1、视神经鞘直径和颅内视神经鞘直径和颅内压压2视神经鞘直径和颅内压解剖学基础Pulillary aperature Pulillary aperature 瞳孔瞳孔Iris Iris 虹膜虹膜Cornea Cornea 角膜角膜Ciliary body Ciliary body 睫状体睫状体Lens Lens 晶状体晶状体Vitreous body Vitreous body 玻璃体玻璃体Retina Retina 视网膜视网膜Choroid Choroid 脉络膜脉络膜Sclera Sclera 巩膜巩膜3视神经鞘直径和颅内压4视神经鞘直径和颅内压 眼部结构及超声图像 眼球及眶周结构5视神经鞘直
2、径和颅内压6视神经鞘直径和颅内压 视路视路MRIMRI图像图像 视神经：视神经：眼内部眶部（ONSD段）管内部颅内部7视神经鞘直径和颅内压8视神经鞘直径和颅内压Critical 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11视神经鞘直径和颅内压Conclusions Sonographic measurement
3、of ONSD may be a potentially useful technique for assessing IH in a binary mode(present/absent)when invasive/monitoring methods are not desirable or available.12视神经鞘直径和颅内压14视神经鞘直径和颅内压Conclusion This study suggests that ONSD assessment throughout the acute phase may not be a reliable method to monito
4、r ICP.ONSD expansion can persist even after ICP control,and this may be the reason for ONSD expansions seen in our study even with normal ICPs.Further larger size studies are needed to confirm these findings.15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1、体位Effects of Prone Position and Positive End-Expiratory Pressu
5、re on Noninvasive Estimators of ICP:A Pilot Study.Results:The mean values of ONSD,ICPFVd,and ICPPI significantly increased after change from supine to prone position.Receiver operating characteristic analyses demonstrated that,among the noninvasive methods,the mean ONSD measure had the greatest area
6、 under the curve signifying it is the most effective in distinguishing a hypothetical change in ICP between supine and prone positioning(0.86+/-0.034 0.79 to 0.92).A cutoff of 0.43 cm was found to be a best separator of ONSD value between supine and prone with a specificity of 75.0 and a sensitivity
7、 of 86.7.Conclusions:Noninvasive ICP estimation may be useful in patients at risk of developing intracranial hypertension who require prone positioning.Journal of Neurosurgical Anesthesiology.18 March 2016 17视神经鞘直径和颅内压2 肥胖、气腹There were 62 subjects,28 females(45.2%)and 34 males(54.8%),with a mean age
8、 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 4.7 and 5.5 mm at baseline(p=0.01),5.4 and 6.2 mm 5.4 and 6.2
9、mm at 15 min(p=0.01),5.8 and 6.6 mm 5.8 and 6.6 mm at 30 min(p=0.01),and 5.1 and 5.7 mm 5.1 and 5.7 mm after deflation of pneumoperitoneumpneumoperitoneum(p=0.03),respectively.Surgical EndoscopyJune 2016,Volume 30,Issue6,pp 2321232518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探头的选择和放置 1 选择高频线阵探头(7.5 MHz or greater).
10、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21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部3mm 2 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 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
11、处ONSD,3次均值正常上限值5.8mm24视神经鞘直径和颅内压参考值25视神经鞘直径和颅内压1、单侧异常 The presence of unilateral increased ONSD suggests a lateralizing process,such as optic neuritis or compressive optic neuropathy.Papill edema（视乳头水肿）may also be noted as optic disc bulging into the retina and protruding into the vitreous body.26视神
12、经鞘直径和颅内压2、双侧异常 The cutoff value for increased ONSD correlating with increased ICP has been debatable.Based on the initial study of ultrasound measurement of ONSD,11 many authors cite a diameter 5 mm as elevated in patients older than age 4.Two recent meta-analyses of six studies evaluated the correlation between ONSD and ICP 20 cm H2O and calculated a pooled sensitivity and specificity of 8790%and 7985%,respectively;however,the cutoff for abnormal ONSD varied from 5.0 to 5.9 mm in these studies,with half of the studies utilizing a cutoff 5.7 mm.27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
