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视神神经鞘直径和鞘直径和颅内内压视神经鞘直径和颅内压1解剖学基础2视神经鞘直径和颅内压解剖学基础2视神经鞘直径和颅内压2解剖学基础Pulillary aperature 瞳孔瞳孔Iris 虹膜虹膜Cornea 角膜角膜Ciliary body 睫状体睫状体Lens 晶状体晶状体Vitreous body 玻璃体玻璃体Retina 视网膜网膜Choroid 脉脉络膜膜Sclera 巩膜巩膜3视神经鞘直径和颅内压解剖学基础Pulillary aperature 瞳孔3视神34视神经鞘直径和颅内压4视神经鞘直径和颅内压4眼部结构及超声图像 眼球及眶周结构5视神经鞘直径和颅内压5视神经鞘直径和颅内压56视神经鞘直径和颅内压6视神经鞘直径和颅内压6 视路路MRI图像像 视神神经：眼内部眶部（ONSD段）管内部颅内部7视神经鞘直径和颅内压 视路MRI图像 视神经：7视神经鞘直径和颅内压78视神经鞘直径和颅内压8视神经鞘直径和颅内压8Critical Care 2008,12:R114ONSD视神经ONSD临界值5.82mm ICP20mmHg 9视神经鞘直径和颅内压Critical Care 2008,12:R114ONS9共纳入231例敏感性 0.90（95%CI 0.80-0.95）特异性 0.85（95%CI 0.73-0.93）Intensive Care Med(2011)37:1059106810视神经鞘直径和颅内压共纳入231例Intensive Care Med(2011011视神经鞘直径和颅内压11视神经鞘直径和颅内压11ConclusionsSonographicmeasurementofONSDmaybeapotentiallyusefultechniqueforassessingIHinabinarymode(present/absent)wheninvasive/monitoringmethodsarenotdesirableoravailable.12视神经鞘直径和颅内压Conclusions12视神经鞘直径和颅内压12视神经鞘直径和颅内压培训ppt课件1314视神经鞘直径和颅内压14视神经鞘直径和颅内压14ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP.ONSDexpansioncanpersistevenafterICPcontrol,andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs.Furtherlargersizestudiesareneededtoconfirmthesefindings.15视神经鞘直径和颅内压Conclusion15视神经鞘直径和颅内压15影响因素16视神经鞘直径和颅内压影响因素16视神经鞘直径和颅内压161、体位EffectsofPronePositionandPositiveEnd-ExpiratoryPressureonNoninvasiveEstimatorsofICP:APilotStudy.Results:ThemeanvaluesofONSD,ICPFVd,andICPPIsignificantlyincreasedafterchangefromsupinetoproneposition.Receiveroperatingcharacteristicanalysesdemonstratedthat,amongthenoninvasivemethods,themeanONSDmeasurehadthegreatestareaunderthecurvesignifyingitisthemosteffectiveindistinguishingahypotheticalchangeinICPbetweensupineandpronepositioning(0.86+/-0.0340.79to0.92).Acutoffof0.43cmwasfoundtobeabestseparatorofONSDvaluebetweensupineandpronewithaspecificityof75.0andasensitivityof86.7.Conclusions:NoninvasiveICPestimationmaybeusefulinpatientsatriskofdevelopingintracranialhypertensionwhorequirepronepositioning.Journal of Neurosurgical Anesthesiology.18 March 2016 17视神经鞘直径和颅内压1、体位Effects of Prone Position172肥胖、气腹There were 62 subjects,28 females(45.2%)and 34 males(54.8%),with a mean age of 44.22 10.44 years(range 2366).Forty-eight percent of patients were non-obese,and 52%of patients were obese.The mean body mass index was 30.70 7.61 kg/m2(range 20.059.5).The mean ONSD of non-obese and obese patients was 4.7 and 5.5 mm at baseline(p=0.01),5.4 and 6.2 mm at 15 min(p=0.01),5.8 and 6.6 mm at 30 min(p=0.01),and 5.1 and 5.7 mm after deflation of pneumoperitoneum(p=0.03),respectively.Surgical EndoscopyJune 2016,Volume 30,Issue6,pp 2321232518视神经鞘直径和颅内压2 肥胖、气腹There were 62 subjects,18测量方法19视神经鞘直径和颅内压测量方法19视神经鞘直径和颅内压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1-2cm20视神经鞘直径和颅内压探头的选择和放置1 选择高频线阵探头(7.5 MHz or2021视神经鞘直径和颅内压21视神经鞘直径和颅内压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视神经鞘直径和颅内压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视神经鞘直径和颅内压 视神经鞘是颅内硬脑膜与蛛网膜下腔的延续，因此颅内23ONSD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5.8mm24视神经鞘直径和颅内压24视神经鞘直径和颅内压24参考值25视神经鞘直径和颅内压参考值25视神经鞘直径和颅内压251、单侧异常ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess,suchasopticneuritisorcompressiveopticneuropathy.Papilledema（视乳头水肿）mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody.26视神经鞘直径和颅内压1、单侧异常The presence of unilate262、双侧异常ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.BasedontheinitialstudyofultrasoundmeasurementofONSD,11manyauthorsciteadiameter5mmaselevatedinpatientsolderthanage4.Tworecentmeta-analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP20cmH2Oandcalculatedapooledsensitivityandspecificityof8790%and7985%,respectively;however,thecutoffforabnormalONSDvariedfrom5.0to5.9mminthesestudies,withhalfofthestudiesutilizingacutoff5.7mm.27视神经鞘直径和颅内压2、双侧异常The cutoff value for in27谢谢聆听！28视神经鞘直径和颅内压谢谢聆听！28视神经鞘直径和颅内压28
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