Ana amfani da ma'aunin kwararar jini don zama aiki mara kyau akan duban dan tayi na Doppler launi.Yanzu, tare da ci gaba da yaɗawa na duban dan tayi a fagen samun damar shiga jini na hemodialysis, ya zama buƙatu mai tsauri.Duk da cewa ya zama ruwan dare a yi amfani da duban dan tayi wajen auna magudanar ruwa a bututun masana'antu, amma ba a mai da hankali sosai kan ma'aunin ma'aunin jini a jikin dan adam.Akwai dalilin hakan.Idan aka kwatanta da bututun masana'antu, magudanar jinin da ke cikin jikin mutum suna binne a ƙarƙashin fata waɗanda ba a iya gani, kuma diamita na bututun ya bambanta sosai (misali, diamita na wasu tasoshin kafin AVF bai wuce 2mm ba, wasu AVFs sun fi yawa. fiye da 5mm bayan balaga), kuma gabaɗaya suna roba ne, wanda ke kawo rashin tabbas ga ma'aunin kwarara.Wannan takarda yana yin bincike mai sauƙi na abubuwan da ke tasiri na ma'aunin kwarara, kuma yana jagorantar ayyuka masu amfani daga waɗannan abubuwan, don haka inganta daidaito da maimaita ma'aunin jini.
Ƙididdiga don kimanta kwararar jini:
Gudun jini = matsakaicin adadin lokacin gudu × yanki yanki × 60, (raka'a: ml/min)
Tsarin tsari yana da sauqi qwarai.Kawai ƙarar ruwa ne da ke gudana ta hanyar giciye na tashar jini a kowane lokaci guda.Abin da ake buƙatar ƙididdigewa su ne masu canji guda biyu-- yanki na giciye da matsakaicin yawan kwarara.
Wurin giciye a cikin tsarin da ke sama yana dogara ne akan zato cewa jigon jini wani bututun madauwari ne mai tsauri, da kuma yankin giciye = 1/4 * π * d * d, inda d shine diamita na tashar jini. .Duk da haka, ainihin magudanar jini na ɗan adam suna da ƙarfi, waɗanda suke da sauƙin matsewa da lalacewa (musamman veins).Don haka, lokacin auna diamita na bututu ko auna yawan magudanar ruwa, kuna buƙatar tabbatar da cewa jijiyoyin jini ba su matse ko sun lalace ba yadda za ku iya.Lokacin da muka duba sashin tsayin daka, ana iya yin amfani da ƙarfi ba tare da saninsa ba a yawancin lokuta, don haka gabaɗaya ana ba da shawarar kammala ma'aunin diamita na bututu a sashin giciye.Idan ba a matse jirgin da ke jujjuyawar da ƙarfi daga waje ba, jigon jini gabaɗaya kusan da'ira ne, amma a yanayin da aka matse, sau da yawa yakan kasance a kwance ellipse.Za mu iya auna diamita na jirgin ruwa a cikin yanayin yanayi, kuma mu sami ingantacciyar ƙimar ma'aunin diamita a matsayin tunani don ma'aunin sashe mai tsayi na gaba.
Bayan nisantar matse magudanar jini, wajibi ne a kula da sanya magudanar jini daidai da sashin hoton duban dan tayi yayin da ake auna sassan magudanar jini.Yaya za a yi hukunci ko tasoshin jini na tsaye tun lokacin da suke subcutaneous?Idan sashin hoton binciken bai kasance daidai da magudanar jini ba (kuma ba a matse magudanar jini ba), hoton da aka samu shi ma zai zama tsayayyen ellipse, wanda ya sha bamban da ellipse na kwance da extrusion ya yi.Lokacin karkatar da kusurwar binciken ya fi girma, ellipse ya fi bayyane.A lokaci guda kuma, saboda karkatarwar, yawancin ƙarfin kuzarin abin da ya faru na duban dan tayi yana nunawa zuwa wasu kwatance, kuma ƙaramin ƙararrawa ne kawai aka karɓa ta hanyar binciken, wanda ya haifar da raguwar hasken hoton.Don haka, yin la'akari da ko binciken ya kasance daidai da jigon jini ta hanyar kusurwar da hoton ya fi haske kuma hanya ce mai kyau.
Ta hanyar nisantar karkatar da jirgin da kiyaye binciken daidai gwargwado ga jirgin gwargwadon yuwuwar, ana iya samun daidaitaccen ma'aunin diamita na jirgin a cikin sashin giciye cikin sauƙi tare da aiki.Koyaya, har yanzu za a sami ɗan bambanta a cikin sakamakon kowane ma'auni.Mai yiwuwa jirgin ba bututun ƙarfe ba ne, kuma zai faɗaɗa ko kwangila tare da canje-canjen hawan jini yayin zagayowar zuciya.Hoton da ke ƙasa yana nuna sakamakon bugun jini na carotid a cikin B-yanayin duban dan tayi da kuma duban dan tayi na M-yanayin.Bambanci tsakanin diastolic systolic da diastolic diastolic da aka auna a M-ultrasound zai iya zama kusan 10%, kuma bambancin 10% na diamita zai iya haifar da bambanci 20% a cikin yanki na giciye.Samun damar hemodialysis yana buƙatar kwarara mai yawa kuma bugun tasoshin ya fi bayyana fiye da na al'ada.Don haka, kuskuren auna ko maimaitawar wannan ɓangaren ma'aunin za a iya jurewa kawai.Babu wata shawara mai kyau ta musamman, don haka kawai ɗauki ƙarin ma'auni idan kuna da lokaci kuma zaɓi matsakaici.
Tun da ƙayyadaddun jeri na jirgin ruwa ko kusurwa tare da sashin bincike ba za a iya saninsa a ƙarƙashin madaidaicin ra'ayi ba, amma a cikin ra'ayi mai tsayi na jirgin ruwa, ana iya lura da daidaitawar jirgin da kusurwar tsakanin jagorancin jigilar jirgin ruwa Ana iya auna layin binciken Doppler.Don haka ƙididdige madaidaicin saurin gudu na jini a cikin jirgin ruwa ba za a iya yin shi kawai a ƙarƙashin share tsawon lokaci ba.Tsawon tsayin jirgin ruwa aiki ne mai wahala ga yawancin masu farawa.Kamar dai lokacin da mai dafa abinci ya yanka kayan lambu na columnar, yawanci ana yanka wuka a cikin jirgin sama, don haka idan ba ku yarda da ni ba, gwada yanka bishiyar bishiyar asparagus a cikin jirgin sama mai tsayi.Lokacin yankan bishiyar asparagus a tsayi, don raba bishiyar bishiyar bishiyar bishiyar bishiyar bishiyar, dole ne a sanya wuka a hankali zuwa saman, amma kuma don tabbatar da cewa jirgin wuka zai iya ketare axis, in ba haka ba wuka zai yi wuya, bishiyar asparagus ya kamata mirgine zuwa gefe.
Haka abin yake ga tsayuwar duban dan tayi na jirgin ruwa.Don auna diamita na jirgin ruwa mai tsayi, sashin duban dan tayi dole ne ya wuce ta axis na jirgin, sannan kawai abin da ya faru na duban dan tayi daidai da bangon gaba da na baya na jirgin.Muddin binciken ya ɗan ɗan bambanta, wasu daga cikin abubuwan da suka faru na duban dan tayi za a nuna su zuwa wasu kwatance, wanda zai haifar da raunin raƙuman raɗaɗi da binciken ya samu, kuma tare da gaskiyar cewa ainihin tsinkayyar katako na duban dan tayi (mayar da ruwan tabarau) suna da kauri. akwai abin da ake kira "tasirin ƙarar sashi", wanda ke ba da damar amsawa daga wurare daban-daban da zurfin bangon jirgin ruwa don haɗuwa tare, wanda ya haifar da hoton ya zama duhu kuma bangon bututu ba ya bayyana santsi.Don haka, ta hanyar kallon hoton sashin tsayin daka na jirgin, za mu iya tantance ko sashin tsayin daka na leka yana da kyau ta lura ko bangon yana da santsi, a sarari da haske.Idan an duba jijiya, ana iya lura da intima a fili a madaidaicin hangen nesa.Bayan samun ingantacciyar hoton 2D mai tsayi, ma'aunin diamita yana da ingantacciyar daidai, kuma hakanan ya zama dole don hoton kwararar Doppler na gaba.
Hoto mai gudana na Doppler gabaɗaya an raba shi zuwa hoto mai gudana mai launi mai nau'i biyu da hoto mai jujjuyawar Doppler (PWD) tare da kafaffen kofa na samfur.Za mu iya yin amfani da hoto mai gudana mai launi don yin tsayin daka na ci gaba daga jijiya zuwa anastomosis sannan daga anastomosis zuwa jijiya, kuma taswirar saurin gudu na launi zai iya gano ƙananan ɓangarori na jijiyoyin jini kamar su stenosis da occlusion.Duk da haka, don auna yawan jini, yana da mahimmanci a guje wa wurin da waɗannan ɓangarori na jirgin ruwa marasa kyau suke, musamman anastomoses da stenoses, wanda ke nufin cewa wuri mai kyau don auna jinin jini shine yanki mai laushi.Wannan shi ne saboda kawai a cikin tsayin tsayin sassan madaidaiciya na iya kwararar jini yakan zama barga mai gudana na laminar, yayin da a wurare marasa kyau kamar su stenoses ko aneurysms, yanayin kwararar na iya canzawa ba zato ba tsammani, yana haifar da ruɗaɗɗen ruwa ko tashin hankali.A cikin zane-zanen launi na launi na al'ada na al'ada na al'ada da kuma jijiyar carotid stenotic da aka nuna a kasa, ana nuna ma'auni a cikin yanayin laminar da babban saurin gudu a tsakiyar jirgin ruwa da kuma rage gudu a kusa da bango, yayin da yake cikin sashin stenotic ( musamman a ƙasa na stenosis), yanayin gudana ba daidai ba ne kuma yanayin tafiyar da ƙwayoyin jini ya ɓace, yana haifar da rashin tsari na ja-blue a cikin hoton launi.
Lokacin aikawa: Fabrairu-07-2022
