Kuyerera kweropa kuyerwa kwaimbove kupenga basa pane ruvara Doppler ultrasound.Iye zvino, nekuenderera mberi kwemukurumbira we ultrasound mumunda wehemodialysis vascular access, yave kuwedzera uye kuomarara kudiwa.Kunyangwe zvakajairika kushandisa ultrasound kuyera kuyerera kwemvura mumapombi eindasitiri, haina kubhadharwa zvakanyanya kune kuyerwa kweropa rekuyerera kwetsinga dzeropa mumuviri wemunhu.Pane chikonzero cheizvozvo.Kuenzaniswa nemapaipi emaindasitiri, tsinga dzeropa mumuviri wemunhu dzinovigwa pasi peganda risingaoneki, uye dhayamita yechubhu inosiyana zvakanyanya (semuenzaniso, dhayamita yeimwe midziyo pamberi peAVF isingasviki 2mm, uye mamwe maAVF akawanda. kupfuura 5mm mushure mekukura), uye kazhinji ari vey elastic, izvo zvinounza kusavimbika kukuru pakuyerera kuyerwa.Iri bepa rinoita ongororo yakapusa yezvinhu zvinopesvedzera zvekuyerwa kwekuyerera, uye inotungamira mashandiro anoshanda kubva kune izvi zvinhu, nekudaro ichivandudza kurongeka uye kudzokorora kuyerwa kwekuyerera kweropa.
Iyo formula yekufungidzira kuyerera kweropa:
Kuyerera kweropa = chiyero chenguva yekuyerera × chikamu chechikamu × 60, (chikamu: ml/min)
Iyo fomula iri nyore kwazvo.Ingori huwandu hwemvura inoyerera nemuchinjiko-chikamu chetsinga yeropa panguva yeyuniti.Chinoda kufungidzirwa ndiwo maviri akasiyana-- nzvimbo yepakati-yepakati uye avhareji yekuyerera mwero.
Muchinjikwa-chikamu muchimiro chepamusoro chakavakirwa pakufungidzira kuti mudziyo weropa ishubhu yakaomesesa yedenderedzwa, uye nzvimbo yepakati-chikamu = 1/4 * π * d * d, uko d ndiyo dhayamita yemudziyo weropa. .Zvisinei, tsinga dzeropa dzemunhu chaidzo dzakaita elastic, dziri nyore kusvinwa nekuremara (kunyanya tsinga).Naizvozvo, pakuyera dhayamita yechubhu kana kuyera mwero wekuyerera, unofanirwa kuve nechokwadi chekuti tsinga dzeropa hadzina kusvinwa kana kuremara sezvaunokwanisa.Kana isu tichitarisa chikamu chelongitudinal, simba rinogona kuitwa nekusaziva mune dzakawanda zviitiko, saka zvinowanzokurudzirwa kupedzisa kuyerwa kwepombi dhayamita muchikamu chemuchinjikwa.Muchiitiko chekuti ndege inochinjika haina kudzvanywa nesimba rekunze, tsinga yeropa inowanzoita denderedzwa, asi kana yakadzvanywa, inowanzoita denderedzwa.Tinogona kuyera dhayamita yemudziyo mumamiriro echisikigo, uye kuwana chiyero chechiyero chechiyero chechiyero sereferensi yezviyero zvinotevera zvelongitudinal chikamu.
Kunze kwekudzivirira kusvina mitsipa yeropa, inofanirwawo kutarisisa kuita tsinga dzeropa perpendicular kune chikamu cheiyo ultrasound imaging pakuyera chikamu chemuchinjikwa chetsinga.Nzira yekutonga sei kana tsinga dzeropa dzakamira sezvo dziri subcutaneous?Kana iyo yekufungidzira chikamu cheprobe isiri perpendicular kumudziyo weropa (uye mudziyo weropa hauna kudzvinyirirwa), iyo yakawanikwa yemuchinjikwa-sectional mufananidzo ichavawo erect ellipse, iyo yakasiyana kubva kune yakatwasuka ellipse yakagadzirwa neextrusion.Kana kurerekera kona yeprobe yakakura, ellipse inova pachena.Panguva imwecheteyo, nekuda kwekutenderera, simba rakawanda rechiitiko ultrasound rinoratidzwa kune dzimwe nzira, uye zvishoma chete echoes inogamuchirwa neprobe, zvichiita kuti kupenya kwemufananidzo kuderedzwa.Naizvozvo, kutonga kana probe iri perpendicular kumudziyo weropa kuburikidza nekona iyo mufananidzo wakajeka zvakare inzira yakanaka.
Nekudzivisa kukanganisa kwechikepe uye kuchengetedza probe perpendicular kumudziyo zvakanyanya sezvinobvira, kuyerwa kwakarurama kwechidimbu chemudziyo mumuchinjikwa-chikamu chinogona kuwanikwa nyore nyore nekuita.Zvisinei, pachange pachiine mutsauko mumibairo yechiyero chimwe nechimwe.Zvinonyanya kuitika kuti mudziyo hausi simbi chubhu, uye ichawedzera kana chibvumirano nekuchinja kweropa panguva yekutenderera kwemoyo.Mufananidzo uri pazasi unoratidza mhedzisiro yecarotid pulses muB-mode ultrasound uye M-mode ultrasound.Musiyano uripo pakati pe systolic uye diastolic madhayamita akayerwa muM-ultrasound inogona kunge inosvika gumi kubva muzana, uye 10% mutsauko mudhayamita inogona kuguma ne20% mutsauko munzvimbo inoyambuka-sectional.Kupinda kwehemodialysis kunoda kuyerera kwakanyanya uye kuputika kwemidziyo kunonyanya kutaurwa kupfuura zvakajairika.Naizvozvo, chikanganiso chekuyera kana kudzokororwa kwechikamu ichi chechiyero chinogona kutenderwa chete.Iko hakuna yakanyanya kunaka zano, saka ingotora mashoma mamwe zviyero kana uine nguva uye sarudza avhareji.
Sezvo kurongeka kwakananga kwemudziyo kana kona ine chikamu cheprobe haigoni kuzivikanwa pasi pekuona kwemukati, asi mukuona kwenguva refu kwemudziyo, kurongeka kwemudziyo kunogona kuonekwa uye kona pakati pekutungamirirwa kwechikepe chekugadzirisa uye. iyo Doppler scan line inogona kuyerwa.Saka fungidziro yeanoreva kuyerera velocity yeropa mumudziyo inogona kuitwa chete pasi pekutsvaira kwe longitudinal.The longitudinal kutsvaira kwechikepe ibasa rakaoma kune vakawanda vanotanga.Sezvakangoita kana shefu achicheka muriwo wekoramu, banga rinowanzochekwa mundege inochinjika, saka kana usinganditendi, edza kuchekerera asparagus mundege refu.Paunenge uchicheka asparagus kureba, kugovera asparagus kuita maviri akaenzana hafu, zvakakosha kuisa banga zvakanyatsonaka kumusoro, asiwo kuve nechokwadi kuti ndege yebanga inogona kungoyambuka axis, zvikasadaro banga richava rakaoma, asparagus inofanira kukungurukira kudivi.
Izvi zvakafanana kune longitudinal ultrasound sweeps yemudziyo.Kuyera iyo longitudinal mudziyo dhayamita, chikamu che ultrasound chinofanira kupfuura nepakati pemudziyo, uye chete ipapo chiitiko che ultrasound chinoenderana nemadziro epamberi uye kumashure kwemudziyo.Chero bedzi iyo probe iri zvishoma lateralized, imwe yechiitiko ultrasound inozoratidzwa kune mamwe mafambiro, zvichiita kuti maungira asina kusimba anogamuchirwa neprobe, uye pamwe nekuti iwo chaiwo ultrasound beam zvimedu (acoustic lens focus) ndeyeukobvu, kune inonzi "partial volume effect", iyo inobvumira echoes kubva kunzvimbo dzakasiyana-siyana uye kudzika kwemadziro emudziyo kusanganiswa pamwe chete, zvichiita kuti Chifananidzo chacho chive chakasviba uye rusvingo rwechubhu haruratidzike rwakatsetseka.Naizvozvo, nekucherechedza mufananidzo weiyo scanned longitudinal chikamu chechikepe, tinogona kuona kana iyo scanned longitudinal chikamu chakanakira nekucherechedza kana madziro akatsetseka, akajeka uye akajeka.Kana tsinga ikaongororwa, intima yacho inogona kunyatsoonekwa mune yakanakira longitudinal maonero.Mushure mekuwana iyo yakakodzera longitudinal 2D mufananidzo, kuyerwa kwedhayamita kwakaringana, uye inodiwawo kune inotevera Doppler inoyerera yekufungidzira.
Doppler inoyerera imaging inowanzokamurwa kuita maviri-dimensional color flow imaging uye pulsed wave Doppler (PWD) spectral imaging ine yakagadziriswa sampling gedhi chinzvimbo.Tinogona kushandisa color flow imaging kuti tiite inoenderera yakareba longitudinal kutsvaira kubva mutsinga kuenda kuanastomosis uyezve kubva kuanastomosis kusvika kune mutsinga, uye mepu yevelocity yekuyerera kwemavara inogona kukurumidza kuona isina kujairika vascular segment senge stenosis uye occlusion.Zvisinei, pakuyera kuyerera kweropa, zvakakosha kuti udzivise nzvimbo yezvikamu izvi zvisina kujairika zvemidziyo, kunyanya anastomoses uye stenoses, izvo zvinoreva kuti nzvimbo yakakodzera yekuyera kuyerera kweropa chikamu chakati sandara chemudziyo.Izvi zvinodaro nekuti muzvikamu zvakareba zvakakwana chete zvinogona kuyerera kweropa kunenge kwakagadzikana kuyerera kwelaminar, nepo munzvimbo dzisina kujairika senge stenoses kana aneurysms, mamiriro ekuyerera anogona kungoerekana achinja, zvichikonzera eddy kana mhirizhonga kuyerera.Mune dhayagiramu yekuyerera kwemavara yeyakajairika carotid artery uye stenotic carotid artery inoratidzwa pazasi, kuyerera kwelaminar state kunoratidzwa nehupamhi hwekuyerera velocity pakati pemudziyo uye kuderedzwa kuyerera kwevheji padhuze nemadziro, apo iri muchikamu che stenotic ( kunyanya kudzika kwe stenosis), mamiriro ekuyerera haana kujairika uye mafambiro emasero eropa haana kurongeka, zvichikonzera kusarongeka kwakatsvuka-bhuruu mumufananidzo wekuyerera kwemavara.
Nguva yekutumira: Feb-07-2022
