超声检测视神经鞘直径在急性颅内压增高患者诊断与治疗的临床价值研究

目的 探讨超声检测视神经鞘直径(ONSD)在急性颅内压(ICP)增高患者诊断与治疗的临床价值。方法 选择2020年3月至2023年3月在本院治疗的急性ICP增高患者180例,收集患者术前(T0)、麻醉后(T1)、手术开始(T2)、术后即刻(T3)、术后清醒时刻(T4)的ONSD以及ICP,分析各时刻ONSD与ICP的关系。并参考格拉斯哥预后评分(GOS)进行预后评估,分为预后良好组(157例)和预后不良组(23例),比较两组术前、术后即刻ONSD,并分析ONSD与GOS的相关性,采用受试者工作特征(ROC)曲线分析ONSD对围术期急性ICH患者预后的预测价值。结果 T0～T2时刻患者ONSD、ICP无明显变化,T3～T4时刻患者ONSD、ICP明显降低,差异均有统计学意义(P<0.05)。Pearson相关性结果发现,T0～T4时刻ONSD均与ICP呈正相关(P<0.05)。预后良好组与预后不良组术后ONSD、ICP水平均降低,且预后良好组术后ONSD、ICP水平更低,差异均有统计学意义(P<0.05)。Spearman相关性结果发现,术后即刻ONSD、ICP均与GOS呈负相关(P<0.05)。ROC曲线分析结果显示,术后即刻ONSD、ICP预测患者预后不良的的AUC分别为0.886、0.782,均有较好的预测价值(P<0.05)。结论 超声检测ONSD可有效评估急性ICP增高患者的ICP情况,且对患者预后有一定的预测价值。     

床旁即时超声测量视神经鞘直径与重型颅脑损伤患者术后颅内压增高的关系研究

目的:探讨床旁即时超声测量视神经鞘直径(ONSD)与重型颅脑损伤患者术后颅内压(ICP)增高的关系。方法:选取兰溪市人民医院急诊科2018年6月-2021年6月收治的重型颅脑损伤患者62例,均行手术治疗,将其按照患者术后ICP值分为3组。ICP值>25 mmHg组：13例,15～25 mmHg组：20例,<15 mmHg组：29例。应用床旁即时超声测量各组ONSD值,比较3组ONSD值的差异,使用Pearson分析ONSD和ICP间的关系,并通过ROC曲线分析ONSD评估术后ICP增高的准确性。结果:ICP值>25 mmHg组和15～25 mmHg组的ICP值、ONSD值均显著高于ICP值<15 mmHg组,差异均有统计学意义(P<0.05);ICP值>25 mmHg组ICP值、ONSD值显著高于15～25 mmHg组,差异均有统计学意义(P<0.05);且3组30°头高位ONSD值均低于平卧位,3组使用甘露醇后30 min ONSD值均低于使用甘露醇前,差异均有统计学意义(P<0.05)。通过Pearson分析相关性显示,床旁即时超声测...     

超声测量视神经鞘直径预测围手术期急性颅内压增高患者预后的临床价值

目的 探讨超声测量视神经鞘直径（ONSD）在预测围手术期急性颅内压增高患者预后中的临床价值。方法 选取我院收治的急性颅内压增高患者180例,使用超声测量术前（T0）、麻醉后（T1）、手术开始（T2）、术后即刻（T3）、术后清醒时（T4）ONSD,无创颅内压监测仪测量不同时点颅内压,比较不同时点ONSD和颅内压的差异。分析不同时点ONSD与颅内压的关系。依据格拉斯哥预后（GOS）评分将患者分为预后良好组157例（4～5分）和预后不良组23例（1～3分）,比较两组不同时点ONSD的差异,分析ONSD、颅内压与GOS评分的相关性。绘制受试者工作特征（ROC）曲线分析ONSD、颅内压预测围手术期急性颅内压增高患者预后的诊断效能。结果 所有患者T0～T2时ONSD、颅内压比较差异均无统计学意义;T3、T4时ONSD、颅内压均较T0时降低,差异均有统计学意义（均P<0.05）。相关性分析显示,T0～T4时ONSD均与颅内压呈正相关（均P<0.001）。预后良好组和预后不良组T3时ONSD、颅内压均较T0时降低,且预后良好组ONSD和颅内压均更低,差异均有统计学意义（均P<0.05...     

床旁超声测量视神经鞘直径对颅脑损伤患者颅内压增高的诊断价值

[目的]探讨利用床旁超声测量视神经鞘直径在颅脑损伤患者中检出颅内压（ICP）增高者的应用价值.[方法]35例颅脑损伤（ICP正常22例,ICP增高13例）患者及10名健康志愿者行床旁超声检查测量视神经鞘直径,并对颅脑损伤患者进行ICP测定.比较三组之间视神经鞘直径,计算视神经鞘直径与ICP的相关性,利用ROC曲线探究预测ICP增高的最佳阈值及准确性.[结果]ICP增高组视神经鞘直径显著高于ICP正常组及对照组（P〈0.05）,ICP正常组视神经鞘直径与对照组差异无统计学意义（P〉0.05）,视神经鞘直径与ICP之间存在正相关关系（r=0.733,P〈0.01）.ROC曲线显示视神经鞘直径≥5.0 mm作为判断标准效果最佳,此时敏感度86.4%（19/22）、特异度84.6%（11/13）、准确度85.7%（30/35）、阳性预测值90.5%（19/21）、阴性预测值78.9%（11/14）.[结论]床旁超声测量视神经鞘直径能够较好预测ICP水平,当视神经鞘直径≥5.0mm提示ICP增高.     

超声测量视神经鞘直径评估颅内压增高的临床研究进展

颅内压监测在神经重症的治疗中十分重要,目前主要有无创和有创两种方法,各具优点,有创监测颅内压虽为颅内压监测的金标准,但缺点明显,无法广泛应用。视神经鞘具有特殊的解剖结构,颅内压增高时视神经鞘直径(ONSD)会出现增粗,故超声监测ONSD判断颅内压升高是一种无创、简便、易行且可以床旁重复操作的方法。本文就国内外超声监测ONSD判断颅高压研究进展进行综述。     

超声测量视神经鞘直径与眼球横径比值在重症颅脑损伤患者颅内压监测中的应用

目的研究重症颅脑损伤(TBI)患者颅内压监测中超声测量视神经鞘直径(ONSD)与眼球横径(ETD)比值的应用价值。方法回顾性选取2020年1月至2021年1月保定市第二中心医院收治入院的98例重症TBI患者为研究对象。所有患者均于入院24 h内接受开颅手术治疗,采用腰椎穿刺术测定颅内压,手术完成后24 h内选取索诺声超声M-Turbo与6-13 MHz线阵超声探头测定ETD、ONSD,选取颅内压监护仪记录颅内压值。参考颅内压值分为研究组(n=58,颅内压≤20 mmHg)与对照组(n=40,颅内压>20 mmHg)。分析并比较两组入院后同期监测指标水平及与ONSD/ETD比值相关性;分析两组超声测量ONSD/ETD比值、ONSD与颅内压相关性;超声测量ONSD/ETD比值、ONSD预测颅内压水平上升的准确性经受试者工作特征(ROC)曲线评价,并比较金标准脑室内测压与超声测量ONSD/ETD比值、ONSD诊断一致性。结果研究组较对照组GSC评分、颅内温度、ETD更高,颅内压、ONSD、ONSD/ETD比值更低,差异均有统计学意义(P <0.05)。两组患者GCS与ONSD/E...     

脑外伤急性期床旁超声ONSD监测颅内压变化研究

脑外伤患者急性期的颅内压(ICP)升高和严重残疾及死亡等预后不良相关[1-2],脑室内颅内压监测被认为是ICP监测的金标准,但存在本身手术有创,可能继发感染和颅内出血等风险[3-4].床旁超声技术具有动态、实时、可重复操作的优势[5].近年国内外利用床旁超声监测视神经鞘直径(optic nerve sheath diameter,ONSD)评估升高的颅内压,相关临床研究已有大量报道[6-8].但是对于ICP超过20mmHg(1 mmHg=0.133 kPa)时视神经鞘直径的临界值仍存在争议.尤其Wang等[9]最近报道的国人颅内压升高超过20 mmHg时ONSD的临界值为0.41 cm,与国外报道0.48～0.52 cm水平差异较大.该临界值的确定对于降颅压治疗具有指导意义,因此有进一步研究价值.     

超声测量视神经鞘直径预测颅内压的影响因素研究

目的探讨超声测量视神经鞘直径(ONSD)预测颅内压(ICP)的相关影响因素。方法选取神经内科门诊需行腰椎穿刺颅内压测量的患者。对所有被纳入本研究的受试者进行一般检查及眼科检查,采用眼科B型超声测量视神经鞘直径。采用Pearson相关系数评价ICP和ONSD与各影响因素之间的关系,多元线性回归方程用于预测颅内压。结果共130例受试者被纳入本研究。腰椎穿刺测得的ICP为(209.84±79.99)mm H2O,B型超声波测得的受检者的球后3mm处ONSD分别为右眼(5.68±0.78)mm,左眼(5.78±0.78)mm,双眼平均值为(5.73±0.71)mm。ONSD-mean与ICP (r=0.6,P0.001),BMI (r=0.28,P=0.001)和性别(r=-0.281,P=0.001)之间具有明显的相关性,而与年龄(r=-0.161,P=0.068)没有明显的相关性。ICP与ONSD-R (r=0.54,P0.001),ONSD-L (r=0.56,P0.001),ONSD-mean (r=0.6,P0.001)以及BMI (r=0.58,P0.001)之间具有明显的相关性,而与年龄(r=-0.139,P=0.114)和性别(r=0.20,P=0.817)之间没有明显的相关性。结论超声测量ONSD是一种安全、有效的无创ICP检查方法。ONSD和ICP均受到多种因素影响,在实际应用中应考虑到这些因素对结果的影响。     

视神经鞘超声测值在诊断儿童颅内压增高中的应用研究

目的：探讨超声测量视神经鞘直径（optic nerve sheath diameter,ONSD）在诊断儿童颅内压增高中的应用价值。方法：选取2021年8月—2022年10月贵港市人民医院神经外科重症监护室和儿童重症监护室收治的神经危重患儿80例,记录患儿的性别、年龄、身高、体重以及体质量指数（body mass index,BMI）。所有患儿均行腰椎穿刺术测定颅内压（intracranial pressure,ICP）。于腰椎穿刺术前1 h内应用超声测量患儿双眼ONSD值,以ICP≥20 mmHg为研究组,ICP <20 mmHg为对照组,比较两组患儿ONSD和ICP的差异。分析ONSD值与年龄、ICP的相关性,并比较<4岁与≥4岁儿童ONSD值的差异。绘制受试者工作特征（receiveroperatingcharacteristic,ROC）曲线,计算ONSD诊断颅内压增高（IH）的最佳阈值。研究组行降颅压治疗后再次测量ONSD和ICP值,比较降颅压治疗前后ONSD和ICP的差异。结果：研究组ICP和ONSD值显著大于对照组[（23.30±1.31） mmHg vs (...     

超声在围拔管期颅内压监测中的应用

目的 通过超声测量视网膜后3 mm处视神经鞘直径(ONSD)的变化评估不同麻醉策略对全麻颅内动脉瘤栓塞术后拔管期颅内压(ICP)的影响。方法 选取拟行全麻颅内动脉瘤栓塞术患者60例,采用随机数字表法分为右美托咪定组(D组)、瑞芬太尼组(R组)和对照组(C组),每组20例。3组患者均采用标准化全凭静脉麻醉,D组于手术开始前泵入负荷剂量右美托咪定,泵速1μg/(kg·h),泵注10 min。术中继续以0.5μg/(kg·h)速率泵注,手术结束前30 min停止泵注。R组于手术结束后继续以0.1μg/(kg·min)的速率泵注瑞芬太尼直至拔除气管导管。C组不做特殊处理。在唤醒前(T0)、拔管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)、拔管后15 min(T4)不同时间点,用经眶超声测量视网膜后3 mm处ONSD及眼球横径(ETD),左右眼分别测量3次取平均值,并计算ONSD/ETD,评估ICP的情况。同时记录不同组拔管时的平均动脉压、心率、血氧饱和度、咳嗽程度、拔管时间。结果 与T0时点比较,3组患者在T1、T2时点ONSD均增大(P<0.05);与C组比较,D组...     

Intraoperative non invasive intracranial pressure monitoring during pneumoperitoneum: a case report and a review of the published cases and case report series

Non-invasive measurement of ICP (nICP) can be warranted in patients at risk for developing increased ICP during pneumoperitoneum (PP). Our aim was to assess available data on the application of nICP monitoring during these procedures and to present a patient assessed with an innovative combination of noninvasive tools. Literature review of nICP assessment during PP did not find any studies comparing different methods intraprocedurally and only few studies of any nICP monitoring were available: transcranial Doppler (TCD) studies used the pulsatility index (PI) as an estimator of ICP and failed to detect a significant ICP increase during PP, whereas two out of three optic nerve sheath diameter (ONSD) studies detected a statistically significant ICP increase. In the case study, we describe a 52 year old man with a high grade thalamic glioma who underwent urgent laparoscopic cholecystectomy. Considering the high intraoperative risk of developing intracranial hypertension, he was monitored through parallel ONSD ultrasound measurement and TCD derived formulae (flow velocity diastolic formula, FVdnICP, and PI). ONSD and FVdnICP methods indicated a significant ICP increase during PP, whereas PI was not significantly increased. Our experience, combined with the literature review, seems to suggest that PI might not detect ICP changes in this context, however we indicate a possible interest of nICP monitoring during PP by means of ONSD and of TCD derived FVdNICP, especially for patients at risk for increased ICP.     

Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure

Introduction  

The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated. Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath. The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP.     

Using MRI of the optic nerve sheath to detect elevated intracranial pressure

The current gold standard for the diagnosis of elevated intracranial pressure (ICP) remains invasive monitoring. Given that invasive monitoring is not always available or clinically feasible, there is growing interest in non-invasive methods of assessing ICP using diagnostic modalities such as ultrasound or magnetic resonance imaging (MRI). Increased ICP is transmitted through the cerebrospinal fluid surrounding the optic nerve, causing distention of the optic nerve sheath diameter (ONSD). In this issue of Critical Care, Geeraerts and colleagues describe a non-invasive method of diagnosing elevated ICP using MRI to measure the ONSD. They report a positive correlation between measurements of the ONSD on MRI and invasive ICP measurements. If the findings of this study can be replicated in larger populations, this technique may be a useful non-invasive screening test for elevated ICP in select populations.     

Optic nerve sheath diameter measurement: a means of detecting raised ICP in adult traumatic and non-traumatic neurosurgical patients

Introduction

Bedside ultrasound measurement of optic nerve sheath diameter (ONSD) is emerging as a non-invasive technique to evaluate and predict raised intracranial pressure (ICP). It has been shown in previous literature that ONSD measurement has good correlation with surrogate findings of raised ICP such as clinical and radiological findings suggestive of raised ICP.

Real time optic nerve sheath diameter measurement during lumbar puncture

Measurement of optic nerve sheath diameter (ONSD) using point of care ultrasound has been used to indirectly assess the intracranial pressure (ICP) particularly in conditions where it is raised. Direct pressure measurements using probes reaching the ventricle system correlated with ONSD using ultrasound. Attempts were made to measure the ONSD pre and post lumbar puncture (LP) after draining cerebrospinal fluid (CSF) as well as post ventricular shunt placement. We report ONSD measurement and demonstrate dynamic changes during LP in a patient with known idiopathic intracranial hypertension (IIH).     

Optic nerve sonography in the diagnostic evaluation of adult brain injury

Introduction  

The optic nerve sheath diameter (ONSD) may be increased in brain-injured patients, especially children, with intracranial hypertension. We investigated whether measurements of ONSD correlated with simultaneous noninvasive and invasive measurements of the intracranial pressure (ICP) in brain-injured adults.     

Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients

Objective  To assess the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in neurocritical care patients. Design  Prospective, observational study. Setting  Surgical critical care unit, level 1 trauma center. Patients  A total number of 37 adult patients requiring sedation and ICP monitoring after severe traumatic brain injury, subarachnoid hemorrhage, intracranial hematoma, or stroke. Measurements and main results  Optic nerve sheath diameter was measured with a 7.5 MHz linear ultrasound probe. ICP was measured invasively via a parenchymal device. Simultaneous measurements were performed atleast once a day during the first 2 days after ICP insertion and in cases of acute changes. There was a significant relationship between ONSD and ICP (78 simultaneous measures, r = 0.71, P < 0.0001). Changes in ICP were strongly correlated with changes in ONSD (39 measures, r = 0.73, P < 0.0001). Enlarged ONSD was a suitable predictor of elevated ICP (>20 mmHg) (area under ROC curve = 0.91). When ONSD was less than 5.86 mm, the negative likehood ratio for raised ICP was 0.06. Conclusion  In sedated neurocritical care patients, non-invasive sonographic measurements of ONSD are correlated with invasive ICP, and the probability to have raised ICP if ONSD is less than 5.86 mm is very low. This method could be used as a screening test when raised ICP is suspected. The authors received no financial support for this work.