Ibipimo byo gutembera kw'amaraso byahoze ari imikorere ishimishije ku ibara rya Doppler ultrasound.Noneho, hamwe no gukomeza gukwirakwiza ultrasound mu rwego rwo kuvura imitsi ya hemodialyse, byabaye byinshi kandi bikomeye.Nubwo ari ibisanzwe gukoresha ultrasound kugirango bapime umuvuduko w'amazi mu miyoboro y'inganda, ntabwo yitaye cyane ku gupima umuvuduko w'amaraso w'imiyoboro y'amaraso mu mubiri w'umuntu.Hariho impamvu yabyo.Ugereranije n'imiyoboro y'inganda, imiyoboro y'amaraso mu mubiri w'umuntu yashyinguwe munsi y'uruhu rutagaragara, kandi diameter y'igituba iratandukanye cyane (urugero, diameter y'imiyoboro imwe n'imwe mbere ya AVF iri munsi ya 2mm, kandi AVF zimwe ni nyinshi kurenza 5mm nyuma yo gukura), kandi mubisanzwe ni vey elastique, izana ibintu byinshi bidashidikanywaho kubipimo bitemba.Uru rupapuro rukora isesengura ryoroshye ryibintu bigira uruhare runini mu gupima imigezi, kandi rukayobora ibikorwa bifatika biva kuri ibyo bintu, bityo bikazamura ukuri no gusubiramo ibipimo byamaraso.
Inzira yo kugereranya amaraso:
Amaraso atemba = impuzandengo yigihe cyo gutemba area agace kambukiranya igice × 60, (igice: ml / min)
Inzira iroroshye cyane.Nubunini bwamazi atembera mu gice cyambukiranya amaraso mugihe kimwe.Igikenewe kugereranywa ni ibintu bibiri bihinduka-- agace kambukiranya igice hamwe nimpuzandengo yikigereranyo.
Agace kambukiranya ibice muri formula yavuzwe haruguru gashingiye ku kwibwira ko umuyoboro wamaraso ari umuyoboro wizenguruko ukomeye, kandi agace kambukiranya = 1/4 * π * d * d, aho d ari diameter yumubyimba wamaraso. .Nyamara, imiyoboro yamaraso nyayo yumuntu iroroshye, yoroshye kuyinyunyuza no guhinduka (cyane cyane imitsi).Kubwibyo, mugihe upimye diametre yigituba cyangwa gupima umuvuduko wogutemba, ugomba kumenya neza ko imiyoboro yamaraso idacometse cyangwa ngo ihindurwe uko ubishoboye.Iyo dusuzumye igice kirekire, imbaraga zirashobora gukoreshwa mubushishozi mubihe byinshi, kubwibyo birasabwa rero kurangiza gupima diameter ya pipe mu gice cyambukiranya.Mugihe indege ihindagurika idakandamijwe nimbaraga zo hanze, umuyoboro wamaraso mubusanzwe ni uruziga rugereranijwe, ariko muburyo bwakubiswe, akenshi ni ellipse itambitse.Turashobora gupima umurambararo wubwato muburyo busanzwe, kandi tukabona igipimo gisanzwe cyo gupima diameter nkigipimo cyo gupima igice kirekire.
Usibye kwirinda kunyunyuza imiyoboro y'amaraso, ni ngombwa kandi kwitondera gukora imiyoboro y'amaraso iterekeranye n'igice cyerekana amashusho ya ultrasound mugihe upima igice cyambukiranya imiyoboro y'amaraso.Nigute ushobora kumenya niba imiyoboro y'amaraso ihagaritse kuva ari munsi y'ubutaka?Niba igice cyerekana amashusho ya probe kidahuye nuyoboro wamaraso (kandi imitsi yamaraso ntigikwega), ishusho yabonetse yambukiranya ibice nayo izaba ellipse ihagaze, itandukanye na ellipse itambitse iterwa no gusohora.Iyo inguni ihanamye ya probe nini, ellipse iragaragara.Muri icyo gihe, kubera kugorama, ingufu nyinshi zibyabaye ultrasound zigaragarira mubindi byerekezo, kandi amajwi make gusa yakirwa na anketi, bigatuma ubwiza bwishusho bugabanuka.Kubwibyo, urebye niba probe itandukanijwe nuyoboro wamaraso unyuze mu mfuruka ko ishusho ari nziza kandi ninzira nziza.
Mu kwirinda kugoreka ubwato no kugumisha iperereza kuri perpendikulari yubwato uko bishoboka kwose, gupima neza diameter yubwato mubice byambukiranya bishobora kugerwaho byoroshye hamwe nimyitozo.Ariko, hazakomeza kubaho itandukaniro mubisubizo bya buri gipimo.Birashoboka cyane ko ubwato butari umuyoboro wibyuma, kandi bizaguka cyangwa bigabanuke nimpinduka zumuvuduko wamaraso mugihe cyumutima.Ishusho ikurikira irerekana ibisubizo bya karotide pulses muri B-ultrasound na M-ultrasound.Itandukaniro riri hagati ya diametre ya systolique na diastolique yapimwe muri M-ultrasound irashobora kuba hafi 10%, kandi itandukaniro rya 10% muri diameter rishobora kuvamo itandukaniro rya 20% mubice byambukiranya ibice.Kwinjira kwa hemodialyse bisaba gutembera cyane kandi guhindagurika kw'imitsi kugaragara cyane kuruta ibisanzwe.Kubwibyo, ikosa ryo gupimwa cyangwa gusubiramo iki gice cyibipimo birashobora kwihanganira gusa.Nta nama nziza cyane, rero fata ibindi bipimo bike mugihe ufite umwanya uhitemo impuzandengo.
Kubera ko ihuza ryihariye ryubwato cyangwa inguni nigice cyiperereza ridashobora kumenyekana munsi yinyuma, ariko mubirebire birebire byubwato, guhuza ubwato birashobora kugaragara hamwe nu mfuruka iri hagati yicyerekezo cyo guhuza ubwato na umurongo wa Doppler scan urashobora gupimwa.Ikigereranyo rero cyumuvuduko ukabije wamaraso mumitsi irashobora gukorwa gusa mugihe kirekire.Gukuraho uburebure bwubwato ni umurimo utoroshye kubantu benshi batangiye.Nkoku mugihe umutetsi atemye imboga zinkingi, icyuma gikatirwa mu ndege ihindagurika, niba rero utanyizeye, gerageza gukata asparagus mu ndege ndende.Iyo ukata asparagus igihe kirekire, kugirango ugabanye asparagus mo kabiri ndetse na kabiri, ni ngombwa gushyira icyuma witonze hejuru, ariko kandi ukareba ko indege yicyuma ishobora kwambuka umurongo, bitabaye ibyo icyuma kizaba gikomeye, asparagus igomba kuzunguruka kuruhande.
Ni nako bimeze kuri ultrasound ultrasound yohanagura ubwato.Kugirango bapime diameter ndende, igice cya ultrasound kigomba kunyura mumurongo wubwato, hanyuma noneho niho habaye ultrasound perpendicular kumurongo wimbere ninyuma yubwato.Igihe cyose iperereza rizengurutse gato, bimwe mubyabaye ultrasound bizagaragarira mubindi byerekezo, bikavamo urusaku rudakomeye rwakiriwe na anketi, kandi bikajyana no kuba uduce duto twa ultrasound (intumbero ya acoustic) ifite ubunini, hari icyo bita "igice cyubunini bwigice", cyemerera urusaku ruva ahantu hatandukanye hamwe nubujyakuzimu bwurukuta rwubwato kuvangwa hamwe, bikavamo Ishusho ihinduka urujijo kandi urukuta rwigituba ntirugaragara neza.Kubwibyo, iyo twitegereje ishusho yicyerekezo cyerekanwe cyerekanwa cyubwato, dushobora kumenya niba igice cyerekanwe cyerekanwe ari cyiza nukureba niba urukuta rworoshye, rusobanutse kandi rwiza.Niba imiyoboro isikuwe, intima irashobora no kugaragara neza muburyo bwiza bwo kureba.Nyuma yo kubona ishusho nziza ya 2D ishusho, gupima diameter birasa neza, kandi birakenewe no gukurikira amashusho ya Doppler.
Amashusho ya Doppler muri rusange agabanijwemo ibice bibiri-byerekana amabara yerekana amashusho hamwe na pulsed wave Doppler (PWD) yerekana amashusho hamwe numwanya uhamye w'irembo.Turashobora gukoresha amashusho yerekana amabara kugirango dukore ibintu birebire kuva kuri arteri kugeza kuri anastomose hanyuma tuvane kuri anastomose kugera mumitsi, kandi ikarita yumuvuduko wibara ryamabara irashobora kumenya byihuse ibice byimitsi idasanzwe nka stenosis na occlusion.Nyamara, kugirango bapime umuvuduko w'amaraso, ni ngombwa kwirinda aho ibyo bice by'imitsi idasanzwe, cyane cyane anastomose na stenose, bivuze ko ahantu heza hapimwa amaraso ari igice gisa neza.Ibi ni ukubera ko mubice birebire bihagije bigororotse bishobora gutembera neza mumaraso, mugihe mugihe kidasanzwe nka stenose cyangwa aneurysms, imiterere yimigezi irashobora guhinduka muburyo butunguranye, bikaviramo gutemba cyangwa guhungabana.Igishushanyo cyibara ryamabara yimitsi isanzwe ya karotide hamwe nimiyoboro ya karotide ya stenotic yerekanwa hepfo, gutembera muri leta ya laminari birangwa numuvuduko mwinshi utembera hagati yubwato kandi bikagabanya umuvuduko w umuvuduko hafi yurukuta, mugihe mugice cya stenotic ( cyane cyane epfo na ruguru ya stenosis), imiterere yimigezi ntisanzwe kandi icyerekezo cyogutembera kwingirangingo zamaraso ntigitunganijwe, bikavamo ubururu butukura-ubururu butagaragara mubishusho byamabara.
Igihe cyo kohereza: Gashyantare-07-2022
