視神經(jīng)鞘直徑和顱內(nèi)壓專家講座

解剖學基礎(chǔ)視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第1頁解剖學基礎(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鞏膜視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第2頁視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第3頁眼部結(jié)構(gòu)及超聲圖像

眼球及眶周結(jié)構(gòu)視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第4頁視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第5頁視路MRI圖像視神經(jīng)：眼內(nèi)部眶部（ONSD段）管內(nèi)部顱內(nèi)部視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第6頁視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第7頁CriticalCare,12:R114ONSD視神經(jīng)ONSD臨界值5.82mmICP>20mmHg視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第8頁共納入231例敏感性0.90（95%CI0.80-0.95）特異性0.85（95%CI0.73-0.93）IntensiveCareMed()37:1059–1068視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第9頁視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第10頁ConclusionsSonographicmeasurementofONSDmaybeapotentiallyusefultechniqueforassessingIHinabinarymode(present/absent)wheninvasive/monitoringmethodsarenotdesirableoravailable.視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第11頁視神經(jīng)鞘直徑可準確評定顱內(nèi)壓增高？視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第12頁視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第13頁ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP.ONSDexpansioncanpersistevenafterICPcontrol,andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs.Furtherlargersizestudiesareneededtoconfirmthesefindings.視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第14頁影響原因視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第15頁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.18March視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第16頁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.SurgicalEndoscopyJune,Volume30,Issue

6,pp2321–2325視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第17頁測量方法視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第18頁探頭選擇和放置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，防止擠壓眼球（以面頰或者額頭為受力點）4深度在視網(wǎng)膜下1-2cm視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第19頁視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第20頁測量方法和注意事項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視神經(jīng)鞘直徑并求出平均值。3測量對側(cè)視神經(jīng)鞘直徑。視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第21頁視神經(jīng)鞘是顱內(nèi)硬腦膜與蛛網(wǎng)膜下腔延續(xù)，所以顱內(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)壓改變彈性伸縮性最大。

視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第22頁ONSD評定顱內(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視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第23頁參考值視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第24頁1、單側(cè)異常ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess,suchasopticneuritisorcompressiveopticneuropathy.Papilledema（視乳頭水腫）

mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody.視神經(jīng)鞘直徑和顱內(nèi)壓專家講座第25頁2、雙側(cè)異常ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.BasedontheinitialstudyofultrasoundmeasurementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.Tworecentmeta-analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificityof87–90%