|
|
超声监测视神经鞘直径预防颅内压增高在围术期的应用进展
|
Abstract:
颅内压升高会导致脑灌注压下降、甚至脑缺血、脑疝等严重并发症，因此加强围术期颅内压的监测十分必要。由于有创ICP监测的潜在风险，以及CT、MRI床旁连续使用的限制，更多研究者将目光转向超声测量视神经鞘直径预测颅内压增高来证明其有效性和实用性。研究表明超声测量球后3 mm处的视神经鞘直径(optic nerve sheath diameter, ONSD)可以作为临床上无创评估颅内压的可靠替代工具。通过近年来的研究成果，总结围术期超声监测ONSD对评估ICP的指导意义。
Elevated intracranial pressure (ICP) can lead to serious complications such as decreased cerebral perfusion pressure, and even cerebral ischaemia and cerebral herniation, so enhanced perioperative monitoring of intracranial pressure (ICP) is essential. Due to the potential risks of invasive ICP monitoring and the limitations of continuous use of CT and MRI at the bedside, more researchers have turned to ultrasound to measure the optic nerve sheath diameter to predict increased intracranial pressure to demonstrate its validity and usefulness. Studies have shown that ultrasound measurement of ONSD at 3 mm behind the globe can be a reliable alternative tool for non-invasive assessment of intracranial pressure in clinical practice. The results of recent studies are summarised in terms of the significance of perioperative ultrasound monitoring of the ONSD as a guide to the assessment of ICP.
| [1] | 吴江, 贾建平, 主编. 神经病学[M]. 北京: 人民卫生出版社, 2015. |
| [2] | 齐洪武, 曾维俊, 任胤朋, 等. 有创颅内压监测技术的研究进展[J]. 中国微侵袭神经外科杂志, 2020, 25(6): 281-284. |
| [3] | Capizzi, A., Woo, J. and Verduzco-Gutierrez, M. (2020) Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. Medical Clinics of North America, 104, 213-238. https://doi.org/10.1016/j.mcna.2019.11.001 |
| [4] | 梁强, 邵淑琦, 段磊. 颅内压监测研究进展[J]. 中国神经精神疾病杂志, 2019, 45(4): 242-245. |
| [5] | Harary, M., Dolmans, R.G.F. and Gormley, W.B. (2018) Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors, 18, Article 465. https://doi.org/10.3390/s18020465 |
| [6] | 武蒙蒙, 胡红建, 梅其勇. 无创颅内压监测技术研究进展[J]. 第二军医大学学报, 2021, 42(8): 897-902. |
| [7] | Killer, H.E. (2003) Architecture of Arachnoid Trabeculae, Pillars, and Septa in the Subarachnoid Space of the Human Optic Nerve: Anatomy and Clinical Considerations. British Journal of Ophthalmology, 87, 777-781. https://doi.org/10.1136/bjo.87.6.777 |
| [8] | Hansen, H. and Helmke, K. (1996) The Subarachnoid Space Surrounding the Optic Nerves. An Ultrasound Study of the Optic Nerve Sheath. Surgical and Radiologic Anatomy, 18, 323-328. https://doi.org/10.1007/bf01627611 |
| [9] | Hansen, H. and Helmke, K. (1997) Validation of the Optic Nerve Sheath Response to Changing Cerebrospinal Fluid Pressure: Ultrasound Findings during Intrathecal Infusion Tests. Journal of Neurosurgery, 87, 34-40. https://doi.org/10.3171/jns.1997.87.1.0034 |
| [10] | Hayreh, S.S. (1968) Pathogenesis of Oedema of the Optic Disc. Documenta Ophthalmologica, 24, 289-411. https://doi.org/10.1007/bf02550944 |
| [11] | Liu, D. and Kahn, M. (1993) Measurement and Relationship of Subarachnoid Pressure of the Optic Nerve to Intracranial Pressures in Fresh Cadavers. American Journal of Ophthalmology, 116, 548-556. https://doi.org/10.1016/s0002-9394(14)73195-2 |
| [12] | Hansen, H., Lagrèze, W., Krueger, O. and Helmke, K. (2011) Dependence of the Optic Nerve Sheath Diameter on Acutely Applied Subarachnoidal Pressure—An Experimental Ultrasound Study. Acta Ophthalmologica, 89, e528-e532. https://doi.org/10.1111/j.1755-3768.2011.02159.x |
| [13] | Launey, Y., Nesseler, N., Le Maguet, P., Mallédant, Y. and Seguin, P. (2014) Effect of Osmotherapy on Optic Nerve Sheath Diameter in Patients with Increased Intracranial Pressure. Journal of Neurotrauma, 31, 984-988. https://doi.org/10.1089/neu.2012.2829 |
| [14] | Chen, L., Wang, L., Hu, Y., Jiang, X., Wang, Y. and Xing, Y. (2018) Ultrasonic Measurement of Optic Nerve Sheath Diameter: A Non-Invasive Surrogate Approach for Dynamic, Real-Time Evaluation of Intracranial Pressure. British Journal of Ophthalmology, 103, 437-441. https://doi.org/10.1136/bjophthalmol-2018-312934 |
| [15] | Helmke, K. and Hansen, H.C. (1996) Fundamentals of Transorbital Sonographic Evaluation of Optic Nerve Sheath Expansion under Intracranial Hypertension. Pediatric Radiology, 26, 701-705. https://doi.org/10.1007/bf01383383 |
| [16] | B？uerle, J., Schuchardt, F., Schroeder, L., Egger, K., Weigel, M. and Harloff, A. (2013) Reproducibility and Accuracy of Optic Nerve Sheath Diameter Assessment Using Ultrasound Compared to Magnetic Resonance Imaging. BMC Neurology, 13, Article No. 187. https://doi.org/10.1186/1471-2377-13-187 |
| [17] | Tayal, V.S., Neulander, M., Norton, H.J., Foster, T., Saunders, T. and Blaivas, M. (2007) Emergency Department Sonographic Measurement of Optic Nerve Sheath Diameter to Detect Findings of Increased Intracranial Pressure in Adult Head Injury Patients. Annals of Emergency Medicine, 49, 508-514. https://doi.org/10.1016/j.annemergmed.2006.06.040 |
| [18] | Rajajee, V., Fletcher, J., Rochlen, L. and Jacobs, T. (2012) Comparison of Accuracy of Optic Nerve Ultrasound for the Detection of Intracranial Hypertension in the Setting of Acutely Fluctuating vs Stable Intracranial Pressure: Post-Hoc Analysis of Data from a Prospective, Blinded Single Center Study. Critical Care, 16, R79. https://doi.org/10.1186/cc11336 |
| [19] | Robba, C., Santori, G., Czosnyka, M., Corradi, F., Bragazzi, N., Padayachy, L., et al. (2018) Optic Nerve Sheath Diameter Measured Sonographically as Non-Invasive Estimator of Intracranial Pressure: A Systematic Review and Meta-analysis. Intensive Care Medicine, 44, 1284-1294. https://doi.org/10.1007/s00134-018-5305-7 |
| [20] | Fernando, S.M., Tran, A., Cheng, W., Rochwerg, B., Taljaard, M., Kyeremanteng, K., et al. (2019) Diagnosis of Elevated Intracranial Pressure in Critically Ill Adults: Systematic Review and Meta-Analysis. BMJ, 366, l4225. https://doi.org/10.1136/bmj.l4225 |
| [21] | Blaivas, M. (2003) Elevated Intracranial Pressure Detected by Bedside Emergency Ultrasonography of the Optic Nerve Sheath. Academic Emergency Medicine, 10, 376-381. https://doi.org/10.1197/aemj.10.4.376 |
| [22] | Hassen, G.W., Bruck, I., Donahue, J., Mason, B., Sweeney, B., Saab, W., et al. (2015) Accuracy of Optic Nerve Sheath Diameter Measurement by Emergency Physicians Using Bedside Ultrasound. The Journal of Emergency Medicine, 48, 450-457. https://doi.org/10.1016/j.jemermed.2014.09.060 |
| [23] | De Bernardo, M. and Rosa, N. (2018) Measuring Optic Nerve Sheath Diameter as a Proxy for Intracranial Pressure. JAMA Ophthalmology, 136, 1309-1310. https://doi.org/10.1001/jamaophthalmol.2018.3429 |
| [24] | 王丽娟, 冯良枢, 姚燕, 等. 超声评估中国健康成年人视神经鞘直径[J]. 中国卒中杂志, 2016, 11(7): 556-562. |
| [25] | 王丽娟, 冯良枢, 姚燕, 等. 中国高颅压患者视神经鞘直径的诊断价值[J]. 中国卒中杂志, 2016, 11(7): 563-569. |
| [26] | 罗俏聪, 张龙, 李艳雅. 中国健康成人视神经鞘直径的超声解剖学研究[J]. 影像研究与医学应用, 2018, 2(17): 46-48. |
| [27] | Kim, D.H., Jun, J.S. and Kim. R. (2017) Ultrasonographic Measurement of the Optic Nerve Sheath Diameter and Its Association with Eyeball Transverse Diameter in 585 Healthy Volunteers. Scientific Reports, 7, Article No. 15906. https://doi.org/10.1038/s41598-017-16173-z |
| [28] | 王旭, 杨丽娟, 刘晓宇, 等. 超声测量成人视神经鞘直径诊断颅内高压症: Meta分析[J]. 中国医学影像技术, 2022, 38(10): 1464-1469. |
| [29] | 贾绍茂, 张莉, 罗开琴, 等. 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[J]. 临床超声医学杂志, 2023, 25(12): 1010-1014. |
| [30] | 姜辉, 杨柳, 谢志惠, 等. 动态超声测量视神经鞘直径指导院前创伤性脑外伤应用甘露醇的价值[J]. 临床急诊杂志, 2024, 25(4): 164-169. |
| [31] | 李琦, 任永凤, 王洲, 等. 经颅多普勒超声及超声测量视神经鞘直径在颅脑损伤患者颅内压增高中的应用价值[J]. 中国医疗设备, 2024, 39(2): 148-153. |
| [32] | 吴楚伟, 黄贤键, 邹隽风, 等. 超声测量视神经鞘直径与颅内压的相关性研究[J]. 中国微侵袭神经外科杂志, 2019, 24(9): 385-388. |
| [33] | 陈曦, 谢春林, 周维德, 等. 全凭静脉麻醉和硬膜外麻醉对重度子痫前期产妇颅内压的影响[J]. 临床麻醉学杂志, 2021, 37(11): 1164-1167. |
| [34] | 关雨斐. 分娩镇痛对产妇颅内压影响的临床观察[D]: [硕士学位论文]. 太原: 山西医科大学, 2022. |
| [35] | 黎合剑, 王祖文, 徐国海, 等. 不同肌松程度对腹腔镜胆囊切除联合胆总管探查术患者视神经鞘直径的影响[J]. 临床麻醉学杂志, 2021, 37(9): 924-928. |
| [36] | Kim, E.J., Koo, B.N., Choi, S.H., et al. (2018) Ultrasonographic Optic Nerve Sheath Diameter for Predicting Elevated Intracranial Pressure during Laparoscopic Surgery: A Systematic Review and Meta-Analysis. Surgical Endoscopy, 32, 175-182. https://doi.org/10.1007/s00464-017-5653-3 |
| [37] | Zhu, T., Yuan, C., Qian, M., et al. (2022) Effect of Dexmedetomidine on Intracranial Pressure in Patients Undergoing Gynecological Laparoscopic Surgery in Trendelenburg Position through Ultrasonographic Measurement of Optic Nerve Sheath Diameter. American Journal of Translational Research, 14, 6349-6358. |
| [38] | 杨贯宇, 朱泽飞, 郑红雨, 等. 丙泊酚与七氟醚对妇科腹腔镜患者视神经鞘直径的影响[J]. 临床麻醉学杂志, 2020, 36(11): 1059-1062. |
| [39] | Kim, J.E., Koh, S.Y. and Jun. I.J. (2022) Comparison of the Effects of Propofol and Sevoflurane Anesthesia on Optic Nerve Sheath Diameter in Robot-Assisted Laparoscopic Gynecology Surgery: A Randomized Controlled Trial. Journal of Clinical Medicine, 11, Article 2161. https://doi.org/10.3390/jcm11082161 |
| [40] | 王志刚, 石文汇, 侯俊德, 等. 呼气末正压通气对腹腔镜宫颈癌根治术患者眼压和视神经鞘直径的影响[J]. 临床麻醉学杂志, 2020, 36(5): 457-461. |
| [41] | Yilmaz, G., Akca, A., Kiyak, H., et al. (2020) Elevation in Optic Nerve Sheath Diameter Due to the Pneumoperitoneum and Trendelenburg Is Associated to Postoperative Nausea, Vomiting and Headache in Patients Undergoing Laparoscopic Hysterectomy. Minerva Anestesiologica, 86, 270-276. https://doi.org/10.23736/S0375-9393.19.13920-X |
| [42] | 高瑞云, 杨玲, 刘英英, 等. 围拔管期瑞芬太尼持续泵注对脑膜瘤切除术患者气管拔管时视神经鞘直径的影响[J]. 中国现代手术学杂志, 2022, 26(3): 167-171. |
| [43] | 刘玥, 张伟, 宋芬, 等. 气管插管与喉罩对非颅脑手术患者视神经鞘直径影响的比较[J]. 临床麻醉学杂志, 2019, 35(11): 1089-1092. |
