Ngokusakazwa okuqhubekayo kwemishini ye-ultrasound, abasebenzi bezokwelapha abaningi ngokwengeziwe bangasebenzisa i-ultrasound ukwenza umsebenzi wokubuka.Ngaphansi kokubonwa kobuchwepheshe be-ultrasound, igagasi lokubhoboza kwe-ultrasound lingamaza ngemva kwamagagasi.Isibonelo, hhayi kuphela i-ultrasound ye-GE, i-Philips, i-Siemens, i-Esaote, i-Chison, ne-Sonoscape ethandwa kakhulu, kodwa ama-stents awo omhlahlandlela wokubhoboza afanayo nawo adumile emakethe.Inkampani yethu iyahlinzeka njengamanjeama-stents omhlahlandlela we-punctureyemikhiqizo emikhulu
Kodwa-ke, ngokusho kwezinye izimo zokusetshenziswa komtholampilo ezibonwa umbhali, ukuthandwa kwemishini ye-ultrasound kanye nokuthandwa kokubukwa kwe-ultrasound akukwazi ukulingana ngokuqondile.Thatha i-ultrasound-guided puncture emkhakheni wokufinyelela kwe-vascular njengesibonelo, abantu abaningi basesesimweni sokungazi, okungaholela kalula ezingozini zezokwelapha.Ngoba nakuba kwakukhona i-ultrasound, kwakungenakwenzeka ukubona ukuthi inaliti yokubhoboza yashonaphi.Inqubo yangempela yokubhoboza eqondiswa yi-ultrasound idinga kuqala ukuqinisekisa ukuthi indawo yenaliti noma ithiphu yenaliti ingabonakala ngaphansi kwe-ultrasound, kunokwenza isilinganiso esinzima, bese "i-puncture" ngaphansi kokuqondisa kwe-ultrasound.Ngokuvamile, kuhlanganisa izimo ezilandelayo:
Ukubhoboza okuqondiswa yi-Ultrasound ngokuvamile kuhlukaniswe ngezindlela ezimbili: ukubhoboza okusendizeni kanye nokubhoboza ngaphandle kwendiza.Womabili amasu okubhoboza anezimo ezisebenzayo emkhakheni wokufinyelela kwemithambo, futhi kungcono kakhulu ukuba nekhono kuzo.(Isigaba esilandelayo siyingcaphuno evela kumhlahlandlela wokuzijwayeza we-American Society of Ultrasound Medicine mayelana nokuhlinzwa kokufinyelela emithanjeni eqondiswa yi-ultrasound.)
Endizeni (i-eksisi ende) vs.Ngaphandle kwendiza (i-eksisi emfushane)
Endizeni/engaphandle kwendiza imele ubudlelwano obuhlobene nenaliti, inaliti ihambisana nendiza yokuthwebula ye-ultrasound esendizeni, futhi inaliti i-perpendicular endizeni ye-ultrasound imaging ingaphandle kwendiza.
Ngaphansi kwezimo ezijwayelekile, ukubhoboza kwendiza kubonisa i-eksisi ende noma ingxenye yobude bomthambo wegazi;ukubhoboza ngaphandle kwendiza kubonisa i-eksisi emfushane noma ingxenye enqamulayo yomkhumbi wegazi
Ngakho-ke, i-vascular access ultrasound defaults to out-of-plane/i-axis emfushane, futhi in-plane/i-eksisi ende yizilinganiso ezifanayo.
Inaliti ingashuthekwa ukusuka phezulu phakathi nendawo yomkhumbi wegazi ngaphandle kwendiza, kodwa ithiphu yenaliti kufanele ilandelelwe futhi ibekwe ngokuzungezisa uphenyo ukuze kugwenywe ukubukela phansi ukujula kwephuzu yenaliti.
Ukuma kwephuzu yenaliti kungabonwa ngezibalo endizeni, kodwa kulula "ukushelela" indiza lapho inaliti ikhona noma / kanye nendiza yesikhungo somkhumbi wegazi;ukubhoboza endizeni kulungele kakhulu imikhumbi emikhulu
Indlela ehlanganisiwe engaphakathi kwendiza/engaphandle kwendiza: ukuskena okungaphandle kwendiza/i-eksisi emfushane ukuze uqinisekise ukuthi ukubhobozwa kwethiphu yenaliti kufinyelela phakathi nendawo yomkhumbi, zungezisa uphenyo luye endizeni/i-eksisi ende ukuze kufakwe inaliti.
Isikhundla sesikhathi sangempela sethiphu yenaliti noma ngisho nomzimba wonke yenaliti ungabonwa ngezibalo endizeni, okusobala ukuthi kunenzuzo kakhulu!Kodwa-ke, ngaphandle kokusekelwa kwezinsiza ezinjengama-rocks okubhoboza, ngempela kuthatha amakhulukhulu wokuzijwayeza ukugcina inaliti endizeni yokuthwebula ye-ultrasound ukuze uphumelele amakhono.Ezimweni eziningi, ngenxa yokuthi i-engeli yokubhoboza inkulu kakhulu, inaliti yokubhoboza ibonakala ngokucacile endizeni ye-ultrasound, kodwa inaliti ayikabonakali.Kungani lokhu?
Ama-engeli okufaka inaliti enaliti yokubhoboza emfanekisweni ongezansi angu-17° no-13° ngokulandelana.Uma i-engeli ingu-13°, wonke umzimba yenaliti yenaliti yokubhoboza uboniswa ngokucacile.Uma i-engeli ingu-17°, umzimba yenaliti ungabonakala ngokungaqondakali.Kancane kancane, futhi lapho i-engeli inkulu, uzophuphuthekiswa kakhulu.Pho kungani kunomehluko we-engeli engu-4° kuphela, futhi kungani kunomehluko omkhulu kangaka ekusebenzeni kwenaliti yokubhoboza?
Lokhu futhi kufanele kuqale ngokukhishwa kwe-ultrasonic nokugxila kokwamukela.Njengokulawula kwembobo ekugxilweni kwezithombe, iphuzu ngalinye esithombeni liwumphumela wokugxila ohlangene wakho konke ukukhanya okudlula endaweni yokuvula, futhi iphuzu ngalinye elisesithombeni se-ultrasonic liwumphumela ohlanganisiwe wokugxila wawo wonke ama-transducer e-ultrasound ngaphakathi kwe-transmit kanye. thola izimbobo.Njengoba kuboniswe emfanekisweni ongezansi, ububanzi obumakwe ngomugqa obomvu uhla lwe-schematic lokugxila kokudluliselwa kwe-ultrasonic, futhi umugqa oluhlaza uhla lwe-schematic (umngcele ongakwesokudla) wokwamukela ukugxila.Ngenxa yokuthi inaliti ikhanya ngokwanele, ukucabangela okukhethekile kuzokwenzeka, futhi umugqa omhlophe uphawula isiqondiso esivamile sokubonakaliswa okukhethekile.Uma sicabanga ukuthi ububanzi bokugxila kokukhishwayo obumakwe ngomugqa obomvu bufana "nezibani" ezimbili, ngemva kokushaya indawo yesibuko yenaliti, "izibani" ezibonisiwe zifana nemigqa emibili ewolintshi esithombeni.Njengoba "ukukhanya" ngakwesokudla komugqa oluhlaza kudlula ububanzi bembobo eyamukelayo futhi akukwazi ukutholwa yi-probe, "ukukhanya" okungatholwa kuboniswa endaweni ewolintshi esithombeni.Kungabonakala ukuthi ku-17 °, i-probe isengathola ama-echoes ambalwa kakhulu e-ultrasonic, ngakho-ke isithombe esihambisanayo siyisithombe esibuthakathaka, futhi ku-13 °, ama-echoes angamukelwa angaphezu kuka-17 °.Isikhathi sanda kakhulu, ngakho-ke ukuthwebula izithombe nakho kucacile.Njengoba i-engeli yokubhoboza iyancipha, inaliti iba "flat", futhi ama-echoes avela emzimbeni wenaliti angamukelwa ngempumelelo, ngakho-ke ukubonwa kwenaliti kuba ngcono futhi kube ngcono.
Abanye abantu abacophelelayo bazophinde bathole into yokuthi uma i-engeli ingaphansi kwenani elithile (inaliti ayidingi ukuba "flat") ngokuphelele, ukuthuthukiswa komzimba wenaliti ngokuyisisekelo kugcina izinga elifanayo lokucaca.kuthiwani ngalokhu?Kungani ububanzi bokugxilwa kokudlulisa (umugqa obomvu) zidwetshwe buncane kunobubanzi bokugxilwa kokwamukela (umugqa oluhlaza) esithombeni esingenhla?Lokhu kungenxa yokuthi ohlelweni lokuthwebula izithombe lwe-ultrasound, ukugxila kokukhipha kungagxilwa kuphela ekujuleni okukodwa.Nakuba singakwazi ukulungisa ukujula kokugxila kokukhiphayo ukuze senze isithombe esiseduze nokujula kokunaka kwethu kucace kakhudlwana, asifuni indawo edlula ukujula kokugxila ifiphele kakhulu..Lokhu kuhluke kakhulu esidingweni sethu sokuthatha izithombe zamanzi ashukela zabesifazane abahle.Ifilimu yamanzi kashukela idinga ukuthi ingemuva nangaphambili elethwe imbobo enkulu kanye nokujula kwensimu konke kufiphalisiwe.Ngomfanekiso we-ultrasound, sithemba ukuthi izithombe ezisebangeni ngaphambi nangemuva kokujula kokugxila zicace ngokwanele, ngakho-ke singasebenzisa indawo encane yokukhipha umoya ukuze sithole ukujula kwenkambu enkulu, ukuze sigcine ukufana kwesithombe.Ngokuqondene nokugxila kokwamukela, ngenxa yokuthi izinhlelo zamanje ze-imaging ze-ultrasonic zenziwe ngedijithali ngokugcwele, ama-echoes we-ultrasonic we-transducer ngayinye / i-array element ingagcinwa, bese konke ukujula kwe-imaging kungacutshungulwa ngokuguquguqukayo ngezindlela zedijithali.Ukugxila okuqhubekayo, ngakho-ke ngalesi sikhathi, zama ukuvula indawo yokwamukela kaningi ngangokunokwenzeka, inqobo nje uma izakhi zohlelo ezingathola isignali ye-echo zisetshenziswa, ukuze uqinisekise ukuthi ukugxila okucolekile kanye nesixazululo esingcono kungatholakala.Emuva esihlokweni manje, lapho i-engeli yokubhoboza incane ngokwezinga elithile, amaza e-ultrasonic akhishwa imbobo encane angatholwa imbobo enkulu yokwamukela ngemva kokuboniswa ngumzimba yenaliti, ngakho umphumela wokuthuthukiswa komzimba yenaliti. ngokwemvelo izohlala ingashintshile..
Ngophenyo olungenhla, yini okufanele ngiyenze uma inaliti yokubhoboza ingabonakali ngemva kokuba i-angle yokubhoboza endizeni ingaphezu kuka-17 °?
Uma uhlelo luyisekela, ungazama umsebenzi wokuthuthukisa inaliti yokubhoboza ngalesi sikhathi.Okubizwa ngokuthi ubuchwepheshe bokuthuthukisa inaliti yokubhoboza ngokuvamile ukufaka ifreyimu yokuthwebula izithombe ephambukile kukho kokubili ukudlulisela nokwamukela ngemva kokuthi uhlaka oluvamile lwethishu luskeniwe.Isiqondiso sokuchezuka isiqondiso somzimba wenaliti, ukuze ukubonakaliswa komzimba wenaliti kubuyiselwe Igagasi liwela endaweni yokubeka lapho kugxilwe khona kakhulu ngangokunokwenzeka, futhi isithombe somzimba senaliti esiqinile esifanekisweni sokuchezuka siyakhishwa futhi kuboniswa ngemva kokuhlanganiswa nesithombe sethishu esivamile.Ngokuya ngosayizi nokuvama kwe-elementi yohlelo lokuhlola, i-engeli yokuchezuka ye-high-frequency linear probe ngokuvamile ayibi ngaphezu kuka-30°, ngakho i-engeli yokubhoboza ingaphezu kuka-30°.Ayikakaqhubekeli kulesi sigaba)
Okulandelayo, ake sibheke isimo sokubhoboza ngaphandle kwendiza.Ngemva kokuqonda isimiso sokuthuthukiswa kwezinaliti zokubhoboza ezingenhla, kuzoba lula kakhulu ukuhlaziya ukuthuthukiswa kwezinaliti zokubhoboza ngaphandle kwendiza.Ukushanela kwabalandeli okujikelezayo okukhulunywe ngakho kumhlahlandlela wokuzijwayeza kuyisinyathelo esibalulekile sokubhoboza ngaphandle kwendiza, okungasebenzi nje kuphela ekutholeni indawo yethiphu yenaliti, kodwa nasekutholeni isidumbu senaliti.Ukuthi nje inaliti yokubhoboza kanye nesithombe se-ultrasound akukho endizeni efanayo ngalesi sikhathi.Kuphela lapho inaliti yokubhoboza incike endizeni yokucabanga lapho isigameko samagagasi e-ultrasonic enaliti yokubhoboza singaboniswa emuva kuphenyo lwe-ultrasonic.Njengoba ukujiya kokuqondisa kwe-probe ngokuvamile kuwukugxila ngokomzimba kwelensi ye-acoustic, izimbobo zakho kokubili ukudlulisa nokwamukela ziyafana kule ndlela, futhi usayizi wembobo ububanzi be-wafer ye-transducer.Ububanzi be-array probe cishe bungu-3.5mm kuphela (imbobo yokwamukela yesithombe esisendizeni ngokuvamile ingaphezu kuka-15mm, okukhudlwana kakhulu kunobubanzi be-wafer).Ngakho-ke, uma i-echo ebonisiwe yenaliti yokubhoboza ngaphandle kwendiza iwukubuyela ku-probe, kuyadingeka kuphela ukuqinisekisa ukuthi inaliti yokubhoboza kanye ne-Engeli phakathi kwezindiza zokuthwebula iseduze namadigri angu-90.Ngakho uyehlulela kanjani i-engeli eqondile?Into enembile kakhulu "umsila wenkanyezi enomsila" omude odonsa ngemuva kwendawo ekhanyayo eqinile.Lokhu kungenxa yokuthi lapho amagagasi e-ultrasonic esenzeka enalini yokubhoboza ngokuqondile, ngaphezu kwama-echoes aboniswa ngokuqondile emuva ku-probe nge-surface yenaliti, inani elincane lamandla e-ultrasonic lingena yenaliti.Ukuboniswa okuningi emuva naphambili, kanye nokunanela okuningi okuboniswayo okukhonjiswa ohlangothini lwe-probe futhi, kuza kamuva, ukuze kwakheke "umsila wenkanyezi enomsila" omude.Uma inaliti ingaqondile endizeni yokucabanga, amaza omsindo avela emuva naphambili azobonakala kwezinye izinkomba futhi awakwazi ukubuyela ku-probe, ngakho-ke "umsila wenkanyezi enomsila" awukwazi ukubonakala.Isenzakalo somsila wenkanyezi enomsila asibonakali kuphela ekubhobozeni ngaphandle kwendiza, kodwa futhi ekubhobhozeni kwendiza.Uma inaliti yokubhoboza icishe ihambisane nendawo yokuhlola, imigqa yemigqa evundlile ingabonakala.Umsila weComet".
Ukuze ufanekisele ngokucacile "umsila wenkanyezi enomsila" ongaphakathi kwendiza nangaphandle kwendiza, sithatha ukusebenza kokuskena okungaphandle kwendiza nangaphakathi kwendiza ngezisekelo emanzini, futhi imiphumela iboniswa esithombeni. ngezansi.
Isibalo esingezansi sibonisa ukusebenza kwesithombe sama-engeli ahlukene uma umzimba wenaliti uphumile endizeni futhi ifeni ephendukayo iskenwa.Lapho i-probe i-perpendicular enaliti yokubhoboza, kusho ukuthi inaliti yokubhoboza incike endizeni yokucabanga ye-ultrasound, ngakho-ke ungabona "umsila wenkanyezi enomsila" osobala.
Gcina i-probe i-perpendicular enaliti yokubhoboza bese uyihambisa eduze nomzimba yenaliti uye echosheni yenaliti.Lapho "umsila wenkanyezi enomsila" uphela, kusho ukuthi isigaba sokuskena siseduze nephuzu yenaliti, futhi indawo ekhanyayo izonyamalala phambili phambili.Isikhundla ngaphambi kokunyamalala kwendawo ekhanyayo yilapho ichopho lonaliti likhona.Indawo.Uma ungakhululekile, shanela ifeni ene-engeli encane eduze kwale ndawo ukuze uqinisekise futhi.
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Isikhathi sokuthumela: Aug-17-2022
