无创颅内压监测的研究进展 Research Progress of Noninvasive Intracranial Pressure Monitoring

颅内压是指颅腔内容物对颅腔壁的压力，其变化能反映颅内的生理、病理变化情况。成人平卧位的颅内压持续维持在15 mmHg（1 mmHg=0.133 kPa）以上，即为颅内高压。目前，颅内压的监测方法以有创的脑室外引流和实质内探针为“金标准”，然而该方法存在感染风险高、易导致脑损伤和出血等缺陷，且成本高昂。鉴于此，探寻一种安全、精确的无创颅内压监测手段显得尤为关键。本文综述无创颅内压监测的最新研究进展，比较分析了多种技术方法的优势与缺陷，脑成像技术、TCD、脑电图、近红外光谱以及基于眼和耳的监测方法等在颅内压评估中均发挥着一定作用，特别是视神经鞘直径已成为识别颅内高压风险患者的有效指标，而TCD则展现出代替传统有创监测手段的潜力。 Abstract: Intracranial pressure refers to the pressure exerted by the intracranial contents on the cranial cavity walls, and its changes can reflect the physiological and pathological changes within the skull. In adults lying flat, the intracranial pressure consistently maintains above 15 mmHg (1 mmHg=0.133 kPa), which is considered intracranial hypertension. Currently, the monitoring methods for intracranial pressure, such as invasive external ventricular drainage and parenchymal probe, are considered the “gold standard”. However, these methods have disadvantages such as a high risk of infection, potential for brain injury and bleeding, and high costs. Given this, exploring a safe and accurate noninvasive intracranial pressure monitoring method is particularly critical. This article reviewed the latest research progress in noninvasive intracranial pressure monitoring, and compared the advantages and disadvantages of various techniques. Brain imaging, TCD, electroencephalogram, near-infrared spectroscopy, and monitoring methods based on the eyes and ears all play a certain role in intracranial pressure assessment. In particular, the optic nerve sheath diameter has become an effective indicator for identifying patients at risk of intracranial hypertension, and TCD shows potential to replace traditional invasive monitoring methods.