1. Iyintoni inzuzo ye-lung ultrasound?
Kwiminyaka embalwa edlulileyo, i-lung ultrasound imaging isetyenziswe ngakumbi nangakumbi kwezonyango.Ukusuka kwindlela yesiNtu yokugweba kuphela ubukho kunye nobungakanani bokuphuma kwepleural, iye yaluguqula uvavanyo lwemiphuphu ye-parenchyma imaging.Siyakwazi ukuxilonga i-5 eyona nto ixhaphakileyo yezizathu ezinzima zokungaphumeleli kokuphefumula (i-pulmonary edema, i-pneumonia, i-pulmonary embolism, i-COPD, i-pneumothorax) ngaphezu kwe-90% yamatyala kunye ne-3-5 yemizuzu ye-lung ultrasound elula.Oku kulandelayo sisingeniso esifutshane kwinkqubo ngokubanzi ye-lung ultrasonography.
2. Indlela yokukhetha i-ultrasound probe?
Ezona probes zisetyenziswa kakhulu kwi lung ultrasound zeziL10-5(ekwabizwa ngokuba yi-organ probe encinci, i-frequency range 5 ~ 10MHz i-linear array) kunyeC5-2(ekwabizwa ngokuba yi-probe yesisu okanye i-convex enkulu, i-2 ~ 5MHz i-convex uluhlu), ezinye iimeko zingasebenzisa i-P4-2 (ekwabizwa ngokuba yi-cardiac probe, i-2 ~ 4MHz ngokwezigaba).
I-probe yesiqhelo yelungu elincinci le-L10-5 kulula ukufumana umgca we-pleural ocacileyo kunye nokuqwalasela i-echo ye-subpleural tissue.Ubambo lunokusetyenziswa njengesiphawuli ukujonga umgca we-pleural, onokuthi ube yinto yokuqala yokukhetha uvavanyo lwe-pneumothorax.Ubuninzi beeprobes zesisu buphakathi, kwaye umgca we-pleural unokubonwa ngokucacileyo ngelixa uhlola isifuba sonke.Iiprobe zoluhlu olunezigaba zilula ukwenza umfanekiso ngesithuba se-intercostal kwaye zinobunzulu bokubona ubunzulu.Zihlala zisetyenziswa kuvavanyo lwe-pleural effusions, kodwa azilunganga ekubhaqeni i-pneumothorax kunye neemeko zesithuba sepleural.
3. Ngawaphi amalungu afanele ukutshekishwa?
I-Lung ultrasonography idla ngokusetyenziswa kwiskim se-lung lung ultrasonography (mBLUE) elungisiweyo okanye i-two-lung 12-division scheme kunye neskim se-8-division.Kukho iindawo zokuhlola ezili-10 kumacala omabini emiphunga kwiskimu se-mBLUE, esifanelekileyo kwiimeko ezifuna ukuhlolwa ngokukhawuleza.Iskimu se-12-zone kunye ne-8-zone scheme yi-slide probe ye-ultrasound kwindawo nganye yokuskena ngokucokisekileyo.
Iindawo zokukhangela indawo nganye kwiskim se-mBLUE ziboniswe kulo mfanekiso ulandelayo:
| indawo yokujonga | Indawo |
| ichaphaza elibhlowu | Indawo phakathi komnwe ophakathi kunye nesiseko somnwe weringi kwicala lentloko |
| indawo ye-diaphragm | Fumana indawo ye-diaphragm kunye ne-ultrasound probe kumgca we-midaxillary |
| inqaku M
| I-midpoint yomgca odibanisa indawo ephezulu eluhlaza kunye ne-diaphragm point |
| Inqaku le-PLAPS
| Ukudibana komgca wokwandiswa kwenqaku M kunye nomgca wependicular kumgca we-axillary yangasemva |
| ichaphaza eliluhlaza ngasemva
| Indawo ephakathi kwe-angle ye-subscapular kunye nomqolo |
Iskimu se-12-division sisekelwe kumgca we-parasternal wesigulane, umgca we-axillary wangaphambili, umgca we-axillary yangasemva, kunye nomgca we-paraspinal ukwahlula i-thorax kwiindawo ze-6 zodonga lwesifuba lwangaphambili, lwecala, kunye ne-posterior, kwaye indawo nganye iphinda ihlulwe kwiindawo ezimbini. , phezulu nasezantsi, kunye neendawo ezili-12 zizonke.indawo.Iskimu sesahlulo sesibhozo asibandakanyi iindawo ezine zodonga lwesifuba sangasemva, kwaye zihlala zisetyenziselwa ukuxilongwa kunye nokuhlolwa kwe-ultrasonography ye-interstitial pulmonary syndrome.Indlela ethile yokuskena kukuqala ukusuka kumgca ophakathi kwindawo nganye, i-axis esembindini ye-probe i-perpendicular ngokupheleleyo kwi-bony thorax (inqwelomoya yobude), kuqala isilayidi ecaleni kumgca wokucanda, ubuyele kumgca ophakathi, emva koko utyibilikise ngokuphakathi umgca womda, kwaye emva koko ubuyisele umgca ophakathi.
4. Indlela yokuhlalutya imifanekiso ye-ultrasound?
Njengoko sonke siyazi, umoya "utshaba" lwe-ultrasound, ngenxa yokuba i-ultrasound ibola ngokukhawuleza emoyeni, kwaye ubukho bomoya kwimiphunga yenza kube nzima ukuba umfanekiso ochanekileyo we-lung parenchyma.Kumphunga oqhelekileyo ovuthelwe ngumoya, ekuphela kwezicubu ezinokubonwa yipleura, ebonakala kwi-ultrasound njengomgca othe tyaba we-hyperechoic obizwa ngokuba ngumgca we-pleural (owona ukufutshane kumaleko wezicubu ezithambileyo).Ukongeza, kukho i-parallel, i-repetitive hyperechoic horizontal line artifacts ebizwa ngokuba yi-A-lines ngezantsi kwe-pleural line.Ubukho bomgca we-A buthetha ukuba kukho umoya ongaphantsi komgca we-pleural, onokuba ngumoya wemiphunga oqhelekileyo okanye umoya okhululekile kwi-pneumothorax.
Ngethuba le-lung ultrasonography, umgca we-pleural ufumaneka kuqala, ngaphandle kokuba kukho i-emphysema eninzi engaphantsi kwe-subcutaneous, edla ngokubonakala.Kwimiphunga yesiqhelo, i-visceral kunye ne-parietal pleura inokutyibilika xa ithelekiswa enye kwenye ngokuphefumla, okubizwa ngokuba kukutyibilika kwemiphunga.Njengoko kubonisiwe kwimifanekiso emibini elandelayo, umfanekiso ophezulu unemiphunga etyibilikayo kwaye umfanekiso ongezantsi awunakutyibilika kwemiphunga.
Ngokuqhelekileyo, kwizigulana ezine-pneumothorax, okanye isixa esikhulu se-pleural effusion egcina imiphunga kude nodonga lwesifuba, uphawu lwe-lung sliding luya kunyamalala.Okanye inyumoniya idibanisa imiphunga, kwaye kubonakala ukuncamathela phakathi kwemiphunga kunye nodonga lwesifuba, nto leyo enokwenza ukuba uphawu lokutyibilika lwemiphunga lunyamalale.Ukuvuvukala okungapheliyo kuvelisa izicubu ezine-fibrous ezinciphisa ukuhamba kwemiphunga, kwaye iityhubhu ze-thoracic drainage azikwazi ukubona ukutyibilika kwemiphunga njenge-COPD ephezulu.
Ukuba umgca we-A unokubonwa, oko kuthetha ukuba kukho umoya ongaphantsi komgca we-pleural, kwaye uphawu lwe-lung sliding luyanyamalala, kunokwenzeka ukuba ube yi-pneumothorax, kwaye kuyimfuneko ukufumana indawo ye-lung yokuqinisekisa.Inqaku lemiphunga yindawo yotshintsho ukusuka ekungatyibilikiyo kwemiphunga ukuya kwimiphunga eqhelekileyo kwi-pneumothorax kwaye ngumgangatho wegolide wokuxilongwa kwe-ultrasound yepneumothorax.
Imigca emininzi enxuseneyo eyenziwe ludonga lwesifuba olusisigxina inokubonwa phantsi kwe-M-mode ultrasound.Kwimizobo yesiqhelo ye-lung parenchyma, ngenxa yokutyibilika kwemiphunga emva naphambili, ama-echoes afana nesanti ayakhiwa ngaphantsi, abizwa ngokuba luphawu lolwandle.Kukho umoya ongezantsi kwepneumothorax, kwaye akukho lung sliding, ngoko ke imigca emininzi enxuseneyo yenziwa, ebizwa ngokuba luphawu lwebhakhowudi.Indawo yokwahlula phakathi kophawu lwaselwandle kunye nophawu lwebhakhowudi yindawo yemiphunga.
Ukuba ubukho be-A-lines abubonakali kumfanekiso we-ultrasound, kuthetha ukuba isakhiwo se-tissue kwimiphunga sitshintshile, sivumela ukuba sidlulise i-ultrasound.I-Artifacts efana ne-A-lines iyanyamalala xa indawo ye-pleural yasekuqaleni izaliswe zizicubu ezinjengegazi, ulwelo, usulelo, ukudumba okubangelwa lihlwili legazi, okanye ithumba.Emva koko kufuneka ubeke ingqalelo kwingxaki yomgca B. Umgca we-B, owaziwa nangokuthi "umsila we-comet", i-laser beam-like hyperechoic strip ephuma ngokuthe nkqo kwi-pleural line (visceral pleura), ifikelela ezantsi. kwesikrini ngaphandle kokuphazamiseka.Igquma umgca ongu-A kwaye ihamba ngokuphefumla.Ngokomzekelo, kumfanekiso ongezantsi, asikwazi ukubona ubukho bomgca we-A, kodwa endaweni yomgca we-B.
Musa ukuxhalaba ukuba ufumana imigca ye-B emininzi kumfanekiso we-ultrasound, i-27% yabantu abaqhelekileyo baye bahlala kwindawo ye-B kwi-11-12 intercostal space (ngaphezulu kwe-diaphragm).Ngaphantsi kweemeko eziqhelekileyo ze-physiological, ngaphantsi kwe-3 B imigca eqhelekileyo.Kodwa xa udibana nenani elikhulu le-B-line diffuse, akuqhelekanga, oko kukusebenza kwe-pulmonary edema.
Emva kokujonga umgca wepleyiti, A okanye umgca B, masithethe malunga nokuphuma kwepleyiti kunye nokudityaniswa kwemiphunga.Kwindawo ye-posterolateral yesifuba, i-pleural effusion kunye nokuqiniswa kwemiphunga kunokuhlolwa ngcono.Umfanekiso ongezantsi ngumfanekiso we-ultrasound ohlolwe kwindawo ye-diaphragm.Indawo emnyama ye-anechoic yi-pleural effusion, efumaneka kwi-pleural cavity ngaphezulu kwe-diaphragm.
Ngoko ke uhlula njani phakathi kwe-pleural effusion kunye ne-hemorrhage?I-Fibrous exudate ngamanye amaxesha inokubonwa kwi-hemopleural effusion, ngelixa i-effusion ihlala iyindawo emnyama ye-anechoic, ngamanye amaxesha yahlulahlulwe yangamagumbi amancinci, kwaye izinto ezidadayo zobunzima be-echo obahlukeneyo zinokubonwa ngeenxa zonke.
I-Ultrasound inokuvavanya ngokubonakalayo uninzi (i-90%) yezigulane ezinokuqiniswa kwemiphunga, eyona nkcazo esisiseko yokulahlekelwa komoya.Eyona nto imangalisayo ngokusebenzisa i-ultrasound ukuxilonga ukuqiniswa kwemiphunga kukuba xa imiphunga yesigulana idityanisiwe, i-ultrasound inokudlula kwiindawo ezinzulu zemiphunga apho ukudityaniswa kwenzeka khona.Izicubu zemiphunga yayiyi-hypoechoic kunye nemida emile okweji kwaye engacacanga.Ngamanye amaxesha unokubona uphawu lwe-bronchus yomoya, oluyi-hyperechoic kwaye luhamba ngokuphefumla.Umfanekiso wesonografi onokubaluleka kokuxilonga okuthe ngqo kokudityaniswa kwemiphunga kwi-ultrasound luphawu olufana nezicubu zesibindi, oluyi-echo eyomeleleyo yezicubu efana ne-parenchyma yesibindi evela emva kokuba i-alveoli izaliswe yi-exudate.Njengoko kubonisiwe kumzobo ongezantsi, lo ngumfanekiso we-ultrasound wokuqinisa imiphunga obangelwa yinyumoniya.Kumfanekiso we-ultrasound, ezinye iindawo zingabonwa njenge-hypoechoic, ebonakala ngathi isibindi, kwaye akukho A inokubonwa.
Kwiimeko eziqhelekileyo, imiphunga izaliswe ngumoya, kwaye umbala we-Doppler ultrasound awuboni nto, kodwa xa imiphunga idityanisiwe, ngakumbi xa kukho inyumoniya kufuphi nemithambo yegazi, nemifanekiso yokuhamba kwegazi kwimiphunga inokubonwa, ngolu hlobo lulandelayo. iboniswe emfanekisweni.
Isandi sokuchonga inyumoniya sisakhono esisisiseko se-lung ultrasound.Kuyimfuneko ukuhamba ngasemva naphambili phakathi kweembambo ukujonga ngononophelo ukuba kukho indawo ye-hypoechoic, ingaba kukho uphawu lwe-bronchus yomoya, nokuba kukho uphawu olufana nezicubu zesibindi, nokuba kukho umgca we-A oqhelekileyo okanye awukho.Umfanekiso we-Lung ultrasound.
5. Indlela yokugqiba iziphumo ze-ultrasonography?
Ngokusebenzisa iskena esilula se-ultrasound (iskimu se-mBLUE okanye iskimu sommandla weshumi elinesibini), idatha yeempawu zinokuhlelwa, kwaye isizathu esibi kakhulu sokungaphumeleli kokuphefumla ngokukhawuleza sinokumiselwa.Ukugqiba ngokukhawuleza ukuxilongwa kunokunciphisa i-dyspnea yesigulane ngokukhawuleza kwaye kunciphise ukusetyenziswa kweemviwo ezinzima ezifana ne-CT kunye ne-UCG.Ezi nkcukacha zeempawu ziquka: ukutyibilika kwemiphunga, A ukusebenza (imigca A kwimingxuma yomibini yesifuba), ukusebenza kwe-B (imigca engu-B ebonakala kuyo yomibini imingxuma yesifuba, kwaye akukho migca ingaphantsi kwe-3 B okanye imigca engu-B ekufutshane ibambeneyo), A/B inkangeleko (Ukubonakala kwelinye icala lepleura, inkangeleko engu-B kwelinye icala), indawo yemiphunga, ukuqiniswa kwemiphunga, kunye ne-pleural effusion.
Ixesha lokuposa: Dec-20-2022
