重症超声基础课件.ppt
重症超声技能基础,Neri L, et al. Crit Care Med 2007, 35(5): S290-S304.,重症超声的应用,气道肺部循环血管检查与穿刺创伤筛查,气道管理肺部循环血管检查与穿刺创伤筛查,重症超声的应用,Singh M, et al. J Ultrasound Med 2010, 29:7985.,Lakhal, et al.Anesth Analg 2007,104(3):611-4.,超声在气道管理中的应用,气管插管前评估 确认气管导管位置 经皮扩张气管造口术 。,王俊安, 等. 国际麻醉与复苏杂志,32(5): 566-569.,气道管理肺部循环血管检查与穿刺创伤筛查,重症超声的应用,肺部超声探查部位,Lichtenstein DA,et al. Chest 2008,134(1):117-25.,Lichtenstein DA. Intensive Care Med 2004, 30: 276281.,观察切面,Longitudinal scan,Transversal scan,正常肺部的超声表现,胸膜,A line,A 线,待查 1,Sartori S, et al. Word J Radiol 2010, 2(2):83-90 .,Lichtenstein DA .Crit Care Med 2007,35(5):S250-S261.,正常肺部的超声表现,Bat sign,肋骨,胸膜,A线,正常肺部的超声表现,Lichtenstein DA .Crit Care Med 2007,35(5): S250-S261.,2D,M型,Seashore sign,肺部超声的动态表现,常见肺部疾病的超声表现,胸腔积液肺实变肺水肿气胸肺不张,胸腔积液,Bouhemad B,et al. Critical Care 2007, 11:205,肺实变,Lichtenstein DA. Intensive Care Med 2004, 30: 276281.,Interstitial syndrome,B线,肺炎ARDS心源性肺水肿肺泡蛋白沉积,Lichtenstein DA .Pediatr Crit Care Med 2009,10(6): 693-8.,肺水肿,Bouhemad B,et al. Critical Care 2007, 11:205,气 胸,M型,stratosphere,2D,Lichtenstein DA .Crit Care Med 2005,33(6):1231-8.,Lichtenstein DA .Crit Care Med 2005,33(6):1231-8.,吸气,吸气,呼气,Lung point,气胸诊断流程图,Volpicelli G, et al. Intensive Care Med 2012,38: 577591.,肺不张,气道管理肺部循环血管检查与穿刺创伤筛查,重症超声的应用,心脏基本切面 胸骨旁长轴,Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol,心脏基本切面-胸骨旁短轴,LV,RV,心脏基本切面,心尖四腔心,剑突下四腔心,心脏收缩功能,心脏左室收缩功能-一维,Fractinal shortening（FS）=(EDD-ESD)/EDD * 100正常值 3045%,Seif D, et al. Crit Care Res Pract 2012.,心脏左室收缩功能-一维,Seif D, et al. Crit Care Res Pract 2012.,FAC（Fractional area changge）=（EDA-ESA） /EDA 正常值 35-65%,心脏左室收缩功能-二维,End-diastole,End-systole,心脏左室收缩功能-三维,正常值 55%,容量评估-LVEDA,LVEDA,LVESA,收缩期,收缩末,舒张末,舒张末,容量评估-静态IVC直径,Rudski LG, et al. J Am Soc Echocardiogr 2010, 23(7):685-713.,IVC与RAP的关系,IVC直径 IVC塌陷率 RAP 2.1cm 50% 3mmHg 2.1cm 50% 15mmHg 2.1cm 50% 5-10mmHg,Rudski LG, et al. J Am Soc Echocardiogr 2010, 23(7):685-713.,IVC变异率,Seif D, et al. Crit Care Res Pract 2012.,IVC变异率,Seif D, et al. Crit Care Res Pract 2012.,动态IVC直径,自主呼吸 机械通气,容量反应性,Barbier C, et al.Intensive Care Med 2004,30(9):1740-6.,气道管理肺部循环血管检查与穿刺创伤筛查,重症超声的应用,超声介导下血管置管,Real-time ultrasound-guided catheterisation of the internal jugularvein: a prospective comparison with the landmark technique incritical care patients,超声介导组成功率高，并发症少,Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study*.Crit Care Med 2011 Vol. 39, No. 7,动脉穿刺,DVT的识别,Seif D, et al. Crit Care Res Pract 2012.,颈内静脉,颈总动脉,股动脉,股静脉,气道管理肺部循环血管检查与穿刺创伤筛查,重症超声的应用,FAST -Focused Assessment of Sonography for Trauma,FAST,1-肝肾间隙2-脾肾间隙3-盆腔4-剑突下心脏,Prync Flato1 UA, et al. Rev Bras Ter Intensiva 2010, 22(3):291-299.,EFAST -ExtendedFocused Assessment of Sonography for Trauma,EFAST,1-肝肾间隙2-右侧胸腔3-右肺4-脾肾间隙5-左侧胸腔6-左肺7-盆腔8-剑突下心脏,Prync Flato1 UA, et al. Rev Bras Ter Intensiva 2010, 22(3):291-299.,实 例,
