Chifukwa cha kutchuka kwa zida za ultrasound, ogwira ntchito zachipatala ochulukirapo amatha kugwiritsa ntchito ultrasound powonera ntchito.Anthu omwe sadziwa njira zopangira ultrasound motsogozedwa ndi achisoni kukhalabe pantchitoyi.Komabe, kuchokera ku ntchito zachipatala zomwe ndawonapo, kutchuka kwa zida za ultrasound ndi kutchuka kwa maonekedwe a ultrasound sikufanana.Pankhani ya ultrasound-kutsogoleredwa puncture m'munda wa mitsempha mwayi, anthu ambiri akadali pa siteji ya kunamizira kumvetsa, chifukwa ngakhale pali ultrasound, iwo sangathe kuona kumene puncture anali.Njira yodziwikiratu yotsogozedwa ndi ultrasound imafunikira poyamba kuti malo a singano kapena nsonga ya singano awoneke pansi pa ultrasound, m'malo mongoyerekeza kenako "kulowa mwakhungu" motsogozedwa ndi ultrasound.Lero, tikambirana za kuwonekera ndi kusawoneka kwa singano yoboola pansi pa ultrasound.
Kubowoleza motsogozedwa ndi Ultrasound kumagawika m'mabowo a ndege ndi kutuluka kunja kwa ndege, zonse zomwe zimagwiritsidwa ntchito pokhudzana ndi mitsempha ndipo zimaphunzitsidwa bwino.Zotsatirazi ndizochokera ku American Society of Ultrasound Medicine's practice guidelines for ultrasound-guided vascular access procedures, kufotokoza njira ziwirizi.
Mundege (Njira yayitali) VS Yanja-ndege (Njira yayifupi)
- M'ndege / Kutuluka-ndege kumawonetsa ubale wachibale ndi singano, ndi singano yofananira ndi ndege yojambulira ya ultrasound ili m'ndege ndi singano yolumikizana ndi ndege yoyerekeza ya ultrasound ili kunja kwa ndege.
- Nthawi zambiri, kuwombera mu ndege kumawonetsa mbali yayitali kapena yotalikirapo ya chotengeracho;Kutuluka kunja kwa ndege kumawonetsa mbali yaying'ono kapena gawo lopingasa la chombo.
- Chifukwa chake, kunja kwa ndege / otalikirapo pang'ono ndi mu-ndege/ otalikirana amafanana ndi kusakhazikika kwa mitsempha yofikira ma ultrasound.
- Kutuluka-ndege kungathe kuchitika kuchokera pamwamba pa chotengera chapakati, koma nsonga ya singano iyenera kutsatiridwa pozungulira kafukufukuyo kuti musachepetse kuya kwa nsonga;mafani a probe kuchokera ku thupi la singano kupita kunsonga, ndipo pomwe malo owala a nsonga amatha ndi pomwe nsongayo imawonekera.
- M'ndege imalola kuyang'ana kokhazikika kwa singano, koma zingayambitse "kutsetsereka" mu ndege yomwe singano ili kapena / ndi ndege yapakati ya chombo;kubowola mu ndege ndikoyenera kwambiri zotengera zazikulu.
- Njira yophatikizira m'ndege / kunja kwa ndege: gwiritsani ntchito kusanthula kwakunja kwa ndege / kanjira kakang'ono kuti mutsimikizire kuti nsonga ya singano ifika pakati pachombocho, ndikuzungulirani kafukufukuyo kuti mulowemo mundege/ .
Kutha kuyang'ana nsonga ya singano kapena thupi lonse la singano munthawi yeniyeni mkati mwa ndege ndizothandiza kwambiri!Koma kusunga singanoyo mu ndege yojambulira ma ultrasound popanda kugwiritsa ntchito choboola chimafunika magawo ambiri oyeserera kuti adziwe lusoli.Nthawi zambiri, mbali ya puncture ndi yaikulu kwambiri, kotero kuti singanoyo imakhala bwino mu ndege yojambula zithunzi za ultrasound, koma simungathe kuwona komwe kuli.Mufunseni mkulu wapafupi kuti chikuchitika ndi chani.Akhoza kukuuzani kuti puncture singano si perpendicular kwa ultrasound jambulani mzere, kotero inu simungakhoze kuziwona izo.Ndiye bwanji mukuiwona mokomoka pomwe mbali yokhomerera ili yaying'ono pang'ono, komanso momveka bwino ikakhala yaying'ono kwambiri?Akhoza kudabwa chifukwa chake.
Ngodya ya singano yomwe ili pansipa ndi 17 ° ndi 13 ° motsatana (kuyezedwa ndi phindu la kuyang'ana m'mbuyo), pamene ngodya ya 13 ° thupi lonse la singano yobowola likuwonetsedwa bwino kwambiri, pamene ngodya ya 17 ° , thupi la singano likhoza kuwonedwa pang'ono pang'ono, ndipo ngodyayo imakhala yaikulu ndi hoodwink.Nanga ndichifukwa chiyani pali kusiyana kwakukulu kotere pamakona a singano yoboola ndi kusiyana kwa 4 ° kokha?
Iyenera kuyamba kuchokera ku ultrasound, kulandira ndi kuyang'ana.Monga momwe kuwongolera kabowo koyang'ana pazithunzi, mfundo iliyonse pachithunzicho ndi kuphatikiza kowunikira kwa kuwala konse kudzera pa kabowo, pomwe mfundo iliyonse pa chithunzi cha ultrasound ndi kuphatikiza kophatikizana kwa ma transducers onse a ultrasound mkati mwa zotulutsa ndi zolandilira. .Pachithunzi chomwe chili pansipa, mzere wofiyira umawonetsa kuchuluka kwa ultrasound emission focus schematically, ndipo mzere wobiriwira ndi mndandanda wazomwe amalandila mwadongosolo (malire akumanja).Chifukwa singanoyo ndi yowala mokwanira kuti ipangitse kunyezimira kowoneka bwino, mzere woyera umakhala wolunjika komwe kumawonekera.Pongoganiza kuti mzere wofiyira ukuwonetsa zomwe zimapangidwira zimakhala ngati "miyezi" iwiri, itagunda galasi la singano, "macheza" owoneka ngati mizere iwiri ya lalanje pachithunzichi.Popeza "ray" yomwe ili kumanja kwa mzere wobiriwira umaposa kabowo kolandirira, ndipo sungathe kulandiridwa ndi kafukufuku, "ray" yomwe ingathe kulandiridwa ikuwonetsedwa m'dera la lalanje pachithunzichi.Zitha kuwoneka kuti pa 17 °, kafukufukuyo amatha kulandira ma ultrasound echo pang'ono, kotero chithunzi chofananiracho chikuwoneka mochepa, pamene pa 13 °, ma echoes amatha kulandiridwa kwambiri kuposa 17 °, kotero chithunzicho chimakhalanso chochuluka. zomveka.Ndi kuchepa kwa ngodya yoboola, singanoyo imakhala yopingasa kwambiri, ndipo zowoneka bwino za thupi la singano zimatha kulandiridwa bwino, kotero kukula kwa singano kumakhala bwinoko.
Anthu ena osamala adzapezanso chodabwitsa, pamene ngodyayo ili yochepa kuposa mtengo wina (singano sayenera "kunama lathyathyathya"), kukula kwa thupi la singano kumakhalabe mlingo womwewo womveka bwino.Ndipo chifukwa chiyani izi?Chifukwa chiyani timajambulira kachulukidwe kakang'ono ka umuna (mzere wofiira) kuposa momwe amalandirira (mzere wobiriwira) pachithunzi pamwambapa?Izi ndichifukwa choti mu makina ojambulira a ultrasound, chowunikiracho chimangoyang'ana pang'onopang'ono, ndipo pomwe titha kusintha kuya kwa kuwunikira kuti chithunzicho chimveke bwino pafupi ndi kuya komwe tikuyang'ana, sitikufuna. kukhala kosamveka kupitirira kuya kwa kuyang'ana kwake.Izi ndizosiyana kwambiri ndi zosowa zathu kuti titenge zithunzi zaluso za akazi okongola, zomwe zimafuna pobowo lalikulu, kuzama kwakung'ono kumunda kuti tibweretse maziko akutsogolo onse bokeh.Pakujambula kwa ultrasound, tikufuna kuti chithunzicho chikhale chomveka bwino patali isanayambe komanso itatha kuya, kotero titha kugwiritsa ntchito kabowo kakang'ono kotumizira kuti tipeze kuzama kwakukulu kwa munda, motero kusunga kufanana kwa chithunzicho.Pankhani yolandira chidwi, makina ojambulira a ultrasound tsopano ali ndi digito, motero ma ultrasound amtundu uliwonse wa transducer / gulu amatha kupulumutsidwa, ndipo kuyang'ana kosalekeza kumachitidwa ndi digito pazozama zonse zoyerekeza.Chifukwa chake titha kuyesa kutsegula kabowo kakang'ono kwambiri momwe tingathere, bola zinthu zomwe zimalandira chizindikiro cha echo zonse zikugwiritsidwa ntchito, kuyang'ana kwabwinoko komanso kukonza bwino kumatha kutsimikizika.Kubwerera ku mutu wakale, pamene puncture ngodya imachepetsedwa kufika pamlingo wina, mafunde akupanga omwe amatulutsidwa ndi kabowo kakang'ono amatha kulandiridwa ndi kabowo kakang'ono kamene kamalandira pambuyo powonetseredwa ndi thupi la singano, kotero zotsatira za kukula kwa thupi la singano zidzatha. mwachibadwa kukhalabe chimodzimodzi.
Pazofufuza zomwe zili pamwambapa, tingachite chiyani ngati ngodya yoboola mu ndege ipitilira 17 ° ndipo singanoyo ndi yosawoneka?Ngati pulogalamuyo ikuthandizira, mutha kuyesa ntchito yowonjezera singano.Zomwe zimatchedwa ukadaulo wokulitsa singano nthawi zambiri zimatanthawuza kuti pambuyo pakujambula bwino kwa minofu, chimango chosiyana chimayikidwa pomwe zonse zotumizira ndi kulandira zimapatutsidwa, ndipo komwe kulowera kumalowera ku singanoyo. , kotero kuti ma echo owonetseredwa a thupi la singano akhoza kugwera mu kabowo kamene akulandira momwe angathere.Ndiyeno chithunzi cholimba cha thupi la singano mu chithunzi chopotoka chimachotsedwa ndikuwonetsedwa mutatha kusakaniza ndi chithunzi cha minofu yachibadwa.Chifukwa cha kukula ndi mafupipafupi a probe array element, mbali yokhotakhota ya kafukufuku wamtundu wapamwamba kwambiri nthawi zambiri saposa 30 °, kotero ngati puncture angle ili yoposa 30 °, mutha kuwona thupi la singano bwino lomwe. mwa kulingalira kwanu komwe.
Chotsatira, tiyeni tiwone zochitika za kunja kwa ndege.Pambuyo pomvetsetsa mfundo ya chitukuko cha singano mu ndege, zimakhala zosavuta kusanthula chitukuko cha singano kunja kwa ndege.The rotational fan kusesa zotchulidwa mu kalozera chizolowezi ndi sitepe yovuta kwa kunja kwa ndege punctures, ndipo izi sizikugwira ntchito kokha kupeza singano nsonga malo, komanso kupeza singano thupi.Kungoti phokoso la singano ndi kujambula kwa ultrasound sizili mu ndege imodzi panthawiyo.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 zomwe zimatumiza ndikulandila zimakhala zofanana mbali iyi.Ndipo kukula kwa kabowo ndi m'lifupi mwa chowotcha chopatulira.Kwa ma probe a mizere yokwera kwambiri, m'lifupi mwake ndi pafupifupi 3.5mm (chobowo cholandirira cha kujambula mundege nthawi zambiri chimaposa 15mm, chomwe chimakhala chokulirapo kuposa m'lifupi mwake).Chifukwa chake, ngati kuwonekera kwa thupi la singano yotuluka kunja kwa ndege ndikubwerera ku kafukufuku, zitha kutsimikiziridwa kuti mbali yapakati pa singano yoboola ndi ndege yojambula ili pafupi ndi madigiri 90.Ndiye mumaweruza bwanji mbali yoyimirira?Chodziwika bwino kwambiri ndi "mchira wa comet" wautali womwe umakokera kumbuyo kwa malo owala kwambiri.Ndicho chifukwa pamene akupanga mafunde ndi chochitika vertically pa puncture singano, kuwonjezera mwa mauna mwachindunji zimabwereranso kafukufuku ndi singano pamwamba, pang'ono akupanga mphamvu akulowa singano.The ultrasound imayenda mofulumira kupyola muzitsulo ndipo pali zowonetsera kangapo mkati mwake, chifukwa cha maunivesite omwe amawonetsa nthawi zambiri amabwera pambuyo pake, "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.
Kuti tiwonetsere "mchira wa comet" mu ndege ndi kunja kwa ndege momveka bwino, timatenga zofunikira m'madzi kunja kwa ndege ndi ntchito yosesa mu ndege, zotsatira zake zikuwonetsedwa pachithunzichi.
Chithunzi chili m'munsichi chikuwonetsa momwe chifaniziro chimagwirira ntchito m'makona osiyanasiyana pamene thupi la singano silili kunja kwa ndege ndipo fan yozungulira imafufuzidwa.Pamene kafukufukuyo ali perpendicular kwa puncture singano, zikutanthauza kuti puncture singano perpendicular kwa ultrasound imaging ndege, kotero inu mukhoza kuwona zoonekeratu "comet mchira".
Sungani kafukufukuyo molunjika ku singano yoboola, ndipo yendani pambali pa singanoyo 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.Ngati simukutsimikiza, mutha kusesa mozungulira mozungulira fan pafupi ndi pomwepa kuti mutsimikizirenso.
Cholinga chachikulu cha zomwe zili pamwambazi ndikuthandizira oyamba kumene kupeza kumene nsonga ya singano ndi singano ili.Chiyambi cha ukadaulo wotsogozedwa ndi ultrasound siwokwera kwambiri, ndipo zomwe tiyenera kuchita ndikukhazika mtima pansi ndikumvetsetsa bwino lusolo.
Nthawi yotumiza: Feb-07-2022
