重症超声基础PPT参考幻灯片

重症超声技能基础,1,2,NeriL,etal.CritCareMed2007,35(5):S290-S304.,3,重症超声的应用,气道肺部循环血管检查与穿刺创伤筛查,4,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,5,SinghM,etal.JUltrasoundMed2010,29:7985.,6,Lakhal,etal.AnesthAnalg2007,104(3):611-4.,7,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.,8,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,9,肺部超声探查部位,LichtensteinDA,etal.Chest2008,134(1):117-25.,10,LichtensteinDA.IntensiveCareMed2004,30:276281.,11,观察切面,Longitudinalscan,Transversalscan,12,正常肺部的超声表现,胸膜,Aline,A线,待查1,SartoriS,etal.WordJRadiol2010,2(2):83-90.,13,LichtensteinDA.CritCareMed2007,35(5):S250-S261.,正常肺部的超声表现,Batsign,肋骨,胸膜,A线,14,正常肺部的超声表现,LichtensteinDA.CritCareMed2007,35(5):S250-S261.,2D,M型,Seashoresign,15,肺部超声的动态表现,16,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,17,胸腔积液,BouhemadB,etal.CriticalCare2007,11:205,18,肺实变,LichtensteinDA.IntensiveCareMed2004,30:276281.,19,Interstitialsyndrome,B线,肺炎ARDS心源性肺水肿肺泡蛋白沉积,LichtensteinDA.PediatrCritCareMed2009,10(6):693-8.,20,肺水肿,BouhemadB,etal.CriticalCare2007,11:205,21,气胸,M型,stratosphere,2D,LichtensteinDA.CritCareMed2005,33(6):1231-8.,22,LichtensteinDA.CritCareMed2005,33(6):1231-8.,吸气,吸气,呼气,Lungpoint,23,气胸诊断流程图,VolpicelliG,etal.IntensiveCareMed2012,38:577591.,24,肺不张,25,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,26,心脏基本切面胸骨旁长轴,BedsideUltrasoundinResuscitationandtheRapidUltrasoundinShockProtocol,27,心脏基本切面-胸骨旁短轴,LV,RV,28,心脏基本切面,心尖四腔心,剑突下四腔心,29,心脏收缩功能,30,心脏左室收缩功能-一维,Fractinalshortening（FS）=(EDD-ESD)/EDD*100正常值3045%,SeifD,etal.CritCareResPract2012.,31,心脏左室收缩功能-一维,SeifD,etal.CritCareResPract2012.,32,FAC（Fractionalareachangge）=（EDA-ESA）/EDA正常值35-65%,心脏左室收缩功能-二维,End-diastole,End-systole,33,心脏左室收缩功能-三维,正常值55%,34,容量评估-LVEDA,LVEDA,LVESA,35,收缩期,收缩末,舒张末,舒张末,36,容量评估-静态IVC直径,RudskiLG,etal.JAmSocEchocardiogr2010,23(7):685-713.,37,IVC与RAP的关系,IVC直径IVC塌陷率RAP2.1cm50%3mmHg2.1cm50%15mmHg2.1cm50%5-10mmHg,RudskiLG,etal.JAmSocEchocardiogr2010,23(7):685-713.,38,IVC变异率,SeifD,etal.CritCareResPract2012.,39,IVC变异率,SeifD,etal.CritCareResPract2012.,40,动态IVC直径,自主呼吸机械通气,容量反应性,BarbierC,etal.IntensiveCareMed2004,30(9):1740-6.,41,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,42,超声介导下血管置管,Real-timeultrasound-guidedcatheterisationoftheinternaljugularvein:aprospectivecomparisonwiththelandmarktechniqueincriticalcarepatients,43,超声介导组成功率高，并发症少,Real-timeultrasound-guidedsubclavianveincannulationversusthelandmarkmethodincriticalcarepatients:Aprospectiverandomizedstudy*.CritCareMed2011Vol.39,No.7,44,45,46,动脉穿刺,47,DVT的识别,SeifD,etal.CritCareResPract2012.,颈内静脉,颈总动脉,股动脉,股静脉,48,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,49,FAST-FocusedAssessmentofSonographyforTrauma,FAST,1-肝肾间隙2-脾肾间隙3-盆腔4-剑突下心脏,PryncFlato1UA,etal.RevBrasTerIntensiva2010,22(3):291-299.,50,51,EFAST-ExtendedFocusedAssessmentofSonographyforTra