超声测量视神经鞘直径监测颅内压在麻醉手术的应用
Application of Ultrasonic Measurement of Optic Nerve Sheath Diameter in Monitoring Intracranial Pressure During Anesthesia and Surgery
DOI: 10.12677/acm.2025.15113225, PDF,   
作者: 姜 卓, 史明泽, 王嘉微:西安医学院研究生工作部,陕西 西安;李 扬*:陕西省人民医院麻醉科,陕西 西安
关键词: 围手术期颅内压视神经鞘直径Perioperative Period Intracranial Pressure Optic Nerve Sheath Diameter
摘要: 目前有多种有创或无创的方法可以在围术期监测患者颅内压,不同的方法具有各自的使用范围。超声测量视神经鞘直径因其便捷、可重复性强、灵敏度高等特点,可用于监测术中颅内压变化的高危患者和术中采用特殊体位的患者以及指导术后并发症的治疗。本文就超声测量ONSD在麻醉手术中的应用进行综述,旨在为该技术在麻醉手术中的推广提供一定依据。
Abstract: Currently, there are various invasive or non-invasive methods for monitoring intracranial pressure during anesthesia and surgery, each with its specific clinical applicability. Ultrasonic measurement of the optic nerve sheath diameter is particularly suitable for monitoring high-risk patients with intraoperative intracranial pressure fluctuations, those requiring special surgical positioning, and guiding postoperative complication management due to its advantages of convenience, strong reproducibility, and high sensitivity. This article reviews the clinical applications of optic nerve sheath diameter measurement in perioperative anesthesia, aiming to provide evidence-based support for promoting this technique in surgical anesthesia practice.
文章引用:姜卓, 史明泽, 王嘉微, 李扬. 超声测量视神经鞘直径监测颅内压在麻醉手术的应用[J]. 临床医学进展, 2025, 15(11): 1315-1323. https://doi.org/10.12677/acm.2025.15113225

参考文献

[1] Chodobski, A., Zink, B.J. and Szmydynger-Chodobska, J. (2011) Blood-Brain Barrier Pathophysiology in Traumatic Brain Injury. Translational Stroke Research, 2, 492-516. [Google Scholar] [CrossRef] [PubMed]
[2] Marmarou, A. (2007) A Review of Progress in Understanding the Pathophysiology and Treatment of Brain Edema. Neurosurgical Focus, 22, 1-10. [Google Scholar] [CrossRef] [PubMed]
[3] Canac, N., Jalaleddini, K., Thorpe, S.G., Thibeault, C.M. and Hamilton, R.B. (2020) Review: Pathophysiology of Intracranial Hypertension and Noninvasive Intracranial Pressure Monitoring. Fluids and Barriers of the CNS, 17, Article No. 40. [Google Scholar] [CrossRef] [PubMed]
[4] Hawryluk, G.W.J., Citerio, G., Hutchinson, P., Kolias, A., Meyfroidt, G., Robba, C., et al. (2022) Intracranial Pressure: Current Perspectives on Physiology and Monitoring. Intensive Care Medicine, 48, 1471-1481. [Google Scholar] [CrossRef] [PubMed]
[5] Schievink, W.I. (2021) Spontaneous Intracranial Hypotension. New England Journal of Medicine, 385, 2173-2178. [Google Scholar] [CrossRef] [PubMed]
[6] Le Roux, P., Menon, D.K., Citerio, G., et al. (2014) Consensus Summary Statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: A Statement for Healthcare Professionals from the Neuro-Critical Care Society and the European Society of Intensive Care Medicine. Neurocritical Care, 21, S1-S26.
[7] Langfitt, T.W., Weinstein, J.D. and Kassell, N.F. (1964) Transmission of Increased Intracranial Pressure. Journal of Neurosurgery, 21, 989-997. [Google Scholar] [CrossRef] [PubMed]
[8] Andrews, P.D. and Citerio, G. (2004) Intracranial Pressure. Part One: Historical Overview and Basic Concepts. Intensive Care Medicine, 30, 1730-1733. [Google Scholar] [CrossRef] [PubMed]
[9] Heldt, T., Zoerle, T., Teichmann, D. and Stocchetti, N. (2019) Intracranial Pressure and Intracranial Elastance Monitoring in Neurocritical Care. Annual Review of Biomedical Engineering, 21, 523-549. [Google Scholar] [CrossRef] [PubMed]
[10] Moretti, R. and Pizzi, B. (2011) Ultrasonography of the Optic Nerve in Neurocritically Ill Patients. Acta Anaesthesiologica Scandinavica, 55, 644-652. [Google Scholar] [CrossRef] [PubMed]
[11] Sekhon, M.S., Griesdale, D.E., Robba, C., McGlashan, N., Needham, E., Walland, K., et al. (2015) Erratum to: Optic Nerve Sheath Diameter on Computed Tomography Is Correlated with Simultaneously Measured Intracranial Pressure in Patients with Severe Traumatic Brain Injury. Intensive Care Medicine, 41, 177-177. [Google Scholar] [CrossRef] [PubMed]
[12] Geeraerts, T., Merceron, S., Benhamou, D., Vigué, B. and Duranteau, J. (2008) Non-Invasive Assessment of Intracranial Pressure Using Ocular Sonography in Neurocritical Care Patients. Intensive Care Medicine, 34, 2062-2067. [Google Scholar] [CrossRef] [PubMed]
[13] 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. [Google Scholar] [CrossRef] [PubMed]
[14] Hirzallah, M.I., Lochner, P., Hafeez, M.U., Lee, A.G., Krogias, C., Dongarwar, D., et al. (2024) Optic Nerve Sheath Diameter Point-of-Care Ultrasonography Quality Criteria Checklist: An International Consensus Statement on Optic Nerve Sheath Diameter Imaging and Measurement. Critical Care Medicine, 52, 1543-1556. [Google Scholar] [CrossRef] [PubMed]
[15] Sharie, S.A., Almari, R., Azzam, S., Al-Husinat, L., Araydah, M., Battaglini, D., et al. (2025) Brain Protective Ventilation Strategies in Severe Acute Brain Injury. Current Neurology and Neuroscience Reports, 25, Article No. 68. [Google Scholar] [CrossRef
[16] Alexandri, M., Smith, T.M., Mitchell, C.A., Ausman, C. and Brillhart, D.B. (2025) Real-Time Reduction in Optic Nerve Sheath Diameter Following Hypertonic Saline Bolus in a Patient with Penetrating Traumatic Brain Injury: A Case Report. Journal of Special Operations Medicine, 25, 87-91. [Google Scholar] [CrossRef
[17] Radkowski, P., Oniszczuk, H., Opolska, J., Kłosińska, A., Dabdoub, T. and Onichimowski, D. (2024) Optimizing Anesthetic Management for Laparoscopic Surgery: A Comprehensive Review. Medical Science Monitor, 30, e945951. [Google Scholar] [CrossRef] [PubMed]
[18] Kamine, T.H., Papavassiliou, E. and Schneider, B.E. (2014) Effect of Abdominal Insufflation for Laparoscopy on Intracranial Pressure. JAMA Surgery, 149, 380-382. [Google Scholar] [CrossRef] [PubMed]
[19] Chen, K., Wang, L., Wang, Q., Liu, X., Lu, Y., Li, Y., et al. (2019) Effects of Pneumoperitoneum and Steep Trendelenburg Position on Cerebral Hemodynamics during Robotic-Assisted Laparoscopic Radical Prostatectomy. Medicine, 98, e15794. [Google Scholar] [CrossRef] [PubMed]
[20] Song, B., Li, L., Wang, X., Guo, Y. and Li, J. (2024) Relationship between Intracranial Pressure and Neurocognitive Function among Older Adults after Radical Resection of Rectal Cancer. World Journal of Gastrointestinal Surgery, 16, 3261-3268. [Google Scholar] [CrossRef] [PubMed]
[21] Edgcombe, H., Carter, K. and Yarrow, S. (2008) Anaesthesia in the Prone Position. British Journal of Anaesthesia, 100, 165-183. [Google Scholar] [CrossRef] [PubMed]
[22] Wright, J.M., Gerges, C., Shammassian, B., Labak, C.M., Herring, E.Z., Miller, B., et al. (2021) Prone Position Ventilation in Neurologically Ill Patients: A Systematic Review and Proposed Protocol. Critical Care Medicine, 49, e269-e278. [Google Scholar] [CrossRef] [PubMed]
[23] Robba, C., Bragazzi, N.L., Bertuccio, A., Cardim, D., Donnelly, J., Sekhon, M., et al. (2017) Effects of Prone Position and Positive End-Expiratory Pressure on Noninvasive Estimators of ICP: A Pilot Study. Journal of Neurosurgical Anesthesiology, 29, 243-250. [Google Scholar] [CrossRef] [PubMed]
[24] Duan, X., Wei, J., Liang, A., et al. (2024) Small Tidal Volume Hyperventilation Relieves Intraocular and Intracranial Pressure Elevation in Prone Spinal Surgery: A Randomized Controlled Trial. Journal of Southern Medical University, 44, 660-665.
[25] Nekludov, M., Bellander, B.‐M. and Mure, M. (2006) Oxygenation and Cerebral Perfusion Pressure Improved in the Prone Position. Acta Anaesthesiologica Scandinavica, 50, 932-936. [Google Scholar] [CrossRef] [PubMed]
[26] Huang, Q.B., Zhang, Y., Su, Y.H., et al. (2013) Prognostic Correlation of Intracranial Pressure Monitoring in Patients with Severe Craniocerebral Injury. Chinese Medical Journal, 93, 1788-1790.
[27] McCormack, E., Aysenne, A., Cardona, J.J., Chaiyamoon, A., Bui, C.J., Dumont, A.S., et al. (2023) Effects of Intubation Technique on Intracranial Pressure: A Cadaveric Study. Neurosurgical Review, 46, Article No. 88. [Google Scholar] [CrossRef] [PubMed]
[28] Maissan, I.M., Hollestelle, R.V., Rijs, K., Jaspers, S., Hoeks, S., Haitsma, I.K., et al. (2023) Intravenous Lidocaine Attenuates Distention of the Optical Nerve Sheath, a Correlate of Intracranial Pressure, during Endotracheal Intubation. Minerva Anestesiologica, 89, 131-137. [Google Scholar] [CrossRef] [PubMed]
[29] Shortland, D.B., Field, D., Archer, L.N., Gibson, N.A., Woods, K.L., Evans, D.H., et al. (1989) Cerebral Haemodynamic Effects of Changes in Positive End Expiratory Pressure in Preterm Infants. Archives of Disease in Childhood, 64, 465-469. [Google Scholar] [CrossRef] [PubMed]
[30] Scala, R., Turkington, P.M., Wanklyn, P., Bamford, J. and Elliott, M.W. (2003) Effects of Incremental Levels of Continuous Positive Airway Pressure on Cerebral Blood Flow Velocity in Healthy Adult Humans. Clinical Science, 104, 633-639. [Google Scholar] [CrossRef] [PubMed]
[31] Bowie, R.A., O’Connor, P.J., Hardman, J.G. and Mahajan, R.P. (2001) The Effect of Continuous Positive Airway Pressure on Cerebral Blood Flow Velocity in Awake Volunteers. Anesthesia & Analgesia, 92, 415-417. [Google Scholar] [CrossRef] [PubMed]
[32] Apuzzo, M.L.J., Weiss, M.H., Petersons, V., Small, R.B., Kurze, T. and Heiden, J.S. (1977) Effect of Positive End Expiratory Pressure Ventilation on Intracranial Pressure in Man. Journal of Neurosurgery, 46, 227-232. [Google Scholar] [CrossRef] [PubMed]
[33] 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.
[34] Maissan, I.M., Dirven, P.J.A.C., Haitsma, I.K., Hoeks, S.E., Gommers, D. and Stolker, R.J. (2015) Ultrasonographic Measured Optic Nerve Sheath Diameter as an Accurate and Quick Monitor for Changes in Intracranial Pressure. Journal of Neurosurgery, 123, 743-747. [Google Scholar] [CrossRef] [PubMed]
[35] Robba, C., Cardim, D., Tajsic, T., Pietersen, J., Bulman, M., Donnelly, J., et al. (2017) Ultrasound Non-Invasive Measurement of Intracranial Pressure in Neurointensive Care: A Prospective Observational Study. PLOS Medicine, 14, e1002356. [Google Scholar] [CrossRef] [PubMed]
[36] 付鸿林, 胡静娜, 张雪薇, 等. 超声在围拔管期颅内压监测中的应用[J]. 中国超声医学杂志, 2024, 40(4): 361-365.
[37] Zoerle, T., Beqiri, E., Åkerlund, C.A.I., Gao, G., Heldt, T., Hawryluk, G.W.J., et al. (2024) Intracranial Pressure Monitoring in Adult Patients with Traumatic Brain Injury: Challenges and Innovations. The Lancet Neurology, 23, 938-950. [Google Scholar] [CrossRef] [PubMed]
[38] Gao, G., Wu, X., Feng, J., Hui, J., Mao, Q., Lecky, F., et al. (2020) Clinical Characteristics and Outcomes in Patients with Traumatic Brain Injury in China: A Prospective, Multicentre, Longitudinal, Observational Study. The Lancet Neurology, 19, 670-677. [Google Scholar] [CrossRef] [PubMed]
[39] Ives, C.W., Sinkey, R., Rajapreyar, I., Tita, A.T.N. and Oparil, S. (2020) Preeclampsia—Pathophysiology and Clinical Presentations. Journal of the American College of Cardiology, 76, 1690-1702. [Google Scholar] [CrossRef] [PubMed]
[40] Sterrett, M.E., Austin, B., Barnes, R.M. and Chang, E.Y. (2022) Optic Nerve Sheath Diameter in Severe Preeclampsia with Neurologic Features versus Controls. BMC Pregnancy and Childbirth, 22, Article No. 224. [Google Scholar] [CrossRef] [PubMed]
[41] Amorim, M.M.R., Katz, L., Barros, A.S., Almeida, T.S.F., Souza, A.S.R. and Faúndes, A. (2015) Maternal Outcomes According to Mode of Delivery in Women with Severe Preeclampsia: A Cohort Study. The Journal of Maternal-Fetal & Neonatal Medicine, 28, 654-660. [Google Scholar] [CrossRef] [PubMed]
[42] Park, S., Kim, H., Kim, Y., Jang, Y. and Kim, J. (2024) Effect of Epidural Anesthesia on the Optic Nerve Sheath Diameter in Patients with Pre-Eclampsia: A Prospective Observational Study. Regional Anesthesia & Pain Medicine, 50, 828-834. [Google Scholar] [CrossRef] [PubMed]
[43] da Mota, M.F., de Amorim, M.M., Correia, M.D.T. and Katz, L. (2024) The Optic Nerve Sheath in Hypertensive Disorders of Pregnancy and Perinatal Outcomes: A Cohort Study. BMC Pregnancy and Childbirth, 24, Article No. 654. [Google Scholar] [CrossRef] [PubMed]
[44] Sprigge, J.S. and Harper, S.J. (2008) Accidental Dural Puncture and Post Dural Puncture Headache in Obstetric Anaesthesia: Presentation and Management: A 23‐Year Survey in a District General Hospital. Anaesthesia, 63, 36-43. [Google Scholar] [CrossRef] [PubMed]
[45] Uppal, V., Russell, R., Sondekoppam, R., Ansari, J., Baber, Z., Chen, Y., et al. (2023) Consensus Practice Guidelines on Postdural Puncture Headache from a Multisociety, International Working Group: A Summary Report. JAMA Network Open, 6, e2325387. [Google Scholar] [CrossRef] [PubMed]
[46] Li, H., Wang, Y., Oprea, A.D. and Li, J. (2022) Postdural Puncture Headache—Risks and Current Treatment. Current Pain and Headache Reports, 26, 441-452. [Google Scholar] [CrossRef] [PubMed]
[47] Schyns-van den Berg, A.M.J.V. and Gupta, A. (2023) Postdural Puncture Headache: Revisited. Best Practice & Research Clinical Anaesthesiology, 37, 171-187. [Google Scholar] [CrossRef] [PubMed]
[48] Leger, F.B.S., Medina, L., Chiniard, T., et al. (2023) The Value of the Optic Nerve Sheath Diameter (ONSD) in Predicting Postdural Puncture Headache (PDPH): A Prospective Observational Study. Pain Physician Journal, 26, 45-52. [Google Scholar] [CrossRef
[49] Besir, A., Tertemiz, O.F., Akdogan, A. and Duman, E.N. (2019) The Importance of Optic Nerve Sheath Diameter in Post-Dural Puncture Headache Diagnosis and Follow-Up. Archives of Neuropsychiatry, 56, 195-199. [Google Scholar] [CrossRef] [PubMed]
[50] Boyacı, S., Onay, M. and Güleç, M.S. (2024) Optic Nerve Sheath Diameter Measurement for Prediction of Postdural Puncture Headache. Journal of Clinical Monitoring and Computing, 38, 415-422. [Google Scholar] [CrossRef] [PubMed]
[51] Dubost, C., Le Gouez, A., Zetlaoui, P.J., Benhamou, D., Mercier, F.J. and Geeraerts, T. (2011) Increase in Optic Nerve Sheath Diameter Induced by Epidural Blood Patch: A Preliminary Report. British Journal of Anaesthesia, 107, 627-630. [Google Scholar] [CrossRef] [PubMed]
[52] McEvoy, M.D., Thies, K., Einav, S., Ruetzler, K., Moitra, V.K., Nunnally, M.E., et al. (2018) Cardiac Arrest in the Operating Room: Part 2—Special Situations in the Perioperative Period. Anesthesia & Analgesia, 126, 889-903. [Google Scholar] [CrossRef] [PubMed]
[53] Nolan, J.P., Sandroni, C., Böttiger, B.W., Cariou, A., Cronberg, T., Friberg, H., et al. (2021) European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-Resuscitation Care. Resuscitation, 161, 220-269. [Google Scholar] [CrossRef] [PubMed]
[54] Rush, B., Wormsbecker, A., Berger, L., Wiskar, K., Sekhon, M.S. and Griesdale, D.E. (2017) Optic Nerve Sheath Diameter on Computed Tomography Not Predictive of Neurological Status Post-Cardiac Arrest. CJEM, 19, 181-185. [Google Scholar] [CrossRef] [PubMed]
[55] Lee, D.H., Lee, S.H., Oh, J.H., Cho, I.S., Lee, Y.H., Han, C., et al. (2018) Optic Nerve Sheath Diameter Measured Using Early Unenhanced Brain Computed Tomography Shows No Correlation with Neurological Outcomes in Patients Undergoing Targeted Temperature Management after Cardiac Arrest. Resuscitation, 128, 144-150. [Google Scholar] [CrossRef] [PubMed]
[56] Chae, M.K., Ko, E., Lee, J.H., Lee, T.R., Yoon, H., Hwang, S.Y., et al. (2016) Better Prognostic Value with Combined Optic Nerve Sheath Diameter and Grey-to-White Matter Ratio on Initial Brain Computed Tomography in Post-Cardiac Arrest Patients. Resuscitation, 104, 40-45. [Google Scholar] [CrossRef] [PubMed]
[57] Verhulst, M.M.L.H., Visser, I.M., Keijzer, H.M., de Kruijf, N.L.M., Peters, E.J.G., Wilbers, T., et al. (2023) Additional Predictive Value of Optic Nerve Sheath Diameter for Neurological Prognosis after Cardiac Arrest: A Prospective Cohort Study. The Ultrasound Journal, 15, Article No. 46. [Google Scholar] [CrossRef] [PubMed]