Mkhalidwe wapadziko lonse wa matenda aakulu a impso
Kafukufuku wa Epidemiological awonetsa kuti matenda a impso osatha akhala amodzi mwa matenda omwe akuwopseza thanzi la anthu padziko lonse lapansi.M'zaka zaposachedwa, ziwerengero zikuwonetsa kuti m'maiko otukuka (monga United States ndi Netherlands), pafupifupi 6.5% mpaka 10% ya anthu ali ndi magawo osiyanasiyana a matenda a impso, omwe kuchuluka kwa matenda a impso ku United States kuli nawo. idaposa 20 miliyoni, ndipo zipatala zimathandizira odwala matenda a impso opitilira 1 miliyoni chaka chilichonse.Chiwerengero chonse cha odwala omwe ali ndi matenda omaliza aimpso ku China chikuchulukiranso, ndipo zikuyembekezeka kuti chiwerengero cha odwala omwe ali ndi matenda a impso omaliza ku China chidzapitilira 4 miliyoni pofika 2030.
Hemodialysis (HD) ndi imodzi mwazinthu zothandizira aimpso kwa odwala omwe ali ndi vuto lalikulu laimpso.
Kukhazikitsidwa kwa mwayi wopezeka m'mitsempha ndikofunikira kuti hemodialysis ipite patsogolo.Ubwino wa mwayi wa mitsempha umakhudza mwachindunji ubwino wa dialysis ndi moyo wa odwala.Kugwiritsa ntchito moyenera komanso kutetezedwa bwino kwa mitsempha ya mitsempha sikungangowonjezera moyo wautumiki wa mitsempha, komanso kuwonjezera moyo wa odwala dialysis, kotero kuti mitsempha ya mitsempha imatchedwa "moyo" wa odwala dialysis.
Kugwiritsa ntchito kwachipatala kwa ultrasound mu AVF
Akatswiri a gulu lofikira m'mitsempha amakhulupirira kuti AVF iyenera kukhala chisankho choyamba pakupeza mitsempha.Chifukwa chosasinthika, chiwerengero chochepa cha mitsempha ya mitsempha, ndipo sichingasinthidwe kwathunthu, kuti apititse patsogolo moyo wautumiki wa wodwalayo, kugwiritsa ntchito moyenera ndi kukonza arteriovenous fistula, komanso kupewa zovuta zokhudzana ndi puncture ndizovuta zomwe zakopa chidwi cha azachipatala ndi anamwino.
Kukhazikitsa preoperative vascular evaluation ya arteriovenous fistula (AVF)
1) Kaya mitsempha yamagazi ndi yachilendo: tortuosity, stenosis ndi dilatation
2) ngati khoma la chotengeracho ndi losalala, ngati pali plaque echo, ngati pali chosweka kapena cholakwika, komanso ngati pali dissection.
3) ngati pali thrombi ndi zomveka zina mu lumen
4) Kaya kudzaza kwa magazi kwamtundu wamtundu wathunthu komanso ngati mayendedwe ndi kuthamanga kwa magazi ndizosazolowereka
5) Kuwunika kwa magazi
Chithunzichi chikuwonetsa Pulofesa Gao Min akuchiza wodwala pafupi ndi bedi
Kuwunika kwa fistulas mkati
Popeza kukhazikitsidwa kwa fistula mkati kwa odwala ndi sitepe yoyamba ya "ulendo wautali", AVF musanagwiritse ntchito akupanga muyeso wa mitsempha ndi magazi mwachibadwa, poyesa fistula akhoza, kukhala ndi miyezo yokhwima, kuti athe kuyeza ngati odwala omwe ali ndi fistula deta ntchito muyezo, ultrasound mosakayikira kwambiri mwachilengedwe komanso njira yolondola.
Kuwunika kwa AVF: Kuwunika kwa Ultrasound kunkachitika kamodzi pamwezi
1) Kutuluka kwa magazi
2) M'mimba mwake
3) Kaya anastomosis ndi yopapatiza komanso ngati pali thrombosis (ngati pali thrombosis, m'pofunika kuwonjezera buluni)
Kuweruza kokhwima kwa autogenous arteriovenous fistula
Mosasamala nthawi yomwe akulimbikitsidwa kuti ayambe puncture, chofunikira chiyenera kukhala fistula yamkati ikakhwima.
Amakhulupirira kuti kukhwima kwa fistula mkati kuyenera kukwaniritsa njira zitatu za "6":
1) arteriovenous fistula flow > 600ml/mphindi (2019 Chinese akatswiri agwirizana pa mtima mwayi wa mtima hemodialysis:> 500 ml/mphindi)
2) m'mimba mwake wa mtsempha wobowoleza> 6mm (kuvomerezana kwa akatswiri aku China ku 2019 pakupeza mitsempha yamagazi a hemodialysis:> 5 mm)
3) Venous subcutaneous kuya & LT;6mm, ndipo payenera kukhala zokwanira magazi chotengera puncture mtunda kukumana ntchito hemodialysis.
Nthawi zambiri, arteriovenous fistula yokhala ndi mitsempha yowongoka komanso kunjenjemera kwabwino kumatha kuponyedwa bwino mkati mwa masabata anayi atakhazikitsidwa.
Kuwunika ndi kukonza
Ndikofunika kwambiri kuti nthawi zonse muziwunika ndikuwunika zizindikiro za matenda a arteriovenous fistula ndi kukwanira kwa hemodialysis pambuyo pa opaleshoni.
Kuwunika kwabwino ndi njira zowunikira zikuphatikizapo
① Pezani kuyang'anira kayendedwe ka magazi: tikulimbikitsidwa kuyang'anira kamodzi pamwezi;
② Kuyeza thupi: tikulimbikitsidwa kuti dialysis iliyonse iyenera kufufuzidwa, kuphatikizapo kuyendera, palpation ndi auscultation;
③ Doppler ultrasound: akulimbikitsidwa kamodzi pa miyezi 3;
④ Njira yochepetsera yopanda urea ikulimbikitsidwa kuyeza zobwezeretsanso kamodzi miyezi itatu iliyonse;
⑤ Kuzindikira kwachindunji kapena kosalunjika kwa venous kumalimbikitsidwa kamodzi pa miyezi itatu iliyonse.
Pamene autologous AVF silingakhazikitsidwe, kusankha yachiwiri ayenera kumezanitsa mkati fistula (AVG).Kaya ndikukhazikitsa AVF kapena AVG, ultrasound ndiyofunikira pakuwunika koyambirira kwa mitsempha yamagazi, kuwongolera kwa intraoperative ya puncture, kuyesa kwa postoperative ndi kukonza.
PTA idachitidwa motsogozedwa ndi ultrasound
Vuto losapeŵeka la arteriovenous fistula ndi stenosis.Kuthamanga kwa magazi kwa nthawi yayitali kungayambitse hyperplasia yogwira ntchito ya venous intima ya mkati mwa fistula, yomwe imatsogolera ku mitsempha ya stenosis ndi magazi osakwanira, zomwe zimakhudza zotsatira za dialysis, ndikuyambitsa fistula occlusion, thrombosis ndi kulephera pamene stenosis ndi yovuta.
Pakali pano, ambiri ntchito zochizira mkati fistula stenosis kwa ultrasound kutsogoleredwa arteriovenous fistula stenosis mu keratoplasty (PTA), baluni Kukula chithandizo ndi khungu biopsy odwala fistula mu mitsempha, mu catheter baluni kukula, motsogozedwa ndi ultrasound kwa vascular stenosis malo kukula, kukonza yopapatiza mbali, kubwezeretsa yachibadwa chotengera m'mimba mwake, kuti kutalikitsa moyo utumiki wa odwala arteriovenous mkati fistula.
PTA motsogozedwa ndi ultrasound, ndiyosavuta, palibe kuwonongeka kwa radiation, palibe kuwonongeka kofananira, imatha kuwonetsa ndi zotupa zam'mitsempha mozungulira momwe zinthu ziliri, magawo oyenda amagazi ndikuwunika kuthamanga kwa magazi, ndipo zitha kuchitika nthawi yomweyo pambuyo pakuchita bwino. kupeza hemodialysis, safuna catheter osakhalitsa, ndi otetezeka, ogwira ntchito ndi makhalidwe yaing`ono zoopsa, kuchira mofulumira, kuchepetsa ululu wa wodwalayo, The ndondomeko yokonza ndi chosavuta.
Clinical ntchito ultrasound pakati venous catheterization
Asanakhazikitse chapakati venous catheter, ultrasound ayenera kugwiritsidwa ntchito kuona mkhalidwe wa mkati jugular mtsempha kapena femoral mtsempha, makamaka odwala ndi mbiri ya intubation yapita, ndi ultrasound ayenera kugwiritsidwa ntchito kufufuza mtsempha stenosis kapena occlusion.Motsogozedwa ndi ultrasound, ultrasound, monga "diso lachitatu" la dokotala, limatha kuwona momveka bwino komanso moona.
1) Unikani m'mimba mwake, kuya ndi patency ya mtsempha wa puncture
2) Kuboola singano mumtsempha wamagazi kumatha kuwonedwa
3) Kuwonetsa zenizeni zenizeni za trajectory ya singano mumtsempha wamagazi kuti mupewe kuvulala kwapamtima
4) Pewani kupezeka kwa zovuta (kuphulika kwa mitsempha mwangozi, kupanga hematoma kapena pneumothorax)
5) Kupititsa patsogolo kupambana kwa puncture yoyamba
Kugwiritsa ntchito kwachipatala kwa ultrasound mu peritoneal dialysis catheterization
Peritoneal dialysis ndi mtundu wamankhwala obwezeretsa aimpso, omwe makamaka amagwiritsa ntchito chikhalidwe cha peritoneum yake kuti athandizire aimpso.Poyerekeza ndi hemodialysis, ali ndi makhalidwe osavuta opaleshoni, kudziletsa dialysis ndi pazipita chitetezo cha yotsalira aimpso ntchito.
Kusankha kuyika kwa catheter ya peritoneal dialysis pamwamba pa thupi ndi gawo lofunikira kwambiri pakukhazikitsa mwayi wosatsekeka wa peritoneal dialysis.Kuti mukhalebe patency ya peritoneal dialysis ngalande ndikuchepetsa kuyambika kwa zovuta za catheterization, ndikofunikira kudziwa bwino momwe khoma lamkati lamkati lamkati lamkati limapangidwira ndikusankha malo oyenera oyikapo catheter ya peritoneal dialysis.
Kuyika kwapang'onopang'ono kwa catheter ya peritoneal dialysis pansi pa chitsogozo cha ultrasound ndikosavuta, kopanda ndalama, kosavuta kugwira ntchito, kotetezeka, mwachilengedwe komanso kodalirika.
SonoEye palmar ultrasonication ankagwiritsa ntchito mtima mwayi
SonoEye ndiyosavuta kunyamula komanso yaying'ono, sikhala pafupi ndi bedi, ndiyosavuta kuyang'ana, imatha kulumikizidwa mwachindunji ndi foni kapena piritsi, tsegulani pulogalamuyi nthawi iliyonse.
Chithunzichi chikuwonetsa Pulofesa Gao Min akuchiza wodwala pafupi ndi bedi
Chison palm ultrasound ili ndi zithunzi zodziwira matenda ndipo ili ndi phukusi lanzeru loyezera magazi, lomwe limadziunjikira ndikupereka zotsatira za kutuluka kwa magazi.
Kuphulika kwa ultrasound mkati mwa fistula kumatha kupititsa patsogolo kupambana kwa puncture ndi kuchepetsa mavuto monga hematoma ndi pseudoaneurysm.
Takulandilani kuti mutitumizireni kuti mupeze mankhwala azachipatala ndi chidziwitso.
Contact Tsatanetsatane
Icy Yi
Malingaliro a kampani Amain Technology Co., Ltd.
Mob/WhatsApp: 008617360198769
E-mail: amain006@amaintech.com
Linkedin: 008617360198769
Tel.: 00862863918480
Nthawi yotumiza: Nov-03-2022
