Ngokwanda kokuthandwa kwezixhobo ze-ultrasound, ngakumbi nangakumbi abasebenzi bezempilo bezonyango bayakwazi ukusebenzisa i-ultrasound ngomsebenzi wokubonwa.Abantu abangazaziyo iindlela zokugqobhoza ezikhokelwa yi-ultrasound bayaxolisa ngokuhlala kwishishini.Nangona kunjalo, ukusuka kusetyenziso lweklinikhi ndibonile, ukuthandwa kwezixhobo ze-ultrasound kunye nokuthandwa kokubonwa kwe-ultrasound akulingani.Kwimeko ye-ultrasound-guided puncture kwintsimi yokufikelela kwi-vascular, abantu abaninzi basesesiteji sokuzenza ngathi bayayiqonda, kuba nangona kukho i-ultrasound, abakwazi ukubona apho inaliti yokubhoboza yayikhona.Indlela yokwenyani yokugqobhoza ekhokelwa yi-ultrasound ifuna okokuqala ukuba indawo enaliti okanye incam yenaliti ibonakale phantsi kwe-ultrasound, kunokuba iqikelelwe kwaye "ingene ngokungaboniyo" phantsi kwesikhokelo se-ultrasound.Namhlanje, siza kuthetha ngokubonakala kunye nokungabonakali kwenaliti yokubhoboza phantsi kwe-ultrasound.
I-Ultrasound-guided puncture ihlulwe ngokubanzi kwi-in-plane puncture kunye ne-out-of-plane puncture, zombini ezo zisetyenziselwa kwintsimi yokufikelela kwi-vascular kwaye zihamba kakuhle kakuhle.Oku kulandelayo kukucatshulwa kwi-American Society of Ultrasound Medicine's practice guidelines for ultrasound-guided access to vascular procedures, echaza iindlela ezimbini.
Kwinqwelo-moya (i-axis ende) VS Ngaphandle kwenqwelo-moya (I-axis emfutshane)
- In-plane/ Out-of-plane ibonisa unxulumano olunxulumene nenaliti, kunye nenaliti enxusene nenqwelomoya yokucinga ye-ultrasound ikwinqwelo-moya kunye nenaliti ethe gqolo kwinqwelo-moya yomfanekiso we-ultrasound ingaphandle kwenqwelo-moya.
- Ngokubanzi, i-in-plane puncture ibonisa i-axis ende okanye i-longitudinal icandelo lomkhumbi;I-puncture ephuma ngaphandle kwendiza ibonisa i-axis emfutshane okanye icandelo elinqamlezayo lomkhumbi.
- Ke ngoko, i-out-of-plane/ i-short-axis kunye ne-in-plane/ i-long-axis zifana nqwa ngokungagqibekanga kwi-vascular access ultrasound.
- Ukuphuma ngaphandle kwenqwelomoya kunokwenziwa ukusuka phezulu kwiziko lenqanawa, kodwa incam yenaliti kufuneka ilandelwe ngokujikeleza i-probe ukuze ugweme ukujongela phantsi ubunzulu be-tip;iifeni zeprobe ukusuka kumzimba wenaliti ukuya kwincam, kwaye umzuzu oqaqambileyo wencam unyamalala yindawo yencam yencam.
I-In-plane ivumela ukubonwa okuzinzileyo kwendawo yencapha yenaliti, kodwa kunokukhokelela ngokulula "ekutyibilikeni" kwinqwelomoya apho inaliti ibekwe khona okanye/ kunye nenqwelomoya esembindini yenqanawa;ukubhoboza kwinqwelomoya kufanelekile ngakumbi kwimikhumbi emikhulu.
-In-plane/ out-of-plane indibaniselwano indlela: sebenzisa i-out-of-plane/ short-axis scanning ukuqinisekisa ukuba incam yenaliti ifika embindini wenqanawa, kwaye ujikelezise iprobe ukuya kwinqwelomoya/ yokungena inaliti ende. .
Ukukwazi ukujonga incam yenaliti okanye umzimba wonke wenaliti ngexesha lokwenyani kwinqwelomoya kuyacaca ukuba luncedo kakhulu!Kodwa ukugcina inaliti kwi-ultrasound imaging plane ngaphandle koncedo lwefreyimu yokubhoboza kufuna amakhulu eeseshoni zokuziqhelanisa ukuze akwazi ubuchule.Kwiimeko ezininzi, i-angle ye-puncture inkulu kakhulu, ukwenzela ukuba inaliti icace ngokucacileyo kwindiza ye-imaging ye-ultrasound, kodwa awukwazi ukubona apho ikhona.Buza kwixhego elingumakhelwane ukuba kuqhubeka ntoni.Unokukuxelela ukuba inaliti yokubhoboza ayikho i-perpendicular kumgca we-ultrasound scan, ngoko awukwazi ukuyibona.Ke kutheni unokuyibona kancinane xa i-engile yokugqobhoza incinci, kwaye icace ngakumbi xa incinci kakhulu?Usenokuba uxakiwe ukuba kutheni.
I-angle yenaliti yokuhlatywa kulo mzobo ungezantsi yi-17 ° kunye ne-13 ° ngokulandelanayo (ilinganiswe ngenzuzo yokujonga emva), xa i-engile ye-13 ° wonke umzimba wenaliti yokuhlatywa iboniswe ngokucacileyo, xa i-angle ye-17 ° , umzimba wenaliti unokubonwa kancinci kancinci, kwaye i-angle inkulu nge-hoodwink.Ke kutheni kukho umahluko omkhulu kangaka kwi-engile yesiboniso senaliti yokuhlatywa kunye nomahluko we-4 ° kuphela?
Kufuneka iqale kwi-ultrasound emission, ukwamkela kunye nokugxila.Njengolawulo lokuvula kugxininiso lwefoto, inqaku ngalinye kwifoto sisiphumo esidityanisiweyo sokugxila kuko konke ukukhanya ngokuvula, ngelixa indawo nganye kumfanekiso we-ultrasound sisiphumo esidityanisiweyo sazo zonke ii-transducers ze-ultrasound ngaphakathi kokuphuma kunye neendawo zokwamkela. .Kulo mfanekiso ungezantsi, umgca obomvu uphawula uluhlu lokugxilwa kwe-ultrasound emission schematically, kwaye umgca ohlaza luluhlu lwe-focus yokufumana i-schematically (umda wasekunene).Ngenxa yokuba inaliti ikhazimle ngokwaneleyo ukuvelisa umboniso okhethekileyo, umgca omhlophe uphawula ulwalathiso oluqhelekileyo kwi-specular reflection.Ukucinga ukuba umgca obomvu uphawula uluhlu olugxininisiweyo lokukhutshwa lufana ne "rays" ezimbini, emva kokubetha isibuko senaliti, "imisebe" ebonakalisiweyo ifana nemigca emibini ye-orange emfanekisweni.Ekubeni "i-ray" kwicala lasekunene lomgca oluhlaza idlula i-aperture yokufumana, kwaye ayinakufunyanwa yi-probe, "i-ray" enokufunyanwa iboniswa kwindawo ye-orange emfanekisweni.Kuyabonakala ukuba kwi-17 °, i-probe isenokufumana i-echo encinci kakhulu ye-ultrasound, ngoko ke umfanekiso ohambelanayo ubonakala ngokukhawuleza, ngelixa i-13 °, i-echoes ingafunyanwa kakhulu ngaphezu kwe-17 °, ngoko ke umfanekiso ungaphezulu. icacile.Ngokuhla kwe-angle ye-puncture, inaliti ilele ngakumbi nangaphezulu, kwaye ngakumbi nangakumbi i-echoes ebonakalisiweyo yomzimba wenaliti inokufunyanwa ngokufanelekileyo, ngoko ke uphuhliso lwenaliti lungcono kwaye lungcono.
Abanye abantu abacokisekileyo baya kufumana isenzeko, xa i-engile ingaphantsi kwexabiso elithile (inaliti ayifuni ngokupheleleyo "ukulala tyaba"), uphuhliso lomzimba wenaliti ngokusisiseko luhlala lukwinqanaba elifanayo lokucaca.Kwaye kutheni le nto?Kutheni sizoba uluhlu oluncinci lokugxilwa kokukhupha (umgca obomvu) kunoluhlu lolwamkelo (umgca oluhlaza) kumfanekiso ongentla?Oku kungenxa yokuba kwinkqubo yomfanekiso we-ultrasound, ugxininiso losasazo lunokuba bubunzulu obunye kuphela bokugxila, kwaye ngelixa sinokuhlengahlengisa ubunzulu bogqithiso lokugxila ukwenza umfanekiso ucace kufutshane nobunzulu esigxile kubo, asifuni. iya kuba luzizi ngaphaya kobunzulu bengqwalasela.Oku kwahluke kakhulu kwiimfuno zethu zokuthatha iifoto zobugcisa zabasetyhini abahle, ezifuna i-aperture enkulu, ubunzulu obuncinci bentsimi ukuzisa imvelaphi yangaphambili yonke i-bokeh.Kwi-imaging ye-ultrasound, sifuna ukuba umfanekiso ucace ngokwaneleyo kuluhlu ngaphambi nasemva kobunzulu bengqwalasela, ngoko ke sinokusebenzisa i-aperture encinci yokudlulisa ukufumana ubunzulu bentsimi, ngaloo ndlela sigcina ukufana komfanekiso.Ngokubhekiselele ekufumaneni ugxininiso, inkqubo yokucinga ye-ultrasound ngoku yenziwe yedijithali ngokupheleleyo, ngoko ke i-echo ye-ultrasound ye-transducer/i-array element nganye inokugcinwa, kwaye ugxininiso oluguquguqukayo oluqhubekayo lwenziwa ngokwedijithali kubo bonke ubunzulu bomfanekiso.Ke sinokuzama ukuvula indawo yokufumana indawo enkulu kangangoko sinakho, okoko nje indawo efumana umqondiso we-echo isetyenzisiwe, ugqaliselo olugqwesileyo kunye nesisombululo esingcono sinokuqinisekiswa.Buyela kwisihloko sangaphambili, xa i-angle yokubhoboza iyancipha ukuya kwinqanaba elithile, amaza e-ultrasonic akhutshwa yi-aperture encinci inokufunyanwa yi-aperture enkulu yokufumana emva kokubonakaliswa ngumzimba wenaliti, ngoko umphumo wokuphuhliswa komzimba ngokwendalo zihlala ziyafana.
Kwiprobe engasentla, sinokwenza ntoni xa i-angle yokubhoboza kwinqwelomoya idlula i-17 ° kwaye inaliti ingabonakali?Ukuba isixokelelwano siyaxhasa, ungazama umsebenzi wokwandisa inaliti.Itekhnoloji ebizwa ngokuba yitekhnoloji yokuphucula inaliti yokuhlatywa ngokubanzi ithetha ukuba emva kwesakhelo sokuskena esiqhelekileyo sethishu, kufakwe isakhelo sokuskena esahlukileyo apho ukuhanjiswa kunye nokwamkela kuyaphambukiswa, kwaye icala lokuphambuka libhekisa kwicala lomzimba wenaliti. , ukwenzela ukuba i-echo ebonakalisiweyo yomzimba wenaliti ikwazi ukuwela kwi-focus yokufumana i-aperture kangangoko kunokwenzeka.Kwaye ke umfanekiso oqinileyo womzimba wenaliti kumfanekiso ophambukayo uyakhutshwa kwaye uboniswe emva kokuxutywa nomfanekiso oqhelekileyo wethishu.Ngenxa yobungakanani kunye nokuphindaphinda kweprobe yearray element, i-angle yokuphambuka ye-high-frequency linear linear probe ngokubanzi ayikho ngaphezulu kwe-30 °, ke ukuba i-angle yokuhlatywa ingaphezulu kwe-30 °, unokubona kuphela umzimba wenaliti ngokucacileyo. ngengqondo yakho.
Okulandelayo, makhe sijonge imeko yokuphuma kwenqwelomoya.Emva kokuqonda umgaqo wophuhliso lwenaliti yendiza, kulula kakhulu ukuhlalutya uphuhliso lwenaliti yangaphandle.Ukutshatyalaliswa kwefeni ejikelezayo ekhankanywe kwisikhokelo sokuziqhelanisa linyathelo elibalulekileyo le-punctures ngaphandle kwendiza, kwaye oku akusebenzi nje ekufumaneni indawo yencapha yenaliti, kodwa kunye nokufumana umzimba wenaliti.Kuphela nje ukuba inaliti yokuhlatywa kunye ne-imaging ye-ultrasound ayikho kwindiza enye ngelo xesha.Kuphela xa inaliti yokubhoboza i-perpendicular kwindiza yokucinga inokuthi isiganeko samaza e-ultrasonic kwinaliti yokubhoboza ingabonakaliswa emva kwiprobe ye-ultrasonic.Kuba umkhombandlela wobungqingqwa weprobe ngokuqhelekileyo ujoliswa kwilensi ye-acoustic, iindawo zokuvula kuzo zombini ezo zinto zigqithisayo kunye nokwamkela ziyafana kolu lwalathiso.Kwaye ubungakanani bembobo bububanzi be-wafer ye-transducer.Kwiiprobe zoluhlu oluneziza eziphakamileyo, ububanzi bumalunga ne-3.5mm kuphela (indawo yokuvula yokufumana umfanekiso ongaphakathi kwinqwelo-moya iyodlula i-15mm, engaphezulu kakhulu kunobubanzi be-wafer).Ke ngoko, ukuba i-echo ebonakalisiweyo yomzimba wenaliti yokuhlatywa engaphandle kwenqwelomoya kukubuyela kwiprobe, inokuqinisekiswa kuphela ukuba i-angle phakathi kwenaliti yokuhlatywa kunye nenqwelomoya yomfanekiso isondele kwiidigri ezingama-90.Uyigweba njani ke i-engile ethe nkqo?Eyona nto icacileyo yi "comet tail" ende edonsa emva kwendawo eqaqambileyo eqaqambileyo.Kungenxa yokuba xa amaza e-ultrasonic eyenzeka ngokuthe nkqo kwinaliti yokubhoboza, ukongeza kwii-echoes ezibonakaliswe ngokuthe ngqo kwi-probe ngumphezulu wenaliti, inani elincinci lamandla e-ultrasonic lingena kwinaliti.I-ultrasound ihamba ngokukhawuleza ngentsimbi kwaye kukho ukubonakaliswa okuphindaphindiweyo ngaphakathi nangaphandle ngaphakathi kwayo, ngenxa ye-echoes ebonisa amaxesha amaninzi afika kamva, "umsila we-comet" omde wenziwa.Emva kokuba inaliti ingekho i-perpendicular kwindiza ye-imaging, amaza omsindo abonakaliswe ngasemva naphambili aya kubonakaliswa kwezinye iindawo kwaye akakwazi ukubuyela kwi-probe, ngoko "umsila we-comet" awukwazi ukubonwa.I-phenomenon yomsila we-comet ayibonakali kuphela kwi-puncture yangaphandle, kodwa nakwi-in-plane puncture.Xa inaliti yokuhlatywa iphantse yangqamana nomphezulu weprobe, imiqolo yemigca ethe tye inokubonwa.
Ukuze ubonise i-in-plane kunye ne-out-of-plane "umsila we-comet" ngakumbi, sithatha i-staples emanzini ngaphandle kwendiza kunye nokusebenza kwe-plane yokutshayela, iziphumo ziboniswe kumfanekiso ongezantsi.
Umfanekiso ongezantsi ubonisa ukusebenza komfanekiso wee-angles ezahlukeneyo xa umzimba wenaliti uphuma kwinqwelomoya kwaye i-fan ejikelezayo iskenwa.Xa i-probe i-perpendicular kwi-puncture inaliti, oko kuthetha ukuba inaliti ye-puncture i-perpendicular kwi-plane imaging ye-ultrasound, ngoko unokubona ngokucacileyo "umsila we-comet".
Gcina i-probe perpendicular kwinaliti yokuhlatywa, kwaye uhambe ngomzimba wenaliti ukuya kwincam yenaliti.Xa "umsila we-comet" uphela, kuthetha ukuba icandelo lokuskena lisondele kwincam yenaliti, kwaye indawo eqaqambileyo iya kunyamalala phambili.Indawo phambi kokuba indawo eqaqambileyo inyamalale kulapho incam yenaliti ikhona.Ukuba awuqinisekanga, ungenza i-engile encinci ejikelezayo ifeni kufutshane nale ndawo ukuze uqinisekise kwakhona.
Injongo ephambili yale ngasentla kukunceda abaqalayo ukufumana ngokukhawuleza apho inaliti yokuhlatywa kunye nenaliti.Umda wetekhnoloji ye-ultrasound-guided puncture ayiphezulu kangako, kwaye into ekufuneka siyenze kukuzola kwaye siqonde kakuhle isakhono.
Ixesha lokuposa: Feb-07-2022
