2016-8-3-李志鹏-眼部超声与颅内压监测PPT.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 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。 It is imperative to acquire a true on-axis, longitudinal cross section of the optic nerve sheath because off-axis ima ging 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. Epub 2016 Mar 16. 视神经鞘直径#脑功能监护 Th