Ngokuthandwa okwandayo kwemishini ye-ultrasound, abasebenzi bezempilo abaningi ngokwengeziwe bayakwazi ukusebenzisa i-ultrasound emsebenzini wokubuka.Abantu abangazazi izindlela zokubhoboza eziqondiswa yi-ultrasound bayaxolisa ngokuhlala embonini.Kodwa-ke, ekusetshenzisweni komtholampilo engikubonile, ukuthandwa kwemishini ye-ultrasound kanye nokuthandwa kokubukwa kwe-ultrasound akufani.Endabeni yokubhoboza okuqondiswa yi-ultrasound emkhakheni wokufinyelela kwe-vascular, abantu abaningi basesesiteji sokuzenza sengathi bayaqonda, ngoba nakuba kukhona i-ultrasound, abakwazi ukubona lapho inaliti yokubhoboza yayikuphi.Indlela yeqiniso yokubhoboza eqondiswa yi-ultrasound idinga okokuqala ukuthi indawo yenaliti noma ithiphu yenaliti ibonakale ngaphansi kwe-ultrasound, kunokuba ilinganiswe bese "ingena ngokungaboni" ngaphansi kokuqondiswa kwe-ultrasound.Namuhla, sizokhuluma ngokubonakala nokungabonakali kwenaliti yokubhoboza ngaphansi kwe-ultrasound.
Ukubhoboza okuqondiswa yi-Ultrasound kuvame ukuhlukaniswa ngokubhoboza okusendizeni kanye nokubhoboza ngaphandle kwendiza, kokubili okusetshenziswa emkhakheni wokufinyelela emithanjeni futhi asebenza kahle kakhulu.Okulandelayo ingcaphuno evela ku-American Society of Ultrasound Medicine's practice guidelines for ultrasound-guided vascular access procedures, echaza amasu amabili.
Endizeni (i-eksisi ende) VS Ingaphandle kwendiza (I-eksisi emfushane)
- Endizeni/ Engaphandle kwendiza kukhombisa ukuhlobana okuhlobene nenaliti, inaliti ehambisana nendiza yokuthwebula ye-ultrasound isendizeni futhi inaliti iqonde endizeni yesithombe se-ultrasound ingaphandle kwendiza.
- Ngokuvamile, ukubhoboza kwendiza kubonisa i-eksisi ende noma ingxenye ye-longitudinal yomkhumbi;ukubhoboza ngaphandle kwendiza kubonisa i-eksisi emfushane noma ingxenye enqamulayo yomkhumbi.
- Ngakho-ke, i-out-of-plane/ i-axis emfushane kanye nendiza/i-eksisi ende zifana ngokuzenzakalela ku-ultrasound yokufinyelela kwemithambo.
- Ukuphuma kwendiza kungenziwa kusukela phezulu kwesikhungo somkhumbi, kodwa isihloko senaliti kufanele silandelwe ngokuzungezisa uphenyo ukuze kugwenywe ukubukela phansi ukujula kwephuzu;abalandeli be-probe abasuka emzimbeni wenaliti baye ekugcineni, futhi ngesikhathi indawo ekhanyayo yethiphu inyamalala iphoyinti lokuma kwephuzu.
- In-plane ivumela ukubonwa okumile kwendawo yethiphu yenaliti, kodwa kungaholela kalula "ekusheleleni" endizeni lapho inaliti ikhona noma/ kanye nendiza emaphakathi yomkhumbi;ukubhoboza endizeni kulungele kakhulu imikhumbi emikhulu.
- Indlela yokuhlanganisa esendizeni/ engaphandle kwendiza: sebenzisa ukuskena kwangaphandle kwendiza/ kwe-eksisi emfushane ukuze uqinisekise ukuthi ithiphu lenaliti lifika phakathi nendawo yomkhumbi, bese uzungezisa uphenyo ukuze ungene endizeni/i-eksisi ende .
Ikhono lokubuka i-statically tip yenaliti noma ngisho nomzimba wonke yenaliti ngesikhathi sangempela ngaphakathi kwendiza ngokusobala liwusizo kakhulu!Kodwa ukugcina inaliti endizeni yezithombe ze-ultrasound ngaphandle kosizo lwefreyimu yokubhoboza kudinga izikhathi eziningi zokuprakthiza ukuze lo msebenzi uphumelele.Ezimweni eziningi, i-angle ye-puncture inkulu kakhulu, kangangokuthi inaliti ngokucacile endizeni ye-ultrasound imaging, kodwa awukwazi ukubona ukuthi ikuphi.Libuze ikhehla elingumakhelwane ukuthi kwenzakalani.Angase akutshele ukuthi inaliti yokubhoboza ayiyona i-perpendicular kulayini wokuskena kwe-ultrasound, ngakho awukwazi ukuyibona.Khona-ke kungani ungayibona kancane lapho i-engeli yokubhoboza incane, futhi icace nakakhulu uma incane kakhulu?Angase axakeke ukuthi kungani.
I-engeli yenaliti yokubhoboza emfanekisweni ongezansi ingu-17° kanye no-13° ngokulandelanayo (ikalwa ngokuzuzisa ukubuka emuva), lapho i-engeli engu-13° wonke umzimba wenaliti yokubhoboza iboniswa ngokucacile, lapho i-engeli engu-17° , umzimba wenaliti ungabonakala kancane kancane, futhi i-engeli inkulu nge-hoodwink.Pho kungani kunomehluko omkhulu kangaka ku-engeli yesibonisi senaliti yokubhoboza enomehluko ongu-4° kuphela?
Kufanele iqale kusukela ekuphumeni kwe-ultrasound, ukwamukela nokugxila.Njengokulawula kwembobo ekugxilweni kwesithombe, iphoyinti ngalinye esithombeni liwumphumela wokugxila ohlangene wakho konke ukukhanya ngembobo, kuyilapho iphuzu ngalinye esithombeni se-ultrasound liwumphumela wokugxila ohlanganisiwe wawo wonke ama-transducer e-ultrasound ngaphakathi kwezikhala eziphumayo nezamukelayo. .Esithombeni esingezansi, umugqa obomvu uphawula ububanzi bokugxila kokukhishwa kwe-ultrasound ngokohlelo, futhi umugqa oluhlaza uwububanzi bokugxila kokwamukela ngokohlelo (umngcele wesokudla).Ngenxa yokuthi inaliti ikhanya ngokwanele ukukhiqiza ukubukeka okukhethekile, umugqa omhlophe uphawula isiqondiso esivamile ekukhanyeni okukhethekile.Uma sicabanga ukuthi umugqa obomvu uphawula ububanzi bokugxila kokukhishwayo kufana "nemisebe" emibili, ngemva kokushaya isibuko senaliti, "imisebe" ebonisiwe ifana nemigqa emibili ewolintshi esithombeni.Njengoba "umsebe" ohlangothini lwesokudla lomugqa oluhlaza udlula indawo yokwamukela, futhi awukwazi ukwamukelwa ngophenyo, "i-ray" engatholwa iboniswa endaweni ewolintshi esithombeni.Kungabonakala ukuthi ku-17 °, i-probe isengathola i-echo encane kakhulu ye-ultrasound, ngakho-ke isithombe esihambisanayo sibonakala kancane, kuyilapho ku-13 °, ama-echoes angamukelwa ngokuphawulekayo ngaphezu kwe-17 °, ngakho-ke isithombe singaphezulu. cacile.Ngokuncipha kwe-engeli yokubhoboza, inaliti ilala ngokuvundlile, futhi ama-echoes avelayo womzimba yenaliti angatholwa ngempumelelo, ngakho-ke ukuthuthukiswa kwenaliti kuba ngcono futhi kungcono.
Abanye abantu abacophelelayo bayophinde bathole into ethile, lapho i-engeli ingaphansi kwenani elithile (inaliti ayidingi "ukulala flat"), ukuthuthukiswa komzimba wenaliti ngokuyisisekelo kuhlala izinga elifanayo lokucaca.Futhi kungani lokhu?Kungani sidweba uhla oluncane lokugxila kokukhiphayo (umugqa obomvu) kunobubanzi bokugxila kokwamukela (umugqa oluhlaza) esithombeni esingenhla?Lokhu kungenxa yokuthi kusistimu yesithombe se-ultrasound, ukugxila kokudlulisa kungaba ukujula okukodwa kuphela kokugxila, futhi ngenkathi singakwazi ukulungisa ukujula kokugxila kokudlulisa ukuze senze isithombe sicace eduze nokujula esigxile kukho, asifuni. kube lufifi ngaphezu kokujula kokugxilile.Lokhu kuhluke kakhulu ezidingweni zethu zokuthatha izithombe zobuciko zabesifazane abahle, okudinga indawo enkulu yokuvula, ukujula okuncane kwensimu ukuletha ingemuva elingaphambili yonke i-bokeh.Ngomfanekiso we-ultrasound, sifuna ukuthi isithombe sicace ngokwanele ebangeni ngaphambi nangemuva kokujula kokugxila, ngakho-ke singasebenzisa imbobo encane yokudlulisa ukuze sithole ukujula okukhulu kwenkambu, ngaleyo ndlela sigcine ukufana kwesithombe.Mayelana nokutholwa kokugxila, isistimu ye-imaging ye-ultrasound manje seyenziwe idijithali ngokugcwele, ngaleyo ndlela i-ultrasound echo ye-transducer ngayinye/i-array element ingagcinwa, futhi ukugxila okuqhubekayo okuguquguqukayo bese kwenziwa ngedijithali kukho konke ukujula kwesithombe.Ngakho-ke singazama ukuvula indawo yokwamukela ibe nkulu ngangokunokwenzeka, inqobo nje uma i-elementi ye-array ethola isignali ye-echo isetshenziswa, ukugxila okucolekile nokulungiswa okungcono kungaqinisekiswa.Emuva esihlokweni sangaphambilini, lapho i-engeli yokubhoboza yehliswa ngezinga elithile, amaza e-ultrasonic akhishwa imbobo encane angatholwa imbobo enkulu yokwamukela ngemva kokuboniswa ngumzimba yenaliti, ngakho umphumela wokuthuthukiswa komzimba wenaliti ngokwemvelo zihlale zifana ngokuyisisekelo.
Ngophenyo olungenhla, yini esingayenza uma i-engeli yokubhoboza endizeni idlula u-17° futhi inaliti ingabonakali?Uma isistimu isekela, ungazama umsebenzi wokuthuthukisa inaliti.Okubizwa ngokuthi ubuchwepheshe bokuthuthukisa inaliti yokubhoboza ngokuvamile kusho ukuthi ngemva kohlaka olujwayelekile lokuskena lwethishu, kufakwa uhlaka oluhlukile lokuskena lapho kokubili okudluliswayo nokwamukela kuphambuka, futhi isiqondiso sokuchezuka sibheke ohlangothini lwenaliti yomzimba. , ukuze i-echo ebonisiwe yomzimba wenaliti iwele endaweni yokugxila eyamukelayo ngangokunokwenzeka.Bese isithombe esiqinile somzimba yenaliti esithombeni esichezukile siyakhishwa futhi siboniswe ngemva kokuhlanganisa nesithombe esivamile sethishu.Ngenxa yosayizi nokuvama kwe-elementi yohlu lokuhlola, i-engeli yokuchezuka ye-high-frequency linear probe ngokuvamile ayikho ngaphezu kuka-30°, ngakho-ke uma i-engeli yokubhoboza ingaphezu kuka-30°, ungabona kuphela umzimba wenaliti ngokucacile. ngomcabango wakho.
Okulandelayo, ake sibheke isimo sokubhoboza ngaphandle kwendiza.Ngemva kokuqonda isimiso sokuthuthukiswa kwezinaliti zendiza, kulula kakhulu ukuhlaziya ukuthuthukiswa kwezinaliti ezingaphandle kwendiza.I-rotational fan sweep okukhulunywe ngayo kumhlahlandlela wokuzijwayeza kuyisinyathelo esibalulekile se-punctures ngaphandle kwendiza, futhi lokhu akusebenzi nje kuphela ekutholeni indawo yephuzu yenaliti, kodwa futhi ekutholeni umzimba wenaliti.Ukuthi nje inaliti yokubhoboza kanye nesithombe se-ultrasound akukho endizeni efanayo ngaleso sikhathi.Kuphela lapho inaliti yokubhoboza incike endizeni yokucabanga lapho isigameko samagagasi e-ultrasonic enaliti yokubhoboza singaboniswa emuva kuphenyo lwe-ultrasonic.Njengoba ukujiya kokuqondisa kwe-probe kuvame ukudlula ngokugxila ngokomzimba kwelensi ye-acoustic, izimbobo zazo zombili ezidlulisayo nezokwamukela ziyefana kule ndlela.Futhi ubukhulu bembobo ububanzi be-wafer ye-transducer.Kuma-probe omugqa womugqa onemvamisa ephezulu, ububanzi bucishe bube ngu-3.5mm (imbobo yokwamukela yesithombe esisendizeni ngokuvamile ingaphezu kuka-15mm, okukhulu kakhulu kunobubanzi obuyiwafa).Ngakho-ke, uma i-echo ebonisiwe yomzimba wenaliti yokubhoboza engaphandle kwendiza kuwukubuyela ku-probe, kungaqinisekiswa kuphela ukuthi i-engeli ephakathi kwenaliti yokubhoboza nendiza yokuthwebula iseduze namadigri angu-90.Ngakho uyehlulela kanjani i-engeli eqondile?Into esobala kakhulu "umsila wenkanyezi enomsila" omude odonsa ngemuva kwendawo ekhanyayo eqinile.Lokhu kungenxa yokuthi lapho amagagasi e-ultrasonic esenzeka ngokubheka yenaliti yokubhoboza, ngaphezu kwama-echoes aboniswa ngokuqondile emuva ku-probe nge-surface yenaliti, inani elincane lamandla e-ultrasonic lingena enalitini.I-ultrasound ihamba ngokushesha ensimbi futhi kukhona ukuboniswa okuningi emuva naphambili ngaphakathi kwayo, ngenxa ye-echoes ekhombisa izikhathi eziningi eza kamuva, kwakheka "umsila wenkanyezi enomsila" omude.Uma inaliti ingaqondile endizeni yokucabanga, amaza omsindo avela emuva naphambili azobonakala kwezinye izinkomba futhi awakwazi ukubuyela ku-probe, ngakho-ke "umsila wenkanyezi enomsila" awukwazi ukubonakala.Isenzakalo somsila wenkanyezi enomsila asibonakali kuphela ekubhobozeni ngaphandle kwendiza, kodwa futhi ekubhobhozeni kwendiza.Uma inaliti yokubhoboza icishe ihambisane nendawo yokuhlola, imigqa yemigqa evundlile ingabonakala.
Ukuze ufanekise "umsila wenkanyezi enomsila" ongaphakathi kwendiza nangaphandle kwendiza, sithatha okuyisisekelo emanzini angaphandle kwendiza kanye nokusebenza kokushanela kwendiza, imiphumela iboniswa esithombeni esingezansi.
Isithombe esingezansi sibonisa ukusebenza kwesithombe sama-engeli ahlukene uma umzimba wenaliti uphumile endizeni futhi ifeni ejikelezayo iskenwa.Uma i-probe ibhekene nenaliti yokubhoboza, kusho ukuthi inaliti yokubhoboza i-perpendicular endizeni ye-imaging ye-ultrasound, ukuze ukwazi ukubona "umsila wenkanyezi enomsila".
Gcina i-probe iqonde enalithini yokubhoboza, bese uhamba nomzimba yenaliti uye echosheni yenaliti.Lapho "umsila wenkanyezi enomsila" uphela, kusho ukuthi isigaba sokuskena siseduze nephuzu yenaliti, futhi indawo ekhanyayo izonyamalala phambili phambili.Isikhundla ngaphambi kokunyamalala kwendawo ekhanyayo yilapho ichopho lonaliti likhona.Uma ungenaso isiqiniseko, ungenza ifeni ephendukayo ene-engeli encane eduze kwale ndawo ukuze uqinisekise futhi.
Inhloso eyinhloko yalokhu okungenhla ukusiza abaqalayo ukuthola ngokushesha lapho inaliti yokubhoboza kanye nethiphu yenaliti.Umkhawulo wobuchwepheshe bokubhoboza obuqondiswa yi-ultrasound awuphezulu kangako, futhi okufanele sikwenze ukuzola futhi siliqonde kahle ikhono.
Isikhathi sokuthumela: Feb-07-2022
