Ndi kuchulukitsidwa kosalekeza kwa zida za ultrasound, ogwira ntchito zamankhwala ochulukirapo amatha kugwiritsa ntchito ultrasound kuti agwire ntchito yowonera.Poyang'aniridwa ndi ukadaulo wa ultrasound, mafunde a ultrasound amatha kugwedezeka pambuyo pa mafunde.Mwachitsanzo, osati ma ultrasound okha a GE, Philips, Siemens, Esaote, Chison, ndi Sonoscape omwe ali otchuka kwambiri, koma ma stents awo ofananira nawo amakhalanso otchuka pamsika.Kampani yathu imaperekansoma stents otsogolazamitundu yayikulu
Komabe, malinga ndi zochitika zina zachipatala zomwe wolembayo adawona, kutchuka kwa zida za ultrasound ndi kutchuka kwa maonekedwe a ultrasound sikungafanane mwachindunji.Tengani puncture yotsogoleredwa ndi ultrasound m'munda wa mitsempha ya mitsempha monga chitsanzo, anthu ambiri akadali osadziwa, zomwe zingayambitse ngozi zachipatala mosavuta.Chifukwa ngakhale kuti panali ultrasound, kunali kosatheka kuona kumene singanoyo inapita.The zenizeni ultrasound kutsogozedwa puncture njira choyamba ayenera kuonetsetsa kuti malo a singano kapena singano nsonga zikhoza kuoneka pansi pa ultrasound, osati kupanga kuyerekeza akhakula, ndiyeno "khungu puncture" motsogozedwa ndi ultrasound.Nthawi zambiri, zimakhala ndi izi:
Kubowoleza motsogozedwa ndi Ultrasound kumagawika m'njira ziwiri: kubowola mu ndege ndi kutuluka kunja kwa ndege.Njira zonse ziwiri za puncture zili ndi zochitika zomwe zimagwira ntchito pakugwira ntchito kwa mitsempha, ndipo ndi bwino kukhala odziwa bwino.(Ndime yotsatirayi ndi yochokera ku American Society of Ultrasound Medicine's practice guideline on ultrasound-guided vascular access surgery.)
M'ndege (njira yayitali) vs.Kunja kwa ndege (mzere wamfupi)
M'ndege / kunja kwa ndege kumayimira ubale wachibale ndi singano, singano ikufanana ndi ndege yojambula ya ultrasound ili mu ndege, ndipo singanoyo ndi yolunjika ku ndege yojambula ya ultrasound yatuluka.
Muzochitika zachilendo, kuphulika kwa ndege kumasonyeza mbali yayitali kapena yotalika ya mtsempha wamagazi;Kutuluka kunja kwa ndege kumawonetsa kanjira kakang'ono kapena kagawo kakang'ono ka mtsempha wamagazi
Chifukwa chake, ma ultrasound a vascular access ultrasound kusakhulupirika kupita kunja kwa ndege/kufupi-axis, ndipo mu-ndege/kutalika ndi mawu ofanana.
Singano ikhoza kuyikidwa pamwamba pakatikati pa chotengera chamagazi kunja kwa ndege, koma nsonga ya singano iyenera kutsatiridwa ndikuyiyika pozungulira kafukufukuyo kuti asachepetse kuya kwa nsonga ya singano.
Malo a nsonga ya singano akhoza kuwonedwa statically mu ndege, koma n'zosavuta "kuzembera" ndege kumene singano ili kapena / ndi ndege pakati pa chotengera cha magazi;kubowola mu ndege ndikoyenera kwambiri zotengera zazikulu
M'ndege / kunja kwa ndege njira yophatikizira: jambulani kunja kwa ndege / nsonga zazifupi kuti mutsimikizire kuti kubowola kwa singano kumafika pakati pachombo, tembenuzani kafukufukuyo kuti mulowe mu ndege / mbali yayitali kuti muyike singano.
Malo enieni a nsonga ya singano kapena thupi lonse la singano likhoza kuwonedwa mu ndege, zomwe mwachiwonekere zimapindulitsa kwambiri!Komabe, popanda kuthandizidwa ndi zida zothandizira monga zoboola, pamafunika kuchita mazana ambiri kusunga singano mu ndege yojambula ya ultrasound kuti idziwe luso.Nthawi zambiri, chifukwa choboola ngodya ndi yayikulu kwambiri, singano yoboola imawonekera bwino mu ndege ya ultrasound, koma singanoyo imakhala yosawoneka.Chifukwa chiyani?
Kuyika kwa singano kwa singano mu chithunzi pansipa ndi 17 ° ndi 13 ° motsatira.Pamene ngodya ili 13 °, thupi lonse la singano la singano yoboola limawoneka bwino kwambiri.Pamene ngodya ili 17 °, thupi la singano likhoza kuwoneka momveka bwino.Pang'ono pang'ono, ndipo kukula kwake kumakhala kokulirapo, mudzachititsidwa khungu.Ndiye nchifukwa ninji pali kusiyana kwa ngodya ya 4 °, ndipo nchifukwa ninji pali kusiyana kwakukulu pakuchita kwa singano yoboola?
Izi zikuyeneranso kuyamba ndi akupanga umuna ndi kulandila chidwi.Monga momwe kabowo kabowolere muzithunzithunzi, mfundo iliyonse pa chithunzi ndi kuphatikiza cholinga cha kuwala konse kudutsa pobowo, ndipo mfundo iliyonse pa akupanga fano ndi The ophatikizana kuganizira zotsatira za onse ultrasound transducers mkati kufalitsa ndi. landirani zibowo.Monga momwe chithunzi chili m'munsimu, osiyanasiyana chizindikiro ndi wofiira mzere ndi schematic osiyanasiyana akupanga kufala molunjika, ndi wobiriwira mzere ndi schematic osiyanasiyana (kumanja malire) kulandira molunjika.Chifukwa singanoyo ndi yowala mokwanira, kuwunikira kwapadera kudzachitika, ndipo mzere woyera umasonyeza njira yachibadwa ya maonekedwe apadera.Pongoganiza kuti mzere wowunikira womwe umadziwika ndi mzere wofiira uli ngati "zowunikira" ziwiri, mutatha kugunda pagalasi pamwamba pa singano, "zowunikira" zowonekera zimakhala ngati mizere iwiri ya lalanje pachithunzichi.Popeza "kuwala" kumbali yakumanja ya mzere wobiriwira kumapitirira malire a kabowo kolandirira ndipo sikungalandiridwe ndi kafukufuku, "kuwala" komwe kungathe kulandiridwa kukuwonetsedwa m'dera la lalanje pachithunzichi.Zitha kuwoneka kuti pa 17 °, kafukufukuyo angalandirebe ma ultrasonic echoes ochepa kwambiri, kotero chithunzi chofananira ndi chithunzi chofooka, ndipo pa 13 °, ma echoes omwe angalandire ndi oposa 17 °.Nthawi ikuwonjezeka kwambiri, kotero kujambula kumawonekeranso bwino.Pamene puncture angle imachepetsa, singanoyo imakhala "yophwanyika", ndipo zowonjezereka zimawonekera kuchokera ku thupi la singano zimatha kulandiridwa bwino, kotero kuti mawonekedwe a singano amakhala bwino komanso abwino.
Anthu ena osamala adzapezanso chodabwitsa kuti pamene ngodya ili yochepa kuposa mtengo wina (singano sikuyenera kukhala "lathyathyathya"), kukula kwa thupi la singano kumatsimikiziranso chimodzimodzi.nanga izi?Chifukwa chiyani kuchuluka kwa ma transmit focus (mzere wofiyira) ndi wocheperako kuposa momwe amalandirira (mzere wobiriwira) pachithunzi pamwambapa?Izi zili choncho chifukwa mu kachitidwe ka ultrasound imaging, kuyang'ana kwa mpweya kumangoyang'ana pa kuya kumodzi.Ngakhale titha kusintha kuzama kwa zomwe timatulutsa kuti chithunzi chomwe chili pafupi ndi kuya kwa chidwi chathu chiwonekere bwino, sitikufuna kuti malo opitilira kuzama kwake akhale osawoneka bwino..Izi ndizosiyana kwambiri ndi kufunikira kwathu kutenga zithunzi za shuga-madzi a akazi okongola.Filimu yamadzi a shuga imafuna kuti maziko ndi kutsogolo zomwe zimabweretsedwa ndi pobowo lalikulu ndi kuya pang'ono kwamunda zonse zikhale zodetsedwa.Kwa kujambula kwa ultrasound, tikuyembekeza kuti zithunzi zomwe zili m'ndandanda isanayambe komanso itatha kuzama kwakuya ndizomveka bwino, kotero tikhoza kugwiritsa ntchito kabowo kakang'ono kameneka kuti tipeze kuzama kwakukulu kwa munda, kuti tisunge kufanana kwa chithunzicho.Ponena za kulandira molunjika, chifukwa makina omwe akupanga zojambula zamakono akhala akugwiritsidwa ntchito kwambiri, ma ultrasonic echoes amtundu uliwonse wa transducer / array element akhoza kupulumutsidwa, ndiyeno zozama zonse zowonongeka zimatha kusinthidwa ndi njira zamakono.Kukhazikika kosalekeza, kotero panthawiyi, yesetsani kutsegula malo olandirira momwe mungathere, malinga ngati zinthu zomwe zingalandire chizindikiro cha echo zimagwiritsidwa ntchito, kuti zitsimikizire kuti kuyang'ana bwino komanso kuthetsa bwino kungapezeke.Kubwerera ku mutu pakali pano, pamene puncture ngodya ndi yaying'ono kumlingo wakutiwakuti, ndi akupanga mafunde otulutsidwa ndi kabowo kakang'ono akhoza kulandiridwa ndi lalikulu kulandira kabowo pambuyo kuonekera ndi singano thupi, kotero zotsatira za singano thupi chitukuko. mwachibadwa adzakhala osasinthika..
Pazofufuza zomwe zili pamwambapa, ndiyenera kuchita chiyani ngati singano yoboola sikuwoneka pambuyo poti mbali ya ndegeyo idutsa 17 °?
Ngati makinawo amathandizira, mutha kuyesa kukulitsa singano panthawiyi.Zomwe zimatchedwa ukadaulo wowongolerera singano nthawi zambiri zimakhala zoyika chithunzi cha sikani chomwe chimasokonekera pakupatsirana komanso kulandira pambuyo poti minyewa yamba yafufuzidwa.Mayendedwe opotoka ndikuwongolera kwa thupi la singano, kotero kuti chiwonetsero cha thupi la singano chikhoza kubwezeredwa Mafunde amagwera m'malo olowera momwe alandirira momwe angathere, ndipo chithunzi champhamvu cha singano pazithunzithunzi chimachotsedwa ndipo zowonetsedwa pambuyo pophatikizana ndi chithunzi chodziwika bwino cha minofu.Kutengera kukula ndi ma frequency a probe array element, mbali yokhotakhota ya mzere wopendekera wokwera kwambiri nthawi zambiri saposa 30°, kotero kuti puncture imadutsa 30°.Sichinapite patsogolo mpaka pano)
Kenako, tiyeni tione mmene kubowola kunja kwa ndege kumachitikira.Pambuyo pomvetsetsa mfundo za kukula kwa singano zomwe zili pamwambazi mu ndege, zidzakhala zosavuta kusanthula kukula kwa singano zakunja.Kusesa kozungulira kwa mafani omwe atchulidwa mu bukhuli ndi gawo lofunikira kwambiri pakubowola kunja kwa ndege, zomwe sizikugwira ntchito kokha pakupeza malo a nsonga ya singano, komanso kupeza thupi la singano.Kungoti phokoso la singano ndi kujambula kwa ultrasound sikuli mu ndege imodzi panthawiyi.Pokhapokha pamene puncture singano ndi perpendicular kwa kulingalira ndege akhoza akupanga mafunde chochitika pa puncture singano zimaonekera mmbuyo akupanga kafukufuku.Popeza makulidwe a probe nthawi zambiri amangoyang'ana ma lens acoustic, zotchingira zonse zotumizira ndi kulandira zimakhala zofanana mbali iyi, ndipo kukula kwa kabowo ndi m'lifupi mwa chophatikizira cha transducer.M'lifupi mwa kafukufukuyu ndi pafupifupi 3.5mm (chobowo cholandirira chojambula mu ndege nthawi zambiri chimakhala choposa 15mm, chomwe chimakhala chokulirapo kuposa m'lifupi mwake).Chifukwa chake, ngati kuwonekera kwa singano yoboola kunja kwa ndege ndikubwerera ku kafukufuku, ndikofunikira kuwonetsetsa kuti singano yopumira ndi mbali yapakati pa ndege yojambula ili pafupi ndi madigiri 90.Ndiye mumaweruza bwanji mbali yoyimirira?Chodabwitsa kwambiri ndi "mchira wa comet" wautali womwe umakokera kuseri kwa malo owala kwambiri.Ichi ndi chifukwa pamene akupanga mafunde zikuchitika pa puncture singano vertically, kuwonjezera mwa mauna mwachindunji zimabwereranso kafukufuku ndi singano pamwamba, pang'ono akupanga mphamvu akulowa singano.Kuwonetserako kangapo mmbuyo ndi mtsogolo, ndi kuwunikira kambirimbiri komwe kumawonekeranso kumayendedwe a kafukufukuyo, kumabwera pambuyo pake, motero "mchira wa comet" wautali umapangidwa.Singano ikangokhala yosagwirizana ndi ndege yojambula, mafunde amawu omwe amawonekera mmbuyo ndi mtsogolo adzawonekera mbali zina ndipo sangathe kubwereranso ku kafukufuku, kotero "mchira wa comet" sungathe kuwonedwa.Chodabwitsa cha mchira wa comet sichingawonekere pokha kutuluka kunja kwa ndege, komanso kuphulika kwa ndege.Pamene singano yoboolayo yatsala pang'ono kufanana ndi pamwamba pake, mizere yopingasa imatha kuwoneka.Mchira wa Comet".
Kuti tifotokoze momveka bwino za "mchira wa comet" mu ndege ndi kunja kwa ndege, timatenga mawonekedwe a kunja kwa ndege ndi m'ndege ndi zitsulo zam'madzi, ndipo zotsatira zake zikuwonetsedwa pachithunzichi. pansipa.
Chithunzi chili m'munsichi chikuwonetsa momwe chifaniziro chimagwirira ntchito pamakona osiyanasiyana pamene thupi la singano lachoka mu ndege ndipo fani yozungulira imafufuzidwa.Pamene kafukufuku ndi perpendicular kwa puncture singano, zikutanthauza kuti puncture singano perpendicular kwa ultrasound kulingalira ndege, kotero inu mukhoza kuwona zoonekeratu "comet mchira" danga.
Sungani kachipangizo koyang'ana pa singano yoboolayo ndikusunthira pambali pa singano kupita kunsonga ya singano."Mchira wa comet" ukasowa, zikutanthauza kuti gawo lojambulira lili pafupi ndi nsonga ya singano, ndipo malo owala adzazimiririka patsogolo.Malo omwe malo owala asanafike ndi pomwe nsonga ya singano ili.Malo.Ngati simuli omasuka, sesani fan yozungulira pang'ono pafupi ndi pomwepa kuti mutsimikizirenso.
Takulandilani kuti mutitumizireni kuti mupeze mankhwala azachipatala ndi chidziwitso
zambiri
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Nthawi yotumiza: Aug-17-2022
