重症超声基础ppt课件.ppt

1、重症超声技能基础,1,2,Neri L, et al. Crit Care Med 2007, 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,Singh M, et al. J Ultrasound Med 2010, 29:7985.,6,Lakhal, et al.Anesth Analg 2007,104(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): 56

2、6-569.,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,Lichtenstein DA,et al. Chest 2008,134(1):117-25.,10,Lichtenstein DA. Intensive Care Med 2004, 30: 276281.,11,观察切面,Longitudinal scan,Transversal scan,12,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 .,13,Lichtenstein

3、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,14,正常肺部的超声表现,Lichtenstein DA .Crit Care Med 2007,35(5): S250-S261.,2D,M型,Seashore sign,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,Bouhemad B,et al. Critical Care 2007, 11:205,18,肺实变,Lichtenstein DA. Intensive Care Med 2

4、004, 30: 276281.,19,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.,20,肺水肿,Bouhemad B,et al. Critical Care 2007, 11:205,21,气 胸,M型,stratosphere,2D,Lichtenstein DA .Crit Care Med 2005,33(6):1231-8.,22,Lichtenstein DA .Crit Care Med 2005,33(6):12

5、31-8.,吸气,吸气,呼气,Lung point,23,气胸诊断流程图,Volpicelli G, et al. Intensive Care Med 2012,38: 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,Bedside Ultrasound in Resuscitation and the Rapid Ultrasound in Shock Protocol,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

6、,Fractinal shortening（FS）=(EDD-ESD)/EDD * 100 正常值 3045%,Seif D, et al. Crit Care Res Pract 2012.,31,心脏左室收缩功能-一维,Seif D, et al. Crit Care Res Pract 2012.,32,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,33,心脏左室收缩功能-三维,正常值 55%,34,容量评估-LVEDA,LVEDA,LVESA,35,

7、收缩期,收缩末,舒张末,舒张末,36,容量评估-静态IVC直径,Rudski LG, et al. J Am Soc Echocardiogr 2010, 23(7):685-713.,37,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.,38,IVC变异率,Seif D, et al. Crit Care Res Pract 2012.,39,IVC变异率,Se

8、if D, et al. Crit Care Res Pract 2012.,40,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.,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-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in c

9、ritical care patients,43,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. 7,44,45,46,动脉穿刺,47,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,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 -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.,50,51,EFAST -ExtendedFocused Assessment of Sonography for Traum