1. Chii chakanakira mapapu Ultrasound?
Mumakore mashoma apfuura, mapapu e-ultrasound imaging yakashandiswa zvakanyanya uye zvakanyanya kuchipatara.Kubva pamaitiro echinyakare ekutonga chete kuvepo uye kuwanda kwepleural effusion, yakashandura mapapu parenchyma imaging kuongororwa.Tinokwanisa kuongorora zvishanu zvinonyanya kukonzeresa kutadza kufema kwakanyanya (pulmonary edema, pneumonia, pulmonary embolism, COPD, pneumothorax) mune zvinopfuura makumi mapfumbamwe muzana ezviitiko zvine nyore 3-5 miniti yemapapu eultrasound.Izvi zvinotevera sumo pfupi kune general process ye lung ultrasonography.
2. Ungasarudza sei ultrasound probe?
Iyo inonyanya kushandiswa probes yemapapu ultrasound ndeyeL10-5(inonziwo diki organ probe, frequency renji 5 ~ 10MHz mutsara array) uyeC5-2(inonziwo abdominal probe kana hombe convex, 2~5MHz convex array), mamwe mascenario anogonawo Kushandisa P4-2 (inonziwo cardiac probe, 2~4MHz phased array).
Iyo yechinyakare diki nhengo yekuongorora L10-5 iri nyore kuwana yakajeka pleural mutsara uye kuona maungira eiyo subpleural tissue.Mbabvu inogona kushandiswa sechiratidzo chekutarisa mutsara wepleural, inogona kuve sarudzo yekutanga yepneumothorax assessment.Kuwanda kwemudumbu probes kune mwero, uye mutsara wepleural unogona kucherechedzwa zvakajeka paunenge uchiongorora chipfuva chose.Phased array probes ari nyore kuita mufananidzo kuburikidza neiyo intercostal space uye ane yakadzika yekuona kudzika.Anowanzo shandiswa mukuongorora kwepleural effusions, asi haana kunaka pakuona pneumothorax uye pleural space mamiriro.
3. Ndezvipi zvikamu zvinofanira kuongororwa?
Lung ultrasonography inowanzoshandiswa muchirongwa chemodified bedside lung ultrasonography (mBLUE) kana maviri-mapapu 12-division scheme uye 8-division scheme.Kune huwandu hwegumi hwekutarisa kumativi ese emapapu mumBLUE scheme, iyo yakakodzera kune mamiriro anoda kuongororwa nekukurumidza.Iyo 12-zone scheme uye 8-zone chirongwa ndeyekutsvedza iyo ultrasound probe munzvimbo yega yega kuitira kunyatsoongorora.
Nzvimbo dzeimwe neimwe yekutarisa mumBLUE scheme inoratidzwa mumufananidzo unotevera:
| checking point | Nzvimbo |
| blue dot | Nzvimbo iri pakati pemunwe wepakati uye hwaro hwechigunwe chemhete parutivi rwemusoro |
| diaphragm point | Tsvaga nzvimbo ye diaphragm ine ultrasound probe mu midaxillary line |
| pfungwa M
| Pakati pemutsara unobatanidza nzvimbo yebhuruu yepamusoro uye diaphragm point |
| PLAPS point
| Mharadzano yemutsara wekuwedzera wepoinzi M uye mutsara wakatarisana neiyo posterior axillary line. |
| back blue dot
| Nzvimbo iri pakati pe subscapular angle uye musana |
I-12-division scheme inobva pamutsara wemurwere weparasternal, anterior axillary line, posterior axillary line, uye mutsara weparaspinal kuti uparadzanise thorax mu6 nzvimbo dzeanterior, lateral, uye posterior chest wall, uye nzvimbo imwe neimwe inoparadzaniswa kuva nzvimbo mbiri. , kumusoro nekudzika, pamwe nenzvimbo gumi nembiri.area.Iro sere-partition scheme haisanganisi nzvimbo ina dzemashure emadziro echipfuva, uye inowanzoshandiswa pakuongorora uye kuongororwa kwe ultrasonography ye interstitial pulmonary syndrome.Iyo chaiyo yekuvheneka nzira ndeyekutanga kubva pakati pepakati munzvimbo yega yega, iyo yepakati axis ye probe yakanyatso perpendicular kune bony thorax (longitudinal ndege), tanga slide nedivi kune mutsara wekutema, dzokera kune yepakati, wozotsvedza nepakati kune mutsara wekuganhura, uye wozodzoka pakati.
4. Nzira yekuongorora sei ultrasound mifananidzo?
Sezvatinoziva tose, mhepo ndiyo "muvengi" we ultrasound, nokuti ultrasound inoora nokukurumidza mumhepo, uye kuvapo kwemhepo mumapapu kunoita kuti zvive zvakaoma kunyatsofananidza mapapu parenchyma.Mumapapu anowanzo putika, chinyama chimwechete chinogona kuonekwa i pleura, iyo inoonekwa pa ultrasound semutsara we hyperechoic wakaoma unonzi pleural line (iyo iri padyo neganda rakapfava).Pamusoro pazvo, kune anofambirana, anodzokorora hyperechoic horizontal line artifacts anonzi A-mitsetse pazasi pepleural line.Kuvapo kweA-line kunoreva kuti kune mweya pasi pemutsara wepleural, unogona kunge uri mhepo yemapapu yakajairika kana mweya wakasununguka mupneumothorax.
Munguva yemapapu ultrasonography, mutsara wepleural unotanga kuwanikwa, kunze kwekuti kune yakawanda ye subcutaneous emphysema, iyo inowanzoonekwa.Mumapapu akajairika, visceral uye parietal pleura inogona kutsvedza inoenderana nekufema, kunonzi kutsvedza kwemapapu.Sezvinoratidzwa mumifananidzo miviri inotevera, mufananidzo wepamusoro une mapapu anotsvedza uye mufananidzo wezasi hauna kutsvedza kwemapapu.
Kazhinji, muvarwere vane pneumothorax, kana kuwanda kwepleural effusion inochengeta mapapu kure nemadziro echipfuva, chiratidzo chemapapu chinotsvedza chinopera.Kana kuti pneumonia inosimbisa mapapu, uye kunamatira kunoonekwa pakati pemapapu nemadziro echipfuva, izvo zvinogonawo kuita kuti chiratidzo chemapapu chinotsvedza chinyangarika.Kuzvimba kwenguva refu kunogadzira matishu ane fibrous anoderedza kufamba kwemapapu, uye thoracic drainage chubhu haigone kuona mapapu achitsvedza senge muCOPD yepamusoro.
Kana iyo A mutsara ichigona kucherechedzwa, zvinoreva kuti pane mhepo pazasi pemutsara wepleural, uye chiratidzo chemapapu chinotsvedza chinonyangarika, inogona kunge iri pneumothorax, uye inofanirwa kutsvaga nzvimbo yemapapu yekusimbisa.Nzvimbo yemapapu ndiyo nzvimbo yeshanduko kubva pakusina mapapu inotsvedza kuenda kune yakajairwa mapapu anotsvedza mupneumothorax uye ndiyo yegoridhe chiyero cheiyo ultrasound kuongororwa kwepneumothorax.
Mitsetse yakawanda yakafanana yakaumbwa nemadziro echipfuva yakanyatsogadziriswa inogona kuonekwa pasi peM-mode ultrasound.Mumifananidzo yakajairika yemapapu parenchyma, nekuda kwekutsvedza kwemapapu kumashure nekudzoka, maungira akafanana nejecha anoumbwa pasi, anodaidzwa kuti chiratidzo chemahombekombe.Pazasi pepneumothorax pane mweya, uye hapana mapapu anotsvedza, saka mitsetse yakawanda yakafanana inoumbwa, iyo inonzi chiratidzo chebhakodhi.Nzvimbo yekuparadzanisa pakati pechiratidzo chemahombekombe uye chiratidzo chebarcode ndiyo nzvimbo yemapapu.
Kana kuvepo kweA-mitsara kusingaonekwe mumufananidzo we ultrasound, zvinoreva kuti chimwe chimiro chetishu mumapapu chachinja, chichibvumira kutumira ultrasound.Zvigadzirwa zvakaita seA-mitsetse zvinonyangarika kana iyo yekutanga nzvimbo yepleural yakazadzwa nematishu akadai seropa, mvura, hutachiona, contusion inokonzerwa neropa rakagwamba, kana bundu.Ipapo iwe unofanirwa kubhadhara kune dambudziko remutsara B. B-mutsara, inozivikanwawo se "comet muswe" chiratidzo, inonzi laser beam-like hyperechoic strip inomira vertically kubva kumutsara wepleural (visceral pleura), inosvika pasi. yekrini pasina attenuation.Inovhara iyo A-line uye inofamba nekufema.Somuenzaniso, mumufananidzo uri pasi apa, hatigoni kuona kuvapo kweA line, asi panzvimbo yeB line.
Usanetseka kana ukawana B-mitsetse yakati wandei pamufananidzo weultrasound, 27% yevanhuwo zvavo vakaisa B-mitsara munzvimbo 11-12 intercostal space (pamusoro pe diaphragm).Pasi pezvakajairwa mamiriro emuviri, isingasviki 3 B mitsetse yakajairika.Asi kana iwe ukasangana nenhamba yakawanda yekupararira B-mitsara, haisi yakajairika, iyo inoitwa yepulmonary edema.
Mushure mekutarisa mutsara wepleural, A kana B mutsara, ngatitaure nezve pleural effusion uye kubatanidzwa kwemapapu.Muchikamu chemashure chechipfuva, pleural effusion uye kusimbiswa kwemapapu kunogona kuongororwa zviri nani.Mufananidzo uri pazasi mufananidzo we ultrasound wakaongororwa panzvimbo yediaphragm.Iyo dema anechoic area ndiyo pleural effusion, iyo iri mu pleural cavity pamusoro pe diaphragm.
Saka unosiyanisa sei pakati pepleural effusion uye hemorrhage?Fibrous exudate dzimwe nguva inogona kuonekwa muhemopleural effusion, nepo effusion ichiwanzoita dema homogeneous anechoic nzvimbo, dzimwe nguva yakakamurwa kuita makamuri madiki, uye zvinhu zvinoyangarara zvekusiyana echo kusimba zvinogona kuoneka zvakatenderedza.
Ultrasound inogona kuona kuona ruzhinji (90%) yevarwere vane mapapu kusimbiswa, iyo inonyanya kukosha tsanangudzo iyo kurasikirwa kwemhepo.Chinhu chinoshamisa pamusoro pekushandisa ultrasound kuongorora mapapu kubatanidzwa ndechekuti kana mapapu emurwere abatanidzwa, iyo ultrasound inogona kupfuura nepakati-pathoracic nzvimbo dzemapapu umo kubatanidzwa kunoitika.Matishu emumapapu aive ari hypoechoic aine miganho yakaita seweji uye isina kujeka.Dzimwe nguva unogonawo kuona mhepo bronchus chiratidzo, iri hyperechoic uye inofamba nekufema.Mufananidzo wesonographic une chakanyanya kukosha kwekubatanidzwa kwemapapu mu Ultrasound ndiyo chiropa-yakafanana nechiratidzo, inova yakasimba tishu-yakafanana maungira akafanana nechiropa parenchyma inoonekwa mushure mekunge alveoli yazadzwa ne exudate.Sezvinoratidzwa pamufananidzo uri pazasi, uyu mufananidzo we ultrasound wekubatanidzwa kwemapapu kunokonzerwa nemabayo.Mumufananidzo we ultrasound, dzimwe nzvimbo dzinogona kuonekwa se hypoechoic, iyo inotarisa zvishoma sechiropa, uye hapana A inogona kuonekwa.
Mumamiriro ezvinhu akajairika, mapapu anozadzwa nemhepo, uye ruvara Doppler ultrasound haagone kuona chero chinhu, asi kana mapapu abatanidzwa, kunyanya kana paine mabayo pedyo netsinga, kunyange kuyerera kweropa mifananidzo mumapapu inogona kuonekwa, sezvinotevera. inoratidzwa mumufananidzo.
Ruzha rwekuzivisa pneumonia ndiyo hunyanzvi hwekutanga hwemapapu ultrasound.Izvo zvinodikanwa kuti ufambe uchidzoka pakati pembabvu kuti unyatsoongorora kana pane hypoechoic area, kana paine air bronchus sign, kana paine chiropa-like sign, uye kana pane yakajairika A-line kana kwete.Lung ultrasound mufananidzo.
5. Nzira yekusarudza sei migumisiro ye ultrasonography?
Kuburikidza neiyo yakapfava ultrasound scan (mBLUE chirongwa kana gumi nemaviri-zone scheme), iyo data yehunhu inogona kuverengerwa, uye chakakomba chikonzero chekutadza kufema kwakanyanya chinogona kutsanangurwa.Kukurumidza kupedza kuongororwa kunogona kubvisa dyspnea yemurwere nekukurumidza uye kuderedza kushandiswa kwekuongorora kwakaoma seCT uye UCG.Iyi data yehunhu inosanganisira: kutsvedza kwemapapu, A kuita (A mitsetse pamakumbo ese emuchipfuva), B kuita (B mitsetse inoonekwa mumakumbo emuchipfuva, uye hapana isingasviki mitsara ye3 B kana mitsara yepedyo B yakanamatira), A / B. chimiro (Kuonekwa kune rumwe rutivi rwepleura, B kuonekwa kune rumwe rutivi), nzvimbo yemapapu, kubatanidzwa kwemapapu, uye pleural effusion.
Nguva yekutumira: Zvita-20-2022
