视神经鞘直径与颅内压.ppt

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1、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231例敏感性0.90（95%CI0.80-0.95

2、）特异性0.85（95%CI0.73-0.93）IntensiveCareMed(2011)37:1059–1068ConclusionsSonographicmeasurementofONSDmaybeapotentiallyusefultechniqueforassessingIHinabinarymode(present/absent)wheninvasive/monitoringmethodsarenotdesirableoravailable.视神经鞘直径可准确评估颅内压增高？ConclusionThiss

3、tudysuggeststhatONSDassessmentthroughouttheacutephasemaynotbeareliablemethodtomonitorICP.ONSDexpansioncanpersistevenafterICPcontrol,andthismaybethereasonforONSDexpansionsseeninourstudyevenwithnormalICPs.Furtherlargersizestudiesareneededtoconfirmthesefindings.影响

4、因素1、体位EffectsofPronePositionandPositiveEnd-ExpiratoryPressureonNoninvasiveEstimatorsofICP:APilotStudy.Results:ThemeanvaluesofONSD,ICPFVd,andICPPIsignificantlyincreasedafterchangefromsupinetoproneposition.Receiveroperatingcharacteristicanalysesdemonstratedthat,a

5、mongthenoninvasivemethods,themeanONSDmeasurehadthegreatestareaunderthecurvesignifyingitisthemosteffectiveindistinguishingahypotheticalchangeinICPbetweensupineandpronepositioning(0.86+/-0.034[0.79to0.92]).Acutoffof0.43cmwasfoundtobeabestseparatorofONSDvaluebetwe

6、ensupineandpronewithaspecificityof75.0andasensitivityof86.7.Conclusions:NoninvasiveICPestimationmaybeusefulinpatientsatriskofdevelopingintracranialhypertensionwhorequirepronepositioning.JournalofNeurosurgicalAnesthesiology.18March20162肥胖、气腹Therewere62subjects,2

7、8females(45.2%)and34males(54.8%),withameanageof44.22±10.44years(range23–66).Forty-eightpercentofpatientswerenon-obese,and52%ofpatientswereobese.Themeanbodymassindexwas30.70±7.61kg/m2(range20.0–59.5).ThemeanONSDofnon-obeseandobesepatientswas4.7and5.5mmatbaseline

8、(p=0.01),5.4and6.2mmat15min(p=0.01),5.8and6.6mmat30min(p=0.01),and5.1and5.7mmafterdeflationofpneumoperitoneum(p=0.03),respectively.SurgicalEndoscopyJune2016,Volume30,Issue 6