眼部超聲與顱內(nèi)壓監(jiān)測第1頁/共29頁解剖學基礎(chǔ)第2頁/共29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鞏膜第3頁/共29頁第4頁/共29頁視神經(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。

第5頁/共29頁測量方法第6頁/共29頁探頭的選擇和放置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第7頁/共29頁第8頁/共29頁第9頁/共29頁第10頁/共29頁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。Itisimperativetoacquireatrueon-axis,longitudinalcrosssectionoftheopticnervesheathbecauseoff-axisimagingresultsinerroneousmeasurementoftheONSD.第11頁/共29頁第12頁/共29頁參考值第13頁/共29頁1、單側(cè)異常ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess,suchasopticneuritisorcompressiveopticneuropathy.Papilledema（視乳頭水腫）

mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody.第14頁/共29頁2、雙側(cè)異常ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.BasedontheinitialstudyofultrasoundmeasurementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.Tworecentmeta-analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificityof87–90%and79–85%,respectively;however,thecutoffforabnormalONSDvariedfrom5.0to5.9mminthesestudies,withhalfofthestudiesutilizingacutoff≥5.7mm.第15頁/共29頁臨床應(yīng)用第16頁/共29頁視神經(jīng)鞘直徑#可準確評估顱內(nèi)壓增高第17頁/共29頁視神經(jīng)鞘直徑#可準確預測心肺復蘇的結(jié)局Afteradjustmentonpredictivefactors,ONSD1wassignificantlyassociatedwithin-hospitalmortality(OR6.3;95%CI[1.05-40]permmofONSD1above5.5mm;p=0.03),andCPCscore(ORfor1pointincreaseinCPCscore:3.2;95%CI[1.2-9.4]permmofONSD1above5.5mm;p=0.03).ONSD1wassignificantlycorrelatedwithbrainedemaassessedbythecerebrumgraymatterattenuationtowhitematterattenuationratio,measuredbythebraincomputedtomographyscanperformedonadmissionin20patients(Spearmanrho=-0.5,p=0.04).Resuscitation.2016Jun;103:7-13.doi:10.1016/j.resuscitation.2016.03.006.Epub2016Mar16.

第18頁/共29頁視神經(jīng)鞘直徑#腦功能監(jiān)護Theopticnervesheathdiameterhasbeenverifiedbyvariousclinicalstudiesasanon-invasiveindicatorofintracranialhypertension.Theaimofthisstudywastocomparetheopticnervesheathdiameterbeforeandimmediatelyafterventriculo-peritonealshuntsurgeryinchildrenwithhydrocephalus.Weanalysedtransorbitalultrasonographicimagesrecordedafterinductionofanaesthesiaand30minaftershuntinsertionin34children,measuringtheopticnervesheathdiametersusingalinearultrasoundprobe.Themean(SD)opticnervesheathdiameterswere5.4(0.6)mm(right)and5.3(0.7)mm(left)beforesurgeryand4.4(0.5)mm(right)and4.5(0.7)mm(left)aftersurgery(p<0.0001forbeforeandaftercomparisonsforbotheyes).Thetechniqueallowsrapidandnon-invasiveassessmentofintracranialpressuretoguideappropriatepostoperativemanagement.Anaesthesia.70(11):1268-1273,November2015.第19頁/共29頁第20頁/共29頁第21頁/共29頁ONSD0.8cm0.82cm提醒醫(yī)生既是檢查發(fā)現(xiàn)了未知原因的腦梗死大小3cm2cm第22頁/共29頁評估第三腦室底部造瘺術(shù)的標準之一Opticnervesheathdiameterascriteriaforendoscopicthirdventriculostomyfailureinchildren.第23頁/共29頁影響因素第24頁/共29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.18March2016第25頁/共29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),and5.1and5.7