Isimo somhlaba wonke sesifo sezinso esingamahlalakhona
Ucwaningo lwe-Epidemiological lubonise ukuthi isifo sezinso esingamahlalakhona sesiphenduke esinye sezifo ezisongela impilo yomphakathi emhlabeni wonke.Eminyakeni yamuva, izibalo zibonisa ukuthi emazweni athuthukile (njenge-United States ne-Netherlands), cishe amaphesenti angu-6.5 kuya kwayi-10 abantu abaningi banamazinga ahlukene esifo sezinso, okuyisibalo saso sesifo sezinso e-United States. idlule ezigidini ezingu-20, futhi izibhedlela zelapha iziguli ezinesifo sezinso ezingaphezu kwesigidi esisodwa unyaka ngamunye.Isibalo esiphelele seziguli ezinesifo sezinso esisezingeni lokugcina eChina nalo liyakhula, futhi kulindeleke ukuthi isibalo seziguli ezinesifo sezinso esisekupheleni eChina sizodlula izigidi ezi-4 ngo-2030.
I-Hemodialysis (i-HD) ingenye yezindlela zokwelapha zokubuyisela izinso ezigulini ezinokwehluleka okukhulu kwezinso okungamahlalakhona.
Ukusungulwa kokufinyelela okusebenzayo kwemithambo kuyisidingo sokuqhubeka kahle kwe-hemodialysis.Izinga lokufinyelela kwemithambo lithinta ngqo ikhwalithi ye-dialysis kanye nempilo yeziguli.Ukusetshenziswa okufanele nokuvikelwa ngokucophelela kokufinyelela kwe-vascular akukwazi nje ukwandisa impilo yesevisi yokufinyelela kwe-vascular, kodwa futhi kwandise impilo yeziguli ze-dialysis, ngakho ukufinyelela kwe-vascular kubizwa ngokuthi "umugqa wokuphila" weziguli ze-dialysis.
Ukusetshenziswa komtholampilo kwe-ultrasound ku-AVF
Ochwepheshe beqembu lokufinyelela kwe-vascular bakholelwa ukuthi i-AVF kufanele ibe yisinqumo sokuqala sokufinyelela kwe-vascular.Ngenxa yokungavuseleleki, inani elilinganiselwe lemithombo ye-vascular, futhi ayikwazi ukushintshwa ngokuphelele, ukuze kwandiswe impilo yesevisi yokufinyelela kwesiguli, ukusetshenziswa okujwayelekile nokugcinwa kwe-arteriovenous fistula, futhi ngokuphumelelayo ukugwema izinkinga ezihlobene nokubhoboza yizinkinga zidonse ukunaka kwabelaphi nabahlengikazi.
Ukusungula ukuhlolwa kwe-vascular preoperative ye-arteriovenous fistula (AVF)
I-1) Kungakhathaliseki ukuthi imithwalo yegazi ijwayelekile: i-tortuosity, i-stenosis ne-dilatation
2) ukuthi udonga lomkhumbi lubushelelezi, noma kukhona i-plaque echo, noma ngabe kukhona ukuphuka noma ukukhubazeka, nokuthi ingabe kukhona ukuhlukana
3) kungakhathaliseki ukuthi kukhona ama-thrombi namanye ama-echoes ku-lumen
4) Ukuthi ukugcwaliswa kokugeleza kwegazi kombala kuqedile nokuthi isiqondiso nesivinini sokugeleza kwegazi akujwayelekile
5) Ukuhlolwa kokugeleza kwegazi
Isithombe sibonisa uSolwazi Gao Min elapha isiguli eceleni kombhede
Ukuqapha i-fistula yangaphakathi
Njengoba ukusungulwa kwe-fistula yangaphakathi ezigulini kuyisinyathelo sokuqala "sohambo olude", i-AVF ngaphambi kokusebenzisa isilinganiso se-ultrasonic ububanzi be-vascular kanye nokugeleza kwegazi ngokwemvelo, lapho kuhlolwa i-fistula ingaba nezindinganiso ezivuthiwe, ukukala ukuthi iziguli ezine-fistula idatha esebenzisa okujwayelekile, i-ultrasound ngokungangabazeki iyindlela enembile nenembile kakhulu.
Ukuqapha kwe-AVF: Ukuqapha kwe-Ultrasound kwenziwa kanye ngenyanga
1) Ukugeleza kwegazi
2) Ububanzi bomkhumbi
3) Ukuthi i-anastomosis incane futhi ngabe kukhona i-thrombosis (uma kukhona i-thrombosis, kuyadingeka ukwandisa ibhaluni)
Ukwahlulela okuvuthiwe kwe-autogenous arteriovenous fistula
Kungakhathalekile ukuthi yisiphi isikhathi esinconyiwe sokuqala ukubhoboza, imfuneko kufanele ibe ngemva kokuba i-fistula yangaphakathi isivuthiwe.
Ngokuvamile kunenkolelo yokuthi ukuvuthwa kwe-fistula yangaphakathi kufanele kuhlangabezane nemibandela emithathu “ye-6”:
1) ukugeleza kwe-arteriovenous fistula > 600ml/min (ukuvumelana kochwepheshe baseShayina ngo-2019 ngokufinyelela kwemithambo ye-hemodialysis: > 500 ml/min)
2) ububanzi bomthambo wokubhoboza > 6mm (imvumelwano yochwepheshe baseShayina ka-2019 ngokufinyelela kwemithambo ye-hemodialysis: > 5 mm)
3) Ukujula kwe-venous subcutaneous & LT;6mm, futhi kufanele kube nebanga elanele lokubhoboza imithambo yegazi ukuze kuhlangatshezwane nokusetshenziswa kwe-hemodialysis.
Ezimweni eziningi, i-arteriovenous fistulas enemithambo ezwakalayo kanye nokundindizela okuhle kungaba yimpumelelo kungakapheli amasonto ama-4 esungulwe.
Ukuhlola nokugcinwa
Kubaluleke kakhulu ukuhlola njalo nokuqapha izinkomba zomtholampilo ze-arteriovenous fistula nokwanela kwe-hemodialysis ngemva kokuhlinzwa.
Ukuhlola okuhle nezindlela zokuqapha zihlanganisa
① Finyelela ekuqaphelweni kokugeleza kwegazi: kuyanconywa ukuthi ugade kanye ngenyanga;
② Ukuhlolwa ngokomzimba: kunconywa ukuthi yonke i-dialysis kufanele ihlolwe, kuhlanganise nokuhlolwa, ukushaywa kwenhliziyo kanye ne-auscultation;
③ I-Doppler ultrasound: Kunconywa kanye njalo ezinyangeni ezi-3;
④ Indlela yokuhlanjululwa okungeyona i-urea iyanconywa ukukala ukugaywa kabusha kanye njalo ezinyangeni ezi-3;
⑤ Ukutholwa kwengcindezi ye-venous eqondile noma engaqondile kuyanconywa kanye njalo ezinyangeni ezi-3.
Uma i-AVF ye-autologous ingasungulwa, ukukhetha kwesibili kufanele kube i-graft internal fistula (AVG).Kungakhathaliseki ukuthi kusungulwe i-AVF noma i-AVG, i-ultrasound ibalulekile ekuhlolweni kwangaphambi kokuhlinzwa kwemithambo yegazi, isiqondiso sangaphakathi sokuhlinzwa sokubhoboza, ukuhlolwa kwangemva kokuhlinzwa nokugcinwa.
I-PTA yenziwa ngaphansi kokuqondiswa kwe-ultrasound
Inkinga engenakugwemeka ye-arteriovenous fistula yi-stenosis.Ukugeleza kwegazi okuhamba ngesivinini eside isikhathi eside kungabangela i-hyperplasia esebenzayo ye-venous intima ye-fistula yangaphakathi, okuholela e-vascular stenosis nokugeleza kwegazi okwanele, okuthinta umphumela we-dialysis, futhi kuholele ekuvinjweni kwe-fistula, i-thrombosis kanye nokwehluleka lapho i-stenosis inzima.
Njengamanje ukuhlinzwa okujwayelekile kokwelashwa kwe-fistula stenosis yangaphakathi ye-ultrasound eqondiswa i-arteriovenous fistula stenosis ku-keratoplasty (PTA), ukwelashwa kwebhaluni nge-biopsy yesikhumba ezigulini ezine-fistula emithanjeni yegazi, ekunwebeni kwebhaluni le-catheter, ngaphansi kokuqondisa kwe-ultrasound ukunwetshwa kwendawo ye-vascular stenosis, lungisa izingxenye eziwumngcingo, ubuyisele ububanzi obujwayelekile bomkhumbi wegazi, ukuze kwandiswe impilo yesevisi yeziguli ezine-fistula yangaphakathi ye-arteriovenous.
I-PTA ngaphansi kokuqondisa kwe-ultrasound, ilungele, akukho monakalo wemisebe, akukho monakalo we-ejenti ehlukile, ingabonisa nezilonda ze-vascular occlusion ezungeze isimo, imingcele yokugeleza kwegazi elinganiselwe futhi ihlole ukugeleza kwegazi, futhi ingaba ngokushesha ngemva kwempumelelo njenge-vascular. ukufinyelela kwe-hemodialysis, akudingi i-catheter yesikhashana, ephephile, ephumelelayo kanye nezici zokuhlukumezeka okuncane, ukululama ngokushesha, ukunciphisa ubuhlungu besiguli, Inqubo yokucubungula yenziwe lula.
Ukusetshenziswa komtholampilo kwe-ultrasound ku-central venous catheterization
Ngaphambi kokusungula i-catheter ye-venous ephakathi, i-ultrasound kufanele isetshenziselwe ukuhlola isimo somthambo wangaphakathi we-jugular noma i-femoral vein, ikakhulukazi ezigulini ezinomlando we-intubation yangaphambilini, futhi i-ultrasound kufanele isetshenziselwe ukuhlola i-vein stenosis noma i-occlusion.Ngaphansi kokuqondiswa kwe-ultrasound, i-ultrasound, njengoba "iso lesithathu" likadokotela, lingabona ngokucacile nangokweqiniso.
1) Linganisa ububanzi, ukujula kanye ne-patency yomthambo wokubhoboza
2) Inaliti yokubhoboza emthanjeni wegazi ingabonwa ngeso lengqondo
I-3) Ukuboniswa kwesikhathi sangempela kwe-trajectory yenaliti emkhunjini wegazi ukuze ugweme ukulimala okusondelene
4) Gwema ukuvela kwezinkinga (ukubhoboza umthambo ngengozi, ukwakheka kwe-hematoma noma i-pneumothorax)
5) Ukuthuthukisa izinga lokuphumelela kokubhoboza kokuqala
Ukusetshenziswa komtholampilo kwe-ultrasound ku-peritoneal dialysis catheterization
I-Peritoneal dialysis iwuhlobo lokwelapha lokubuyisela izinso, olusebenzisa kakhulu isimo se-peritoneum yayo ukwenza ukwelashwa kokubuyisela izinso.Uma kuqhathaniswa ne-hemodialysis, inezici zokusebenza okulula, i-self-dialysis kanye nokuvikelwa okuphezulu kokusebenza kwezinso ezisele.
Ukukhethwa kokubekwa kwe- peritoneal dialysis catheter ebusweni bomzimba kuyisinyathelo esibaluleke kakhulu ekusungulweni kokungena kwe-peritoneal dialysis okungavinjelwe.Ukuze kugcinwe amandla okukhipha amanzi e-peritoneal dialysis futhi kuncishiswe ukuvela kwezinkinga ze-catheterization, kuyadingeka ukujwayelana nesakhiwo se-anatomical sodonga lwangaphambili lwesisu bese ukhetha indawo yokufaka efanelekile kakhulu ye-peritoneal dialysis catheter.
Ukubekwa kwe-Percutaneal dialysis catheter ngaphansi kokuqondiswa kwe-ultrasound kuhlasela kancane, ukonga, kulula ukusebenza, kuphephe kakhulu, kunembile futhi kunokwethenjelwa.
I-SonoEye palmar ultrasonication yasetshenziselwa ukufinyelela kwemithambo
I-SonoEye iyaphatheka kakhulu futhi incane, ayihlali endaweni eseceleni kombhede, kulula ukuyihlola, ingaxhumeka ngqo ocingweni noma kuthebhulethi, vula uhlelo lokusebenza nganoma yisiphi isikhathi.
Isithombe sibonisa uSolwazi Gao Min elapha isiguli eceleni kombhede
I-Chison palm ultrasound inezithombe zokuxilonga futhi ifakwe iphakethe elihlakaniphile lokulinganisa ukugeleza kwegazi, elizivala ngokuzenzakalelayo futhi linikeze imiphumela yokugeleza kwegazi.
I-Ultrasound-guided puncture ye-fistula yangaphakathi ingathuthukisa kakhulu izinga lokuphumelela lokubhoboza futhi inciphise izehlakalo zezinkinga ezifana ne-hematoma kanye ne-pseudoaneurysm.
Siyakwamukela ukuthi uxhumane nathi ukuze uthole imikhiqizo yezokwelapha nolwazi oluthe xaxa.
Imniningwano Yokuxhumana
Icy Yi
Inkampani Amain Technology Co., Ltd.
Mob/WhatsApp: 008617360198769
E-mail: amain006@amaintech.com
I-Linkedin: 008617360198769
Ucingo: 00862863918480
Isikhathi sokuthumela: Nov-03-2022
