1. Menene amfanin huhu duban dan tayi?
A cikin 'yan shekarun da suka gabata, an yi amfani da hoton duban dan tayi fiye da asibiti.Daga tsarin al'ada na kawai yin la'akari da kasancewar da adadin zubar da jini, ya canza gwajin hoto na parenchyma na huhu.Za mu iya bincikar 5 mafi na kowa m Sanadin m numfashi gazawar (na huhu edema, ciwon huhu, huhu embolism, COPD, pneumothorax) a cikin fiye da 90% na lokuta tare da sauki 3-5 minti huhu duban dan tayi.Mai zuwa shine taƙaitaccen gabatarwar ga tsarin aikin huhu na huhu.
2. Yadda za a zabi duban dan tayi?
Abubuwan da aka fi amfani da su don duban huhu suneL10-5(wanda kuma ake kira ƙananan binciken gabobin jiki, kewayon mitar 5 ~ 10MHz layin layi) daC5-2(wanda kuma ake kira binciken ciki ko babban convex, 2 ~ 5MHz convex array), wasu al'amuran kuma na iya amfani da P4-2 (wanda ake kira binciken zuciya, 2 ~ 4MHz tsararrun tsararru).
Binciken ƙananan gabobin gargajiya na al'ada L10-5 yana da sauƙi don samun madaidaicin layin pleural kuma lura da amsawar nama na subpleural.Ana iya amfani da haƙarƙarin a matsayin alama don lura da layin pleural, wanda zai iya zama zaɓi na farko don kimanta pneumothorax.Yawan gwaje-gwajen ciki yana da matsakaici, kuma ana iya lura da layin pleural a fili yayin da ake nazarin duka kirji.Binciken tsararru masu tsari suna da sauƙin hoto ta sararin samaniya kuma suna da zurfin ganowa.Ana amfani da su sau da yawa wajen tantance zubar da jini, amma ba su da kyau wajen gano pneumothorax da yanayin sararin samaniya.
3. Wadanne sassa ya kamata a duba?
Ana amfani da ultrasonography na huhu a cikin gyare-gyaren tsarin huhu na huhu (mBLUE) ko tsarin kashi biyu na huhu 12 da tsarin 8-division.Akwai jimlar wuraren bincike guda 10 a bangarorin biyu na huhu a cikin tsarin mBLUE, wanda ya dace da yanayin da ke buƙatar saurin dubawa.Makirci mai yanki 12 da makircin yanki 8 shine don zamewar binciken duban dan tayi a kowane yanki don cikakken bincike.
Ana nuna wuraren kowane wurin bincike a cikin tsarin mBLUE a cikin adadi mai zuwa:
| wurin dubawa | Wuri |
| dige blue | Ma'anar tsakanin yatsan tsakiya da tushe na yatsan zobe a gefen kai |
| diaphragm batu | Nemo wurin diaphragm tare da binciken duban dan tayi a cikin layin midaxillary |
| nufi M
| Matsakaicin layin da ke haɗa madaidaicin shuɗi na sama da maƙallan diaphragm |
| PLAPS batu
| Matsakaicin layin tsawo na maki M da layin madaidaiciya zuwa layin axillary na baya. |
| digo shudi na baya
| Wurin da ke tsakanin kusurwar subscapular da kashin baya |
Tsarin kashi 12 yana dogara ne akan layin majiyyaci, layin axillary na gaba, layin axillary na baya, da layin paraspinal don raba thorax zuwa wurare 6 na bangon kirji na gaba, ta gefe, da na baya, kuma kowane yanki an kara raba kashi biyu. , sama da ƙasa, tare da jimlar yanki 12.yanki.Tsarin kashi takwas ba ya haɗa da wurare huɗu na bangon kirji na baya, kuma ana amfani dashi sau da yawa a cikin ganewar asali da kimantawa na ultrasonography don ciwon huhu na huhu.Takamaiman hanyar dubawa ita ce farawa daga tsakiyar layi a kowane yanki, tsakiyar axis na binciken gaba ɗaya yana daidai da ƙashin ƙashin ƙashi (jirgin tsayi), da farko zamewa a kaikaice zuwa layin ƙaddamarwa, komawa tsakiyar layi, sannan zamewa medially zuwa ga layin shata iyaka, sannan ya dawo tsakiyar layi.
4. Yadda za a tantance hotuna na duban dan tayi?
Kamar yadda muka sani, iska ita ce "maƙiyi" na duban dan tayi, saboda duban dan tayi yana saurin rubewa a cikin iska, kuma kasancewar iska a cikin huhu yana da wuya a iya kwatanta parenchyma na huhu kai tsaye.A cikin huhu da aka saba, kawai nama da za a iya ganowa shine pleura, wanda ke bayyana akan duban dan tayi a matsayin layin hyperechoic a kwance wanda ake kira layin pleural (wanda yake kusa da Layer na taushi).Bugu da kari, akwai layi daya, masu maimaita hyperechoic a kwance kayan tarihi da ake kira A-line dake kasa da layin pleural.Kasancewar layin A yana nufin cewa akwai iska a ƙarƙashin layin pleural, wanda zai iya zama iska ta huhu ta al'ada ko kuma iska kyauta a cikin pneumothorax.
Lokacin duban huhu na huhu, layin pleural yana farawa, sai dai idan akwai emphysema mai yawa na subcutaneous, wanda yawanci ana iya gani.A cikin huhu na al'ada, visceral da parietal pleura na iya zamewa dangi da juna tare da numfashi, wanda ake kira zamewar huhu.Kamar yadda aka nuna a cikin hotuna biyu na gaba, hoton na sama yana da zamewar huhu kuma hoton ƙasa ba shi da zamewar huhu.
Gabaɗaya, a cikin marasa lafiya tare da pneumothorax, ko babban adadin ɓacin rai wanda ke nisantar da huhu daga bangon ƙirji, alamar zamewar huhu za ta ɓace.Ko ciwon huhu yana ƙarfafa huhu, kuma adhesions yana bayyana tsakanin huhu da bangon ƙirji, wanda kuma zai iya sa alamar zamewar huhu ta ɓace.Kumburi na yau da kullun yana haifar da nama mai fibrous wanda ke rage motsin huhu, kuma bututun magudanar ruwa na thoracic ba zai iya ganin zamewar huhu kamar a cikin COPD mai ci gaba.
Idan za a iya lura da layin A, yana nufin cewa akwai iska a ƙarƙashin layin pleural, kuma alamar zazzagewar huhu ta ɓace, yana yiwuwa ya zama pneumothorax, kuma dole ne a sami wurin huhu don tabbatarwa.Wurin huhu shine wurin canzawa daga babu huhu zamewa zuwa huhu na yau da kullun a cikin pneumothorax kuma shine ma'aunin zinare don ganewar asali na pneumothorax.
Layukan layi ɗaya da yawa waɗanda aka kafa ta wurin kafaffen bangon ƙirji ana iya gani a ƙarƙashin yanayin duban dan tayi.A cikin hotunan parenchyma na huhu na al'ada, saboda huhu yana zamewa da baya da baya, ana yin rehoes kamar yashi a ƙasa, wanda ake kira alamar bakin teku.Akwai iska a ƙasan pneumothorax, kuma babu wani zamewar huhu, don haka an yi layukan layi ɗaya da yawa, wanda ake kira alamar barcode.Matsakaici tsakanin alamar rairayin bakin teku da alamar barcode shine wurin huhu.
Idan ba a iya ganin layin A-layin a cikin hoton duban dan tayi, yana nufin cewa wasu tsarin nama a cikin huhu ya canza, yana ba shi damar watsa duban dan tayi.Abubuwan kayan tarihi irin su A-layi suna ɓacewa lokacin da ainihin sararin sararin samaniya ya cika da nama kamar jini, ruwa, kamuwa da cuta, ƙwayar cuta da ta haifar da gudan jini, ko ƙari.Sannan kuna buƙatar kula da matsalar layin B. Layin B, wanda kuma aka sani da alamar "comet tail", laser beam-kamar hyperechoic tsiri ne wanda ke fitowa a tsaye daga layin pleural (visceral pleura), yana kaiwa ƙasa. na allon ba tare da attenuation ba.Yana rufe layin A kuma yana motsawa da numfashi.Alal misali, a hoton da ke ƙasa, ba za mu iya ganin wanzuwar layin A ba, amma maimakon layin B.
Kada ku damu idan kun sami layin B da yawa akan hoton duban dan tayi, 27% na al'ada na al'ada sun sanya layin B a cikin sararin intercostal 11-12 (sama da diaphragm).Ƙarƙashin yanayin ilimin lissafi na al'ada, ƙasa da layin B3 na al'ada ne.Amma lokacin da kuka haɗu da adadi mai yawa na layin B, ba al'ada bane, wanda shine aikin edema na huhu.
Bayan lura da layin pleural, layin A ko layin B, bari muyi magana game da zubar da jini da haɓaka huhu.A cikin gefen kirji na baya, za'a iya tantance zubar da jini da haɓakar huhu.Hoton da ke ƙasa hoto ne na duban dan tayi da aka bincika a wurin diaphragm.Baƙar fata anechoic yankin shine zubar da jini, wanda ke cikin rami na pleural sama da diaphragm.
To ta yaya za ku bambanta tsakanin zubar da jini da zubar jini?Ana iya ganin fibrous exudate wani lokaci a cikin zubar jini na hemopleural, yayin da effusion ɗin yawanci baƙar fata ce mai kama da juna, wani lokacin kuma ana iya raba shi zuwa ƙananan ɗakuna, kuma ana iya ganin abubuwa masu yawo na ƙarfin amsawa daban-daban.
Duban dan tayi na iya tantance mafi yawan (90%) na marasa lafiya tare da ƙarfafa huhu, mafi mahimmancin ma'anar wanda shine asarar samun iska.Abin ban mamaki game da amfani da duban dan tayi don gano haɓakar huhu shine lokacin da huhun majiyyaci ya ƙarfafa, duban dan tayi zai iya wucewa ta cikin zurfin thoracic na huhu inda ƙarfafawa ya faru.Nama na huhu ya kasance hypoechoic tare da siffa mai siffa da iyakoki marasa sani.Wani lokaci kuma kuna iya ganin alamar iska, wanda shine hyperechoic kuma yana motsawa tare da numfashi.Hoton sonographic wanda ke da takamaiman mahimmancin bincike don haɓakar huhu a cikin duban dan tayi shine alamar hanta mai kama da nama, wanda ke da ƙarfi mai kama da nama mai kama da hanta parenchyma wanda ke bayyana bayan alveoli ya cika da exudate.Kamar yadda aka nuna a cikin hoton da ke ƙasa, wannan hoton duban dan tayi ne na ƙarfafa huhu wanda ciwon huhu ya haifar.A cikin hoton duban dan tayi, ana iya ganin wasu wurare a matsayin hypoechoic, wanda yayi kama da hanta, kuma ba za a iya ganin A ba.
A yanayi na yau da kullun, huhu yana cika da iska, kuma launin Doppler Ultrasound ba zai iya ganin komai ba, amma idan huhu ya taru, musamman idan akwai ciwon huhu a kusa da hanyoyin jini, har ma ana iya ganin hotunan jini a cikin huhu, kamar haka. wanda aka nuna a cikin adadi.
Sautin gano ciwon huhu shine ainihin fasaha na duban dan tayi na huhu.Wajibi ne a motsa gaba da gaba tsakanin hakarkarin don bincika a hankali ko akwai wani yanki na hypoechoic, ko akwai alamar bronchus ta iska, ko akwai alamar hanta mai kama da hanta, da kuma ko akwai al'ada A-line ko a'a.Hoton duban dan tayi.
5. Yadda za a yanke shawarar sakamakon ultrasonography?
Ta hanyar na'urar duban dan tayi mai sauƙi (tsarin mBLUE ko tsarin yanki goma sha biyu), za'a iya rarraba bayanan halayen, kuma za'a iya ƙayyade ainihin dalilin rashin gazawar numfashi.Da sauri kammala ganewar asali na iya sauƙaƙa dyspnea na mara lafiya da sauri da kuma rage amfani da hadaddun gwaje-gwaje kamar CT da UCG.Waɗannan bayanan halayen sun haɗa da: zamewar huhu, A yi (A Lines a kan duka thoracic cavities), aikin B (Layin B da ke bayyana a cikin cavities na thoracic, kuma babu ƙasa da layin 3 B ko layin B kusa da ake bi), A / B bayyanar (Bayani a gefe ɗaya na pleura, bayyanar B a daya gefen), alamar huhu, ƙarfafa huhu, da zubar da jini.
Lokacin aikawa: Dec-20-2022
