图 7B 经 Abhilash Koratala 博士的许可使用。

该协议中的所有超声都是在人类受试者身上进行的，并按照伊利诺伊大学医院的道德标准和赫尔辛基宣言及其修订版进行。作为常规教育和临床护理的一部分，在事先口头同意的情况下，对作者本人和急诊科的患者进行了影像学检查，这是该机构的标准。收集的图像说明了正常的解剖学和生理学，以及在伊利诺伊大学医院收集的异常发现。用于说明扫描技术的图像是在写作小组的成员身上进行的。所有超声图像均不含任何识别信息。随后的协议是使用同行评审期刊和书籍章节 10、15、16、17、18、19 的来源设计的。在本综述中，该协议将侧重于获取成人的美国图像。
1. 安全
注意:POCUS 研究可以使用非无菌手套（丁腈或乳胶）进行，具体取决于患者的过敏程度。根据临床情况和机构政策，可以采取额外的安全措施。
<ol><li>使用前检查超声系统的清洁度，并在使用后以适当的方式清洁机器和探头。清洗材料和工艺由超声设备制造商和机构标准决定。</li>
</ol>2. 探头的选择
<ol><li>对于大多数成年人来说，腹主动脉最好使用 2.5-3.5 MHz 的曲线探头进行可视化，该探头占地面积大，视野宽，呈凸波束形状。该探头通常将提供出色的分辨率和测量能力。</li>
	<li>或者，使用相控阵探头 （1-5 mHz），通常用于超声心动图，通常非正式地称为心脏探头。 注意:相控阵探头非常有用，尤其是在尝试观察近端腹主动脉通过膈裂孔离开时的情况。如果仅次于木突的空间太窄而无法容纳更宽的曲线探针，则尤其如此。相控阵探头具有矩形尺寸和三角形光束形状，视场比曲线探头更窄，但应足以实现成像目标。</li>
</ol>3. 机器预设
<ol><li>无论使用何种探头，都应使用机器上的 腹部 预设。</li>
	<li>将模式设置为 B 模式 或 二维灰度。</li>
	<li>将深度设置为 20 厘米。 注意:这通常足以可视化椎体，椎体是主动脉的重要标志。</li>
	<li>主动脉可视化后调整深度，使主动脉保持在屏幕的中间。</li>
	<li>如果由于肠气过多而难以成像，请考虑使用谐波成像来提供更好的可视化。 注意:谐波使用组织的共振特性，并创建具有更少伪影的更高分辨率图像。</li>
	<li>为体重指数高的患者选择较低的频率范围，以改善图像采集。</li>
</ol>4. 扫描技术
<ol><li>将超声波凝胶涂抹在换能器上。</li>
	<li>患者仰卧位，腹部暴露。如果患者能够耐受髋关节屈曲，将放松腹部肌肉，并可能改善图像采集。 注意:肠气会阻碍图像采集。为了改善存在肠道气体时的图像采集，操作者可以对扫描区域施加牢固的连续压力（称为分级压缩）几分钟，从而置换肠道气体。评估冠状平面的主动脉也可以避免在横平面中遇到肠气（见步骤4.3.5）。</li>
	<li>要对腹主动脉进行全面评估，请获取下面列出的图像。<ol><li>获取横平面中近端主动脉的图像。<ol><li>将换能器定向在横向平面上，指示器朝向患者右侧。确保指示器位置与屏幕上的指示器匹配（图 1A）。</li>
			<li>将换能器放置在患者剑突的远端，并施加轻微的压力，以可视化椎骨的前部及其高回声阴影投射弓（图1B）。 注意:肝脏将出现在屏幕的左上角，并充当声学窗口。主动脉将出现在椎体正上方，作为屏幕右侧的消声圈，对应于患者的左侧。下腔静脉 （IVC） 位于屏幕的左侧，对应于患者的右侧。IVC 的壁比主动脉壁薄，即使在轻压下也经常可折叠。</li>
			<li>向尾部滑动换能器，直到看到腹腔躯干。腹腔躯干较短，迅速分叉成肝动脉和脾动脉。当两条动脉一起观察时，这称为 海鸥征 （图2）。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
			<li>向尾部滑动换能器以遇到肠系膜上动脉 （SMA），该动脉从前主动脉脱落并很快向下移动，通常沿着与主动脉平行的路径。脾静脉在SMA前方，左肾静脉在SMA和主动脉之间（图3）。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
			<li>通过优化该位置主动脉的实时图像，然后按下系统的 冻结 按钮，测量肾上主动脉的 AP 直径。</li>
			<li>按 卡尺 或 测量 并将系统的轨迹球或触摸板移动到前壁的外边缘，即外膜，然后单击 选择。</li>
			<li>再次将轨迹球或触摸板移动到后壁的外边缘，然后单击 "选择"。等待系统生成测量值（图 4）。</li>
			<li>通过单击系统上保存静止图像的按钮，将此图像保存为包含测量值的静止图像。 注意:主动脉 AP 直径的法线上限为 3.0 厘米。任何测量值>3 cm 都被认为是动脉瘤15、16、20、21。</li>
		</ol></li>
		<li>对横平面中的远端主动脉进行成像。 注意:远端主动脉占腹主动脉的三分之二，从肾动脉的远端开始。大多数 AAA 发生在该远端节段。<ol><li>与近端主动脉一样，继续在横向平面上扫描，通过分叉观察整个主动脉。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
			<li>当远端主动脉的实时图像得到优化时，测量肾下主动脉的 AP 直径。</li>
			<li>按 卡尺 或 测量 并将系统的轨迹球或触摸板移动到前壁的外边缘，即外膜，然后单击 选择。</li>
			<li>再次将轨迹球或触摸板移动到后壁的外边缘，然后单击 "选择"。等待系统生成测量值。</li>
			<li>通过单击系统上保存静止图像的按钮，将此图像保存为包含测量值的静止图像。 注意:鉴于远端主动脉的长度更长且动脉瘤扩张的可能性增加，因此至少对远端主动脉进行两次测量是谨慎的。</li>
			<li>当腹主动脉经腹部尾部时调整深度，因为它变得更加浅表并略微变细。</li>
		</ol></li>
		<li>获取主动脉分叉到左右髂动脉的视频剪辑（视频 1 - 参见补充文件 1:补充图 S1）。<ol><li>继续向尾部扫描，根据需要调整深度以保持主动脉和椎体在屏幕中间。</li>
			<li>通过主动脉分叉扫描到左髂动脉和右髂动脉。</li>
			<li>在扫描分岔时捕获图像。</li>
		</ol></li>
		<li>在纵向平面上获取主动脉的图像和视频剪辑。<ol><li>将探头放在近端腹部，从剑突下区域重新开始。</li>
			<li>通常更容易从横向平面开始，指示器朝向患者右侧。优化主动脉的横视图后，顺时针旋转探头，沿着主动脉旋转，因为图像在屏幕上变得纵向并且指示器指向患者的头部（图 5A）。</li>
			<li>在扫描尾部检查动脉瘤扩张时获取图像。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。 注意:在长轴视图中，腹腔主干和SMA很容易从前主动脉突出（图5B）。建议不要测量主动脉在纵轴上的直径。如果超声束与主动脉相切相交，而不是在其中线，则测量值将错误地小于通过最大 AP 直径的测量值（图 6）。</li>
		</ol></li>
		<li>可选:获取冠状平面中主动脉的纵向视图。如果难以在横向或纵向平面上获取视图，则此视图非常有用。<ol><li>从患者右侧腋窝中线冠状面上的换能器开始，指示器指向颅骨（图7A）。</li>
			<li>如果患者可以，将他们置于左侧卧位，以便更好地获取图像。</li>
			<li>扫描冠状平面中的主动脉。如果对两条血管都进行成像，主动脉将在 IVC 深处可视化（图 7B）。</li>
			<li>通过单击录制剪辑的系统上的按钮来捕获这些图像以供以后查看。</li>
		</ol></li>
	</ol></li>
</ol>

使用床旁超声对腹主动脉进行成像

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<li>Tayal, V. S., Graf, C. D., Gibbs, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Prospective+study+of+accuracy+and+outcome+of+emergency+ultrasound+for+abdominal+aortic+aneurysm+over+two+years%5BTitle%5D)+AND+%22Academic+Emergency+Medicine%22%5BJournal%5D)">Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years.</a> Academic Emergency Medicine. 10 (8), 867-871 (2003).</li>
<li>Kuhn, M., Bonnin, R. L., Davey, M. J., Rowland, J. L., Langlois, S. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Emergency+department+ultrasound+scanning+for+abdominal+aortic+aneurysm%3A+accessible%2C+accurate%2C+and+advantageous%5BTitle%5D)+AND+%22Annals+of+Emergency+Medicine%22%5BJournal%5D)">Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous.</a> Annals of Emergency Medicine. 36 (3), 219-223 (2000).</li>
<li>Cazes, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Emergency+ultrasound%3A+a+prospective+study+on+sufficient+adequate+training+for+military+doctors%5BTitle%5D)+AND+%22Diagnostic+and+Interventional+Imaging%22%5BJournal%5D)">Emergency ultrasound: a prospective study on sufficient adequate training for military doctors.</a> Diagnostic and Interventional Imaging. 94 (11), 1109-1115 (2013).</li>
<li>Bonnafy, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Reliability+of+the+measurement+of+the+abdominal+aortic+diameter+by+novice+operators+using+a+pocket-sized+ultrasound+system%5BTitle%5D)+AND+%22Archives+of+Cardiovascular+Diseases%22%5BJournal%5D)">Reliability of the measurement of the abdominal aortic diameter by novice operators using a pocket-sized ultrasound system.</a> Archives of Cardiovascular Diseases. 106 (12), 644-650 (2013).</li>
<li>Baliga, R. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+role+of+imaging+in+aortic+dissection+and+related+syndromes%5BTitle%5D)+AND+%22Journal+of+the+American+College+of+Cardiology%3A+Cardiovascular+Imaging%22%5BJournal%5D)">The role of imaging in aortic dissection and related syndromes.</a> Journal of the American College of Cardiology: Cardiovascular Imaging. 7 (4), 406-424 (2014).</li>
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</ol>

作者没有利益冲突需要声明。

及时诊断 AAA 和主动脉夹层是治疗这些高发病率疾病的关键。与传统影像学相比，用于 AAA 诊断的 POCUS 可改善结果并显着缩短诊断和手术干预的时间27。POCUS 对 AAA 具有高敏感性和特异性，对主动脉夹层具有高特异性12、13、19、21、28、29。它对各个专业和不同培训水平的医生都很有用。在无法获得血管手术、体外循环甚至 CT 成像的医疗环境中，早期床旁超声评估因腹主动脉急症而出现胸部、腹部、背部、腰部、盆腔或腹股沟疼痛的不稳定患者，可以加快转入确定性治疗。此外，对未分化休克患者的腹主动脉进行评估可能是指导复苏和管理的关键。
该检测 AAA 和腹主动脉夹层的方案既简单又全面，并且需要注意一些关键步骤。从膈裂孔到主动脉分叉到髂血管的整个腹主动脉扫描必须横向进行。从膈裂孔到主动脉分叉到髂血管的整个腹主动脉扫描必须在纵向方向上进行。如果纵向平面成像不理想，则可以在冠状平面进行扫描。必须在肾上腹主动脉和肾下腹主动脉的两个水平上测量优化图像的静态测量，测量横平面中主动脉外前壁到外后壁。
区分主动脉和 IVC 很重要，因为这是一个常见的错误。排便和身体习惯是获得良好图像最具挑战性和最常见的陷阱。当肠气遮挡视线时，使用渐变压缩可以改善图像。
腹主动脉的POCUS有一些重要的局限性。首先，超声波依赖于操作者，虽然即使是新手医生也可以准确地进行这项研究，但接受培训和实践很重要30,31。POCUS检测AAA的灵敏度和特异性均大于98%12,19,21,28,29,30。虽然在腹主动脉夹层中 POCUS 上观察到的内膜瓣的特异性为 99%，但腹主动脉夹层的敏感性较差且变化很大 13,14,32。最后，POCUS 不是评估 AAA 破裂的理想影像学检查方式，因为大多数会在腹膜后破裂，而 POCUS 不能很好地评估该位置。
通过实践，该协议可以在五分钟内执行，如果存在肠气，则允许一到两分钟进行分级压缩。至于达到该协议的能力需要多长时间，这是可变的。急诊医学住院医师教育和许多培训计划的程序能力方面的文献表明，在毕业前应进行包括 腹主动脉在内的主要 POCUS 应用中总共 150 次审查考试。然而，完成的考试数量可能不会赋予能力，而评估工具，例如使用标准化直接观察工具的观察结构化临床检查，可以提供更有力的能力评估33。对于那些已经完成培训和/或在 POCUS 出现之前的时代接受过培训的人，超声主任应该为想要执行此考试的提供者制定认证计划。
我们坚信，执业医生，尤其是那些主要在急诊、重症监护、初级保健或其他有高危人群的环境中工作的医生，应该能够舒适地使用 POCUS 来评估腹主动脉是否存在危及生命的病理。POCUS 是一种节省生命和时间的工具，可以实时提供数据，并且只需很少的额外资源。

床旁超声 （POCUS） 的使用在过去几年中有所增加，并越来越多地被纳入各种住院医师培训计划 1,2。POCUS在急诊科和重症监护室等重症监护领域具有很大的实用性，特别是有助于快速诊断危及生命的腹腔内紧急情况，如急性主动脉夹层，以及腹主动脉瘤，特别是那些有破裂风险的动脉瘤和那些已经破裂到腹膜的动脉瘤。
AAA 破裂和急性主动脉夹层与高死亡率相关。主动脉瘤破裂的死亡率为 67% 至 94%3,4。急性夹层后，A 型主动脉夹层的死亡率以每小时 1% 的速度增加，B 型主动脉夹层的死亡率在 30 天时为 10% 至 25%5。孤立的腹主动脉夹层很少见，仅占所有主动脉夹层的0.2%-4%6,7,8,9,10。由于大多数腹主动脉夹层是胸主动脉夹层的延伸，因此评估腹主动脉的夹层证据可能有助于胸主动脉夹层的诊断11。
计算机断层扫描与血管造影 （CTA） 是腹主动脉相关影像学病理学的金标准;但是，它有几个缺点。这可能很耗时，尤其是在不稳定的患者中，并且需要技术人员执行，并需要放射科医生或血管外科医生来解释图像。CTA 使用电离辐射，需要使用静脉注射造影剂以最佳方式检测病理学。此外，CTA 的性能要求潜在不稳定的患者离开重症监护区。相比之下，POCUS 是非侵入性的、具有成本效益的，并且缺乏 CT 所需的电离辐射和造影剂。它也可以由同一个人实时执行和解释，不需要患者离开监测区域。
Rubano 等人对急诊科 POCUS 诊断 AAA 的系统评价显示，其敏感性为 99%，特异性为 98%，阳性似然比为 99，阴性似然比为 0.0112。这项汇总分析评估了不同操作员组的测试特征，包括接受过广泛 POCUS 培训的住院医师和主治医师。
腹主动脉夹层 POCUS 评估的测试特征与 AAA 不同，并且可能因夹层的起源而异。内膜瓣分离真腔和假腔的超声检查结果对主动脉夹层的敏感性为 67%-79%，特异性为 99%-100%13,14。由于在腹部发现的大多数主动脉夹层是胸主动脉夹层的延伸，因此可以进行心脏和肺部的额外 POCUS 应用以评估心包积液、主动脉根部扩张和左胸腔积液，但不是本文的重点13。
最后，需要注意的是，美国预防服务工作组为对 65-75 岁曾经吸烟的男性进行一次性 AAA 超声筛查提供了 B 级建议。这与初级保健环境特别相关。
本综述将描述POCUS在腹主动脉床旁评估中表现的分步方案，特别是评估AAA和腹主动脉夹层。该协议假定诊断超声的基本知识，包括物理学、仪器，以及腹主动脉和主要分支动脉的解剖学和病理状态的医学知识。建议读者参考其他来源以获取先决条件知识。

<table><tbody><tr><td>M9 Ultrasound Machine&amp;nbsp;</td><td>Mindray&amp;nbsp;</td><td>n/a</td><td>Used to obtain all adequate and inadequate images/clips</td></tr></tbody></table>

an approach to point-of-care ultrasound evaluation of the abdominal aorta

腹主动脉疾病，包括动脉瘤和夹层，具有潜在的高发病率和死亡率。虽然计算机断层扫描 （CT） 是目前腹主动脉成像的金标准，但获得 CT 的过程可能很耗时，需要使用静脉注射造影剂，并且涉及暴露于电离辐射。床旁超声（POCUS）可以在床旁进行，对腹主动脉瘤的诊断具有极好的敏感性和特异性，对腹主动脉夹层的诊断具有极好的特异性。此外，POCUS 是非侵入性的、具有成本效益的、没有电离辐射的，不需要静脉注射造影剂，并且可以在不将患者从重症监护区带走的情况下进行。腹主动脉瘤 （AAA） 的筛查也可以在初级保健机构进行。 
本文将回顾腹主动脉 POCUS 的评估方法，以评估此类关键病理学。在本文中，我们将回顾腹主动脉的超声解剖结构以及超声探头的选择、POCUS 图像采集的描述以及使用 POCUS 帮助诊断可能危及生命的腹主动脉病变的一些细节和陷阱。

充分的检查 从腹主动脉超声中获得准确结果的最大挑战之一是缺乏对测量的共识。如协议步骤 4.3.1.10 所述，腹主动脉的任何直径大于 3 cm 都被认为是动脉瘤15、16、22、23。然而，用于测量主动脉直径的方法存在很大差异，并且对于测量腹主动脉尚无国际共识。目前使用的有三种方法:（1）外壁到外壁（OTO）测量，（2）内壁到内壁（ITI）测量，（3）前缘到前缘（LELE）测量，测量前壁的外层和后壁的内层。使用每种方法各有利弊，其描述超出了本协议的范围。我们使用OTO方法，该方法与CT衍生的测量结果最相关。这是因为超声束相对于主动脉的角度（isonation角）导致AP测量值比横向测量值15,20更清晰。与其他两种方法相比，OTO方法的测量值也更大。从风险和筛查的角度来看，使用 OTO 方法将捕获更多可以在动脉瘤监测计划中随访的高危患者。使用 OTO 测量还提醒操作者寻找血管的外膜而不是管腔，因为在动脉瘤扩张中，管腔可能是动脉瘤直径的一小部分。美国医学超声研究所和欧洲心脏病学会推荐使用OTO方法15,16,17,23。然而，考虑到这一点，重要的是要注意大多数动脉瘤不对称地扩展，如果横向测量值明显更大，建议进行较大的测量16。
充分的正常检查应至少有两张静态图像，并测量腹主动脉的最大直径。图像应取自肾上主动脉和肾下主动脉。最好从肾下主动脉捕获两个测量值，因为与肾上主动脉相比，其长度更长，并且肾下段动脉瘤发生率更高。此外，扫描腹主动脉从横断裂孔到横向和纵向平面分叉的整个长度，甚至可以捕捉到直径的微小变化。如果在横向和纵向平面上采集图像具有挑战性，则在日冕平面上扫描可能很有用。
POCUS可以显示腹主动脉的许多异常。对于该方案，我们将描述腹主动脉瘤和夹层的超声检查结果。大约 85% 的 AAA 是肾下24。当在横平面上对腹主动脉进行成像时，任何大于 3.0 cm 的主动脉测量值都被认为是动脉瘤。动脉瘤还可能含有血肿，血肿可以填满大部分管腔。 视频 2 （参见 补充文件 1:补充图 S2）和 视频 3 （参见 补充文件 1:补充图 S3）说明了伴有明显血肿的动脉瘤。 图 8 是一张静止图像，通过屏幕上的标尺说明了动脉瘤的大小。纵向平面的值在确定动脉瘤是梭形还是囊状时特别有用。虽然两者都是病理性的，但囊状动脉瘤更容易破裂22. 
主动脉夹层是主动脉内膜的撕裂，在主动脉壁的内层内扩散。主动脉夹层可能起源于主动脉的任何部位，并延伸至腹主动脉并进入髂动脉。当腹主动脉内膜瓣可见时，考虑胸主动脉夹层很重要。孤立性腹主动脉夹层仅占所有主动脉夹层的 0.2-4%，通常为肾下6、7、8、9、10。在POCUS上，关键发现是主动脉管腔内的内膜瓣，将真腔与假腔分开。根据夹层的慢性程度，皮瓣可能很薄，并随着主动脉的搏动而移动（视频 4 和补充文件 1:补充图 S4），或者可能增厚并伴有邻近的血肿（图 9）。视频 5（参见补充文件 1:补充图 S5）显示了急性胸主动脉夹层，并延伸至腹主动脉并进入右髂动脉。彩色多普勒可用于辅助诊断主动脉夹层。如果有流经真腔和假腔，则可以在内膜瓣的两侧看到颜色流动。仅流经部分管腔会引起对内膜瓣的关注，即使瓣瓣看不清。此外，随着血管内动脉瘤修复 （EVAR） 的使用越来越多，患者可能会出现内移植并发症，例如内漏、支架移位和动脉瘤囊直径增加15,16。对接受 EVAR 的患者进行内移植评估的详细讨论超出了本文的范围。
考试不足:珍珠和陷阱 在评估腹主动脉时，有几个常见的陷阱和局限性，以及一些需要讨论的重要伪影。评估腹主动脉时最常见的陷阱之一是将 IVC 误认为是主动脉。IVC是薄壁的，比主动脉更容易压缩。IVC 也沿着患者右侧的横向平面延伸。在患者右侧的冠状平面中，主动脉位于 IVC 的"下方"。另一个常见的陷阱是将腹腔主干、SMA 或 SMV 误认为主动脉，因为深度不足且未能将椎体识别为标志。可以采用其他先进的超声技术，如彩色多普勒或脉搏波多普勒来区分动脉血流和静脉血流。
对整个腹主动脉进行成像可能具有挑战性，并且由于身体习惯、肠气、腹水、呼吸急促和守卫的存在，可能无法定位某些动脉瘤19.控制患者的疼痛可以提高图像采集和质量。
迂曲的主动脉可能很难追踪，可能需要从非典型角度进行测量，因为换能器错位可能会高估直径（图 10）。虽然 POCUS 在检测 AAA 方面具有出色的灵敏度和特异性，但它不能可靠地检测 AAA 破裂，因为大多数破裂发生在腹膜后间隙，超声无法很好地观察到该区域19,21。对于 AAA 患者的腹膜内破裂，腹部游离液体的检测令人担忧。游离破裂的其他体征包括 AAA 壁局灶性不连续性、动脉瘤形状不规则和/或漂浮血栓22。
最后，还有一些值得一提的工件。第一种是腹主动脉假性血栓，在纵向平面扫描时通常位于 SMA 水平。假血栓（图11）是由超声束在SMA前壁和后壁之间的反射产生的混响伪影。SMA 壁显示为腹主动脉腔内与后壁距离相等的高回声线性结构。通过摇晃或扇动探头来改变探头位置通常会导致该伪影的分辨率15,25。另一个伪影是主动脉的重复，最常见于横向和纵向平面。这种情况更常发生在曲率半径较大的换能器上（即曲线比相控阵更曲线）。这是由于前腹壁的棱柱状脂肪组织，在年轻的运动员中更为常见。这种伪影通常通过换能器在横向平面15,26中的轻微横向移动来解决。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65487/65487fig01.jpg"> 图 1:探头横向成像。 （A） 红点表示探头指示灯。 （B） 横平面近端主动脉成像。 缩写:VB = 椎体;A = 横向近端主动脉;IVC = 下腔静脉。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65487/65487fig02.jpg"> 图 2:横平面腹腔主干近端主动脉成像。 来自腹腔躯干的肝动脉[白色箭头]和脾动脉[红色箭头]的分支构成了"海鸥征"。缩写:A = 主动脉;C = 乳糜泻躯干。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig02large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/65487/65487fig03.jpg"> 图 3:横平面肠系膜上动脉近端主动脉的成像。 脾静脉位于 SMA 前方，左肾静脉 [白色箭头] 位于 SMA 和主动脉之间。注意部分塌陷的下腔静脉。缩写:A = 主动脉;SMA = 肠系膜上动脉;SV = 脾静脉;IVC = 下腔静脉。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig03large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/65487/65487fig04.jpg"> 图 4:使用外壁到外壁约定测量近端主动脉。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig04large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/65487/65487fig05.jpg"> 图5:探头纵向的成像。（A） 红点表示探头指示灯。 （B） 近端主动脉纵轴视图，显示腹腔干和肠系膜上动脉。 缩写:C = 乳糜泻躯干;S = 肠系膜上动脉。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig05large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/65487/65487fig06.jpg"> 图 6:测量主动脉长轴直径的陷阱图示。 左图显示了直接穿过主动脉的超声束，而右图显示了真实直径的缩短。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig06large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/65487/65487fig07.jpg"> 图 7:腹主动脉冠状视图的成像。（A）探头的日冕方向;红点表示探头指示灯。 （B） 冠状平面腹主动脉成像。请注意，主动脉位于下腔静脉的"下方"。作为参考，美国屏幕的左侧是颅骨，屏幕的右侧是尾部。离探头最近的区域（近场）是右翼，离探头最远的区域（远场）是IVC和主动脉可见的深处。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig07large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 8" class="xfigimg" src="/files/ftp_upload/65487/65487fig08.jpg"> 图 8:伴有血肿的大腹主动脉瘤的横视图成像。 动脉瘤大小是使用屏幕上的尺子测量的。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig08large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 9" class="xfigimg" src="/files/ftp_upload/65487/65487fig09.jpg"> 图 9:慢性腹主动脉夹层，真腔和假腔之间的夹层瓣增厚。 缩写:DF = 解剖皮瓣;TL = 真流明;FL = 假腔。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig09large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 10" class="xfigimg" src="/files/ftp_upload/65487/65487fig10.jpg"> 图10:迂曲主动脉。 实线表示垂直于身体中线的角度，但与主动脉的迂曲度不对齐的换能器。虚线更准确地表示主动脉的真实直径，尽管不垂直于中线。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig10large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 11" class="xfigimg" src="/files/ftp_upload/65487/65487fig11.jpg"> 图 11:主动脉长轴成像。 假性血栓 [红色箭头] 是肠系膜上动脉下方常见的伪影。腹腔躯干就在SMA的近端。缩写:SMA = 肠系膜上动脉;C = 乳糜泻躯干。 <a href="https://www.jove.com/files/ftp_upload/65487/65487fig11large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
视频1:腹主动脉分叉进入髂动脉的视频剪辑。 该夹是在探头垂直于远端主动脉的情况下获得的，当腹主动脉分叉到髂动脉时，扫描脐下部。 <a href="https://www.jove.com/files/ftp_upload/65487/video%201%20bifurcation.zip" target="_blank">请按此下载此影片。</a>
视频 2:横平面大腹主动脉瘤的成像，主动脉腔内有血液和血肿的回声漩涡。<a href="https://www.jove.com/files/ftp_upload/65487/video%202%20aneurysm1.zip" target="_blank">请按此下载此影片。</a>
视频 3:比视频 2 更远的横平面中大腹主动脉瘤的成像。 <a href="https://www.jove.com/files/ftp_upload/65487/video%203%20aneurysm2.zip" target="_blank">请按此下载此影片。</a>
视频 4:腹主动脉横平面近端影像学检查，急性夹层。 注意随着主动脉搏动而移动的薄夹层皮瓣。 <a href="https://www.jove.com/files/ftp_upload/65487/video%204%20proximal%20dissection.zip" target="_blank">请按此下载此影片。</a>
视频 5:腹主动脉远端横平面成像，急性夹层并延伸至右髂动脉。<a href="https://www.jove.com/files/ftp_upload/65487/video%205%20dissection%20into%20iliacs.zip" target="_blank">请按此下载此影片。</a>
补充文件 1:与视频 1-5 相对应的静止图像。   <a href="https://www.jove.com/files/ftp_upload/65487/65487_Supplementary%20file.zip" target="_blank">请点击此处下载此文件。</a>

Watch this Scientific Journal Video about An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta at JoVE.com

作者聚焦:使用床旁超声全面评估腹主动脉

该方案回顾了使用床旁超声对腹主动脉进行成像的步骤。我们讨论了图像采集、成像陷阱和伪影的故障排除，以及危及生命的腹主动脉病变的识别。

腹主动脉床旁超声评估方法

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...

我们试图展示使用床旁超声或 POCUS 来评估腹主动脉的解剖结构和病理学。POCUS对腹主动脉瘤的评估具有优异的敏感性和特异性，对腹主动脉夹层的评估具有优异的特异性。其中一些挑战包括确保 POCUS 用户接受足够的培训，并确保他们能够准确地识别病理和伪影。该协议是全面的，可以由同一个人在不到五分钟的时间内执行和解释。这比计算机断层扫描血管造影更快，特别是当患者病情危重且病情不稳定，无法离开重症监护区进行影像学检查时。

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JoVE Journal

Medicine

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

2.4K 次观看.  University of Illinois Hospital. 我们试图展示使用床旁超声或 POCUS 来评估腹主动脉的解剖结构和病理学。POCUS对腹主动脉瘤的评估具有优异的敏感性和特异性，对腹主动脉夹层的评估具有优异的特异性。其中一些挑战包括确保 POCUS 用户接受足够的培训，并确保他们能够准确地识别病理和伪影。该协议是全面的，可以由同一个人在不到五分钟的时间内执行和解释。这比计算机断层扫描血管造影更快，特...

视频: 作者聚焦:使用床旁超声全面评估腹主动脉

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine balloon denudation model, which is comparable with established vessel injury models in large animals. The aorta denudation model with balloon catheters mimics the clinical setting and leads to comparable pathobiological and physiological changes. Briefly, after performing a horizontal incision in the aorta abdominalis, a balloon catheter will be inserted into the vessel, inflated, and introduced retrogradely. Inflation of the balloon will lead to intima injury and overdistension of the vessel. After removing the catheter, the aortic incision will be closed with single stiches. The model shown in this article is reproducible, easy to perform, and can be established quickly and reliably. It is especially suitable for evaluating expensive experimental therapeutic agents, which can be applied in an economical fashion. By using different knockout-mouse strains, the impact of different genes on MH development can be assessed.

This article demonstrates a murine model to study the development of myointimal hyperplasia (MH) after aortic balloon injury.

球囊损伤诱发小鼠腹主动脉 Myointimal 增生的研究

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

科研

医学

Measurement of Pulse Propagation Velocity, Distensibility and Strain in an Abdominal Aortic Aneurysm Mouse Model

An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the abdominal aorta that exceeds the maximal intraluminal diameter (MILD) by 1.5 times of its original size. Clinical and experimental studies have shown that small aneurysms may rupture, while a subpopulation of large aneurysms may remain stable. Thus, in addition to the measurement of intraluminal diameter of the aorta, knowledge of structural traits of the vessel wall may provide important information to assess the stability of the AAA. Aortic stiffening has recently emerged as a reliable tool to determine early changes in the vascular wall. Pulse propagation velocity (PPV) along with the distensibility and radial strain are highly useful ultrasound-based methods relevant for assessing aortic stiffness. The primary purpose of this protocol is to provide a comprehensive technique for the use of ultrasound imaging system to acquire images and analyze the structural and functional properties of the aorta as determined by MILD, PPV, distensibility and radial strain.

This manuscript describes a detailed protocol for using high frequency ultrasound imaging to measure luminal diameter, pulse propagation velocity, distensibility and radial strain on a mouse model of abdominal aortic aneurysm.

腹部主动脉瘤小鼠模型中脉冲传播速度、失散性和应变的测量

An abdominal aortic aneurysm (AAA) is defined as a localized dilation of the abdominal aorta that exceeds the maximal intraluminal diameter (MILD) by 1.5 ...

免疫与感染

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

Lung ultrasound is a noninvasive and valuable tool for bedside evaluation of neonatal lung diseases. However, a relative lack of reference standards, protocols and guidelines may limit its application. Here, we aim to develop a standardized neonatal lung ultrasound diagnostic protocol to be used in clinical decision-making.

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been widely used to measure aortic dimensions in mouse models of aortic aneurysms. Aortic aneurysms are defined as permanent dilations of the aorta, which occur most frequently in the ascending and abdominal regions. Sequential measurements of aortic dimensions by ultrasound are the principal approach for assessing the development and progression of aortic aneurysms in vivo. Although many reported studies used ultrasound imaging to measure aortic diameters as a primary endpoint, there are confounding factors, such as probe position and cardiac cycle, that may impact the accuracy of data acquisition, analysis, and interpretation. The purpose of this protocol is to provide a practical guide on the use of ultrasound to measure the aortic diameter in a reliable and reproducible manner. This protocol introduces the preparation of mice and instruments, the acquisition of appropriate ultrasound images, and data analysis.

Ultrasound imaging has become a common modality to determine the luminal dimensions of thoracic and abdominal aortic aneurysms in mice. This protocol describes the procedure to acquire reliable and reproducible two-dimensional ultrasound images of the ascending and abdominal aorta in mice.

小鼠胸腹主动脉超声检查确定动脉瘤大小

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been ...

Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At present, most primary medical institutions in China have a poor percentage of adoption of blood-testing technology, and a hematology detection system with a high price to performance ratio and easy operation is urgently needed in primary healthcare centers. This paper introduces the principle and operation procedures of a point-of-care testing (POCT) card-based leukocyte analyzer (evaluated system), which was used to detect WBC indexes such as neutrophils, lymphocytes, and intermediate group cells (including eosinophils, basophils, and monocytes) in whole blood. The results from the evaluated system were compared to those from two commercial automatic hematology analyzers (reference system). The correlation and consistency between the evaluated system and the commercial reference systems were analyzed. The results showed that WBC count and number of granulocytes detected by the evaluated and reference systems showed a strong positive correlation (rs = 0.972 and 0.973, respectively), while the number of lymphocytes showed a relatively low correlation (rs = 0.851). A Bland-Altman plot showed that the major difference between the values detected by the evaluated system and the reference systems is within 95% limits of agreement (LoA), indicating that the two systems are in good agreement. In conclusion, the evaluated system has an excellent correlation, robust consistency, and a reliable comparison with the results of the widely used automatic hematology analyzers. It is ideal for WBC detection in primary medical institutions where a full-automatic five-category hematology analyzer is unavailable, especially during the COVID-19 normalized prevention and control period.

A protocol to measure peripheral blood leukocytes using a POCT card-based leukocyte analyzer is presented here. Same blood samples were tested by two automated hematology analyzers to evaluate the consistency and accuracy of the results. The results showed that the evaluated analyzer had a good correlation with the reference system.

用于测量外周血白细胞的床旁测试分析仪的评估

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening sequelae. While whole leg compression ultrasound with color and spectral Doppler is commonly performed in radiology and vascular labs, point-of-care ultrasound (POCUS) is becoming more common in the acute care setting. Providers appropriately trained in focused POCUS can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. This paper describes a simplified yet validated approach to POCUS by describing a three-zone protocol for lower extremity DVT POCUS image acquisition. The protocol explains the steps in obtaining vascular images at six compression points in the lower extremity. Beginning at the level of the proximal thigh and moving distally to the popliteal space, the protocol guides the user through each of the compression points in a stepwise manner: from the common femoral vein to the femoral and deep femoral vein bifurcation, and, finally, to the popliteal vein. Further, a visual aid is provided that may assist providers during real-time image acquisition. The goal in presenting this protocol is to help make proximal lower extremity DVT exams more accessible and efficient for POCUS users at the patient&#39;s bedside.

Traditionally, lower extremity deep venous thrombosis (DVT) is diagnosed by radiology-performed venous duplex ultrasound. Providers appropriately trained in focused point-of-care ultrasound (POCUS) can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. We describe the scanning technique for focused POCUS DVT lower extremity examination.

下肢近端深静脉血栓形成的即时超声筛查

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

Ultrasound Assessment of Aortic and Carotid Artery Intima-media Thickness in Children and Adolescents

Carotid intima-media thickness (IMT), measured using high-resolution B-mode ultrasonography, is a widely utilized surrogate marker of subclinical atherosclerosis, the pathophysiological process underlying most clinical cardiovascular disease events. Atherosclerosis is a gradual disease that originates early in life, thus, there has been increased interest in measuring carotid IMT in childhood and adolescence to assess structural change in the arterial vasculature in response to adverse exposures. However, the timing of atherosclerosis varies across the vascular tree. Primordial atherosclerotic lesions are present in the abdominal aorta as early as infancy, compared to mid-adolescence for the common carotid. Measurement of IMT at either site is susceptible to several technical challenges that need to be considered, especially in younger children. In this paper, we provide a detailed stepwise method for high-quality assessment of IMT of the abdominal aorta and common carotid artery in the young. We also provide insight into the appropriateness of either site when exploring the associations between early-life exposures and later-life cardiovascular disease.

The present article describes the methodological considerations for the noninvasive assessment of abdominal aortic and carotid intima-media thickness using B-mode ultrasonography. This technique is commonly used in the developmental origins of health and disease research as a surrogate for early arterial changes.

儿童和青少年主动脉和颈动脉内膜中层厚度的超声评估

Carotid intima-media thickness (IMT), measured using high-resolution B-mode ultrasonography, is a widely utilized surrogate marker of subclinical ...

Using Point of Care Ultrasound to Augment Acquisition of Physical Exam Skills: Veins and Arteries

Source: Joseph H. Donroe, Rachel Liu; Yale School of Medicine, USA
Vascular diseases make up most cases of emergency hospitalization and carry a high mortality risk. Point-of-care ultrasound or POCUS enables accurate diagnosis of these diseases and shortens the time between detection of the cause and selection of appropriate treatment strategies, thus, reducing the patient mortality rate. POCUS offers a safe, low-cost, and less invasive bedside tool for examining arteries and veins, besides its many other applications.
For learners, the anatomical difference between arteries and veins can also be better understood with the help of POCUS. Arteries are thicker walled and pulsatile; veins are thinner walled, may have valves, and collapse when compressed.
Arteries may be difficult to palpate if they are deeper, have reduced blood flow, or a practitioner does not know the anatomic landmarks or is inexperienced. During an examination, while palpation enables an understanding of the intensity, symmetry, and rhythm of blood flow, POCUS can provide exact information on the underlying anatomy and location of the blood vessels. For example, the dorsalis pedis is a major artery that runs over the dorsal foot. It can become impalpable if the flow is obstructed. In such a condition, POCUS can help to detect the absence of blood flow.&#160;
Consider the internal jugular vein or IJV, which drains venous blood from the brain and superficial veins of the face and finally delivers the blood to the right atrium of the heart. Visualization of the internal jugular vein under ultrasound can improve inspection for jugular venous distension.
Among the arteries, the aorta is the main artery that carries oxygenated blood from the heart and branches off to deliver blood to the rest of the body. The portion of the aorta that passes through the abdomen, from the diaphragm to the umbilical area, is known as the abdominal aorta. The abdominal aorta is examined using POCUS to diagnose life-threatening conditions such as abdominal aortic aneurysm&#8212; a swelling in the aorta, or aortic dissection&#8212; a tear in the artery.&#160;
The conceptual knowledge of the vascular system combined with the technical skills of using palpation and ultrasound can help make life-saving diagnoses during physical examination.
In this video, we will demonstrate how to use POCUS to facilitate learning the examination of veins and arteries.

使用床旁超声增强体格检查技能的习得：静脉和动脉

使用床旁超声增强体格检查技能的习得:静脉和动脉

Source: Joseph H. Donroe, Rachel Liu; Yale School of Medicine, USA
Vascular diseases make up most cases of emergency hospitalization and carry a high ...

教育

JoVE Science Education

临床技能

Physical Examinations IV

High-frequency Ultrasound Imaging of the Abdominal Aorta

Source: Amelia R. Adelsperger, Evan H. Phillips, and <a href="https://www.jove.com/author/Craig+J._Goergen">Craig J. Goergen</a>, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
High-frequency ultrasound systems are used to acquire high resolution images. Here, the use of a state-of-the-art system will be demonstrated to image the morphology and hemodynamics of small pulsatile arteries and veins found in mice and rats. Ultrasound is a relatively inexpensive, portable, and versatile method for the noninvasive assessment of vessels in humans as well as large and small animals. These are several key advantages that ultraound offers compared to other techniques, such as computed tomography (CT), magnetic resonance imaging (MRI), and near-infrared fluorescence tomography (NIRF). CT requires ionizing radiation and MRI can be prohibitively expensive and even impractical in some scenarios. NIRF, on the other hand, is limited by the penetration depth of light required to excite the fluorescent contrast agents.
Ultrasound has limitations in terms of imaging depth; however, this may be overcome by sacrificing resolution and using a lower frequency transducer. Abdominal gas and excess body weight can severely diminish image quality. In the first case, the propagation of sound waves is limited, while in the latter case, they are attenuated by overlying tissues, such as fat and connective tissue. As a result, no contrast or faint contrast may be observed. Finally, ultrasound is a highly user-dependent technique, requiring the sonographer to be familiar with anatomy and to be able to work around issues, such as the appearance of imaging artifacts or acoustic interference.

高频超声成像和图像采集

腹大塔的高频超声成像

Source: Amelia R. Adelsperger, Evan H. Phillips, and Craig J. Goergen, Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 
...

腹主动脉床旁超声评估方法

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球囊损伤诱发小鼠腹主动脉 Myointimal 增生的研究

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基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

小鼠胸腹主动脉超声检查确定动脉瘤大小

用于测量外周血白细胞的床旁测试分析仪的评估

下肢近端深静脉血栓形成的即时超声筛查

儿童和青少年主动脉和颈动脉内膜中层厚度的超声评估

使用床旁超声增强体格检查技能的习得:静脉和动脉

使用床旁超声增强体格检查技能的习得:静脉和动脉

腹大塔的高频超声成像