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1、眼部超聲與顱內(nèi)壓監(jiān)測(cè)佛山市禪城區(qū)中心醫(yī)院李志鵬解剖學(xué)基礎(chǔ)解剖學(xué)基礎(chǔ)Pulillaryaperature瞳孔Iris虹膜Cornea角膜Ciliarybody睫狀體Lens晶狀體Vitreousbody玻璃體Retina視網(wǎng)膜Choroid脈絡(luò)膜Sclera鞏膜視神經(jīng)鞘是顱內(nèi)硬腦膜與蛛網(wǎng)膜下腔的延續(xù)，因此顱內(nèi)壓增高將直接增大視神經(jīng)鞘直徑。測(cè)量主要在眼球后3mm處，因?yàn)樵撎庪S顱內(nèi)壓變化的彈性伸縮性最大。測(cè)量方法探頭的選擇和放置1選擇高頻線陣探頭(7.5MHzorgreater).2無菌貼膜覆蓋眼球3充分耦合，避免擠壓眼球（以面頰或者額頭為受力點(diǎn)）4深度在視
2、網(wǎng)膜下1-2cm測(cè)量的方法和注意事項(xiàng)1測(cè)量位置：位于視網(wǎng)膜和視神經(jīng)交界處深部3mm2分別測(cè)量長(zhǎng)軸和短軸的視神經(jīng)鞘直徑并求出平均值。3測(cè)量對(duì)側(cè)視神經(jīng)鞘的直徑。Itisimperativetoacquireatrueon-axis,longitudinalcrosssectionoftheopticnervesheathbecauseoff-axisimagingresultsinerroneousmeasurementoftheONSD.參考值1、單側(cè)異常ThepresenceofunilateralincreasedONSDsuggestsalater
3、alizingprocess,suchasopticneuritisorcompressiveopticneuropathy.Papilledema（視乳頭水腫）mayalsobenotedasopticdiscbulgingintotheretinaandprotrudingintothevitreousbody.2、雙側(cè)異常ThecutoffvalueforincreasedONSDcorrelatingwithincreasedICPhasbeendebatable.Basedontheinitialstudyofultrasoundmeasur
4、ementofONSD,11manyauthorsciteadiameter>5mmaselevatedinpatientsolderthanage4.Tworecentmeta-analysesofsixstudiesevaluatedthecorrelationbetweenONSDandICP>20cmH2Oandcalculatedapooledsensitivityandspecificityof87–90%and79–85%,respectively;however,thecutoffforabnormalONSDvariedfrom5.0
5、to5.9mminthesestudies,withhalfofthestudiesutilizingacutoff≥5.7mm.臨床應(yīng)用視神經(jīng)鞘直徑#可準(zhǔn)確評(píng)估顱內(nèi)壓增高視神經(jīng)鞘直徑#可準(zhǔn)確預(yù)測(cè)心肺復(fù)蘇的結(jié)局Afteradjustmentonpredictivefactors,ONSD1wassignificantlyassociatedwithin-hospitalmortality(OR6.3;95%CI[1.05-40]permmofONSD1above5.5mm;p=0.03),andCPCscore(ORfor1pointincreasei
6、nCPCscore:3.2;95%CI[1.2-9.4]permmofONSD1above5.5mm;p=0.03).ONSD1wassignificantlycorrelatedwithbrainedemaassessedbythecerebrumgraymatterattenuationtowhitematterattenuationratio,measuredbythebraincomputedtomographyscanperformedonadmissionin20patients(Spearmanrho=-0.5,p=0.04).Resus
7、citation.2016Jun;103:7-13.doi:10.1016/j.resuscitation.2016.03.006.Epub2016Mar16.視神經(jīng)鞘直徑#腦功能監(jiān)護(hù)Theopticnervesheathdiameterhasbeenverifiedbyvariousclinicalstudiesasanon-invasiveindicatorofintracranialhypertension.Theaimofthisstudywastocomparetheopticnervesheathdiameterbeforeandimmed
8、iatelyafterventriculo-peritonealshuntsurgeryinc
