1. Kodi ubwino wa lung ultrasound ndi chiyani?
M'zaka zingapo zapitazi, kujambula kwa ultrasound kwa m'mapapo kwagwiritsidwa ntchito kwambiri kuchipatala.Kuchokera ku njira yachikale yoweruza kupezeka ndi kuchuluka kwa pleural effusion, izo zasintha mapapu parenchyma imaging.Titha kudziwa 5 zomwe zimayambitsa zovuta kwambiri za kupuma kwapang'onopang'ono (pulmonary edema, chibayo, pulmonary embolism, COPD, pneumothorax) mu 90% ya milandu ndi ultrasound yosavuta ya 3-5 mphindi.Zotsatirazi ndizofotokozera mwachidule za njira yonse ya lung ultrasound.
2. Kodi mungasankhe bwanji kafukufuku wa ultrasound?
Ma probe omwe amagwiritsidwa ntchito kwambiri pa lung ultrasound ndiL10-5(amatchedwanso ang'onoang'ono organ probe, pafupipafupi osiyanasiyana 5 ~ 10MHz liniya gulu) ndiC5-2(yotchedwanso probe ya m'mimba kapena yayikulu, 2 ~ 5MHz convex array), zochitika zina zitha kugwiritsanso ntchito P4-2 (yotchedwanso cardiac probe, 2~4MHz phased array).
Chiwalo chaching'ono chofufuza L10-5 ndichosavuta kupeza mzere womveka bwino wa pleural ndikuwona kumveka kwa minofu ya subpleural.Nthiti itha kugwiritsidwa ntchito ngati cholembera kuti muwone mzere wa pleural, womwe ungakhale chisankho choyamba pakuwunika kwa pneumothorax.Mafupipafupi a probes a m'mimba ndi ochepa, ndipo mzere wa pleural ukhoza kuwonedwa momveka bwino poyang'ana chifuwa chonse.Ma probes array array ndi osavuta kujambula kudzera mumlengalenga wa intercostal ndipo amakhala ndi kuya kwakuya.Nthawi zambiri amagwiritsidwa ntchito poyesa kuphulika kwa pleural, koma sali bwino pakuzindikira pneumothorax ndi pleural space.
3. Ndi mbali ziti zomwe ziyenera kufufuzidwa?
Lung ultrasonography imagwiritsidwa ntchito kwambiri mu modified bedside lung ultrasonography (mBLUE) sikimu kapena two-lung 12-division scheme ndi 8-division scheme.Pali malo owerengera 10 mbali zonse za mapapo mumBLUE scheme, yomwe ili yoyenera pazochitika zomwe zimafunikira kuyang'aniridwa mwachangu.Chiwembu cha 12-zone ndi 8-zone chiwembu ndichoti azitha kuyeza kafukufuku wa ultrasound m'dera lililonse kuti awone bwino.
Malo a cheke chilichonse mu dongosolo la mBLUE akuwonetsedwa pachithunzi chotsatirachi:
| poyendera | Malo |
| dontho la buluu | Mfundo pakati pa chala chapakati ndi pansi pa chala cha mphete kumbali ya mutu |
| diaphragm point | Pezani malo a diaphragm ndi kafukufuku wa ultrasound mu mzere wa midaxillary |
| point M
| Pakatikati pa mzere wolumikiza nsonga yabuluu yakumtunda ndi malo a diaphragm |
| PLAPS point
| Kuphatikizika kwa mzere wowonjezera wa mfundo M ndi mzere wokhotakhota ku mzere wakumbuyo kwa axillary |
| kumbuyo dontho labuluu
| Malo omwe ali pakati pa subscapular angle ndi msana |
Ndondomeko yamagulu a 12 imachokera ku mzere wa parasternal wa wodwalayo, mzere wa axillary, mzere wapambuyo wa axillary, ndi mzere wa paraspinal kuti ugawanitse thorax m'madera a 6 a kutsogolo, kumbuyo, ndi kumbuyo kwa khoma lachifuwa, ndipo dera lirilonse limagawidwa m'madera awiri. , mmwamba ndi pansi, ndi madera 12 okwana.dera.Chiwembu cha magawo asanu ndi atatu sichimaphatikizapo madera anayi a khoma lachifuwa chapambuyo, ndipo nthawi zambiri amagwiritsidwa ntchito pozindikira ndi kuwunika kwa ultrasound kwa interstitial pulmonary syndrome.Njira yeniyeni yojambulira ndikuyambira pakatikati pa dera lililonse, chigawo chapakati cha kafukufukuyo chimakhala chokhazikika ku thorax ya bony (ndege yotalika), choyamba slide motsatana ndi mzere wa malire, kubwerera ku midline, kenako slide medially to the malire, ndiyeno kubwereranso pakati.
4. Kodi mungafufuze bwanji zithunzi za ultrasound?
Monga ife tonse tikudziwa, mpweya ndi "mdani" wa ultrasound, chifukwa ultrasound kuwola mofulumira mu mlengalenga, ndi kukhalapo kwa mpweya m'mapapo kumapangitsa kukhala kovuta mwachindunji fano parenchyma m'mapapo.M'mapapo omwe nthawi zambiri amakhala ndi mpweya, minofu yokhayo yomwe ingadziwike ndi pleura, yomwe imawonekera pa ultrasound ngati mzere wopingasa wa hyperechoic wotchedwa pleural line (yomwe ili pafupi kwambiri ndi minofu yofewa).Kuphatikiza apo, pali zinthu zofanana, zobwerezabwereza za hyperechoic horizontal line zotchedwa A-lines pansi pa pleural line.Kukhalapo kwa mzere wa A kumatanthauza kuti pali mpweya pansi pa mzere wa pleural, womwe ukhoza kukhala mpweya wabwino wa m'mapapo kapena mpweya waulere mu pneumothorax.
Pa ultrasound ya m'mapapo, mzere wa pleural umapezeka koyamba, pokhapokha ngati pali subcutaneous emphysema, yomwe nthawi zambiri imawonekera.M'mapapo abwinobwino, ma visceral ndi parietal pleura amatha kusuntha wachibale wina ndi mnzake ndikupuma, komwe kumatchedwa kutsetsereka kwamapapo.Monga momwe ziwonetsedwera muzithunzi ziwiri zotsatirazi, chithunzi chapamwamba chili ndi mapapu otsetsereka ndipo chithunzi chapansi chilibe mapapu otsetsereka.
Nthawi zambiri, odwala omwe ali ndi pneumothorax, kapena kuchuluka kwa pleural effusion yomwe imalepheretsa mapapu kutali ndi khoma la pachifuwa, chizindikiro chotsetsereka cha m'mapapo chimatha.Kapena chibayo chimagwirizanitsa mapapu, ndipo zomatira zimawonekera pakati pa mapapu ndi khoma la pachifuwa, zomwe zingapangitsenso kuti chizindikiro chotsetsereka cha m'mapapo chizimiririka.Kutupa kosatha kumatulutsa minofu yomwe imachepetsa kuyenda kwa mapapu, ndipo machubu a thoracic drainage sangathe kuwona mapapu akutsetsereka ngati mu COPD yapamwamba.
Ngati mzere wa A ukhoza kuwonedwa, zikutanthauza kuti pali mpweya pansi pa mzere wa pleural, ndipo chizindikiro chotsetsereka cha m'mapapo chimatha, chikhoza kukhala pneumothorax, ndipo m'pofunika kupeza malo a mapapo kuti atsimikizire.Mapapo ndi malo osinthira kuchoka ku mapapu osasunthika kupita kumalo otsetsereka a pneumothorax ndipo ndiye muyeso wagolide wowunikira pneumothorax.
Mizere ingapo yofananira yopangidwa ndi khoma lokhazikika pachifuwa imatha kuwoneka pansi pa M-mode ultrasound.Pazithunzi zaparenchyma za m'mapapo, chifukwa cha kutsetsereka kwa mapapo, pansi pake pali maula onga ngati mchenga, omwe amatchedwa chizindikiro cha gombe.Pansi pa pneumothorax pali mpweya, ndipo palibe mapapu otsetsereka, kotero kuti mizere ingapo yofanana imapangidwa, yomwe imatchedwa chizindikiro cha barcode.Malo olekanitsa pakati pa chikwangwani cha m'mphepete mwa nyanja ndi chizindikiro cha barcode ndiye mapapu.
Ngati kupezeka kwa A-mizere sikukuwoneka mu chithunzi cha ultrasound, zikutanthauza kuti mawonekedwe a minofu m'mapapo asintha, kulola kuti apereke ultrasound.Zinthu monga A-mizere zimasowa pamene malo oyambirira a pleural amadzazidwa ndi minofu monga magazi, madzimadzi, matenda, kusokonezeka chifukwa cha magazi oundana, kapena chotupa.Ndiye muyenera kumvetsera vuto la mzere B. B-line, yomwe imadziwikanso kuti chizindikiro cha "comet tail", ndi laser beam-ngati hyperechoic strip imatulutsa vertically kuchokera ku pleural line (visceral pleura), kufika pansi. pawindo popanda attenuation.Imabisa mzere wa A ndikuyenda ndi mpweya.Mwachitsanzo, mu chithunzi pansipa, sitingathe kuwona kukhalapo kwa A mzere, koma m'malo mwa B mzere.
Osadandaula ngati mupeza B-mizere ingapo pa chithunzi cha ultrasound, 27% ya anthu abwinobwino amakhala ndi mizere ya B mu 11-12 intercostal space (pamwamba pa diaphragm).Pamikhalidwe yabwinobwino yathupi, mizere yochepera 3 B ndiyokhazikika.Koma mukakumana ndi mizere yambiri ya B, sizowoneka bwino, zomwe ndikuchita kwa edema ya m'mapapo.
Pambuyo powona mzere wa pleural, A kapena B mzere, tiyeni tikambirane za pleural effusion ndi kuphatikiza mapapo.M'dera la posterolateral la chifuwa, pleural effusion ndi kuphatikiza mapapu akhoza kuyesedwa bwino.Chithunzi chomwe chili pansipa ndi chithunzi cha ultrasound chomwe chikuwunikiridwa pamalo a diaphragm.Dera lakuda la anechoic ndi pleural effusion, yomwe ili mu pleural cavity pamwamba pa diaphragm.
Ndiye mumasiyanitsa bwanji pakati pa pleural effusion ndi hemorrhage?Fibrous exudate nthawi zina imatha kuwoneka mu hemopleural effusion, pomwe effusion nthawi zambiri imakhala dera lakuda la anechoic, nthawi zina limagawika m'zipinda zing'onozing'ono, ndipo zinthu zoyandama zamitundu yosiyanasiyana ya echo zimatha kuwonedwa mozungulira.
Ultrasound amatha kuwona ambiri (90%) odwala omwe ali ndi mapapu ophatikizana, tanthauzo lalikulu lomwe ndikutaya mpweya wabwino.Chodabwitsa chokhudza kugwiritsa ntchito ultrasound kuti azindikire kuphatikizika kwa mapapu ndikuti pamene mapapu a wodwala aphatikizidwa, ultrasound imatha kudutsa m'madera akuya a thoracic m'mapapo momwe kugwirizanitsa kumachitika.Minofu ya m'mapapo inali ya hypoechoic yokhala ndi malire owoneka ngati mphero komanso osawoneka bwino.Nthawi zina mutha kuwonanso chizindikiro cha mpweya wa bronchus, chomwe ndi hyperechoic ndipo chimayenda ndi kupuma.Chithunzi cha sonographic chomwe chili ndi tanthauzo lenileni la kuphatikizika kwa mapapo mu ultrasound ndi chizindikiro chofanana ndi minofu yachiwindi, chomwe chimakhala cholimba ngati echo yofanana ndi parenchyma yachiwindi yomwe imawonekera pambuyo pa alveoli yodzazidwa ndi exudate.Monga momwe tawonetsera pachithunzichi, ichi ndi chithunzi cha ultrasound cha kuphatikiza kwa mapapu chifukwa cha chibayo.Mu chithunzi cha ultrasound, madera ena amatha kuwoneka ngati hypoechoic, omwe amawoneka ngati chiwindi, ndipo palibe A omwe angawoneke.
Nthawi zonse, mapapo amadzazidwa ndi mpweya, ndipo mtundu wa Doppler ultrasound sungathe kuwona kalikonse, koma pamene mapapo aphatikizidwa, makamaka pamene pali chibayo pafupi ndi mitsempha ya magazi, ngakhale zithunzi za magazi m'mapapo zimatha kuwonedwa, motere: kuwonetsedwa pachithunzichi.
Phokoso lozindikiritsa chibayo ndi luso lofunikira la lung ultrasound.M'pofunika kusuntha mmbuyo ndi mtsogolo pakati pa nthiti kuti muwone bwinobwino ngati pali malo a hypoechoic, ngati pali chizindikiro cha mpweya wa bronchus, ngati pali chizindikiro chofanana ndi chiwindi, komanso ngati pali A-line wamba kapena ayi.Chithunzi cha lung ultrasound.
5. Kodi mungadziwe bwanji zotsatira za ultrasound?
Kupyolera mu ultrasound yosavuta jambulani (mBLUE chiwembu kapena khumi ndi ziwiri zone chiwembu), khalidwe deta akhoza m'gulu, ndi chifukwa chachikulu cha pachimake kupuma kulephera angadziŵike.Kutsirizitsa mwamsanga matendawa kungathe kuthetsa vutoli la wodwalayo mofulumira komanso kuchepetsa kugwiritsa ntchito mayesero ovuta monga CT ndi UCG.Zizindikiro izi ndi monga: kutsetsereka kwamapapu, A magwiridwe antchito (mizere A pamiyendo yonse iwiri ya thoracic), magwiridwe antchito a B (mizere ya B yowonekera m'miyendo yonse ya thoracic, ndipo palibe mizere yochepera 3 B kapena mizere yoyandikana nayo), A / B. maonekedwe (Kuwoneka mbali imodzi ya pleura, B maonekedwe mbali inayo), mapapu, kugwirizanitsa mapapo, ndi pleural effusion.
Nthawi yotumiza: Dec-20-2022
