Ubume behlabathi besifo sezintso ezingapheliyo
Uphando lwe-Epidemiological lubonise ukuba isifo sezintso esingapheliyo sesinye sezifo ezisongela impilo yoluntu kwihlabathi liphela.Kwiminyaka yakutshanje, amanani abonisa ukuba kumazwe aphuhlileyo (afana ne-United States ne-Netherlands), malunga ne-6.5% ukuya kwi-10% yabemi ngokubanzi banamaqondo ahlukeneyo esifo sezintso, apho inani lezifo zezintso eUnited States liye lafumana i-degrees ezahlukeneyo. kudlule izigidi ezingama-20, kwaye izibhedlele zinyanga abaguli besifo sezintso ukuya kuthi ga kwisigidi esi-1 ngonyaka.Inani lilonke labaguli abanesifo sezintso e-China liyakhula, kwaye kulindeleke ukuba inani labaguli abanesifo sezintso e-China liya kudlula izigidi ezi-4 ngo-2030.
I-Hemodialysis (HD) lolunye lonyango lokubuyisela izintso kwizigulane ezinokusilela okubukhali kunye nokungapheliyo.
Ukusekwa kokufikelela okusebenzayo kwe-vascular yimfuneko yenkqubela phambili egudileyo ye-hemodialysis.Umgangatho wokufikelela kwi-vascular kuchaphazela ngokuthe ngqo umgangatho we-dialysis kunye nobomi bezigulane.Ukusetyenziswa ngokufanelekileyo kunye nokukhuselwa ngokucokisekileyo kokufikelela kwi-vascular akukwazi nje ukwandisa ubomi benkonzo yokufikelela kwi-vascular, kodwa nokwandisa ubomi bezigulane ze-dialysis, ngoko ukufikelela kwe-vascular kubizwa ngokuba "yi-lifeline" yezigulane ze-dialysis.
Ukusetyenziswa kweklinikhi ye-ultrasound kwi-AVF
Iingcali zeqela lokufikelela kwi-vascular zikholelwa ukuba i-AVF kufuneka ibe yinto yokuqala yokufikelela kwi-vascular.Ngenxa yokungahlaziywayo, inani eliqingqiweyo lemithombo ye-vascular, kwaye ayikwazi ukutshintshwa ngokupheleleyo, ukwenzela ukwandisa ubomi benkonzo yokufikelela kwesigulane, ukusetyenziswa okusemgangathweni kunye nokugcinwa kwe-arteriovenous fistula, kunye nokuphepha ngokufanelekileyo iingxaki ezinxulumene ne-puncture ziingxaki itsale umdla weekliniki kunye nabongikazi.
Ukuseka uvavanyo lwangaphambili lwe-vascular evaluation ye-arteriovenous fistula (AVF)
1) Ingaba imithambo yegazi iqhelekile: i-tortuosity, i-stenosis kunye ne-dilatation
2) ingaba udonga lwesitya lugudileyo, ingaba kukho i-plaque echo, nokuba kukho ukuphuka okanye ukukhubazeka, nokuba kukho ukuhlukana
3) ingaba kukho i-thrombi kunye nezinye i-echoes kwi-lumen
4) Ingaba umbala wokuzaliswa kwegazi uphelele kwaye ingaba isalathiso kunye nesantya sokuhamba kwegazi asiqhelekanga
5) Uvavanyo lokuhamba kwegazi
Umfanekiso ubonisa uNjingalwazi uGao Min enyanga isigulane ecaleni kwebhedi
Ukubeka iliso kwi-fistula yangaphakathi
Ekubeni ukusekwa kwe-fistula yangaphakathi kwizigulane linyathelo lokuqala "lohambo olude", i-AVF ngaphambi kokusebenzisa ukulinganisa kwe-ultrasonic i-vascular diameter kunye nokuhamba kwegazi ngokwemvelo, xa kuhlolwa i-fistula ingaba nemigangatho evuthiweyo, ukulinganisa ukuba izigulane ezine-fistula idatha usebenzisa umgangatho, i-ultrasound ngokungathandabuzekiyo yeyona ndlela inembile kwaye ichanekileyo.
Ukujongwa kwe-AVF: Ukuhlolwa kwe-Ultrasound kwenziwa kanye ngenyanga
1) Ukuhamba kwegazi
2) Umthamo wesitya
3) Ingaba i-anastomosis incinci kwaye ingaba i-thrombosis (ukuba kukho i-thrombosis, kuyimfuneko ukwandisa ibhaluni)
Ukugwetywa kwabantu abadala kwi-autogenous arteriovenous fistula
Nokuba liliphi ixesha elicetyiswayo lokuqalisa ukugqobhoza, imfuneko kufuneka ibe semva kokuba i-fistula yangaphakathi ikhulile.
Ngokuqhelekileyo kukholelwa ukuba ukukhula kwe-fistula yangaphakathi kufuneka kuhlangabezane neenqobo ezintathu ze-"6":
1) ukuhamba kwe-arteriovenous fistula> 600ml/min (2019 imvumelwano yeengcali zaseTshayina malunga nokufikelela kwi-vascular for hemodialysis:> 500 ml/min)
2) Idayimitha ye-puncture vein> 6mm (2019 ingcali yaseTshayina imvumelwano malunga nokufikelela kwimithambo ye-hemodialysis:> 5 mm)
3) Ubunzulu be-venous subcutaneous & LT;6mm, kwaye kufuneka kubekho umgama owaneleyo wokugqobhoza komthambo wegazi ukuhlangabezana nokusetyenziswa kwe-hemodialysis.
Kwiimeko ezininzi, i-arteriovenous fistulas enemithambo ebambekayo kunye nokungcangcazela okuhle kunokugqobhoza ngempumelelo kwiiveki ezi-4 zokusekwa kwazo.
Uvavanyo kunye nokugcinwa
Kubaluleke kakhulu ukuvavanya rhoqo kwaye ubeke iliso izikhombisi zeklinikhi ze-arteriovenous fistula kunye nokwanela kwe-hemodialysis emva kokusebenza.
Uvavanyo olulungileyo kunye neendlela zokuhlola zibandakanya
① Ukufikelela esweni lokuhamba kwegazi: kuyacetyiswa ukuba ubeke iliso kanye ngenyanga;
② Uviwo lomzimba: kucetyiswa ukuba yonke i-dialysis ifanele ihlolwe, kubandakanywa nokuhlolwa, ukubethelwa kwentliziyo kunye nokunyanzeliswa;
③ I-Doppler ultrasound: icetyiswa kanye kwiinyanga ezi-3;
④ Indlela yokuhlanjululwa engeyiyo iurea iyacetyiswa ukulinganisa ukurisayikilishwa kanye kwiinyanga ezi-3;
⑤ Ukuchongwa ngokuthe ngqo okanye ngokungathanga ngqo kwe-static ye-venous kucetyiswa kanye kwiinyanga ezi-3.
Xa i-AVF ye-autologous ayikwazi ukusekwa, ukhetho lwesibini kufuneka lube yi-fistula yangaphakathi ye-graft (AVG).Ingaba kukuseka i-AVF okanye i-AVG, i-ultrasound ibalulekile kuvavanyo lwangaphambili lwemithambo yegazi, isikhokelo se-intraoperative ye-puncture, uvavanyo lwasemva kokuhlinzwa kunye nokugcinwa.
I-PTA yenziwa phantsi kwesikhokelo se-ultrasound
Ingxaki engenakuphepheka ye-arteriovenous fistula yi-stenosis.Ixesha elide lokuhamba kwegazi elikhawulezayo lingabangela i-hyperplasia esebenzayo ye-intima ye-venous ye-fistula yangaphakathi, ekhokelela kwi-vascular stenosis kunye nokungonelanga kwegazi, okuchaphazela umphumo we-dialysis, kunye nokukhokelela kwi-fistula occlusion, i-thrombosis kunye nokungaphumeleli xa i-stenosis inzima.
Okwangoku utyando oluqhelekileyo lonyango lwe-fistula stenosis yangaphakathi ye-ultrasound ekhokelwa yi-arteriovenous fistula stenosis kwi-keratoplasty (PTA), unyango lwebhaluni yokwandisa nge-biopsy yesikhumba kwizigulana ezinefistula kwimithambo yegazi, kwibhaluni ye-catheter yokwandiswa, phantsi kolwalathiso lwe-ultrasound Ukwandiswa kwendawo ye-vascular stenosis, ukulungisa iindawo ezimxinwa, ukubuyisela i-diameter evamile ye-diameter yegazi, ukuze kwandiswe ubomi benkonzo yezigulane ezine-fistula yangaphakathi ye-arteriovenous.
I-PTA phantsi kwe-ultrasound ekhokelwa yi-ultrasound, ikulungele, akukho monakalo we-radiation, akukho monakalo we-agent echaseneyo, unokubonisa kunye nezilonda ze-vascular occlusion malunga nemeko, imilinganiselo yokuhamba kwegazi kunye nokuvavanya ukuhamba kwegazi, kwaye ingaba ngoko nangoko emva kwempumelelo njenge-vascular. ukufikelela kwi-hemodialysis, ayifuni i-catheter yesikhashana, ekhuselekileyo, esebenzayo kunye neempawu zentlungu encinci, ukubuyisela ngokukhawuleza, ukunciphisa intlungu yesigulane, Inkqubo yokucubungula yenziwe lula.
Ukusetyenziswa kweklinikhi ye-ultrasound kwi-catheterization ye-venous ephakathi
Ngaphambi kokuseka i-catheter ye-venous ephakathi, i-ultrasound kufuneka isetyenziswe ukuvavanya imeko ye-jugular vein yangaphakathi okanye i-femoral vein, ngakumbi kwizigulane ezinembali ye-intubation yangaphambili, kunye ne-ultrasound kufuneka isetyenziswe ukujonga i-vein stenosis okanye i-occlusion.Ngaphantsi kolwalathiso lwe-ultrasound, i-ultrasound, njengoko "iliso lesithathu" likagqirha, inokubona ngokucacileyo nangokwenyani.
1) Vavanya ububanzi, ubunzulu kunye nepatency ye-puncture vein
2) Inaliti yokuhlatywa kumthambo wegazi inokubonwa
I-3) Ukuboniswa kwexesha langempela le-trajectory yenaliti kwisitya segazi ukuze ugweme ukulimala kwangaphakathi
I-4) Gwema ukuvela kweengxaki (i-accidental artery puncture, i-hematoma formation okanye i-pneumothorax)
5) Ukuphucula izinga lokuphumelela kwepuncture yokuqala
Ukusetyenziswa kweklinikhi ye-ultrasound kwi-peritoneal dialysis catheterization
I-Peritoneal dialysis luhlobo lonyango lokubuyisela izintso, olusebenzisa ikakhulu imeko ye-peritoneum yakho ukwenza unyango lokubuyisela izintso.Xa kuthelekiswa ne-hemodialysis, ineempawu zokusebenza okulula, i-self-dialysis kunye nokukhuselwa okuphezulu kokusebenza kweentso.
Ukukhethwa kokubekwa kwe-catheter ye-dialysis ye-peritoneal ebusweni bomzimba linyathelo elibaluleke kakhulu ekusekweni kwe-peritoneal dialysis access.Ukuze kugcinwe i-patency ye-peritoneal dialysis drainage kunye nokunciphisa ukuvela kweengxaki ze-catheterization, kuyimfuneko ukuba uqhelane nesakhiwo se-anatomical yodonga lwangaphambili lwesisu kwaye ukhethe eyona ndawo ifanelekileyo yokufaka i-catheter ye-dialysis ye-peritoneal.
Ukubekwa kwe-Percutaneal dialysis catheter phantsi kwesikhokelo se-ultrasound kuncinci, ukonga, kulula ukusebenza, kukhuselekile ngakumbi, enembile kwaye enokwethenjelwa.
I-SonoEye palmar ultrasonication yayisetyenziselwa ukufikelela kwi-vascular
I-SonoEye i-ultra-ephathwayo kwaye incinci, ayihlali kwindawo esecaleni kwebhedi, kulula ukuyijonga, inokuqhagamshelwa ngokuthe ngqo kwifowuni okanye ithebhulethi, vula isicelo nangaliphi na ixesha.
Umfanekiso ubonisa uNjingalwazi uGao Min enyanga isigulane ecaleni kwebhedi
I-Chison palm ultrasound inemifanekiso yoxilongo kwaye ixhotyiswe ngepakethi ekrelekrele yokulinganisa ukuhamba kwegazi, ethi ivule ngokuzenzekelayo kwaye inike iziphumo zokuphuma kwegazi.
I-Ultrasound-guided puncture ye-fistula yangaphakathi ingaphucula kakhulu izinga lokuphumelela kwe-puncture kunye nokunciphisa iziganeko zeengxaki ezifana ne-hematoma kunye ne-pseudoaneurysm.
Wamkelekile ukuba uqhagamshelane nathi ukuze ufumane iimveliso zonyango ngakumbi kunye nolwazi.
Iinkcukacha zoqhakamshelo
Icy Yi
I-Amain Technology Co., Ltd.
Mob/WhatsApp: 008617360198769
E-mail: amain006@amaintech.com
Ikhonkco: 008617360198769
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Ixesha lokuposa: Nov-03-2022
