重视超声技术在围术期医学和疼痛医学中的应用研究
|
摘要
便携式超声设备和床旁超声技术的发展促进了超声技术在麻醉与疼痛医学领域应用。围术期医学和疼痛医学临床,超声主要用于评估血容量和容量反应性、气道、肺和胃容积、区域麻醉影像引导工具和慢性疼痛诊疗。经食管超声心动图主要用于获得心脏解剖、病理和心功能信息。对经胸超声不能获得满意图像及左心耳部血栓、感染性心内膜炎、主动脉夹层、术中监测等尤其优势。超声技术的应用提高了围术期医学和疼痛医学临床诊疗的准确性和安全性,改善了围术期医学和疼痛医学的医疗质量。
The development of portable ultrasound equipment and point-of-care ultrasonography has promoted the application of ultrasound technology in the field of anesthesia and pain medicine.ultrasound is primarily used to evaluate blood volume and volume responsiveness,airway,lung and stomach volume,as imaging guidance tools for regional anesthesia and chronic pain management in perioperative and pain clinics. Transesophageal echocardiography is mainly used to obtain the information of cardiac anatomy,pathology and cardiac function. It is especially advantageous for the unsatisfactory image obtained by transthoracic ultrasound,left auricular thrombosis,infective endocarditis,aortic dissection,intraoperative monitoring,etc. The application of ultrasound technology improves the accuracy and safety of perioperative and pain medical diagnosis and treatment,and improves the quality of perioperative and pain medical treatment.
The development of portable ultrasound equipment and point-of-care ultrasonography has promoted the application of ultrasound technology in the field of anesthesia and pain medicine.ultrasound is primarily used to evaluate blood volume and volume responsiveness,airway,lung and stomach volume,as imaging guidance tools for regional anesthesia and chronic pain management in perioperative and pain clinics. Transesophageal echocardiography is mainly used to obtain the information of cardiac anatomy,pathology and cardiac function. It is especially advantageous for the unsatisfactory image obtained by transthoracic ultrasound,left auricular thrombosis,infective endocarditis,aortic dissection,intraoperative monitoring,etc. The application of ultrasound technology improves the accuracy and safety of perioperative and pain medical diagnosis and treatment,and improves the quality of perioperative and pain medical treatment.
引文
[1] Moore CL,Copel JA. Point-of-care ultrasonography[J]. N Engl J Med,2011,364(8):749-757. DOI:10. 1056/NEJMra0909487.
[2]程智刚,郭曲练,黄长盛.加强疼痛基础与临床研究,促进疼痛医学发展[J].中国医师杂志,2016,18(4):481-486. DOI:10. 3760/cma. j. issn. 1008-1372. 2016. 04. 001.
[3]郭曲练,程智刚,王云姣.重视麻醉与疼痛医学的基础与临床研究[J].中国医师杂志,2014,16(12):1585-1589. DOI:10. 3760/cma. j. issn. 1008-1372. 2014. 12. 001.
[4] Beaulieu Y. Bedside echocardiography in the assessment of the critically ill[J]. Crit Care Med,2007,35(5 Suppl):S235-S249.DOI:10. 1097/01. CCM. 0000260673. 66681. AF.
[5]刘娜,李文强,高成伟.下腔静脉直径和呼吸变异指数评估容量状态的Meta分析[J].临床急诊杂志,2016,17(6):466-469,473.
[6] Lanspa MJ,Grissom CK,Hirshberg EL,et al. Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock:reply[J]. Shock,2013,39(5):462. DOI:10. 1097/SHK. 0b013e318291008e.
[7] Preau S,Bortolotti P,Colling D,et al. Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure[J]. Crit Care Med,2017,45(3):e290-e297.DOI:10. 1097/CCM. 0000000000002090.
[8] Corl KA,George NR,Romanoff J,et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients[J]. J Crit Care,2017,41:130-137.DOI:10. 1016/j. jcrc. 2017. 05. 008.
[9]黄昌云,韩晓雨,方攀攀,等.超声测量下腔静脉内径快速评估老年患者术前血容量的价值[J].临床麻醉学杂志,2018,34(12):1157-1160. DOI:10. 12089/jca. 2018. 12. 003.
[10]杨广宇,郑重,祁富伟,等.超声检测下腔静脉参数在评估椎管内麻醉围术期容量状态中的临床意义[J].中国医师杂志,2018,20(11):1704-1707. DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 11. 026.
[11]张帆,郑泽兵,杨海香,等.超声快速容量评估法对麻醉恢复室胸科患者容量治疗及其预后影响的研究[J].吉林医学,2018,39(8):1528-1529. DOI:10. 3969/j. issn. 1004-0412.2018. 08. 054.
[12] Schiff JH,Welker A,Fohr B,et al. Major incidents and complications in otherwise healthy patients undergoing elective procedures:results based on 1. 37 million anaesthetic procedures[J]. Br J Anaesth,2014,113(1):109-121. DOI:10. 1093/bja/aeu094.
[13] Adhikari S,Zeger W,Schmier C,et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy[J]. Acad Emerg Med,2011,18(7):754-758.DOI:10. 1111/j. 1553-2712. 2011. 01099. x.
[14] Hui CM,Tsui BC. Sublingual ultrasound as an assessment method for predicting difficult intubation:a pilot study[J]. Anaesthesia,2014,69(4):314-319. DOI:10. 1111/anae. 12598.
[15]章艳君,徐魏军,刘金柱,等.超声法确定新生儿气管插管位置的准确性[J].中华麻醉学杂志,2018,38(10):1238-1240.DOI:10. 3760/cma. j. issn. 0254-1416. 2018. 10. 021.
[16] Alzahrani SA,Al-Salamah MA,Al-Madani WH,et al. Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia[J]. Crit Ultrasound J,2017,9(1):6. DOI:10. 1186/s13089-017-0059-y.
[17] Yousefifard M,Baikpour M,Ghelichkhani P,et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis[J]. Emerg(Tehran),2016,4(1):1-10.
[18] Blumhof S,Wheeler D,Thomas K,et al. Change in Diaphragmatic Thickness During the Respiratory Cycle Predicts Extubation Success at Various Levels of Pressure Support Ventilation[J]. Lung,2016,194(4):519-525. DOI:10.1007/s00408-016-9911-2.
[19]王玲,拉佈旦白拉,于建设.超声在麻醉领域的应用[J].内蒙古医科大学学报,2017,39(6):569-574.
[20]刘湘钰,黄穗葵,邓瑞华. B超引导下腰丛复合坐骨神经阻滞麻醉对老年股骨粗隆间骨折患者麻醉效果与免疫功能的影响[J].中国医师杂志,2018,20(11):1689-1692. DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 11. 021.
[21]音樱,章敏,疏树华,等.超声引导下改良髂筋膜间隙阻滞在老年股骨近端骨折麻醉中的应用[J].临床麻醉学杂志,2018,34(7):660-664. DOI:10. 12089/jca. 2018. 07. 009.
[22] Ktlk A,Erdogan MA,Ozgul U,et al. Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors:A prospective,randomized,double-blinded clinical trial[J]. J Clin Anesth,2017,37:103-107. DOI:10. 1016/j.jclinane. 2016. 12. 018.
[23]范俊柏,高旭琴,秦文艳.超声引导下椎旁神经阻滞对乳腺癌根治术患者镇痛效果的研究[J].肿瘤研究与临床,2019,31(1):36-40. DOI:10. 3760/cma. j. issn. 1006-9801. 2019. 01. 008.
[24]靳红绪,张同军,孙学飞,等.超声引导下连续胸椎旁神经阻滞对乳腺癌根治术患者术后慢性疼痛的影响[J].中国医药,2018,13(7):1059-1062. DOI:10. 3760/j. issn. 1673-4777.2018. 07. 025.
[25]王瑞珂,李春玲,段彬,等.超声引导下骶管阻滞用于日间在直肠超声引导经会阴途径穿刺活检术的临床研究[J].中国医师杂志,2018,20(4):490-492. DOI:10. 3760/cma. j. issn.1008-1372. 2018. 04. 003.
[26]耿姣,李民,郭向阳.脊柱畸形老年患者超声引导椎管内麻醉成功实施1例[J].中华麻醉学杂志,2018,38(10):1273-1274. DOI:10. 3760/cma. j. issn. 0254-1416. 2018. 10. 031.
[27]耿姣,陈宣伶,王雪冬,等.超声辅助定位可提高老年患者椎管内麻醉一次穿刺成功率[J].中华医学杂志,2016,96(43):3459-3463. DOI:10. 3760/cma. j. issn. 0376-2491. 2016. 43. 004.
[28] Leslie K,Myles P,Devereaux P,et al. Neuraxial block,death and serious cardiovascular morbidity in the POISE trial[J]. Br J Anaesth,2013,111(3):382-390. DOI:10. 1093/bja/aet120.
[29] Perlas A,Davis L,Khan M,et al. Gastric sonography in the fasted surgical patient:a prospective descriptive study[J]. Anesth Analg,2011,113(1):93-97. DOI:10. 1213/ANE. 0b013e31821b98c0.
[30] Finlayson RJ,Gupta G,Alhujairi M,et al. Cervical medial branch block:a novel technique using ultrasound guidance[J].Reg Anesth Pain Med,2012,37(2):219-223. DOI:10. 1097/AAP. 0b013e3182374e24.
[31]李晓勤,顾楠,吕琳,等.超声引导下外侧膝眼进针膝关节腔注射与盲法膝关节腔注射的对照研究[J].中国疼痛医学杂志,2016,22(11):838-841. DOI:10. 3969/j. issn. 1006-9852.2016. 11. 009.
[32]樊朝美,孟宪强,程克正,王国干,杨浣宜,刘汉英.术中经食管超声技术在心脏外科中的应用[J].中国循环杂志,1994,9(2):92-94,127-128.
[33]周平安,刁杰,张小宾,等.经食管超声心动图评估冠心病患者PCI术后左心室功能和收缩同步性的价值[J].心脑血管病防治,2018,18(6):511-512,523. DOI:10. 3969/j. issn. 1009-816x. 2018. 06. 023.
[34]徐新华,詹樾,江亚平,胡建国.术中经食管彩色多普勒超声心动图实时评价二尖瓣成形术[J].中国超声医学杂志,1994,10(9):32-33.
[35]窦志,谢琦,翁国星,等.经胸超声与经食管超声引导下经皮房间隔缺损封堵术的比较研究[J].中华胸心血管外科杂志,2018,34(9):522-526. DOI:10. 3760/cma. j. issn. 1001-4497.2018. 09. 003.
[36]赵星,王浩,逄坤静,等.经食管超声微探头在低体重儿心脏外科手术中的应用[J].中西医结合心血管病电子杂志,2017,5(12):53-54.
[37]秦芸芸.经食管实时三维超声心动图在心脏瓣膜病应用中的研究进展[J].中华实用诊断与治疗杂志,2017,31(11):1139-1141. DOI:10. 13507/j. issn. 1674-3474. 2017. 11. 029.
[38]任奔,康彧,唐红.经食管实时三维超声心动图对主动脉瓣环形态的可视化定量研究[J].西部医学,2013,25(4):507-510. DOI:10. 3969/j. issn. 1672-3511. 2013. 04. 008.
[39] Arai K,Hozumi T,Matsumura Y,et al. Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction[J]. Am J Cardiol,2004,94(5):552-558. DOI:10. 1016/j. amjcard. 2004. 05. 015.
[40]吕清,王新房,李治安,等.二尖瓣位人工瓣的四维经食管超声心动图显示[J].中国超声医学杂志,1996,12(11):7-10.
[2]程智刚,郭曲练,黄长盛.加强疼痛基础与临床研究,促进疼痛医学发展[J].中国医师杂志,2016,18(4):481-486. DOI:10. 3760/cma. j. issn. 1008-1372. 2016. 04. 001.
[3]郭曲练,程智刚,王云姣.重视麻醉与疼痛医学的基础与临床研究[J].中国医师杂志,2014,16(12):1585-1589. DOI:10. 3760/cma. j. issn. 1008-1372. 2014. 12. 001.
[4] Beaulieu Y. Bedside echocardiography in the assessment of the critically ill[J]. Crit Care Med,2007,35(5 Suppl):S235-S249.DOI:10. 1097/01. CCM. 0000260673. 66681. AF.
[5]刘娜,李文强,高成伟.下腔静脉直径和呼吸变异指数评估容量状态的Meta分析[J].临床急诊杂志,2016,17(6):466-469,473.
[6] Lanspa MJ,Grissom CK,Hirshberg EL,et al. Applying dynamic parameters to predict hemodynamic response to volume expansion in spontaneously breathing patients with septic shock:reply[J]. Shock,2013,39(5):462. DOI:10. 1097/SHK. 0b013e318291008e.
[7] Preau S,Bortolotti P,Colling D,et al. Diagnostic Accuracy of the Inferior Vena Cava Collapsibility to Predict Fluid Responsiveness in Spontaneously Breathing Patients With Sepsis and Acute Circulatory Failure[J]. Crit Care Med,2017,45(3):e290-e297.DOI:10. 1097/CCM. 0000000000002090.
[8] Corl KA,George NR,Romanoff J,et al. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients[J]. J Crit Care,2017,41:130-137.DOI:10. 1016/j. jcrc. 2017. 05. 008.
[9]黄昌云,韩晓雨,方攀攀,等.超声测量下腔静脉内径快速评估老年患者术前血容量的价值[J].临床麻醉学杂志,2018,34(12):1157-1160. DOI:10. 12089/jca. 2018. 12. 003.
[10]杨广宇,郑重,祁富伟,等.超声检测下腔静脉参数在评估椎管内麻醉围术期容量状态中的临床意义[J].中国医师杂志,2018,20(11):1704-1707. DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 11. 026.
[11]张帆,郑泽兵,杨海香,等.超声快速容量评估法对麻醉恢复室胸科患者容量治疗及其预后影响的研究[J].吉林医学,2018,39(8):1528-1529. DOI:10. 3969/j. issn. 1004-0412.2018. 08. 054.
[12] Schiff JH,Welker A,Fohr B,et al. Major incidents and complications in otherwise healthy patients undergoing elective procedures:results based on 1. 37 million anaesthetic procedures[J]. Br J Anaesth,2014,113(1):109-121. DOI:10. 1093/bja/aeu094.
[13] Adhikari S,Zeger W,Schmier C,et al. Pilot study to determine the utility of point-of-care ultrasound in the assessment of difficult laryngoscopy[J]. Acad Emerg Med,2011,18(7):754-758.DOI:10. 1111/j. 1553-2712. 2011. 01099. x.
[14] Hui CM,Tsui BC. Sublingual ultrasound as an assessment method for predicting difficult intubation:a pilot study[J]. Anaesthesia,2014,69(4):314-319. DOI:10. 1111/anae. 12598.
[15]章艳君,徐魏军,刘金柱,等.超声法确定新生儿气管插管位置的准确性[J].中华麻醉学杂志,2018,38(10):1238-1240.DOI:10. 3760/cma. j. issn. 0254-1416. 2018. 10. 021.
[16] Alzahrani SA,Al-Salamah MA,Al-Madani WH,et al. Systematic review and meta-analysis for the use of ultrasound versus radiology in diagnosing of pneumonia[J]. Crit Ultrasound J,2017,9(1):6. DOI:10. 1186/s13089-017-0059-y.
[17] Yousefifard M,Baikpour M,Ghelichkhani P,et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis[J]. Emerg(Tehran),2016,4(1):1-10.
[18] Blumhof S,Wheeler D,Thomas K,et al. Change in Diaphragmatic Thickness During the Respiratory Cycle Predicts Extubation Success at Various Levels of Pressure Support Ventilation[J]. Lung,2016,194(4):519-525. DOI:10.1007/s00408-016-9911-2.
[19]王玲,拉佈旦白拉,于建设.超声在麻醉领域的应用[J].内蒙古医科大学学报,2017,39(6):569-574.
[20]刘湘钰,黄穗葵,邓瑞华. B超引导下腰丛复合坐骨神经阻滞麻醉对老年股骨粗隆间骨折患者麻醉效果与免疫功能的影响[J].中国医师杂志,2018,20(11):1689-1692. DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 11. 021.
[21]音樱,章敏,疏树华,等.超声引导下改良髂筋膜间隙阻滞在老年股骨近端骨折麻醉中的应用[J].临床麻醉学杂志,2018,34(7):660-664. DOI:10. 12089/jca. 2018. 07. 009.
[22] Ktlk A,Erdogan MA,Ozgul U,et al. Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors:A prospective,randomized,double-blinded clinical trial[J]. J Clin Anesth,2017,37:103-107. DOI:10. 1016/j.jclinane. 2016. 12. 018.
[23]范俊柏,高旭琴,秦文艳.超声引导下椎旁神经阻滞对乳腺癌根治术患者镇痛效果的研究[J].肿瘤研究与临床,2019,31(1):36-40. DOI:10. 3760/cma. j. issn. 1006-9801. 2019. 01. 008.
[24]靳红绪,张同军,孙学飞,等.超声引导下连续胸椎旁神经阻滞对乳腺癌根治术患者术后慢性疼痛的影响[J].中国医药,2018,13(7):1059-1062. DOI:10. 3760/j. issn. 1673-4777.2018. 07. 025.
[25]王瑞珂,李春玲,段彬,等.超声引导下骶管阻滞用于日间在直肠超声引导经会阴途径穿刺活检术的临床研究[J].中国医师杂志,2018,20(4):490-492. DOI:10. 3760/cma. j. issn.1008-1372. 2018. 04. 003.
[26]耿姣,李民,郭向阳.脊柱畸形老年患者超声引导椎管内麻醉成功实施1例[J].中华麻醉学杂志,2018,38(10):1273-1274. DOI:10. 3760/cma. j. issn. 0254-1416. 2018. 10. 031.
[27]耿姣,陈宣伶,王雪冬,等.超声辅助定位可提高老年患者椎管内麻醉一次穿刺成功率[J].中华医学杂志,2016,96(43):3459-3463. DOI:10. 3760/cma. j. issn. 0376-2491. 2016. 43. 004.
[28] Leslie K,Myles P,Devereaux P,et al. Neuraxial block,death and serious cardiovascular morbidity in the POISE trial[J]. Br J Anaesth,2013,111(3):382-390. DOI:10. 1093/bja/aet120.
[29] Perlas A,Davis L,Khan M,et al. Gastric sonography in the fasted surgical patient:a prospective descriptive study[J]. Anesth Analg,2011,113(1):93-97. DOI:10. 1213/ANE. 0b013e31821b98c0.
[30] Finlayson RJ,Gupta G,Alhujairi M,et al. Cervical medial branch block:a novel technique using ultrasound guidance[J].Reg Anesth Pain Med,2012,37(2):219-223. DOI:10. 1097/AAP. 0b013e3182374e24.
[31]李晓勤,顾楠,吕琳,等.超声引导下外侧膝眼进针膝关节腔注射与盲法膝关节腔注射的对照研究[J].中国疼痛医学杂志,2016,22(11):838-841. DOI:10. 3969/j. issn. 1006-9852.2016. 11. 009.
[32]樊朝美,孟宪强,程克正,王国干,杨浣宜,刘汉英.术中经食管超声技术在心脏外科中的应用[J].中国循环杂志,1994,9(2):92-94,127-128.
[33]周平安,刁杰,张小宾,等.经食管超声心动图评估冠心病患者PCI术后左心室功能和收缩同步性的价值[J].心脑血管病防治,2018,18(6):511-512,523. DOI:10. 3969/j. issn. 1009-816x. 2018. 06. 023.
[34]徐新华,詹樾,江亚平,胡建国.术中经食管彩色多普勒超声心动图实时评价二尖瓣成形术[J].中国超声医学杂志,1994,10(9):32-33.
[35]窦志,谢琦,翁国星,等.经胸超声与经食管超声引导下经皮房间隔缺损封堵术的比较研究[J].中华胸心血管外科杂志,2018,34(9):522-526. DOI:10. 3760/cma. j. issn. 1001-4497.2018. 09. 003.
[36]赵星,王浩,逄坤静,等.经食管超声微探头在低体重儿心脏外科手术中的应用[J].中西医结合心血管病电子杂志,2017,5(12):53-54.
[37]秦芸芸.经食管实时三维超声心动图在心脏瓣膜病应用中的研究进展[J].中华实用诊断与治疗杂志,2017,31(11):1139-1141. DOI:10. 13507/j. issn. 1674-3474. 2017. 11. 029.
[38]任奔,康彧,唐红.经食管实时三维超声心动图对主动脉瓣环形态的可视化定量研究[J].西部医学,2013,25(4):507-510. DOI:10. 3969/j. issn. 1672-3511. 2013. 04. 008.
[39] Arai K,Hozumi T,Matsumura Y,et al. Accuracy of measurement of left ventricular volume and ejection fraction by new real-time three-dimensional echocardiography in patients with wall motion abnormalities secondary to myocardial infarction[J]. Am J Cardiol,2004,94(5):552-558. DOI:10. 1016/j. amjcard. 2004. 05. 015.
[40]吕清,王新房,李治安,等.二尖瓣位人工瓣的四维经食管超声心动图显示[J].中国超声医学杂志,1996,12(11):7-10.