视神经鞘直径与颅内压ppt课件.ppt

视神经鞘直径 ONSD 与颅内压 ICP 重症医学科 1 解剖学基础 2 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 3 4 眼部结构及超声图像眼球及眶周结构 5 6 视路MRI图像 视神经 眼内部眶部 ONSD段 管内部颅内部 7 8 CriticalCare2008 12 R114 ONSD 视神经 ONSD临界值5 82mmICP 20mmHg 9 共纳入231例敏感性0 90 95 CI0 80 0 95 特异性0 85 95 CI0 73 0 93 IntensiveCareMed 2011 37 1059 1068 10 11 ConclusionsSonographicmeasurementofONSDmaybeapotentiallyusefultechniqueforassessingIHinabinarymode present absent wheninvasive monitoringmethodsarenotdesirableoravailable 12 视神经鞘直径可准确评估颅内压增高 13 14 ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP ONSDexpansioncanpersistevenafterICPcontrol andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs Furtherlargersizestudiesareneededtoconfirmthesefindings 15 影响因素 16 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 17 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 2mmat15min p 0 01 5 8and6 6mmat30min p 0 01 and5 1and5 7mmafterdeflationofpneumoperitoneum p 0 03 respectively SurgicalEndoscopyJune2016 Volume30 Issue6 pp2321 2325 18 测量方法 19 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 20 21 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 22 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 23 ONSD评估颅内压力测量方法 冠状位测量球后3mm处ONSD 3次均值正常上限值5mm矢状位测量球后3mm处ONSD 3次均值正常上限值5 8mm 24 参考值 25 1 单侧异常 ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess suchasopticneuritisorcompressiveopticneuropathy Papilledema 视乳头水肿 mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody 26 2 双侧异常 ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable BasedontheinitialstudyofultrasoundmeasurementofONSD 11manyauthorsciteadiameter 5mmaselevatedinpatientsolderthanage4 Tworecentmeta analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP 20cmH2Oandcalculatedapooledsensitivityandspecificityof87 90 and79 85 respectively h