1. Ni izihe nyungu za ultrasound yo mu bihaha?
Mu myaka mike ishize, amashusho yibihaha ultrasound yakoreshejwe cyane mubuvuzi.Duhereye ku buryo bwa gakondo bwo gusuzuma gusa ibihari n'ubwinshi bwa effusion effusion, byahinduye ibizamini byo gufata amashusho y'ibihaha parenchyma.Turashobora gusuzuma impamvu 5 zikunze gutera indwara zubuhumekero bukabije (edmonary edema, pneumonia, embolism pulmonary, COPD, pneumothorax) mubice birenga 90% hamwe na ultrasound yoroheje yiminota 3-5.Ibikurikira nintangiriro ngufi kubikorwa rusange bya ultrasonography.
2. Nigute ushobora guhitamo ultrasound probe?
Ikoreshwa cyane mubushakashatsi bwibihaha ultrasound niL10-5;C5-2.
Umubiri muto usanzwe L10-5 biroroshye kubona umurongo usobanutse neza no kwitegereza urusaku rwimitsi.Urubavu rushobora gukoreshwa nk'ikimenyetso cyo kureba umurongo ushimishije, ushobora kuba amahitamo ya mbere yo gusuzuma pneumothorax.Inshuro zo munda ziringaniye, kandi umurongo wa pleural urashobora kugaragara neza mugihe usuzuma igituza cyose.Icyiciro cyibisobanuro byoroshye byoroshye gushushanya binyuze mumwanya wa intercostal kandi bifite ubujyakuzimu bwimbitse.Bikunze gukoreshwa mugusuzuma ibibyimba byishimishije, ariko ntabwo ari byiza kumenya pneumothorax hamwe nikirere cyiza.
3. Ni ibihe bice bigomba kugenzurwa?
Ibihaha ultrasonography isanzwe ikoreshwa muburyo bwahinduwe kuryama kuruhande rwibihaha ultrasonography (mBLUE) cyangwa gahunda y'ibihaha bibiri-ibice 12 na gahunda yo kugabana 8.Hano hari igenzura 10 ryose kumpande zombi z ibihaha muri gahunda ya mBLUE, ikwiranye nibibazo bisaba kugenzurwa byihuse.Gahunda ya 12-zone na gahunda ya 8-zone ni ukunyerera ultrasound probe muri buri gace kugirango bisuzumwe neza.
Ibibanza bya buri bariyeri muri gahunda ya mBLUE irerekanwa mumashusho akurikira:
| kugenzura | Aho biherereye |
| Akadomo k'ubururu | Ingingo iri hagati y'urutoki rwo hagati n'urufatiro rw'urutoki rw'impeta ku ruhande rw'umutwe |
| ingingo ya diaphragm | Shakisha aho diafragm iri hamwe na ultrasound probe kumurongo wa midaxillary |
| ingingo M.
| Hagati yumurongo uhuza hejuru yubururu hejuru na diaphragm point |
| Ingingo ya PLAPS
| Ihuriro ryo kwagura umurongo wa point M n'umurongo perpendicular kumurongo winyuma |
| inyuma akadomo k'ubururu
| Agace kari hagati yinguni nini yumugongo |
Gahunda yo kugabana 12 ishingiye kumurongo wa parasternal wumurwayi, umurongo wimbere, umurongo winyuma, n'umurongo wa paraspinal kugirango ugabanye thorax mubice 6 byurukuta rwimbere, kuruhande, ninyuma yigituza, kandi buri gace kagabanijwemo ibice bibiri. , hejuru no hepfo, hamwe nibice 12 byose.akarere.Gahunda y'ibice umunani ntabwo ikubiyemo ibice bine byurukuta rwinyuma rwigituza, kandi ikoreshwa kenshi mugupima no gusuzuma ultrasonography ya syndrome yimpyisi.Uburyo bwihariye bwo gusikana ni ugutangirira kumurongo wo hagati muri buri gace, umurongo wo hagati wa probe ni perpendicular rwose kuri bony thorax (indege ndende), ubanza kunyerera kuruhande ugana kumurongo, ugasubira hagati, hanyuma ukanyerera hagati ugana kuri umurongo utandukanya, hanyuma ugaruke hagati.
4. Nigute ushobora gusesengura amashusho ya ultrasound?
Nkuko twese tubizi, umwuka ni "umwanzi" wa ultrasound, kubera ko ultrasound yangirika vuba mu kirere, kandi kuba umwuka uhari mu bihaha bituma bigora gushushanya mu buryo butaziguye parenchyma y'ibihaha.Mu bihaha bisanzwe byuzuye, tissue yonyine ishobora kugaragara ni pleura, igaragara kuri ultrasound nkumurongo wa horizontal hyperechoic bita umurongo wa pleural (umwe wegereye urwego rworoshye).Mubyongeyeho, hariho parallel, isubiramo hyperechoic horizontal umurongo ibihangano byitwa A-imirongo munsi yumurongo ushimishije.Kubaho kwa A-umurongo bivuze ko hari umwuka munsi yumurongo wa pleural, ushobora kuba umwuka wibihaha bisanzwe cyangwa umwuka wubusa muri pneumothorax.
Mugihe c'ibihaha ultrasonography, umurongo wa pleural ubanza uherereye, keretse niba hariho emphysema nyinshi yo munsi y'ubutaka, ubusanzwe igaragara.Mu bihaha bisanzwe, pleura ya visceral na parietal irashobora kunyerera ugereranije nundi hamwe no guhumeka, ibyo bita kunyerera.Nkuko bigaragara mumashusho abiri akurikira, ishusho yo hejuru ifite kunyerera ibihaha kandi ishusho yo hepfo ntigira ibihaha.
Mubisanzwe, kubarwayi barwaye pneumothorax, cyangwa ubwinshi bwa effusion effusion ituma ibihaha bitaba kurukuta rwigituza, ikimenyetso cyo kunyerera ibihaha kizashira.Cyangwa umusonga uhuza ibihaha, kandi gufatana kugaragara hagati y'ibihaha n'urukuta rw'igituza, bishobora no gutuma ikimenyetso cyo kunyerera ibihaha kibura.Indurwe zidakira zitanga fibrous tissue igabanya umuvuduko wibihaha, kandi imiyoboro y'amazi ya thoracic ntishobora kubona ibihaha kunyerera nko muri COPD yateye imbere.
Niba umurongo ushobora kugaragara, bivuze ko hari umwuka uri munsi yumurongo wa pleural, kandi ikimenyetso cyo kunyerera ibihaha kirazimira, birashoboka ko ari pneumothorax, kandi ni ngombwa gushaka aho ibihaha byemezwa.Ingingo y'ibihaha niho ihinduka kuva nta bihaha byanyerera bijya mu bihaha bisanzwe byanyerera muri pneumothorax kandi ni igipimo cya zahabu cyo gusuzuma ultrasound yo gusuzuma pneumothorax.
Imirongo myinshi ibangikanye igizwe nurukuta rwigituza rushobora kugaragara munsi ya M-ultrasound.Mu mashusho asanzwe ya parenchyma y'ibihaha, kubera ibihaha kunyerera inyuma n'inyuma, urusaku rumeze nk'umucanga ruba munsi, rwitwa ikimenyetso cy'inyanja.Hano hari umwuka munsi ya pneumothorax, kandi nta kunyerera kw'ibihaha, bityo hakozwe imirongo myinshi ibangikanye, bita ikimenyetso cya barcode.Gutandukanya hagati yikimenyetso cyinyanja nicyapa cya barcode nicyo gihaha.
Niba kuba A-imirongo itagaragara mumashusho ya ultrasound, bivuze ko imiterere yinyama zimwe mubihaha yarahindutse, ikemerera kwanduza ultrasound.Ibicuruzwa nka A-imirongo birashira iyo umwanya wambere wishimishije wuzuyemo tissue nkamaraso, amazi, kwandura, kwandura guterwa namaraso yuzuye, cyangwa ikibyimba.Noneho ugomba kwitondera ikibazo cyumurongo B. B-umurongo, uzwi kandi kwizina rya "comet umurizo", ni umurongo wa lazeri umeze nka hyperechoic umurongo usohoka uhagaritse kumurongo ushimishije (visceral pleura), ugera hepfo ya Mugaragaza nta attenuation.Ihisha A-umurongo kandi igenda hamwe numwuka.Kurugero, mwishusho hepfo, ntidushobora kubona kubaho kumurongo A, ariko aho kugirango B.
Ntugire impungenge niba ubonye B-imirongo myinshi kumashusho ya ultrasound, 27% byabantu basanzwe bahinduye B-imirongo mumwanya wa 11-12 (hejuru ya diaphragm).Mubihe bisanzwe bya physiologique, imirongo iri munsi ya 3 B nibisanzwe.Ariko iyo uhuye numubare munini wa diffuse B-imirongo, ntabwo aribisanzwe, aribwo buryo bwo gukora ibihaha.
Nyuma yo kwitegereza umurongo ushimishije, Umurongo cyangwa B umurongo, reka tuvuge kubyerekeranye no kwinezeza no guhuza ibihaha.Mu gice cyinyuma cyigituza, gusohora kwiza no guhuza ibihaha birashobora gusuzumwa neza.Ishusho hepfo ni ultrasound ishusho yasuzumwe aho diafragm.Agace ka anechoic kirabura ni effusion effusion, iherereye mu cyuho cyiza hejuru ya diafragma.
Nigute ushobora gutandukanya pleural effusion na hemorhage?Fibrous exudate irashobora rimwe na rimwe kugaragara mu mikorere ya hemopleural, mu gihe ubusanzwe ubusanzwe ari agace kirabura kamwe kamwe kamwe ka anechoic, rimwe na rimwe kagabanijwemo ibyumba bito, kandi ibintu bireremba bifite imbaraga zitandukanye za echo birashobora kugaragara hirya no hino.
Ultrasound irashobora gusuzuma neza umubare munini (90%) wabarwayi bafite ibihaha, igisobanuro cyibanze muri byo ni uguhumeka.Ikintu gitangaje cyo gukoresha ultrasound kugirango hamenyekane guhuza ibihaha ni uko mugihe ibihaha byumurwayi bihujwe, ultrasound irashobora kunyura mubice byimbitse bya thoracic yibihaha aho guhurira bibera.Ibihaha byari hypoechoic bifite imipaka imeze kandi imipaka itamenyekana.Rimwe na rimwe, ushobora no kubona ikimenyetso cya bronchus yo mu kirere, ari hyperechoic kandi igenda ihumeka.Ishusho ya sonografi ifite akamaro kanini ko kwisuzumisha muguhuza ibihaha muri ultrasound nikimenyetso kimeze nkumwijima, nikimenyetso gikomeye kimeze nka echo isa na parenchyma yumwijima igaragara nyuma ya alveoli yuzuyemo exudate.Nkuko bigaragara ku gishushanyo gikurikira, iyi ni ishusho ya ultrasound yo guhuza ibihaha iterwa n'umusonga.Mu ishusho ya ultrasound, uduce tumwe na tumwe dushobora kugaragara nka hypoechoic, isa nkaho ari umwijima, kandi nta A ishobora kugaragara.
Mubihe bisanzwe, ibihaha byuzuyemo umwuka, kandi ibara rya Doppler ultrasound ntacyo rishobora kubona, ariko mugihe ibihaha bihujwe, cyane cyane iyo hari umusonga hafi yimiyoboro yamaraso, ndetse n'amashusho atembera mumaraso arashobora kuboneka, nkibi bikurikira Ishusho.
Ijwi ryo kumenya umusonga nubuhanga bwibanze bwa ultrasound.Birakenewe gusubira inyuma no hagati yimbavu kugirango tumenye neza niba hari agace ka hypoechoic, niba hari ikimenyetso cya bronchus yo mu kirere, niba hari ikimenyetso kimeze nk'umwijima, kandi niba hari A-umurongo usanzwe cyangwa udahari.Ishusho ya ultrasound.
5. Nigute ushobora guhitamo ibisubizo bya ultrasonography?
Binyuze muri scan ya ultrasound yoroshye (gahunda ya mBLUE cyangwa gahunda ya cumi na kabiri ya zone), amakuru aranga arashobora gushyirwa mubice, kandi nimpamvu ikomeye yo kunanirwa gukabije kwubuhumekero irashobora kumenyekana.Kurangiza vuba kwisuzumisha birashobora kugabanya dyspnea yumurwayi vuba kandi bikagabanya ikoreshwa ryibizamini bigoye nka CT na UCG.Aya makuru aranga arimo: kunyerera mu bihaha, Imikorere (Imirongo ku myanya yombi ya thoracic), imikorere ya B (Imirongo B igaragara mu mwobo yombi wa thoracic, kandi nta murongo uri munsi ya 3 B cyangwa imirongo B yegeranye), A / B isura (Kugaragara kuruhande rumwe rwa pleura, B igaragara kurundi ruhande), ingingo yibihaha, guhuza ibihaha, hamwe na effusion effusion.
Igihe cyo kohereza: Ukuboza-20-2022
