1. He aha ka pōmaikaʻi o ka ultrasound lung?
I nā makahiki i hala iho nei, ua hoʻohana nui ʻia ke kiʻi kiʻi ultrasound lung.Mai ke ʻano kuʻuna o ka hoʻokolokolo wale ʻana i ka hele ʻana a me ka nui o ka pleural effusion, ua hoʻololi ʻo ia i ka hoʻokolokolo kiʻi parenchyma māmā.Hiki iā mākou ke ʻike i ka 5 mau kumu koʻikoʻi maʻamau o ka hāʻule ʻana o ka hanu (pulmonary edema, pneumonia, pulmonary embolism, COPD, pneumothorax) ma mua o 90% o nā hihia me kahi ultrasound māmā 3-5 mau minuke.He ʻōlelo hoʻolauna pōkole kēia i ke kaʻina hana maʻamau o ka ultrasonography māmā.
2. Pehea e koho ai i kahi ʻimi ultrasound?
ʻO nā probes i hoʻohana pinepine ʻia no ka ultrasound lungL10-5(i kapa ʻia hoʻi ʻo ka ʻōnaʻi liʻiliʻi liʻiliʻi, ka laina alapine 5 ~ 10MHz linear array) aC5-2(kapa ʻia ʻo ka ʻōpū ʻōpū a i ʻole convex nui, 2 ~ 5MHz convex array), hiki i kekahi mau hiʻohiʻona ke hoʻohana i ka P4-2 (i kapa ʻia hoʻi ka ʻimi naʻau, 2 ~ 4MHz phased array).
He mea maʻalahi ka ʻimi liʻiliʻi liʻiliʻi L10-5 e kiʻi i kahi laina pleural a nānā i ka leo o ka ʻiʻo subpleural.Hiki ke hoʻohana ʻia ka iwi ʻaoʻao e like me ka māka e nānā i ka laina pleural, hiki ke koho mua no ka loiloi pneumothorax.He haʻahaʻa ka alapine o ka ʻōpū o ka ʻōpū, a hiki ke ʻike maopopo ʻia ka laina pleural i ka nānā ʻana i ka umauma holoʻokoʻa.He mea maʻalahi ke kiʻi ʻana i nā probes array phased ma o ke ākea intercostal a loaʻa ka hohonu hohonu.Hoʻohana pinepine ʻia lākou i ka loiloi ʻana o ka pleural effusions, akā ʻaʻole maikaʻi i ka ʻike ʻana i ka pneumothorax a me nā kūlana pleural space.
3. ʻO nā ʻāpana hea e nānā ʻia?
Hoʻohana maʻamau ʻia ka ultrasonography o ka māmā ma ke ʻano hoʻololi ʻia ʻo bedside lung ultrasonography (mBLUE) a i ʻole ka papa hana ʻelua-lung 12-division a me ka papahana 8-division.He 10 ka nui o na wahi kiko ma na aoao elua o na akemāmā ma ka papahana mBLUE, he mea kupono ia no na kulana e koi ana i ka nana wikiwiki.ʻO ka hoʻolālā 12-zone a me ka 8-zone scheme e hoʻoheheʻe i ka ʻimi ultrasound ma kēlā me kēia wahi no ka nānā pono ʻana.
Hōʻike ʻia nā wahi o kēlā me kēia wahi hōʻoia i ka papahana mBLUE ma kēia kiʻi:
| wahi nānā | Wahi |
| kiko uliuli | ʻO ke kiko ma waena o ka manamana waena a me ke kumu o ka manamana lima ma ka ʻaoʻao o ke poʻo |
| wahi diaphragm | E huli i kahi o ka diaphragm me ka ʻimi ultrasound ma ka laina midaxillary |
| lae M
| ʻO ka waena waena o ka laina e hoʻopili ana i ka lae polū luna a me ka lae diaphragm |
| Lae PLAPS
| ʻO ka hui ʻana o ka laina hoʻonui o ke kiko M a me ke kaha e kū pono ana i ka laina axillary hope |
| kiko uliuli kua
| ʻO ka ʻāpana ma waena o ke kihi subscapular a me ka iwi kuamoʻo |
Hoʻokumu ʻia ka papa hana 12 ma luna o ka laina parasternal o ka mea maʻi, ka laina axillary mua, ka laina axillary hope, a me ka laina paraspinal e hoʻokaʻawale i ka ʻokiʻoki i 6 mau ʻāpana o ka pā mua, ʻaoʻao, a me hope o ka pā umauma, a ua māhele ʻia kēlā me kēia wahi i ʻelua mau ʻāpana. , luna a lalo, me ka huina o 12 mau wahi.wahi.ʻAʻole i hoʻokomo ʻia ka papahana ʻewalu ʻāpana i nā ʻāpana ʻehā o ka paia o ka umauma hope, a hoʻohana pinepine ʻia i ka ʻike a me ka loiloi o ka ultrasonography no ka interstitial pulmonary syndrome.ʻO ke ʻano hiʻohiʻona kikoʻī ʻo ka hoʻomaka ʻana mai ka laina waena ma kēlā me kēia wahi, ʻo ke koʻikoʻi waena o ka probe e kū pono loa i ka iwi ʻokiʻoki (longitudinal plane), e paheʻe mua ma ka ʻaoʻao i ka laina hoʻokaʻawale, e hoʻi i ka laina waena, a laila e paheʻe ma waena o ka. laina palena, a laila e hoʻi i ka laina waena.
4. Pehea e kālailai i nā kiʻi ultrasound?
E like me kā mākou e ʻike ai, ʻo ka ea ka "ʻenemi" o ka ultrasound, no ka mea, he wikiwiki ka pohō ʻana o ka ultrasound i ka ea, a ʻo ka hele ʻana o ka ea i loko o ka māmā he mea paʻakikī ke kiʻi pololei i ka parenchyma māmā.I loko o kahi akemāmā maʻamau, ʻo ka ʻiʻo wale nō e ʻike ʻia ʻo ia ka pleura, i ʻike ʻia ma ka ultrasound ma ke ʻano he laina hyperechoic ākea i kapa ʻia ʻo ka laina pleural (ka mea kokoke loa i ka papa ʻiʻo palupalu).Eia kekahi, aia nā mea like like, hyperechoic horizontal line artifacts i kapa ʻia nā laina A ma lalo o ka laina pleural.ʻO ka loaʻa ʻana o kahi laina A, ʻo ia hoʻi, aia ka ea ma lalo o ka laina pleural, ʻo ia ka ea māmā maʻamau a i ʻole ka ea manuahi i loko o kahi pneumothorax.
I ka wā o ka ultrasonography māmā, ʻike mua ʻia ka laina pleural, ke ʻole ka nui o ka subcutaneous emphysema, ka mea maʻamau e ʻike ʻia.I loko o nā akemāmā maʻamau, hiki i ka pleura visceral a me ka parietal pleura ke paheʻe i kekahi i kekahi me ka hanu ʻana, i kapa ʻia ʻo lung sliding.E like me ka mea i hōʻike ʻia ma nā kiʻi ʻelua e hiki mai ana, ʻo ke kiʻi luna he lung sliding a ʻo ke kiʻi haʻahaʻa ʻaʻohe māmā sliding.
ʻO ka mea maʻamau, i nā poʻe maʻi me ka pneumothorax, a i ʻole ka nui o ka pleural effusion e mālama ana i nā māmā mai ka paia o ka umauma, e nalowale ka hōʻailona hili.A i ʻole ʻo ka maʻi pneumonia e hoʻohui i nā māmā, a ʻike ʻia nā adhesions ma waena o nā akemāmā a me ka paia o ka umauma, kahi e hiki ai ke hoʻopau i ka hōʻailona o ka māmā.Hoʻopuka ka ʻulaʻula maʻamau i ka ʻiʻo fibrous e hōʻemi ana i ka neʻe ʻana o ka māmā, a ʻaʻole hiki ke ʻike ʻia nā paipu hoʻokahe o ka ʻōpū e like me ka COPD kiʻekiʻe.
Inā hiki ke nānā 'ia ka laina A, 'o ia ho'i he ea ma lalo o ka laina pleural, a nalo ka hō'ailona sliding māmā, he pneumothorax paha ia, a he mea pono e 'imi i kahi māmā no ka hō'oia 'ana.ʻO ka wahi māmā ka wahi hoʻololi mai ka ʻaʻohe māmā e hoʻoheheʻe ana i ka māmā maʻamau i ka pneumothorax a ʻo ia ke kūlana gula no ka hōʻoia ʻana o ka ultrasound o ka pneumothorax.
Hiki ke ʻike ʻia nā laina like ʻole i hana ʻia e ka pā umauma paʻa ma lalo o ke ʻano M-mode ultrasound.I loko o nā kiʻi parenchyma māmā maʻamau, ma muli o ka holo ʻana o ka māmā i hope a i waho, ua hoʻokumu ʻia nā leo e like me ke one ma lalo, i kapa ʻia ʻo ka hōʻailona kahakai.Aia ka ea ma lalo o ka pneumothorax, a ʻaʻohe māmā e hoʻoheheʻe ʻia, no laila ua hoʻokumu ʻia nā laina like ʻole, i kapa ʻia ʻo ka hōʻailona barcode.ʻO ka wahi hoʻokaʻawale ma waena o ka hōʻailona kahakai a me ka hōʻailona barcode ka lae māmā.
Inā ʻaʻole ʻike ʻia ka hele ʻana o nā laina A i kahi kiʻi ultrasound, ʻo ia hoʻi, ua loli kekahi ʻano o ka ʻiʻo i loko o ka māmā, hiki iā ia ke hoʻouna i ka ultrasound.Nalo nā mea hana e like me nā laina A ke hoʻopiha ʻia ka wahi pleural mua e nā ʻiʻo e like me ke koko, ka wai, ka maʻi maʻi, ka ʻāʻī i hoʻokumu ʻia e ke koko i hoʻopaʻa ʻia, a i ʻole kahi tumo.A laila pono ʻoe e hoʻolohe i ka pilikia o ka laina B. ʻO ka laina B, i ʻike ʻia ʻo ka hōʻailona "comet tail", he laser beam-like hyperechoic strip e hoʻokuʻu pololei ana mai ka laina pleural (visceral pleura), a hiki i lalo. o ka pale me ka attenuation ole.Hoʻopili ia i ka laina A a neʻe me ka hanu.No ka laʻana, ma ke kiʻi ma lalo nei, ʻaʻole hiki iā mākou ke ʻike i ke ola o ka laina A, akā ma kahi o ka laina B.
Mai hopohopo inā loaʻa iā ʻoe kekahi mau laina B ma ke kiʻi ultrasound, 27% o ka poʻe maʻamau i loaʻa nā laina B i loko o ka 11-12 intercostal space (ma luna o ka diaphragm).Ma lalo o nā kūlana physiological maʻamau, ʻoi aku ka liʻiliʻi o nā laina 3 B maʻamau.Akā ke hālāwai ʻoe i kahi helu nui o nā laina B diffuse, ʻaʻole ia he mea maʻamau, ʻo ia ka hana o ka edema pulmonary.
Ma hope o ka nānā ʻana i ka laina pleural, laina A a i ʻole laina B, e kamaʻilio e pili ana i ka pleural effusion a me ka hoʻohui ʻana i ka māmā.Ma ka ʻaoʻao hope o ka umauma, hiki ke loiloi maikaʻi ʻia ka pleural effusion a me ka hoʻohui ʻana o ka māmā.ʻO ke kiʻi ma lalo nei he kiʻi ultrasound i nānā ʻia ma ka lae o ka diaphragm.ʻO ka wahi anechoic ʻeleʻele ka pleural effusion, aia i loko o ka lua pleural ma luna o ka diaphragm.
No laila pehea ʻoe e hoʻokaʻawale ai ma waena o ka pleural effusion a me ka hemorrhage?Hiki ke ʻike ʻia ka fibrous exudate i kekahi manawa i ka hemopleural effusion, ʻoiai ʻo ka hoʻoheheʻe ʻana he ʻeleʻele homogeneous anechoic wahi, i kekahi manawa i māhele ʻia i loko o nā keʻena liʻiliʻi, a ʻike ʻia nā mea lana o nā ʻano like ʻole a puni.
Hiki i ka Ultrasound ke nānā i ka hapa nui (90%) o nā mea maʻi me ka hoʻohui ʻana i ka māmā, ʻo ka wehewehe nui loa o ka nalowale o ka ea.ʻO ka mea kupanaha e pili ana i ka hoʻohana ʻana i ka ultrasound no ka ʻike ʻana i ka hoʻohui ʻana o ka māmā, ʻo ia ke hoʻohui ʻia nā māmā o ka mea maʻi, hiki i ka ultrasound ke hele ma nā wahi hohonu o ka māmā kahi e hoʻohui ʻia ai.He hypoechoic ka ʻiʻo māmā me ke ʻano o ka weluwelu a ʻaʻole maopopo.I kekahi manawa ʻike paha ʻoe i ka hōʻailona air bronchus, he hyperechoic a neʻe me ka hanu.ʻO ke kiʻi sonographic i loaʻa i ke koʻikoʻi diagnostic no ka hoʻohui ʻana i ka māmā i ka ultrasound, ʻo ia ka hōʻailona like me ke akepaʻa, ʻo ia ka leo paʻa e like me ka parenchyma ate e ʻike ʻia ma hope o ka piha ʻana o ka alveoli me ka exudate.E like me ka mea i hōʻike ʻia ma ka kiʻi ma lalo nei, he kiʻi ultrasound kēia o ka hoʻohui ʻana o ka māmā i hana ʻia e ka maʻi pneumonia.Ma ke kiʻi ultrasound, hiki ke ʻike ʻia kekahi mau wahi he hypoechoic, ʻano like ke ʻano o ke ake, ʻaʻole hiki ke ʻike ʻia ʻo A.
Ma lalo o nā kūlana maʻamau, ua piha ka māmā i ka ea, a ʻaʻole hiki ke ʻike ʻia ke kala Doppler ultrasound i kekahi mea, akā i ka wā e hoʻohui ʻia ai ka māmā, ʻoi aku ka nui o ka maʻi pneumonia kokoke i nā aʻa koko, hiki ke ʻike ʻia nā kiʻi kahe koko i loko o ka māmā, penei. hoikeia ma ke kii.
ʻO ke kani o ka ʻike ʻana i ka maʻi maʻi maʻi ke akamai kumu o ka ultrasound lung.Pono e neʻe i hope ma waena o nā iwi ʻaoʻao e nānā pono inā he wahi hypoechoic, inā he hōʻailona bronchus ea, inā he hōʻailona like me ke akepaʻa, a inā he laina A maʻamau a ʻaʻole paha.Kiʻi ultrasound lung.
5. Pehea e hoʻoholo ai i nā hopena o ka ultrasound?
Ma o ka ultrasound scan (mBLUE scheme a i ʻole ʻumikūmālua-zone scheme), hiki ke hoʻokaʻawale ʻia ka ʻike kikoʻī, a hiki ke hoʻoholo ʻia ke kumu koʻikoʻi o ka hāʻule ʻana o ka hanu.ʻO ka hoʻopau koke ʻana i ka hōʻailona hiki ke hoʻomaha i ka dyspnea o ka mea maʻi me ka wikiwiki a hoʻemi i ka hoʻohana ʻana i nā hoʻokolohua paʻakikī e like me CT a me UCG.ʻO kēia mau ʻike kikoʻī ʻo ia ka: lung sliding, A performance (A laina ma nā ʻōpū ʻelua ʻelua), B performance (B nā laina e ʻike ʻia ma nā ʻōpū ʻelua, a ʻaʻole i emi iho ma mua o 3 mau laina B a i ʻole nā laina B pili e pili ana), A /B hiʻohiʻona (He hiʻohiʻona ma kekahi ʻaoʻao o ka pleura, ʻike B ma ka ʻaoʻao ʻē aʻe), kahi o ka māmā, hoʻohui ʻana i ka māmā, a me ka hoʻoheheʻe ʻana i ka pleural.
Ka manawa hoʻouna: Dec-20-2022
