1. Iyini inzuzo ye-lung ultrasound?
Eminyakeni embalwa edlule, izithombe ze-ultrasound zamaphaphu ziye zasetshenziswa kakhulu emtholampilo.Kusukela endleleni yendabuko yokwahlulela kuphela ubukhona kanye nenani lokuphuma kwe-pleural, kuguqule ukuhlolwa kwe-imaging parenchyma yamaphaphu.Singakwazi ukuxilonga izimbangela ezi-5 ezivame kakhulu zokwehluleka ukuphefumula okunamandla (i-pulmonary edema, inyumoniya, i-pulmonary embolism, i-COPD, i-pneumothorax) ezimweni ezingaphezu kuka-90% nge-ultrasound yamaphaphu elula yemizuzu engu-3-5.Okulandelayo isingeniso esifushane senqubo evamile ye-lung ultrasonography.
2. Ungakhetha kanjani i-ultrasound probe?
Izindlela ezivame ukusetshenziswa kakhulu ze-lung ultrasound ziyiL10-5(ephinde ibizwe ngokuthi i-organ probe encane, imvamisa yohlobo 5~10MHz umugqa womugqa) kanyeC5-2(ephinde ibizwe ngokuthi i-abdominal probe noma i-convex enkulu, i-2~5MHz convex array), ezinye izimo zingasebenzisa futhi i-P4-2 (ebuye ibizwe ngokuthi i-cardiac probe, 2~4MHz isigaba sezigaba).
I-probe yesitho esincane se-L10-5 kulula ukuthola umugqa ocacile we-pleural futhi ibheke i-echo yezicubu ezingaphansi.Ubambo lungasetshenziswa njengomaka ukuze kubhekwe umugqa we-pleural, okungaba ukukhetha kokuqala kokuhlolwa kwe-pneumothorax.Imvamisa ye-probes yesisu iphakathi, futhi umugqa we-pleural ungabonwa ngokucacile ngenkathi uhlola sonke isifuba.Ama-probe ahlelwe ngezigaba kulula ukuwathwebula ngesikhala se-intercostal futhi anokubona ukujula okujulile.Zivame ukusetshenziswa ekuhloleni ukuqhuma kwe-pleural, kodwa azikwazi ukuthola izimo ze-pneumothorax kanye ne-pleural space.
3. Yiziphi izingxenye okufanele zihlolwe?
I-Lung ultrasonography ivamise ukusetshenziswa kusikimu se-lung lung ultrasonography (mBLUE) elungisiwe noma uhlelo lwamaphaphu amabili-12-division scheme kanye nohlelo lwe-8-division.Kunesamba sezindawo zokuhlola eziyi-10 ezinhlangothini zombili zamaphaphu ohlelweni lwe-mBLUE, olufanele izimo ezidinga ukuhlolwa ngokushesha.Isikimu sezoni engu-12 kanye nohlelo lwezoni engu-8 kuwukushelela uphenyo lwe-ultrasound endaweni ngayinye ukuze kuhlolwe kabanzi.
Izindawo zokuhlola ngayinye ohlelweni lwe-mBLUE ziboniswa esithombeni esilandelayo:
| indawo yokuhlola | Indawo |
| ichashazi eliluhlaza okwesibhakabhaka | Iphuzu eliphakathi komunwe ophakathi nendawo kanye nesisekelo somunwe wendandatho ohlangothini lwekhanda |
| iphuzu le-diaphragm | Thola indawo ye-diaphragm nge-ultrasound probe emgqeni we-midaxillary |
| iphuzu M
| Iphoyinti elimaphakathi lomugqa oxhuma indawo eluhlaza okwesibhakabhaka ephezulu kanye nephoyinti le-diaphragm |
| Iphoyinti le-PLAPS
| Ukuphambana komugqa wokunweba wephoyinti M kanye nomugqa oqondile ukuya kumugqa we-axillary wangemuva |
| ichashazi eliluhlaza emuva
| Indawo ephakathi kwe-engeli ye-subscapular kanye nomgogodla |
Uhlelo lwe-12-division lusekelwe emgqeni we-parasternal wesiguli, umugqa we-axillary wangaphambili, umugqa we-axillary wangemuva, kanye nomugqa we-paraspinal ukuze uhlukanise i-thorax ezindaweni ezingu-6 zodonga lwesifuba lwangaphambili, lwe-lateral, ne-posterior, futhi indawo ngayinye iphinde ihlukaniswe ezindaweni ezimbili. , phezulu naphansi, enezindawo ezingu-12 sezizonke.indawo.Uhlelo lokuhlukanisa okuyisishiyagalombili alubandakanyi izindawo ezine zodonga lwesifuba olungemuva, futhi luvame ukusetshenziswa ekuxilongweni nasekuhlolweni kwe-ultrasonography ye-interstitial pulmonary syndrome.Indlela ethile yokuskena iwukuqala ukusuka kumugqa ophakathi nendawo endaweni ngayinye, i-eksisi emaphakathi ye-probe incike ngokuphelele ku-bony thorax (indiza yobude), kuqala ushelele eceleni emugqeni wokuklama, ubuyele emgqeni ophakathi, bese uslayida ngokuphakathi umugqa wokuklama, bese ubuyisela umugqa omaphakathi.
4. Indlela yokuhlaziya izithombe ze-ultrasound?
Njengoba sonke sazi, umoya "uyisitha" se-ultrasound, ngoba i-ultrasound ibola ngokushesha emoyeni, futhi ukuba khona komoya emaphashini kwenza kube nzima ukudweba ngokuqondile i-parenchyma yamaphaphu.Ephashini elivame ukufutheka, okuwukuphela kwezicubu ezingatholwa i-pleura, ebonakala ku-ultrasound njengomugqa ovundlile we-hyperechoic obizwa ngokuthi umugqa we-pleural (owodwa oseduze nongqimba lwethishu ethambile).Ngaphezu kwalokho, kukhona ama-artifacts afanayo, aphindaphindayo omugqa we-hyperechoic ovundlile abizwa ngokuthi imigqa engu-A ngaphansi komugqa we-pleural.Ukuba khona kwe-A-line kusho ukuthi kunomoya ngaphansi komugqa we-pleural, okungaba umoya wamaphaphu ovamile noma umoya okhululekile ku-pneumothorax.
Ngesikhathi se-ultrasound yamaphaphu, umugqa we-pleural utholakala kuqala, ngaphandle uma kune-emphysema engaphansi kwe-subcutaneous, evame ukubonakala.Emaphashini avamile, i-visceral ne-parietal pleura ingase ishelele ihlobene nomunye nomunye ngokuphefumula, okubizwa ngokuthi i-lung sliding.Njengoba kukhonjisiwe ezithombeni ezimbili ezilandelayo, isithombe esiphezulu sinephaphu elishelelayo futhi isithombe esingezansi asinakho ukushelela kwamaphaphu.
Ngokuvamile, ezigulini ezine-pneumothorax, noma inani elikhulu le-pleural effusion egcina amaphaphu ekude nodonga lwesifuba, uphawu olushelelayo lwamaphaphu luzonyamalala.Noma inyumoniya ihlanganisa amaphaphu, bese kuvela ukunamathelana phakathi kwamaphaphu nodonga lwesifuba, okungenza futhi uphawu olushelelayo lwamaphaphu lunyamalale.Ukuvuvukala okungapheli kukhiqiza izicubu ezine-fibrous ezinciphisa ukuhamba kwamaphaphu, futhi amashubhu e-thoracic drainage awakwazi ukubona amaphaphu eshelela njenge-COPD ethuthukisiwe.
Uma umugqa u-A ungabonwa, kusho ukuthi kunomoya ngaphansi komugqa we-pleural, futhi uphawu lokushelela kwamaphaphu luyanyamalala, kungenzeka kube yi-pneumothorax, futhi kuyadingeka ukuthola indawo yamaphaphu ukuze kuqinisekiswe.Iphuzu lephaphu liyiphuzu loguquko ukusuka ekungangeni kwamaphaphu ukuya ekusheleleni okujwayelekile kwamaphaphu ku-pneumothorax futhi iyindinganiso yegolide yokuxilongwa kwe-ultrasound kwe-pneumothorax.
Imigqa eminingi ehambisanayo eyakhiwe ngodonga lwesifuba oluqinile ingabonakala ngaphansi kwe-M-mode ultrasound.Ezithombeni ezijwayelekile zamaphaphu kumaphaphu, ngenxa yokushelela kwamaphaphu emuva naphambili, ama-echo anjengesihlabathi akhiwa ngaphansi, okubizwa ngokuthi uphawu lolwandle.Kunomoya ngaphansi kwe-pneumothorax, futhi akukho ukushelela kwamaphaphu, ngakho kwakhiwa imigqa eminingi ehambisanayo, ebizwa ngokuthi uphawu lwebhakhodi.Iphuzu elihlukanisayo phakathi kophawu lolwandle kanye nophawu lwebhakhodi indawo yamaphaphu.
Uma ukutholakala kwemigqa ye-A kungabonakali esithombeni se-ultrasound, kusho ukuthi isakhiwo sezicubu emaphashini sishintshile, esivumela ukudlulisa i-ultrasound.Izinto zobuciko ezifana nemigqa engu-A ziyanyamalala lapho indawo ye-pleural yasekuqaleni igcwaliswa izicubu ezinjengegazi, uketshezi, ukutheleleka, ukuqunjelwa okubangelwa igazi elijiyile, noma isimila.Khona-ke udinga ukunaka inkinga yomugqa B. I-B-line, eyaziwa nangokuthi "umsila wenkanyezi enomsila", i-laser beam-like hyperechoic strip ephuma iqonde emgqeni we-pleural (visceral pleura), ifinyelela phansi. kwesikrini ngaphandle kokunciphisa.Ivala umugqa ongu-A futhi ihamba nomoya.Isibonelo, esithombeni esingezansi, asikwazi ukubona ubukhona bomugqa A, kodwa esikhundleni somugqa B.
Ungakhathazeki uma uthola imigqa engu-B eminingana esithombeni se-ultrasound, u-27% wabantu abajwayelekile banemigqa engu-B yendawo endaweni eyi-11-12 ye-intercostal (ngenhla kwe-diaphragm).Ngaphansi kwezimo ezijwayelekile zomzimba, imigqa engaphansi kuka-3 B ijwayelekile.Kodwa uma uhlangabezana nenani elikhulu le-B-lines ehlukanisiwe, akuyona into evamile, okuwukusebenza kwe-edema yamaphaphu.
Ngemva kokubheka umugqa we-pleural, umugqa A noma u-B, ake sikhulume ngokuphuma kwe-pleural kanye nokuhlanganiswa kwamaphaphu.Endaweni ye-posterolateral yesifuba, i-pleural effusion kanye nokuhlanganiswa kwamaphaphu kungahlolwa kangcono.Isithombe esingezansi yisithombe se-ultrasound esihlolwe endaweni ye-diaphragm.Indawo emnyama ye-anechoic i-pleural effusion, etholakala emgodini we-pleural ngaphezu kwe-diaphragm.
Ngakho-ke uhlukanisa kanjani phakathi kwe-pleural effusion kanye ne-hemorrhage?I-fibrous exudate ngezinye izikhathi ingabonakala ekuphumeni kwe-hemopleural, kuyilapho ukukhishwa ngokuvamile kuba indawo emnyama ye-anechoic, ngezinye izikhathi ihlukaniswa ngamakamelo amancane, futhi izinto ezintantayo zokuqina kwe-echo ehlukahlukene zingabonakala nxazonke .
I-Ultrasound ingahlola ngokubukeka iningi (90%) leziguli ezinokuqiniswa kwamaphaphu, incazelo eyisisekelo kakhulu ukulahlekelwa komoya.Into emangalisayo ngokusebenzisa i-ultrasound ukuze kuhlonzwe ukuqiniswa kwamaphaphu ukuthi lapho amaphaphu esiguli ehlanganiswa, i-ultrasound ingadlula ezindaweni ezijulile zesifuba sephaphu lapho ukuhlanganiswa kwenzeka khona.Izicubu zamaphaphu zaziyi-hypoechoic enemingcele emise okwe-wedge futhi engacacile.Ngezinye izikhathi ungase ubone uphawu lwe-bronchus yomoya, oluyi-hyperechoic futhi luhamba nokuphefumula.Isithombe sesonographic esinokubaluleka okuqondile kokuxilonga ekuhlanganisweni kwamaphaphu ku-ultrasound wuphawu olufana nezicubu zesibindi, okuyi-echo eqinile efana nezicubu zesibindi ebonakala ngemva kokuba i-alveoli igcwele i-exudate.Njengoba kuboniswe emfanekisweni ongezansi, lesi yisithombe se-ultrasound sokuhlanganiswa kwamaphaphu okubangelwa inyumoniya.Esithombeni se-ultrasound, ezinye izindawo zingabonakala njenge-hypoechoic, ebukeka kancane njengesibindi, futhi akukho u-A ongabonwa.
Ngaphansi kwezimo ezijwayelekile, amaphaphu agcwala umoya, futhi umbala we-Doppler ultrasound awukwazi ukubona lutho, kodwa lapho amaphaphu ehlanganiswa, ikakhulukazi uma kune-pneumonia eduze kwemithambo yegazi, kubonakala ngisho nezithombe zokugeleza kwegazi emaphashini, kanjena. kuboniswe emfanekisweni.
Umsindo wokukhomba inyumoniya yikhono eliyisisekelo le-lung ultrasound.Kudingekile ukuhamba uye phambili phakathi kwezimbambo ukuze uhlole ngokucophelela ukuthi kukhona yini indawo ye-hypoechoic, ukuthi kukhona uphawu lwe-bronchus yomoya, ukuthi kukhona yini uphawu olufana nezicubu zesibindi, nokuthi kukhona yini umugqa we-A ovamile noma cha.Isithombe se-Lung ultrasound.
5. Indlela yokunquma imiphumela ye-ultrasonography?
Ngokuskena okulula kwe-ultrasound (uhlelo lwe-mBLUE noma uhlelo lwezoni eziyishumi nambili), idatha yesici ingahlukaniswa, futhi kutholakale imbangela enzima yokwehluleka ukuphefumula okukhulu.Ukuqeda ngokushesha ukuxilongwa kungakhulula i-dyspnea yesiguli ngokushesha futhi kunciphise ukusetshenziswa kokuhlolwa okuyinkimbinkimbi njenge-CT ne-UCG.Le datha yesici ihlanganisa: ukuslayida kwamaphaphu, ukusebenza A (imigqa A kuyo yomibili imigodi yethoracic), ukusebenza kuka-B (imigqa engu-B evela kuyo yomibili imigodi yethoracic, futhi ayikho ngaphansi kwemigqa engu-3 B noma imigqa engu-B encikene iyanamathela), A /B ukubukeka (Ukubonakala ngakolunye uhlangothi lwe-pleura, ukubukeka kuka-B ngakolunye uhlangothi), indawo yamaphaphu, ukuhlanganiswa kwamaphaphu, nokuphuma kwe-pleural.
Isikhathi sokuthumela: Dec-20-2022
