Sieu am tm chi duoi
Transcript of Sieu am tm chi duoi
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DOPPLER TÓNH MAÏCH NGOAÏI BIEÂN
(PERIPHERAL VESSELS)
BS NGUYEÃN QUANG THAÙI DÖÔNG
BOÄ MOÂN CÑHA ÑAÏI HOÏC Y DÖÔÏC TPHCM
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ANATOMY
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CHÆ ÑÒNH TRONG DOPPLER TÓNH MAÏCH NGOAÏI BIEÂN
• Xaùc ñònh taéc ngheõn do maùu cuïc caáp hoaëc maïn (acute or chronic thrombosed)
• Beänh lyù tónh maïch (ie. Suy tónh maïch, dò daïng tónh maïch baåm sinh, doø...)
• Ñaùnh giaù tónh maïch trong gheùp noái : venous mapping ñaùnh giaù tónh maïch cho gheùp maïch maùu töï thaân (autologous grafts)
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CAÙC KYÕ THUAÄT• Ñaàu doø: phaúng- 5-10Mhz vaø cong 3-5
Mhz• Caùc maët caét ngang vaø doïc theo maïch
maùu• Duøng sieâu aâm B mode vaø Doppler • Kyõ thuaät eùp maïch maùu (compression)• Taêng löôïng maùu hoài löu (augmentation)• Cheøn eùp döôùi doøng (proximal
compression)• Test Valsalva• Test sniffing
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Chuaån bò beänh nhaân Tö Theá Khaûo Saùt
• BN: neân côûi quaàn daøi khi khaûo saùt
• Naèm ñaàu cao, chaân dang ngoaøi vaø xoay ngoaøi nheï, ñaàu goái hôi co
• Ngoài saùt thaønh giöôøng thaû loûng chaân
• Ñöùng treân chaân ñoái dieän vôùi chaân ñöôïc khaûo saùt
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B mode
Ñaùnh giaù thaønh tónh maïch vaø ñöôøng kính tónh maïch
Ñaùnh giaù van tónh maïchPhaùt hieän huyeát khoái (vò trí, möùc ñoä
phaûn aâm, coù keøm voâi hoùa…) Phaùt hieän nhöõng toån thöông ngoaøi maïch
maùu (ie. Haïch, nang hoaït dòch, u cheøn eùp töø beân ngoaøi…)
Ñaùnh giaù möùc ñoä phuø vuøng moâ döôùi daÑaùnh giaù söï thay ñoåi kích thöôùc tónh maïch
khi aùp duïng caùc nghieäm phaùp nhö Valsalva, cheøn eùp, sniffing…)
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Doppler mode
• Ñaùnh giaù huyeát ñoäng tónh maïch• - tính thoâng thoaùng (fill-in color)• - thay ñoåi pha theo hoâ haáp (respiratory
phasicity)• - thay ñoåi treân spectral Doppler khi aùp
duïng caùc nghieäm phaùp nhö Valsalva, augmentation, hoaëc proximal compression
• Ño thôøi gian traøo ngöôïc hoaëc vaän toác traøo ngöôïc treân Doppler phoå
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Nghieäm phaùp cheøn eùp (compression)
• Ñaùnh giaù tröïc tieáp tính thoâng thoaùng (patency) taïi vò trí khaûo saùt
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Thay Ñoåi Pha theo hoâ haáp (respiratory phasicity)
• Ñaùnh giaù giaùn tieáp tính thoâng thoaùng (patency) töø vò trí khaûo saùt tôùi vuøng tim phaûi
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THÔÛ VAØ NGHIEÄM PHAÙP VALSALVA / HUYEÁT ÑOÄNG HOÏC
TÓNH MAÏCH
• Hít vaøo (inspiration): P trong ngöïc giaûm, P oå buïng taêng-> maùu tónh maïch veà tim giaûm ( chi döôùi)
• Ngöôïc laïi ñoái vôùi thôû ra
• Hít saâu nín thôû vaø taêng aùp buïng (deep breath and bear down)--> taêng aùp löïc oå buïng vaø ngöïc
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TAÊNG HOÀI LÖU (AUGMENTATION)vaø EÙP VUØNG HAÏ LÖU (PROXIMAL
COMPRESSION)
• TAÊNG HOÀI LÖU : Boùp (squeezing) vuøng döôùi vò trí khaûo saùt (thöôïng löu-distal compression) --->taêng tính hieäu Doppler
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Cheøn EÙp Vuøng Haï Löu (Proximal Compression)
• Ñaùnh giaù tình traïng Valve naèm giöõa vò trí ñeå ñaàu doø vaø vuøng bò cheøn eùp
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