201683李志鹏眼部超声与颅内压监测课件

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1、眼部超声与颅内压监测佛山市禅城区中心医院李志鹏解剖学基础解剖学基础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巩膜视神经鞘是颅内硬脑膜与蛛网膜下腔的延续，因此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，因为该处随颅内压变化的弹性伸缩性最大。测量方法探头的选择和放置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，避免挤压眼球（以面颊或者额头为受力点）4深度在视

2、网膜下1-2cm测量的方法和注意事项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的视神经鞘直径并求出平均值。3测量对侧视神经鞘的直径。Itisimperativetoacquireatrueon-axis,longitudinalcrosssectionoftheopticnervesheathbecauseoff-axisimagingresultsinerroneousmeasurementoftheONSD.参考值1、单侧异常ThepresenceofunilateralincreasedONSDsuggestsalater

3、alizingprocess,suchasopticneuritisorcompressiveopticneuropathy.Papilledema（视乳头水肿）mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody.2、双侧异常ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.Basedontheinitialstudyofultrasoundmeasur

4、ementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.Tworecentmeta-analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificityof87–90%and79–85%,respectively;however,thecutoffforabnormalONSDvariedfrom5.0

5、to5.9mminthesestudies,withhalfofthestudiesutilizingacutoff≥5.7mm.临床应用视神经鞘直径#可准确评估颅内压增高视神经鞘直径#可准确预测心肺复苏的结局Afteradjustmentonpredictivefactors,ONSD1wassignificantlyassociatedwithin-hospitalmortality(OR6.3;95%CI[1.05-40]permmofONSD1above5.5mm;p=0.03),andCPCscore(ORfor1pointincreasei

6、nCPCscore:3.2;95%CI[1.2-9.4]permmofONSD1above5.5mm;p=0.03).ONSD1wassignificantlycorrelatedwithbrainedemaassessedbythecerebrumgraymatterattenuationtowhitematterattenuationratio,measuredbythebraincomputedtomographyscanperformedonadmissionin20patients(Spearmanrho=-0.5,p=0.04).Resus

7、citation.2016Jun;103:7-13.doi:10.1016/j.resuscitation.2016.03.006.Epub2016Mar16.视神经鞘直径#脑功能监护Theopticnervesheathdiameterhasbeenverifiedbyvariousclinicalstudiesasanon-invasiveindicatorofintracranialhypertension.Theaimofthisstudywastocomparetheopticnervesheathdiameterbeforeandimmed

8、iatelyafterventriculo-peritonealshuntsurgeryinc