重症超声基础.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,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,R,eal-time ultrasound-guided catheterisation of the internal jugular,vein:a prospective comparison with the landmark technique in,critical 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,