideredelevatedOcularultrasoundisavaluabletoolintheevaluationdfoculartraumaandcanbeusedoassessforforeignbody,globerupture,traumaticdetachments,lensdislocation,andvitreoushemorrageInpatientswithpainlessvisionloss,ocularultrasoundcanbeusedtoevaluateforposte-norvitreousdetachmentorretinaldetachmentandforthepresenoeofbloodfowinthecentralretinalarteryandvein解剖学基础ipperldraturePupillaryaperature瞳孔cornearis虹膜AnteriorhambarCornea角膜ClarybodyCiliarybody睫状体ens晶状体vitreousbodyVitreousbody玻璃体ina视网膜Choroid脉络膜Sclera巩膜opticnenve-isopicnerveCertralretinalarteryandvEinFigure31.1NormalocUlaranatcmy.elidComeauD2SHzAnterior一chamberIrisFigure31.2NormalutrasoundofVitreousbodytheeye.AnatomicstructuresthatRetinacanbevisuaizedonanormalocularutrasoundincudethecorneaante-Opticnerve-norchamber,iris,pupil,lens,vitreousbody,retina,andopticnerve.Theretinaappearsasasinglestructurealongwiththechoroidandscleraasthepostenorwalloftheglobe视神经鞘是颅内硬脑膜与蛛网膜下腔的延续,因此颅内压増高将直接増大视神经鞘直径。测量主要在眼球后3mm处,因为该处随颅内压变化的弹性伸缩性最大。AO52%测量方法探头的选择和放置·1选择高频线阵探头(75MHzorgreater·2无菌贴膜覆盖眼球3充分耦合,避免挤压眼球(以面颊或者额头为受力点)·4深度在视网膜下1-2cmHgure31.3Propertransducerplacementtoobtaintransverseviews.Atransparentfilmdressingcow-Figure314Propertransducerplacementtoobtainerstheclosedeyelid.Thetransducerisheldlikeapen,andthefingersandpalmarerestedonthezygomaticarchandbridgeofthenosetostabilzethetransducer.Notethecopiousamountofgelu