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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Retina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5.82mmICP>20mmHg共纳入23

1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▪ConclusionsSonographicmeasurementofONSDmaybeapotentia

llyusefultechniqueforassessingIHinabinarymode(present/absent)wheninvasive/monitoringmethodsarenotdesirableor

available.视神经鞘直径可准确评估颅内压增高？▪ConclusionThisstudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethod

tomonitorICP.ONSDexpansioncanpersistevenafterICPcontrol,andthismaybethereasonforONSDexpansionsseeninourstud

yevenwithnormalICPs.Furtherlargersizestudiesareneededtoconfirmthesefindings.影响因素1、体位▪EffectsofPronePositionandPositiveEnd-ExpiratoryPressureonNonin

vasiveEstimatorsofICP:APilotStudy.▪Results:ThemeanvaluesofONSD,ICPFVd,andICPPIsignificantlyincreasedafterchange

fromsupinetoproneposition.Receiveroperatingcharacteristicanalysesdemonstratedthat,amongthenoninvasivemethods,themeanONS

DmeasurehadthegreatestareaunderthecurvesignifyingitistheJournalofNeurosurgicalAnesthesiology.18March20162肥胖、气腹Therewere62subjects

,28females(45.2%)and34males(54.8%),withameanageof44.22±10.44years(range23–66).Forty-eightpercentofpatientswerenon-obese,and52%ofpat

ientswereobese.Themeanbodymassindexwas30.70±7.61kg/m2(range20.0–59.5).ThemeanONSDofnon-obeseandobesepatien

tswas4.7and5.5mmatbaseline(p=0.01),5.4and6.2mmat15min(p=0.01),5.8and6.6mmat30min(p=0.01),and5.1and5.7mma

fterdeflationofpneumoperitoneum(p=0.03),respectively.SurgicalEndoscopyJune2016,Volume30,Issue6,pp2321–2325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ON

SD,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▪ThepresenceofunilateralincreasedONSDsuggestsalateralizingprocess,suchasopticneuri

tisorcompressiveopticneuropathy.▪Papilledema（视乳头水肿）mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingint

othevitreousbody.2、双侧异常▪ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.▪Bas

edontheinitialstudyofultrasoundmeasurementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.▪Tworecentmeta-analysesofs

ixstudiesevaluatedthecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificity

of87–90%and79–85%,respectively;however,thecutoffforabnormalONSDvariedfrom5.0to5.9mminthesestudies,withhalfofthestudiesutilizingacutof

f≥5.7mm.谢谢聆听！