201683李志鹏眼部超声与颅内压监测__培训课件.pptx

眼部超声与颅内压监测佛山市禅城区中心医院李志鹏解剖学基础解剖学基础Pulillary aperature 瞳孔Iris 虹膜Cornea 角膜Ciliary body 睫状体Lens 晶状体Vitreous body 玻璃体Retina 视网膜Choroid 脉络膜Sclera 巩膜 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。测量方法探头的选择和放置1 选择高频线阵探头 (7.5 MHz or greater) .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。It is imperative to acquire a true on-axis, longitudinalcross section of the optic nerve sheath because off-axis imaging results in erroneous measurement of the ONSD.参考值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.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 87–90% and 79–85%, 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.临床应用视神经鞘直径#可准确评估颅内压增高视神经鞘直径#可准确预测心肺复苏的结局After adjustment on predictive factors, ONSD1 was significantly associated with in-hospital mortality (OR 6.3; 95%CI [1.05-40] per mm of ONSD1 above 5.5mm; p=0.03), and CPC score (OR for 1 point increase in CPC score: 3.2; 95%CI [1.2-9.4] per mm of ONSD1 above 5.5mm; p=0.03). ONSD1 was significantly correlated with brain edema assessed by the cerebrum gray matter attenuation to white matter attenuation ratio, measured by the brain computed tomography scan performed on admission in 20 patients (Spearman rho=-0.5, p=0.04).Resuscitation. 2016 Jun;103:7-13. doi: 10.1016/j.resuscitation.2016.03.006. Ep