ʻO ke ana ʻana o ke kahe ʻana o ke koko he hana ʻino ma ka kala Doppler ultrasound.I kēia manawa, me ka hoʻomau mau ʻana o ka ultrasound ma ke kahua o ka hemodialysis vascular access, ua lilo ia i koi ʻoi aku ka paʻakikī.ʻOiai he mea maʻamau ka hoʻohana ʻana i ka ultrasound e ana i ke kahe o nā wai i loko o nā pipeline ʻoihana, ʻaʻole i uku nui ʻia i ke ana o ke kahe koko o nā kīʻaha koko i loko o ke kino kanaka.Aia kekahi kumu no ia mea.Ke hoʻohālikelike ʻia me nā pipeline ʻoihana, kanu ʻia nā kīʻaha koko i loko o ke kino o ke kanaka ma lalo o ka ʻili i ʻike ʻole ʻia, a ʻokoʻa ke anawaena o ka paipu (no ka laʻana, ʻoi aku ka liʻiliʻi o ke anawaena o kekahi mau moku ma mua o ka AVF ma mua o 2mm, a ʻoi aku kekahi mau AVF. ʻoi aku ma mua o 5mm ma hope o ke oʻo ʻana), a he ʻano elastic nui lākou, e lawe mai ana i ka maopopo ʻole i ke ana kahe.Hana kēia pepa i ka loiloi maʻalahi o nā mea hoʻoikaika o ke ana kahe, a alakaʻi i nā hana kūpono mai kēia mau kumu, a laila e hoʻomaikaʻi ai i ka pololei a me ka hoʻihoʻi ʻana o ke ana kahe koko.
ʻO ke kumu no ka helu ʻana i ke kahe koko:
Kahe koko = ka nui o ka manawa kahe o ka manawa × ʻāpana ʻāpana keʻa × 60, (unit: ml/min)
He maʻalahi loa ke ʻano.ʻO ia wale nō ka nui o ka wai e kahe ana ma ka ʻāpana keʻa o ka moku koko i kēlā me kēia manawa.ʻO ka mea e pono ai ke koho ʻia ʻo ia nā mea hoʻololi ʻelua-- ka ʻāpana cross-sectional a me ka awelika kahe kahe.
Hoʻokumu ʻia ka ʻāpana keʻa i loko o ke ʻano i luna ma luna o ka manaʻo he paipu pōʻai pōʻai ka ipu koko, a ʻo ka ʻāpana keʻa=1/4*π*d*d, kahi d ke anawaena o ka ipu koko. .Eia nō naʻe, he elastic nā kīʻaha koko maoli o ke kanaka, he maʻalahi ke kaomi a me ka deformed (ʻo ia hoʻi nā veins).No laila, i ke ana ʻana i ke anawaena o ka paipu a i ʻole ke ana ʻana i ke kahe o ke kahe, pono ʻoe e hōʻoia ʻaʻole i ʻoki ʻia nā kīʻaha koko e like me kou hiki.Ke nānā mākou i ka ʻāpana longitudinal, hiki ke hoʻohana ʻia ka ikaika me ka ʻike ʻole i nā manawa he nui, no laila e paipai ʻia e hoʻopau i ke ana anawaena paipu ma ka ʻāpana keʻa.Inā ʻaʻole ʻomi ʻia ka mokulele transverse e ka ikaika o waho, ʻo ka ipu koko ka mea maʻamau i kahi pōʻai kokoke, akā i ka mokuʻāina, he ellipse ākea.Hiki iā mākou ke ana i ke anawaena o ka moku ma ke ʻano kūlohelohe, a loaʻa i ke ana ana o ke anawaena maʻamau ma ke ʻano he kuhikuhi no nā ana ʻāpana longitudinal ma hope.
Ma waho aʻe o ka pale ʻana i nā kīʻaha koko, pono nō hoʻi e hoʻolohe i ka hana ʻana i nā kīʻaha koko perpendicular i ka ʻāpana o ka ultrasound imaging i ke ana ʻana i ka pauku keʻa o nā kīʻaha koko.Pehea e hoʻoholo ai inā kū pololei nā kīʻaha koko mai ka subcutaneous?Inā ʻaʻole kū pololei ka ʻāpana kiʻi o ka ʻimi i ke kīʻaha koko (a ʻaʻole ʻomi ʻia ka ipu koko), ʻo ke kiʻi cross-sectional i loaʻa he ellipse erect, ʻokoʻa ia mai ka ellipse ākea i hana ʻia e ka extrusion.Ke ʻoi aku ka nui o ke kihi o ka ʻimi, ʻike ʻia ka ellipse.I ka manawa like, ma muli o ke kāʻei ʻana, ʻike ʻia ka nui o ka ikehu o ka ultrasound hanana i nā ʻaoʻao ʻē aʻe, a he liʻiliʻi wale nō o nā leo i loaʻa e ka probe, e hoʻemi ana ka ʻōlinolino o ke kiʻi.No laila, ʻo ka noʻonoʻo ʻana inā pili ka probe i ke kīʻaha koko ma o ke kihi i ʻoi aku ka mālamalama o ke kiʻi he ala maikaʻi nō hoʻi.
Ma ka pale ʻana i ka distortion o ka moku a me ka mālama ʻana i ka probe perpendicular i ka moku e like me ka hiki, hiki ke maʻalahi ke ana pololei ʻana o ke anawaena moku ma ka ʻāpana keʻa me ka hoʻomaʻamaʻa.Eia nō naʻe, e ʻokoʻa mau ana nā hopena o kēlā me kēia ana.ʻAʻole paha he paipu kila ka moku, a e hoʻonui a ʻaelike paha ia me nā loli o ke koko i ka wā o ka pōʻaiapuni o ka naʻau.Hōʻike ke kiʻi ma lalo nei i nā hopena o nā puʻupuʻu carotid i ka ultrasound B-mode a me M-mode ultrasound.ʻO ka ʻokoʻa ma waena o nā anawaena systolic a me ka diastolic i ana ʻia ma ka M-ultrasound hiki ke ma kahi o 10%, a ʻo ka ʻokoʻa 10% i ke anawaena hiki ke hopena i kahi ʻokoʻa 20% ma ka ʻāpana cross-sectional.Pono ka hemodialysis i ke kahe kiʻekiʻe a ʻoi aku ka nui o ka pulsation o nā moku ma mua o ka maʻamau.No laila, hiki ke ʻae wale ʻia ka hewa a i ʻole ka hana hou ʻana o kēia ʻāpana o ke ana.ʻAʻohe ʻōlelo aʻo maikaʻi loa, no laila e lawe i kekahi mau ana hou aʻe ke loaʻa ka manawa a koho i ka awelika.
No ka mea ʻaʻole hiki ke ʻike ʻia ka alignment kikoʻī o ka moku a i ʻole ke kihi me ka ʻāpana probe ma lalo o ka ʻike transverse, akā i ka ʻike longitudinal o ka moku, hiki ke ʻike ʻia ka alignment o ka moku a me ke kihi ma waena o ke kuhikuhi o ka moku alignment a. hiki ke ana i ka laina scan Doppler.No laila, hiki ke hana ʻia ka manaʻo o ka wikiwiki o ke kahe ʻana o ke koko i loko o ka moku ma lalo o ka sweep longitudinal.He hana paʻakikī ka sweep lōʻihi o ka moku no ka hapa nui o nā poʻe hoʻomaka.E like me ka ʻoki ʻana o ka mea kuke i kahi mea kanu kolamu, ʻoki ʻia ka pahi ma ka mokulele transverse, no laila inā ʻaʻole ʻoe e manaʻoʻiʻo mai iaʻu, e hoʻāʻo e ʻoki i ka asparagus ma ka mokulele longitudinal.I ka wā e ʻoki ai i ka asparagus longitudinally, e puʻunaue i ka asparagus i ʻelua mau ʻāpana like, pono e kau pono i ka pahi i luna, akā no ka hōʻoia ʻana i hiki i ka mokulele o ka pahi ke hele i ke koʻi, i ʻole e paʻakikī ka pahi, ʻO ka asparagus e ʻōwili i ka ʻaoʻao.
Pela no ka ultrasound longitudinal sweeps o ka moku.No ke ana ʻana i ke anawaena moku lōʻihi, pono e hele ka ʻāpana ultrasound ma ke axis o ka moku, a laila ʻo ka hanana ultrasound perpendicular i nā paia mua a me hope o ka moku.I ka lōʻihi o ka liʻiliʻi ʻana o ka probe, e ʻike ʻia kekahi o ka ultrasound i hana ʻia i nā ʻaoʻao ʻē aʻe, e hopena i nā leo nāwaliwali i loaʻa e ka probe, a hui pū ʻia me ka mānoanoa o nā ʻāpana kukuna ultrasound maoli (acoustic lens focus). aia kekahi mea i kapa ʻia he "partial volume effect", e hiki ai i nā leo mai nā wahi like ʻole a me ka hohonu o ka paia o ka moku e hui pū ʻia, ka hopena i lilo ke kiʻi i polū a ʻaʻole ʻike ʻia ka paia o ka paipu.No laila, ma ka nānā ʻana i ke kiʻi o ka ʻāpana longitudinal scanned o ka moku, hiki iā mākou ke hoʻoholo inā maikaʻi ka ʻāpana longitudinal scanned ma ka nānā ʻana i ka paheʻe, akaka a me ka mālamalama.Inā nānā ʻia kahi aʻa, hiki ke ʻike maopopo ʻia ka intima ma ka ʻike longitudinal kūpono.Ma hope o ka loaʻa ʻana o ke kiʻi 2D longitudinal kūpono, ʻano pololei ke ana anawaena, a pono nō hoʻi ia no ke kiʻi kahe Doppler ma hope.
Hoʻokaʻawale ʻia ke kiʻi kahe Doppler i ʻelua-dimensional color flow imaging a me pulsed wave Doppler (PWD) spectral imaging me kahi kūlana sampling paʻa.Hiki iā mākou ke hoʻohana i ke kiʻi kahe kala e hana i ka hoʻomau longitudinal sweep mai ke aʻa a hiki i ka anastomosis a laila mai ka anastomosis i ka vein, a hiki i ka palapala velocity o ke kahe kala ke ʻike koke i nā ʻāpana vascular abnormal e like me ka stenosis a me ka occlusion.Eia nō naʻe, no ke ana ʻana i ke kahe o ke koko, he mea nui ia e pale aku i kahi o kēia mau ʻāpana moku ʻokoʻa, ʻoi aku ka anastomoses a me nā stenoses, ʻo ia hoʻi, ʻo ka wahi kūpono no ke ana kahe ʻana o ke koko he ʻāpana moku pālahalaha.ʻO kēia no ka mea ma nā ʻāpana pololei lōʻihi wale nō e hiki ai ke kahe o ke koko i ke kahe laminar paʻa, akā ma nā wahi ʻano like ʻole e like me nā stenoses a i ʻole aneurysms, hiki ke loli koke ke ʻano kahe, e hopena i ka eddy a i ʻole ke kahe ʻana.Ma ke kiʻikuhi kala kala o ka carotid artery maʻamau a me ka stenotic carotid artery i hōʻike ʻia ma lalo nei, ʻo ke kahe i ka mokuʻāina laminar e hōʻike ʻia e ka wikiwiki kahe kiʻekiʻe i waenakonu o ka moku a hoʻemi ʻia ka wikiwiki o ke kahe kokoke i ka paia, ʻoiai ma ka ʻāpana stenotic ( ʻoi aku ka ma lalo o ka stenosis), ʻano ʻino ke ʻano kahe a ʻaʻole i hoʻonohonoho ʻia ke kuhikuhi ʻana o ke kahe o ke koko, e hopena i kahi disorganization ʻulaʻula-uliuli i ke kiʻi kahe kala.
Ka manawa hoʻouna: Feb-07-2022
