重症超声基础

重症超声技能基础NeriL,etal.CritCareMed2007,35(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SinghM,etal.JUltrasoundMed2010,29:79–85.Lakhal,etal.AnesthAnalg2007,104(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LichtensteinDA,etal.Chest2008,134(1):117-25.LichtensteinDA.IntensiveCareMed2004,30:276–281.观察切面LongitudinalscanTransversalscan正常肺部的超声表现胸膜AlineA线待查1SartoriS,etal.WordJRadiol2010,2(2):83-90.LichtensteinDA.CritCareMed2007,35(5):S250-S261.正常肺部的超声表现Batsign肋骨胸膜A线正常肺部的超声表现LichtensteinDA.CritCareMed2007,35(5):S250-S261.2DM型Seashoresign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BouhemadB,etal.CriticalCare2007,11:205肺实变LichtensteinDA.IntensiveCareMed2004,30:276–281.InterstitialsyndromeB线肺炎ARDS心源性肺水肿肺泡蛋白沉积LichtensteinDA.PediatrCritCareMed2009,10(6):693-8.肺水肿BouhemadB,etal.CriticalCare2007,11:205气胸M型stratosphere2DLichtensteinDA.CritCareMed2005,33(6):1231-8.LichtensteinDA.CritCareMed2005,33(6):1231-8.吸气吸气呼气Lungpoint气胸诊断流程图VolpicelliG,etal.IntensiveCareMed2012,38:577–591.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BedsideUltrasoundinResuscitationandtheRapidUltrasoundinShockProtocol心脏基本切面-胸骨旁短轴LVRV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Fractinalshortening（FS）=[(EDD-ESD)/EDD]*100正常值30–45%SeifD,etal.CritCareResPract2012.心脏左室收缩功能-一维SeifD,etal.CritCareResPract2012.FAC（Fractionalareachangge）=（EDA-ESA）/EDA正常值35-65%心脏左室收缩功能-二维End-diastoleEnd-systole心脏左室收缩功能-三维正常值55%容量评估-LVEDALVEDALVESA收缩期收缩末舒张末舒张末容量评估-静态IVC直径RudskiLG,etal.JAmSocEchocardiogr2010,23(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%5-10mmHgRudskiLG,etal.JAmSocEchocardiogr2010,23(7):685-713.IVC变异率SeifD,etal.CritCareResPract2012.IVC变异率SeifD,etal.CritCareResPract2012.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.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-timeultrasound-guidedcatheterisationoftheinternaljugularvein:aprospectivecomparisonwiththelandmarktechniqueincriticalcarepatients超声介导组成功率高，并发症少Real-timeultrasound-guidedsubclavianveincannulationversusthelandmarkmethodincriticalcarepatients:Aprospectiverandomizedstudy*.CritCareMed2011Vol.39,No.7动脉穿刺DVT的识别SeifD,etal.CritCareResPract2012.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---FocusedAssessmentofSonographyforTraumaFAST1-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.EFAST---ExtendedFocusedAssessmentofSonographyforTraumaEFAST1-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PryncFlato1UA,etal.RevBrasTerIntensiva2010,22(3):291-299.实例