眼部超声与颅内压监测.pptx

眼部超声与颅内压监测 1 2 解剖学基础 3 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 4 5 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 6 测量方法 7 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深度在视网膜下1 2cm 8 9 10 11 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 12 13 参考值 14 1 单侧异常 ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess suchasopticneuritisorcompressiveopticneuropathy Papilledema 视乳头水肿 mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody 15 2 双侧异常 ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable BasedontheinitialstudyofultrasoundmeasurementofONSD 11manyauthorsciteadiameter 5mmaselevatedinpatientsolderthanage4 Tworecentmeta analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP 20cmH2Oandcalculatedapooledsensitivityandspecificityof87 90 and79 85 respectively however thecutoffforabnormalONSDvariedfrom5 0to5 9mminthesestudies withhalfofthestudiesutilizingacutoff 5 7mm 16 临床应用 17 视神经鞘直径 可准确评估颅内压增高 18 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 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 19 视神经鞘直径 脑功能监护 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 20 21 22 ONSD0 8cm0 82cm提醒医生既是检查发现了未知原因的脑梗死大小3cm 2cm 23 评估第三脑室底部造瘘术的标准之一 Opticnervesheathdiameterascriteriaforendoscopicthirdventriculostomyfailureinchildren 24 影响因素 25 1体位 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 26 2肥胖 气腹 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