Nekuwedzera kukurumbira kwemidziyo yeultrasound, vashandi vehutano hwekiriniki vanowedzera vanokwanisa kushandisa ultrasound yebasa rekuona.Vanhu vasingazivi ultrasound-inotungamirirwa puncture matekiniki vane hurombo kugara muindasitiri.Nekudaro, kubva mukushandiswa kwekiriniki kwandakaona, kufarirwa kwemidziyo yeultrasound uye kufarirwa kwekuona kwe ultrasound hakuna kuenzana.Munyaya ye ultrasound-inotungamirirwa puncture mumunda wevascular access, vanhu vazhinji vachiri muchikamu chekunyepedzera kunzwisisa, nekuti kunyangwe paine ultrasound, havagone kuona paive netsono yekubaya.Iyo yechokwadi ultrasound-inotungamirwa puncture tekinoroji inoda kutanga kuti nzvimbo yetsono kana tsono yetsono ionekwe pasi peiyo ultrasound, pane kufungidzirwa uyezve "upofu pinda" pasi pekutungamira kwe ultrasound.Nhasi, tichataura pamusoro pekuonekwa uye kusaonekwa kwepuncture tsono pasi pe ultrasound.
Ultrasound-inotungamirirwa puncture inowanzoparadzaniswa kuva mu-ndege puncture uye kunze-kwe-ndege puncture, iyo yose inoshandiswa mumunda wekuwana vascular uye inonyatso nyatsogona.Izvi zvinotevera chidimbu kubva kuAmerican Society of Ultrasound Medicine's practice guidelines for ultrasound-guided vascular access procedures, inotsanangura maitiro maviri.
Mundege (Yakareba axis) VS Kunze-kwe-ndege (Short axis)
- Mundege/ Kubuda-ndege kunoratidza hukama netsono, netsono inofambirana nendege yekufungidzira yeultrasound iri mundege uye tsono yakanangana nendege yekufungidzira yeultrasound iri kunze kwendege.
- Kazhinji, mu-ndege puncture inoratidza kureba axis kana longitudinal chikamu chemudziyo;kunze-kwe-ndege puncture inoratidza pfupi axis kana muchinjikwa chikamu chechikepe.
- Naizvozvo, kunze-kwe-ndege/ pfupi-axis uye mu-ndege/ refu-axis inofanana nekukasira kune vascular kuwana ultrasound.
-Kubuda-kwendege kunogona kuitwa kubva pamusoro pemudziyo wemudziyo, asi muromo wetsono unofanirwa kuteverwa nekutenderedza probe kuti usatarise kudzika kwechipi;mafeni ekuferefeta kubva pamuviri wetsono akananga kumuromo, uye nguva inopenya nzvimbo yetipi inonyangarika ndiyo nzvimbo yetip.
- In-ndege inobvumira kutarisa kwakamira kwenzvimbo yetsono, asi zvinogona kutungamira "kutsvedza" kunze kwendege uko tsono iripo kana/ uye nepakati ndege yemudziyo;mu-ndege puncture inonyanya kukodzera midziyo mikuru.
- Mu-ndege/ kunze-kwe-ndege nzira yekubatanidza: shandisa kunze-kwe-ndege/ pfupi-axis scanning kuratidza kuti tsono inosvika pakati pechikepe, uye tenderedza probe kupinda mundege/ refu-axis yekupinda tsono. .
Iko kugona kuona statically muromo wetsono kana kunyange muviri wose wetsono munguva chaiyo mukati mendege kunobatsira zvikuru!Asi kuchengeta tsono mundege yekufungidzira yeultrasound pasina rubatsiro rwepuncture frame inoda mazana ezvirongwa zvekudzidzira kugona hunyanzvi.Muzviitiko zvakawanda, kona yepuncture yakakura kwazvo, kuitira kuti tsono inyatsojeka mu ultrasound imaging ndege, asi haugone kuona kuti iripi.Bvunza mudhara wepanext door kuti chii chirikuitika.Anogona kukuudza kuti tsono yekubaya haisi perpendicular kune ultrasound scan line, saka haugone kuiona.Saka nei uchigona kuzviona zvinyoro-nyoro kana kona yepuncture idiki zvishoma, uye zvakatonyanya kujeka kana idiki?Anogona kushamisika kuti sei.
Iko kona yetsono yekubaya mumufananidzo uri pazasi ndeye 17 ° uye 13 ° zvakateerana (kuyerwa nerubatsiro rwekuona kumashure), apo kona ye13 ° muviri wese wetsono yekubaya inoratidzwa zvakajeka, kana kona ye17 °. , muviri wetsono unogona kungoonekwa zvishoma, uye kona yakakura nehoodwink.Saka nei paine mutsauko wakakura kudaro mukona yeiyo puncture tsono kuratidza ine chete 4 ° mutsauko?
Inofanira kutanga kubva kune ultrasound emission, kugamuchira uye kutarisa.Kungofanana neaperture control mukutarisa kwemifananidzo, poindi yega yega pamufananidzo ndiyo yakasanganiswa yekutarisa mhedzisiro yechiedza chese kuburikidza neaperture, nepo poindi yega yega pamufananidzo we ultrasound ndiyo yakasanganiswa yekutarisa maitiro eese ma ultrasound transducers mukati mekuburitsa uye maapertures ekugamuchira. .Mumufananidzo uri pazasi, mutsara mutsvuku unoratidza huwandu hweiyo ultrasound emission inotarisa schematically, uye mutsetse wegirini ndiwo mutsara wekugamuchira kutarisa schematically (kurudyi muganhu).Nekuda kwekuti tsono yacho inopenya zvakakwana kuti ibudise specular reflection, mutsara muchena unotaridza gwara rakajairwa kune specular reflection.Tichifunga kuti mutsara mutsvuku unotaridza kutarisa kwekubuda kwakafanana ne "mwaranzi" miviri, mushure mekurova girazi retsono, iyo inoratidzwa "mwaranzi" yakaita semitsetse miviri yeorenji iri pamufananidzo.Sezvo "ray" iri kurutivi rwerudyi rwemutsara wegirinhi inodarika nzvimbo yekugamuchira, uye haigoni kugamuchirwa neprobe, "ray" inogona kugamuchirwa inoratidzwa munzvimbo yemaranjisi pamufananidzo.Zvinogona kuonekwa kuti pa17 °, probe inogona kugamuchira zvishoma zvishoma zve ultrasound echo, saka mufananidzo unoenderana unoonekwa zvishoma, nepo pa13 °, maungira anogona kugamuchirwa zvakanyanya kudarika pa17 °, saka mufananidzo wacho unowedzerawo. clear.Nekudzikira kwekona yekubaya, tsono inorara yakawedzera kuchinjika, uye kuwedzera uye kuwanda kweinoratidzwa echoes yemuviri wetsono inogona kugamuchirwa zvinobudirira, saka kuvandudza tsono kuri nani uye zvirinani.
Vamwe vanhu vane hungwaru vachawanawo chiitiko, kana kona iri pasi pehumwe kukosha (tsono haidi zvachose "kunyepa yakatsetseka"), kukura kwemuviri wetsono kunoramba kwakafanana nhanho yekujekesa.Uye nei izvi?Sei tichidhirowa diki diki rekutarisa emission (mutsara mutsvuku) pane huwandu hwekutarisisa kwekugamuchira (yegirinhi mutsetse) pamufananidzo uri pamusoro?Izvi zvinodaro nekuti mune ye Ultrasound imaging system, iyo yekutumira inotarisisa inogona kungova kudzika kumwe kwekutarisa, uye nepo isu tichigona kugadzirisa kudzika kwekutarisa kwekutumira kuti mufananidzo ujeke padhuze nekudzika kwatiri kutarisa, isu hatidi. kusviba kupfuura kudzama kwekutarisa.Izvi zvakasiyana chaizvo nezvatinoda kutora mapikicha ehunyanzvi evakadzi vakanaka, izvo zvinoda kuvhura hombe, kudzika kudiki kwemunda kuunza kumashure kumberi kwese bokeh.Pakufungidzira kwe ultrasound, tinoda kuti chifananidzo chacho chive chakajeka zvakakwana muhuwandu husati hwasvika uye shure kwekudzika kwekutarisa, saka tinogona kungoshandisa kaburi kadiki kekutumira kuti tiwane kudzika kwemunda, nokudaro kuchengetedza kufanana kwemufananidzo.Kana iri yekugashira kwekutarisa, iyo ultrasound imaging system ikozvino yave yakanyatso dhijitari, saka iyo ultrasound echo yeimwe neimwe transducer / array element inogona kuchengetwa, uye ine simba inoenderera yakatarisa inozoitwa dijitari kune ese akadzika ekufungidzira.Saka isu tinogona kuedza kuvhura iyo yekugamuchira aperture yakakura sezvinobvira, chero bedzi iyo array element inogamuchira echo chiratidzo ichishandiswa zvese, yakanyatso kutarisisa uye zvirinani kugadzirisa kunogona kuvimbiswa.Kudzokera kunyaya yekutanga, kana kona yepuncture yadzikira kusvika padanho rakati, mafungu e ultrasonic anoburitswa nediki aperture anogona kugashirwa neiyo hombe yekugamuchira aperture mushure mekuratidzwa nemuviri wetsono, saka mhedzisiro yekuvandudzwa kwemuviri wetsono ichaita. zvinongoramba zvakangofanana.
Pakuferefeta kuri pamusoro, chii chatingaite kana kona yekuboora mundege ichidarika 17° uye tsono isingaoneki?Kana iyo system ikatsigira, unogona kuedza basa rekusimudzira tsono.Iyo inodaidzwa kuti puncture yekuvandudza tsono tekinoroji inowanzoreva kuti mushure meyakajairwa scan yetishu, yakaparadzana scan frame inoiswa umo zvese zvinotapurirana nekugashira zvinotsauswa, uye kutungamira kwekutsauka kwakananga kwakananga kwemuviri wetsono. , kuitira kuti iyo inoratidzirwa echo yemuviri wetsono inogona kuwira mukugamuchira yekutarisa aperture zvakanyanya sezvinobvira.Uye ipapo mufananidzo wakasimba wemuviri wetsono mumufananidzo wakatsauka unotorwa uye unoratidzwa mushure mekubatana neyakajairwa tishu mufananidzo.Nekuda kwehukuru uye kuwanda kweiyo probe array element, deflection angle yeyepamusoro-frequency linear array probe kazhinji haipfuuri 30 °, saka kana kona yekubaya inopfuura 30 °, unogona kungoona muviri wetsono zvakajeka. nemafungiro ako.
Tevere, ngatitarisei mamiriro ekunze kwendege.Mushure mekunzwisisa iyo musimboti we-mu-ndege kuvandudza tsono, zviri nyore kwazvo kuongorora kunze-kwe-ndege kusimudzira tsono.Iyo inotenderera fan inotsvaira inotaurwa mugwaro rekudzidzira inhanho yakakosha yekunze-kwe-ndege punctures, uye izvi zvinoshanda kwete chete pakutsvaga nzvimbo yetsono, asiwo pakutsvaga mutumbi wetsono.Ingori kuti tsono yekubaya uye ultrasound imaging haisi mundege imwechete panguva iyoyo.Chete kana tsono yekubaya iri perpendicular kundege yekufungidzira ndipo panogona kuitika mafungu e ultrasonic pane tsono yetsono inoratidzwa kumashure kune ultrasonic probe.Sezvo ukobvu hwekutungamira kweprobe kazhinji kuburikidza nekutarisa kwemuviri kweacoustic lens, maaperture eese ari maviri ekutamisa nekugamuchira akafanana kune iyi nzira.Uye saizi yeaperture ihupamhi hwe transducer wafer.Kune ma-high-frequency linear array probes, hupamhi hunongosvika 3.5mm (nzvimbo yekugamuchira yekufungidzira mundege kazhinji inodarika 15mm, iyo yakakura kudarika upamhi hwewafer).Naizvozvo, kana iyo inoratidzwa maungira ekunze kwendege kubaya tsono muviri ndeyekudzokera kune probe, inogona chete kuve nechokwadi kuti kona iri pakati petsono yekubaya nendege yekufungidzira iri pedyo ne90 degrees.Saka unotonga sei kona yakatwasuka?Chiitiko chinonyanya kujeka ndeye refu "comet muswe" ichikwevera kuseri kwenzvimbo yakasimba yakajeka.Imhaka yekuti kana masaisai e ultrasonic ari chiitiko chakatwasuka pane inobaya tsono, mukuwedzera kune echoes yakanyatso kuratidzwa kumashure kune probe nepamusoro petsono, shoma shoma ye ultrasonic simba inopinda tsono.Iyo ultrasound inofamba nekukurumidza kuburikidza nesimbi uye kune akawanda maratidziro kumashure nekudzoka mukati mayo, nekuda kwemaungira anoratidza kakawanda akauya gare gare, refu "comet muswe" inoumbwa.Kamwe tsono yacho isiri perpendicular kune ndege yekufungidzira, mafungu eruzha anotaridzwa kumashure uye mberi anozoratidzwa mune mamwe maitiro uye haakwanise kudzokera kune probe, saka iyo "comet muswe" haigone kuoneka.Chiitiko chemuswe we comet chinogona kuonekwa kwete chete kunze-kwe-ndege puncture, asiwo mune-mu-ndege puncture.Kana tsono yekubaya ikada kufanana nepamusoro peprobe, mitsetse yemitsara yakachinjika inogona kuonekwa.
Kuti tienzanisire mu-ndege uye kunze-kwendege "comet muswe" zvakanyanya graphically, tinotora zvinyorwa mumvura kunze kwendege uye mu-ndege kutsvaira kushanda, zvigumisiro zvinoratidzwa mumufananidzo uri pasi apa.
Mufananidzo uri pazasi unoratidza kuita kwemufananidzo wemakona akasiyana kana mutumbi wetsono uri kunze kwendege uye fan inotenderera ichiongororwa.Kana iyo probe iri perpendicular kune iyo puncture tsono, zvinoreva kuti iyo puncture tsono iri perpendicular kune iyo ultrasound imaging ndege, saka iwe unogona kuona pachena "comet muswe".
Chengetedza probe perpendicular kune yekubaya tsono, uye famba uchitevedza mutumbi wetsono wakananga kumuromo wetsono.Kana "comet muswe" inonyangarika, zvinoreva kuti chikamu chekuongorora chiri padyo netsono yetsono, uye nzvimbo inopenya ichanyangarika mberi.Nzvimbo iyo nzvimbo inopenya isati yanyangarika ndipo pane tsono yetsono.Kana usina chokwadi, unogona kuita diki-angle inotenderedza fan kutsvaira padyo nenzvimbo iyi kuti usimbise zvakare.
Chinangwa chikuru chezviri pamusoro ndechekubatsira vanotanga nekukurumidza kuwana panowanikwa tsono netsono.Chikumbaridzo cheiyo ultrasound-inotungamirwa puncture tekinoroji haina kukwirira, uye chatinofanira kuita kudzikama uye kunyatsonzwisisa hunyanzvi.
Nguva yekutumira: Feb-07-2022
