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视神经鞘直径(ONSD)与颅内压(ICP)重症医学科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Re

tina视网膜Choroid脉络膜Sclera巩膜▪眼部结构及超声图像眼球及眶周结构视路MRI图像视神经：眼内部眶部（ONSD段）管内部颅内部CriticalCare2008,12:R114ONSD视神经ONSD临界值5.82mm

ICP>20mmHg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▪ConclusionsSonographicmeasurementofONSDmaybea

potentiallyusefultechniqueforassessingIHinabinarymode(present/absent)wheninvasive/monitoringmethodsarenotdesirableoravailable.视神经鞘直径可准确评估颅内压增高

？▪ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP.ONSDexpansioncanpe

rsistevenafterICPcontrol,andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs.Furtherlargersizestudiesareneede

dtoconfirmthesefindings.影响因素1、体位▪EffectsofPronePositionandPositiveEnd-ExpiratoryPressureonNoninvasiveEstimatorsofICP:APilotStudy.▪Results:T

hemeanvaluesofONSD,ICPFVd,andICPPIsignificantlyincreasedafterchangefromsupinetoproneposition.Receiveroperatingcharacteristicanalysesdemonst

ratedthat,amongthenoninvasivemethods,themeanONSDmeasurehadthegreatestareaunderthecurvesignifyingitistheJournalofNeurosurgicalAnesthesiolo

gy.18March20162肥胖、气腹Therewere62subjects,28females(45.2%)and34males(54.8%),withameanageof44.22±10.44years(range23–66).Forty-eightpercentofpatients

werenon-obese,and52%ofpatientswereobese.Themeanbodymassindexwas30.70±7.61kg/m2(range20.0–59.5).Themean

ONSDofnon-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,pp2321–2

325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。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。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参考值1、单侧异常▪ThepresenceofunilateralincreasedONSDsuggestsalatera

lizingprocess,suchasopticneuritisorcompressiveopticneuropathy.▪Papilledema（视乳头水肿）mayalsobenotedasopticdiscbu

lgingintotheretinaandprotrudingintothevitreousbody.2、双侧异常▪ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.▪Basedontheini

tialstudyofultrasoundmeasurementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.▪Tworecentmeta-analysesofsixstudiesevaluated

thecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificityof87–90%and79–85%,respecti

vely;however,thecutoffforabnormalONSDvariedfrom5.0to5.9mminthesestudies,withhalfofthestudiesutilizingacutoff≥5.7mm.谢谢聆听！