超声测量视神经鞘直径评估颅内压增高的临床研究进展

doi:10.3877/cma.j.issn.2096-1537.2020.033

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。

关键词: 颅内压, 颅内高压, 超声, 视神经鞘直径

Intracranial pressure (ICP) monitoring is very important in the treatment of severe neurological diseases. At present, there are mainly two methods of ICP monitoring: non-invasive and invasive, each of them has their own advantages. The invasive method is the gold standard, it has significant shortcomings and cannot be widely used. The optic nerve sheath (ONS) has a special anatomical structure. The diameter of the optic nerve sheath increases as intracranial pressure increases. Therefore, ultrasonographic measurement of optic nerve sheath diameterisanon-invasive, simple, feasible and repeatable method to determine the increase of intracranial pressure. This article reviews the progress in clinical researches on ultrasound monitoring of the diameter of optic sheat for the diagnosis of intracranial hypertension.

Key words: Intracranial pressure, Elevated intracranial pressure, Ultrasound, Optic nerve sheath diameter

图1 视神经示意图（图片来自Liu等^[3]）

图2 电子显微镜下的POSS（图片来自Killer等^[2]）。POSS内可见小梁组成的复杂结构

图3 视神经由视神经鞘及POSS所包绕（图片来自Liu等^[3]）

图4 眼部超声技术（矢状面，图片来自Cimilli Ozturk等^[6]）

图5 视神经示意图及超声图像^[7]

图6 眼内结构、视神经及视神经鞘的超声图像（图片来自del Saz-Saucedo等^[8]）

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Ultrasonographic measurement of optic nerve sheath diameter for intracranial pressure monitoring

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Ultrasonographic measurement of optic nerve sheath diameter for intracranial pressure monitoring