臺灣博碩士論文加值系統

視神經鞘主要由外鞘、內鞘以及兩鞘膜形成的蜘蛛膜下腔構成，兩鞘膜分別又是顱內腦膜硬膜與軟膜向外延伸之結構，並包覆著腦脊髓液。目前在人醫文獻，多已證實腦壓上升與視神經鞘寬度變化具有高度正相關的特性，經眼量測視神經鞘寬度即依據這項特性作為評估腦壓的工具。然而，目前獸醫文獻有關於視神經鞘寬度與腦壓的研究仍不多，例如性別、年齡、體重、體表面積、品種對於視神經鞘寬度的影響等。本篇研究的主要目的有二，第一為評估此技術在獸醫領域應用上的一致性，第二則是評估可能影響視神經鞘寬度之因素。
本研究將至國立臺灣大學附設動物醫院就診、不具眼科疾病、腦部疾病且不具嚴重系統性疾病之犬隻列為研究對象。犬隻於全身麻醉下呈側躺姿勢，以Accutome® B-scan plus超音波儀搭配15MHz超音波探頭進行掃描，量測眼球後方3毫米及5毫米處之視神經鞘寬度。數據以平均值及標準差呈現，依據樣本特性，以獨立t檢定、組內相關係數、雙變數Pearson相關分析、線性回歸曲線以及ANOVA進行統計分析。
研究共納入206例犬隻，結果顯示，以超音波量測視神經鞘寬度，觀測者本身的一致性，以及二位觀測者之間的一致性，平均差異值皆小於0.1毫米，呈高度一致；眼球後方3毫米處與眼球後方5毫米處的量測值亦具高度一致性，平均差異值小於0.1毫米。視神經鞘寬度與各項變因的分析研究顯示，性別、年齡與視神經鞘寬度無顯著相關，而體重、體表面積則與視神經鞘寬度呈高度正相關性。本篇研究中進行第一步統計分析的品種包含瑪爾濟斯、約克夏、貴賓犬、臘腸犬、雪納瑞、米格魯、柯基犬、拉布拉多獵犬、哈士奇與黃金獵犬。犬種與視神經鞘之關係，體型越大之犬種擁有越寬的視神經鞘，但相似體型之犬種其視神經鞘寬度也可能存在顯著差異。單一品種下，除米格魯犬，其餘犬種的體重、體表面積與視神經鞘寬度並無顯著相關。
以上結果顯示，經眼球超音波量測犬隻視神經鞘寬度，能提供良好的再現性與一致性，但在應用時應以犬種的差異性為優先考量，即便是相似體型的犬種，其視神經鞘寬度可能有顯著差異。未來研究上仍需增加各種犬種中的正常族群與高腦壓族群之測量值，以例建立後續臨床應用上的參考值。

Transorbital ultrasonographic measurement of optic nerve sheath diameter (ONSD) has been applied as a noninvasive method for detecting intracranial hypertension in humans. However, there are limited data in veterinary literature describing the correlation between ONSD and intracranial pressure condition, as well as other factors that might influence the width of ONSD, such as body weight, body surface area, and breeds. The aims of this study are: (a) to assess intra- and inter-observer reliability of ultrasonographic measurement of optic nerve sheath diameter, and (b) to evaluate factors that may influence the ONSD in dogs with normal brain function.
Dogs presented to the National Taiwan University Veterinary Hospital, without ophthalmic disease, brain dysfunction, and severe systemic diseases, were included in the study. Under general anesthesia and in lateral recumbency, ONSD was measured at 3 mm and 5mm caudal to the optic disc via- a 15-MHz ultrasonographic probe. Statistical analysis was performed using the SPSS statistical computer program. Data was reported as mean SD values. According to property of sample, intra-class correlation, independent samples t-test, Pearson correlation, linear regression or ANOVA were applied for data analysis.
ONSD was measured in 206 dogs. The intra- and inter-observer reliability was high for ONSD measurement. Gender and age did not significantly affect the measurement of ONSD. Body weight and body surface area were highly positively correlated with ONSD. ONSD in Maltese, Yorkshire, miniature Poodle, miniature Dachshund, miniature Schnauzer, Beagle, Corgi, Labrador Retriever, Husky, and Golden Retriever were further analyzed in this study. Results revealed significant difference in ONSD between various breeds, in which the larger size of breed tends to have the wider ONSD value. However, except for the Beagle, the ONSD was not significantly correlated with body weight and body surface area in dogs of the same breed.
The results demonstrated that ultrasonographic measurement of ONSD is a reproducible technique with high intra- and inter-observer reliability. However, when applying the measurement of ONSD to detect intracranial hypertension, breed variation should be considered as one important factor. The results of our study could be seen as a basis for future investigation. Larger sample size of various breeds including dogs with normal and increased intracranial pressure are needed to establish the reference of different breeds for future application of ultrasonographic ONSD to predict intracranial pressure.

口試委員審定書 i
致謝 ii
中文摘要 iii
英文摘要 v
目錄 vii
表次 ix
圖次 x
第一章、序言 1
第一節、研究背景 1
第二節、研究目的 2
第二章、文獻探討 3
第一節、腦壓 3
第一項、腦壓生理機制 3
第二項、高腦壓 4
第三項、高腦壓時的臨床及神經症狀 5
第二節、腦壓監測 6
第一項、侵入性腦壓監測 6
第二項、間接性腦壓評估 8
第三節、視神經鞘 10
第一項、解剖構造 10
第二項、視神經鞘特性 12
第三項、影像特徵 14
第四節、經眼超音波臨床應用性 17
第一項、人醫相關文獻 17
第二項、獸醫相關文獻 18
第三章、材料與方法 20
第一節、實驗對象 20
第二節、實驗方法 20
第一項、視神經鞘掃描 20
第二項、視神經鞘量測 21
第三節、統計分析 22
第四章、結果 25
第五章、討論 41
第一節、超音波量測犬隻視神經鞘寬度的再現性與一致性 41
第二節、影響視神經鞘寬度之因素 43
第三節、技術學習與未來獸醫領域研究方向 45
第四節、限制性 46
第六章、結論 48
參考文獻 49

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