視神經(jīng)鞘直徑與顱內(nèi)壓.ppt

視神經(jīng)鞘直徑 ONSD 與顱內(nèi)壓 ICP 重癥醫(yī)學(xué)科 解剖學(xué)基礎(chǔ) 解剖學(xué)基礎(chǔ) Pulillaryaperature瞳孔Iris虹膜Cornea角膜Ciliarybody睫狀體Lens晶狀體Vitreousbody玻璃體Retina視網(wǎng)膜Choroid脈絡(luò)膜Sclera鞏膜 眼部結(jié)構(gòu)及超聲圖像眼球及眶周結(jié)構(gòu) 視路MRI圖像 視神經(jīng) 眼內(nèi)部眶部 ONSD段 管內(nèi)部顱內(nèi)部 CriticalCare2008 12 R114 ONSD 視神經(jīng) ONSD臨界值5 82mmICP 20mmHg 共納入231例敏感性0 90 95 CI0 80 0 95 特異性0 85 95 CI0 73 0 93 IntensiveCareMed 2011 37 1059 1068 ConclusionsSonographicmeasurementofONSDmaybeapotentiallyusefultechniqueforassessingIHinabinarymode present absent wheninvasive monitoringmethodsarenotdesirableoravailable 視神經(jīng)鞘直徑可準(zhǔn)確評估顱內(nèi)壓增高 ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP ONSDexpansioncanpersistevenafterICPcontrol andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs Furtherlargersizestudiesareneededtoconfirmthesefindings 影響因素 1 體位 EffectsofPronePositionandPositiveEnd ExpiratoryPressureonNoninvasiveEstimatorsofICP APilotStudy Results ThemeanvaluesofONSD ICPFVd andICPPIsignificantlyincreasedafterchangefromsupinetoproneposition Receiveroperatingcharacteristicanalysesdemonstratedthat amongthenoninvasivemethods themeanONSDmeasurehadthegreatestareaunderthecurvesignifyingitisthemosteffectiveindistinguishingahypotheticalchangeinICPbetweensupineandpronepositioning 0 86 0 034 0 79to0 92 Acutoffof0 43cmwasfoundtobeabestseparatorofONSDvaluebetweensupineandpronewithaspecificityof75 0andasensitivityof86 7 Conclusions NoninvasiveICPestimationmaybeusefulinpatientsatriskofdevelopingintracranialhypertensionwhorequirepronepositioning JournalofNeurosurgicalAnesthesiology 18March2016 2肥胖 氣腹 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 SurgicalEndoscopyJune2016 Volume30 Issue6 pp2321 2325 測量方法 探頭的選擇和放置 1選擇高頻線陣探頭 7 5MHzorgreater 2無菌貼膜覆蓋眼球3充分耦合 避免擠壓眼球 以面頰或者額頭為受力點 4深度在視網(wǎng)膜下1 2cm 測量的方法和注意事項 1測量位置 位于視網(wǎng)膜和視神經(jīng)交界處深部3mm2分別測量長軸和短軸的視神經(jīng)鞘直徑并求出平均值 3測量對側(cè)視神經(jīng)鞘的直徑 視神經(jīng)鞘是顱內(nèi)硬腦膜與蛛網(wǎng)膜下腔的延續(xù) 因此顱內(nèi)壓增高將直接增大視神經(jīng)鞘直徑 測量主要在眼球后3mm處 因為該處隨顱內(nèi)壓變化的彈性伸縮性最大 ONSD評估顱內(nèi)壓力測量方法 冠狀位測量球后3mm處ONSD 3次均值正常上限值5mm矢狀位測量球后3mm處ONSD 3次均值正常上限值5 8mm 參考值 1 單側(cè)異常 ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess suchasopticneuritisorcompressiveopticneuropathy Papilledema 視乳頭水腫 mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody 2 雙側(cè)異常 ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable BasedontheinitialstudyofultrasoundmeasurementofONSD 11manyauthorsciteadiameter 5mmaselevatedinpatientsolderthanage4 Tworecentmeta analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP 20cmH2Oandcalculatedapooledsensitivityandspeci