Australasian Journal of Ultrasound in Medicine最新文献_第3页

Management change following transthoracic echocardiogram in the intensive care unit 重症监护病房经胸超声心动图检查后的管理变化

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-06-25 DOI: 10.1002/ajum.12397

Jeremy A Smith, Ravi Mistry

Introduction/Purpose

The optimal utilisation of echocardiography in intensive care units (ICU) is not yet known; however, its use is becoming more frequent. Management change from transthoracic echocardiography (TTE) in ICU is quoted to be from 3% to 50%.

Methods

A retrospective review of clinical practice was performed over a 2-month period in a tertiary adult ICU, to explore the utilisation of formal TTEs and the findings of these. The rate of management change and critical findings were investigated, along with the indication for TTE and the patient cohort.

Results

Sixty-three TTEs were performed in 54 patients. A change in management occurred in 25.4% (16/63) of TTEs, with critical findings being found in 47.6% (30/63) of all TTEs. The most common indications for formal TTEs were incompletely differentiated or further evaluation of shock, and post arrest cardiac function.

Discussion

Almost half of the TTEs performed had critical findings, with common critical findings being severe LV dysfunction, severe RV dysfunction and regional wall motion abnormalities. Despite critical findings being seen frequently, there was only management change in 25%, suggesting that several of the critical findings were already suspected, clinically confirmed or had anticipatory management prior to TTE.

Conclusion

Critical findings are common in critically ill patients. However, not all critical findings will lead to a change in management. Formal TTEs in the ICU should be focussed to the clinical question being asked and a screening intensivist performed bedside TTE may be appropriate in certain situations to decrease workload of cardiology department.

导言/目的目前尚不清楚重症监护病房（ICU）中超声心动图的最佳使用率，但其使用正变得越来越频繁。据估计，重症监护病房中经胸超声心动图（TTE）对管理的改变从 3% 到 50% 不等。方法在一个三级成人重症监护病房进行了为期两个月的临床实践回顾，以探讨正式 TTE 的使用情况和结果。研究还调查了管理变化率和关键结果，以及 TTE 的适应症和患者群。结果对 54 名患者进行了 63 次 TTE 检查。25.4%（16/63）的 TTE 患者改变了治疗方案，47.6%（30/63）的 TTE 患者发现了危急病症。正式 TTE 最常见的适应症是休克分化不完全或进一步评估，以及骤停后的心脏功能。讨论近一半的 TTE 检查有危重发现，常见的危重发现是严重左心室功能障碍、严重左心室功能障碍和区域室壁运动异常。尽管危重结果经常出现，但只有 25% 的患者改变了治疗方案，这表明一些危重结果在进行 TTE 之前就已被怀疑、临床证实或进行了预期治疗。结论危重病人常见危重结果。然而，并非所有的危重发现都会导致管理的改变。在重症监护病房进行正式的 TTE 检查时，应重点关注所提出的临床问题，在某些情况下，由重症监护医生进行床旁 TTE 筛选可能是合适的，可减少心脏科的工作量。

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引用次数: 0

Diagnostic role of sonography in early detection and surgical intervention of an epidural abscess: A case report 超声在硬膜外脓肿早期发现和手术干预中的诊断作用：1例报告。

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-06-25 DOI: 10.1002/ajum.12400

Issac Cheong, Francisco Marcelo Tamagnone

Introduction

Intracranial epidural abscesses require swift diagnosis and treatment. While magnetic resonance imaging (MRI) is preferred for its detailed visualisation, it is costly and time-consuming. Transcranial sonography offers a rapid, portable and cost-effective alternative for assessing brain lesions.

Methods

We present a case study involving the diagnosis and management of an intracranial epidural abscess in a 25-year-old man with a traumatic brain injury who underwent a craniectomy and later developed fever and drowsiness in the intensive care unit.

Results

Using transcranial point-of-care ultrasound, a hypoechoic collection was identified at the surgical site, prompting further imaging with computed tomography (CT) and MRI, which confirmed the diagnosis of an epidural abscess. Prompt surgical intervention led to the resolution of symptoms and a favourable clinical outcome.

Conclusion

This case highlights the potential utility of brain sonography as an efficient and cost-effective initial diagnostic tool for detecting intracranial complications, particularly in postoperative patients with altered sensorium and fever, where timely intervention is crucial.

简介：颅内硬膜外脓肿需要快速诊断和治疗。虽然磁共振成像（MRI）是其详细可视化的首选，但它既昂贵又耗时。经颅超声为评估脑损伤提供了一种快速、便携和经济的替代方法。方法：我们报告了一个病例研究，涉及诊断和处理一个25岁的男性外伤性脑损伤，他接受了颅骨切除术，后来在重症监护室出现发烧和嗜睡。结果：使用经颅即时超声，在手术部位发现低回声收集，提示进一步进行计算机断层扫描（CT）和MRI成像，确认诊断为硬膜外脓肿。及时的手术干预导致症状的解决和良好的临床结果。结论：该病例强调了脑超声作为检测颅内并发症的有效且经济的初始诊断工具的潜在效用，特别是在术后感觉改变和发烧患者中，及时干预至关重要。

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引用次数: 0

Placental cord insertion migration: Implications for ultrasound documentation and follow-up of abnormal placental cord insertion site 胎盘脐带插入迁移：异常胎盘脐带插入部位的超声记录和随访的意义

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-06-14 DOI: 10.1002/ajum.12399

Samantha Ward, Zhonghua Sun, Sharon Maresse

Introduction/Purpose

It is well-documented in the literature that the placenta migrates during pregnancy; however, studies regarding placental cord insertion (PCI) migration are scarce. This longitudinal, prospective study aimed to determine whether PCI migration is a true phenomenon, to assess whether the PCI can change classification during pregnancy and to determine the validity of PCI site documentation including follow-up of abnormal PCI.

Methods

Eighty-three participants who had first, second and third trimester ultrasound examinations at a Western Australian private imaging practice over a 12-month period between November 2021 and November 2022 were recruited. The measured distance of the lower margin of the placenta to the cervix, the distance of the PCI to the closest placental edge and the PCI classification were documented in each trimester. Data analysis was conducted to determine PCI migration rates during pregnancy and to test for association between PCI migration and maternal and placental factors.

Results

The PCI migrated during pregnancy and the PCI classification has the potential to evolve. All identifiable PCIs that were normal in first trimester remained so throughout the pregnancy. The majority (67.6%) of cord insertions that were marginal in first trimester progressed to a normal insertion site by third trimester; 23.5% remained marginal and 8.8% evolved to a velamentous insertion. Three velamentous cord insertions were recorded in first trimester, none of which normalised—two remained velamentous during the pregnancy and one evolved to marginal in second trimester. Marginal cord insertions (MCIs) ≤10 mm from the placental edge in second trimester remained marginal in third trimester; MCIs that were >15 mm from the placental edge in second trimester normalised in third trimester.

Conclusions

Placental cord insertion migration is a phenomenon that occurs during pregnancy with the potential for PCI classification to evolve. Due to the association between abnormal PCI and perinatal complications, coupled with the potential for marginal cord insertion to evolve, documentation of PCI and follow-up of abnormal PCI is beneficial, particularly in cases of velamentous insertion and marginal insertion at the placental edge or in the lower uterus.

妊娠期间胎盘移位的文献记载很多，但有关胎盘脐带插入（PCI）移位的研究却很少。这项纵向前瞻性研究旨在确定PCI迁移是否是一种真实现象，评估PCI是否会在孕期改变分类，并确定PCI部位记录的有效性，包括对异常PCI的随访。这项研究招募了83名参与者，他们在2021年11月至2022年11月的12个月期间，在西澳大利亚一家私人影像诊所接受了第一、第二和第三孕期超声检查。每个孕期都记录了胎盘下缘到宫颈的测量距离、PCI到最近胎盘边缘的距离以及PCI分类。进行数据分析以确定妊娠期间的 PCI 迁移率，并检验 PCI 迁移与母体和胎盘因素之间的关联性。所有在妊娠头三个月正常的可识别 PCI 在整个孕期都保持正常。大多数（67.6%）脐带在妊娠头三个月时是边缘性的，到妊娠第三个三个月时发展为正常的插入部位；23.5%仍然是边缘性的，8.8%发展为绒毛状插入。在妊娠头三个月有三例绒毛状脐带插入，其中两例在妊娠期间仍为绒毛状，一例在妊娠后三个月演变为边缘性。第二孕期距胎盘边缘≤10毫米的边缘性脐带插入（MCIs）在第三孕期仍为边缘性；第二孕期距胎盘边缘>15毫米的MCIs在第三孕期恢复正常。由于异常 PCI 与围产期并发症之间存在关联，再加上边缘脐带插入可能会发生变化，因此记录 PCI 和随访异常 PCI 是有益的，尤其是在绒毛状插入和边缘插入胎盘边缘或子宫下段的情况下。

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引用次数: 0

Fetal large tubular oesophageal duplication cyst: A case report 胎儿大管状食管重复囊肿：病例报告

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-05-28 DOI: 10.1002/ajum.12387

Călina Maier, Radu Vlădăreanu, Raluca Tocariu, Marcela Șerban, Maria Olincă, Elvira Brătilă

Introduction

Oesophageal duplication cyst (EDC) is a rare congenital anomaly representing, after neuronal tumours, the second most common cause of posterior mass in children, with a prevalence of approximately 1/22,500 live births. Cervical cysts are very rare, and their antenatal detection is fairly uncommon.

Methods

We report the case of an isolated large mediastinal and cervical tubular EDC diagnosed prenatally in the third trimester.

Results

After birth, the baby became symptomatic developing respiratory distress due to the enlargement of the cyst and she underwent excision of the mass. The post-operative evolution was very good.

Conclusion

Our purpose was to raise awareness of the ultrasonographic features of this condition, thus improving the rate of prenatal diagnosis and offering the parents a proper counselling regarding the prognosis and the need for a further multidisciplinary approach after birth.

导言食管重复囊肿（EDC）是一种罕见的先天性畸形，仅次于神经元肿瘤，是导致儿童后部肿块的第二大常见原因，发病率约为 1/22,500。宫颈囊肿非常罕见，产前检查也相当少见。方法我们报告了一例在产前 3 个月诊断出的孤立性纵隔和宫颈管状EDC。结果婴儿出生后，由于囊肿增大而出现呼吸困难症状，她接受了肿块切除术。术后情况良好。结论我们的目的是提高人们对这种疾病的超声波特征的认识，从而提高产前诊断率，并就预后和出生后进一步采取多学科方法的必要性为父母提供适当的咨询。

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引用次数: 0

A stab in the dark 一针见血

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-05-22 DOI: 10.1002/ajum.12391

Gillian Whalley

Procedural guidance with ultrasound is challenging traditional medicine. And for good reason – precision is an ally whenever you are inserting a needle into a human body. With some imagination, I am able to conjure up a gruesome Hollywood-esque image of someone gripping a syringe in a gloved fist and thrusting it towards a body with the intention of hitting a target under the skin. In my mind, there is an element of chance as to whether the needle hits the intended anatomical target. It's a stab in the dark. In a more nuanced and stable clinical scenario, the insertion point is carefully considered and the odds of missing may be relatively low. But no matter how low, it seems intuitively sensible to use any imaging guidance available. And increasingly, that guidance is provided by ultrasound. Ultrasound has been established as a helpful addition to inserting intravenous lines, taking biopsies and draining free fluid, to name but a few.

If one assumes that the person inserting a needle has absolutely no knowledge of underlying anatomy and is simply taking a stab whilst hoping it will hit its spot then it is easy to perceive the massive benefit of ultrasound-guided procedures. But that simply isn't true. Medical students spend many hours learning about surface anatomy and how it relates to the underlying layers of tissue, muscle and bone below the skin. Doctors have a great understanding of anatomy and use their hands to palpate for certain underlying structures such as bony processes, tendons and veins, in order to piece together an image in their mind about the underlying anatomy. Anyone who has had blood taken knows that those technicians who do this are adept at feeling the anatomy on the inside of the elbow to find a vein to puncture and drain blood from no matter how deep it is. It is a well-honed skill.

But taking blood is one thing, injecting substances is quite another. Intra-articular injections for the treatment of joint osteoarthritis have been popular for some time and are safely performed using anatomical landmarks only. But increasingly, practitioners are using ultrasound to guide needle placement. In this issue of AJUM, Oo et al.¹ have performed a systematic review of ultrasound-guided injections and concluded that clinical outcomes are superior compared with landmark-guided injections. As a potential patient, I can see how this may build confidence in the procedure, but the added benefit of improved clinical outcomes makes ultrasound guidance even more compelling.

All new approaches come with a learning curve however and potentially some questions about who should do these procedures. Those with extensive landmark-guided experience may find the ultrasound hinders the process at first. And conversely, those with ultrasound experience may not have the confidence with landmark-guided procedures. Having two professionals (one an ultrasound expert) working side by side may seem attract

超声波手术引导正在挑战传统医学。这是有道理的--只要将针头插入人体，精确度就是盟友。只要稍加想象，我就能勾勒出一幅好莱坞式的可怕画面：戴着手套的人握紧注射器，将其推向人体，意图击中皮下目标。在我看来，针头是否击中预定的解剖目标存在偶然因素。这是在黑暗中摸索。在更细微、更稳定的临床情况下，插入点是经过仔细考虑的，失误的几率可能相对较低。但无论几率有多低，直觉上使用任何可用的成像引导似乎都是明智的。而这种引导越来越多地由超声提供。如果我们假设插针者完全不了解潜在的解剖结构，只是简单地一针刺入，并希望能刺中目标，那么我们就不难发现超声引导手术的巨大优势。但事实并非如此。医科学生花费大量时间学习表面解剖学，以及它与皮下组织、肌肉和骨骼的关系。医生对解剖学非常了解，他们会用手触摸某些底层结构，如骨突、肌腱和静脉，以便在脑海中拼凑出底层解剖的图像。抽过血的人都知道，从事这项工作的技术人员善于感受肘部内侧的解剖结构，无论静脉有多深，都能找到静脉进行穿刺放血。但抽血是一回事，注射药物又是另一回事。用于治疗关节骨关节炎的关节内注射已经流行了一段时间，只需使用解剖标记即可安全进行。但越来越多的医生开始使用超声波引导针头放置。在本期《AJUM》杂志上，Oo 等人1 对超声引导注射进行了系统回顾，并得出结论认为，与地标引导注射相比，超声引导注射的临床效果更佳。作为一名潜在患者，我可以理解这将如何建立起对手术的信心，但临床疗效改善的额外好处让超声引导变得更有说服力。那些拥有丰富地标引导经验的人可能会发现，超声波一开始会阻碍手术的进行。反之，有超声波经验的人可能对地标引导手术没有信心。让两名专业人员（其中一名是超声波专家）并肩工作看似很有吸引力，但随着超声波引导手术数量的增加，成本会很高。此外，我还听到一些从业者担心，经验不足的从业者会过于依赖超声波进行手术；他们会失去传统地标引导技术的艺术，但如果超声波对患者更好，这又是否是个问题呢？由于针吸术需要精确的解剖对准，以确保采集到正确的细胞样本，因此超声波在完善这项技术方面可能非常有用。在本期的《AJUM》杂志中，Akahoshi 等人2 介绍了一项小型研究，他们评估了内窥镜检查中超声引导细针活检低回声病变的效果。它为新手提供了一种练习插针的方法，并通过一系列导线和 LED 灯提供直接和实时的反馈（与无处不在的 "操作 "游戏的方式基本相同，但没有响亮的蜂鸣器！）。我坚信，超声引导正逐渐成为标准护理，增加的费用（如果有的话）将为患者带来更好的治疗效果，并增强从业人员（和患者）对手术的信心。

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引用次数: 0

A novel technique for the measurement of cervical length in non-pregnant women 测量非孕妇宫颈长度的新技术

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-05-22 DOI: 10.1002/ajum.12383

Yana Vinnikov, Eran Barzilay, Oshri Barel, Gil Levy

Introduction

Cervical elongation is considered a risk factor for pelvic organ prolapse treatment failure in uterine preservation surgery. Consensus has not been reached regarding what is considered a normal cervical length, or how to measure it. Our primary aim was to test a new technique for measuring cervical length.

Materials and Methods

We enrolled women undergoing hysterectomy, with or without pelvic organ prolapse (for all indications except cervical tumours/history of cervical operations). Their cervical lengths were measured both by ultrasound and anatomical measurement. The external length of the cervix was measured using Doppler location of the uterine artery near the cervical-uterine junction as the proximal point and compared to the ultrasound measurement of the cervical canal. The uterine specimen was used to record anatomical cervical measurements as well as uterine corpus length. Baseline characteristics such as age, body mass index and pelvic organ prolapse quantification were also collected.

Results

Twenty women were eligible for evaluation. We found the average anatomical cervical canal length was (ccAN) 33.95 mm (range ± 9.23) and by external measurement (ceAN) 36.80 mm (range ± 7.54). We found a significant, high-powered correlation between our ultrasound and anatomical measurements in both techniques, as well as between the two ultrasound techniques. We also found a negative correlation between cervical length and women's age (r_p = −0.443, P = 0.05).

Conclusion

Transvaginal ultrasound measurement of cervical length using the location of the uterine artery was found to have a strong correlation to the anatomical cervical length and can be used for the measurement of normal cervical length.

宫颈过长被认为是保留子宫手术中盆腔器官脱垂治疗失败的风险因素。关于什么是正常宫颈长度或如何测量，目前尚未达成共识。我们招募了接受子宫切除术的女性，无论是否伴有盆腔器官脱垂（除宫颈肿瘤/宫颈手术史外的所有适应症）。她们的宫颈长度通过超声波和解剖测量法进行测量。宫颈外部长度的测量以宫颈与子宫交界处附近的子宫动脉的多普勒位置为近端点，并与宫颈管的超声测量结果进行比较。子宫标本用于记录宫颈解剖测量值和子宫体长度。此外，还收集了年龄、体重指数和盆腔器官脱垂量化等基线特征。我们发现解剖学宫颈管平均长度（ccAN）为 33.95 毫米（范围 ± 9.23），外部测量（ceAN）为 36.80 毫米（范围 ± 7.54）。我们发现这两种技术的超声测量值与解剖测量值之间以及两种超声技术之间存在明显的高功率相关性。我们还发现宫颈长度与女性年龄之间存在负相关（rp = -0.443，P = 0.05）。经阴道超声利用子宫动脉位置测量宫颈长度与解剖学宫颈长度有很强的相关性，可用于测量正常宫颈长度。

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引用次数: 0

Optimising flow without congestion using the venous-arterial Doppler enhanced resuscitation framework 使用静脉-动脉多普勒增强复苏框架优化血流，避免拥堵

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-05-08 DOI: 10.1002/ajum.12388

Jon-Emile S Kenny, Philippe Rola

Introduction

Ultrasonography as a guide for intravenous (IV) fluid therapy is increasingly accepted within the spheres of acute care. Initial investigations and protocols often focused on measures of arterial flow as an objective approach for personalising organ ‘perfusion.’ More recently, and with literature associating excessive IV fluid with adverse outcomes, venous ultrasound as a measure of organ ‘congestion’ is taking hold. Yet, arterial (i.e., ‘perfusion’) and venous (i.e., ‘congestion’) Doppler ultrasound measures are often performed separately and can be time-consuming, especially for novices.

Methods

We report a case, wherein venous and arterial Doppler were simultaneously measured using a wireless, wearable ultrasound as a means to optimise flow without congestion.

Results

Before IV volume expansion, the patient had Doppler measures consistent with low central venous pressure (CVP) and stroke volume (SV). Following IV volume expansion, venous Doppler remained the same; however, carotid corrected flow time (ccFT) increased significantly.

Conclusion

A framework for venous-arterial Doppler enhanced resuscitation (VADER) can be used to guide IV volume in patients at risk for venous congestion.

超声波检查作为静脉输液治疗的指导，在急症护理领域已被越来越多的人所接受。最初的研究和方案通常侧重于动脉血流的测量，作为个性化器官 "灌注 "的客观方法。最近，随着静脉输液过量与不良预后相关的文献报道的出现，静脉超声作为器官 "充血 "的测量方法逐渐被接受。然而，动脉（即 "灌注"）和静脉（即 "充血"）多普勒超声测量通常是分开进行的，而且可能非常耗时，尤其是对新手而言。我们报告了一个病例，使用无线可穿戴超声设备同时测量静脉和动脉多普勒，以优化血流，避免充血。静脉容量扩容后，静脉多普勒保持不变，但颈动脉校正血流时间（ccFT）显著增加。静脉-动脉多普勒增强复苏（VADER）框架可用于指导有静脉充血风险的患者的静脉容量。

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引用次数: 0

Tissue Doppler imaging of the diaphragm and outcome of weaning from mechanical ventilation 膈肌组织多普勒成像与机械通气断奶的结果

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-05-06 DOI: 10.1002/ajum.12389

Shaobo Xin, Yingjia Li, Rui Liu, Xiaozhen Liu, Shaoqing Cai

Purpose

This study aimed to employ tissue Doppler imaging to monitor diaphragmatic peak velocity and acceleration during contraction and relaxation in mechanically ventilated patients, with the objective of assessing the potential utility of this technique in predicting weaning outcomes.

Methods

A total of 89 adult subjects were recruited in this study. After 30 min of spontaneous breathing trial, the diaphragm motion parameters, including peak contraction velocity, peak relaxation velocity, contraction acceleration and relaxation acceleration, were measured in real time using tissue Doppler imaging. According to the results of weaning, the patients were divided into successful weaning group and failed weaning group. The differences of diaphragmatic tissue Doppler imaging monitoring indicators between the two groups were analysed, and the receiver operating characteristic curve was drawn to analyse the value of each ultrasound parameter in predicting weaning.

Results

In the successful weaning group, there were 61 subjects, while in the failed weaning group, there were 28 subjects. The peak contraction velocity, peak relaxation velocity, contraction acceleration and relaxation acceleration of the diaphragm were significantly higher in the failed weaning group compared to the successful weaning group (P < 0.05). The area under the curve of diaphragmatic peak contraction velocity, peak relaxation velocity, diaphragmatic contraction acceleration and diaphragmatic relaxation acceleration were 0.81 (0.72–0.91), 0.85 (0.77–0.93), 0.74 (0.63–0.86) and 0.86 (0.78–0.94), respectively.

Conclusions

The diaphragm ultrasonic tissue Doppler imaging variables can serve as predictive indicators for weaning mechanical ventilation in patients, thus providing an effective tool to assist critical care physicians in determining the optimal timing for weaning mechanical ventilation.

本研究旨在采用组织多普勒成像技术监测机械通气患者在收缩和放松过程中的膈肌峰值速度和加速度，目的是评估该技术在预测断奶结果方面的潜在作用。经过 30 分钟的自主呼吸试验后，使用组织多普勒成像技术实时测量膈肌运动参数，包括收缩峰值速度、松弛峰值速度、收缩加速度和松弛加速度。根据断奶结果，将患者分为断奶成功组和断奶失败组。分析两组患者膈肌组织多普勒成像监测指标的差异，并绘制接收者操作特征曲线，分析各超声参数对断奶的预测价值。断奶失败组的膈肌收缩峰值速度、松弛峰值速度、收缩加速度和松弛加速度均明显高于断奶成功组（P < 0.05）。膈肌收缩峰值速度、松弛峰值速度、膈肌收缩加速度和膈肌松弛加速度的曲线下面积分别为 0.81（0.72-0.91）、0.85（0.77-0.93）、0.74（0.63-0.86）和 0.86（0.78-0.94）。膈肌超声组织多普勒成像变量可作为患者断绝机械通气的预测指标，从而为重症监护医生确定断绝机械通气的最佳时机提供了有效的辅助工具。

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引用次数: 0

Assessment of the liver with two-dimensional shear wave elastography following COVID-19 infection: A pilot study 用二维剪切波弹性成像技术评估COVID-19感染后的肝脏：试点研究

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-05-06 DOI: 10.1002/ajum.12390

Joyce Yea See Lau, Sandra O'Hara, Paul Lombardo, Melinda Goodyear

<div> <section> <h3> Introduction/Purpose</h3> <p>The coronavirus disease (COVID-19) is a widely spread viral infectious disease, which can impact multiple organs, including the liver. Elevated liver enzymes have been reported in COVID-19 patients; however, potential changes in liver stiffness following the viral infection remain uncertain. The main aim of this pilot study was to determine if there is a significant difference in liver stiffness between individuals who have never been infected with COVID-19 and those who had been infected with COVID-19 <6 months, experiencing only mild symptoms. The secondary aim was to compare the liver stiffness between participants infected with COVID-19 depending on the elapsed time since infection.</p> </section> <section> <h3> Methods</h3> <p>Two-dimensional shear wave elastography (2D-SWE) was performed prospectively on 68 participants. Thirty-four participants had been infected with COVID-19 (all for <6 months) (COVID-19 group), and another 34 had never been infected with COVID-19 (control group). The mean 2D-SWE measurements of both the COVID-19 group and the control group were compared using an independent <i>t</i>-test. The mean 2D-SWE measurements of the COVID-19 subgroups A (<2 months), B (2 to <4 months) and C (4 to <6 months) were compared using a one-way ANOVA test (P < 0.05).</p> </section> <section> <h3> Results</h3> <p>The (mean ± standard deviation) liver stiffness (kPa) of the COVID-19 group (5.26 ± 1.63 kPa) was significantly higher than the control group (4.30 ± 0.96 kPa) (P = 0.005). There was no significant difference in liver stiffness among subgroups A (5.20 ± 1.79 kPa), B (4.70 ± 1.53 kPa) and C (5.96 ± 1.48 kPa) (P = 0.143) respectively.</p> </section> <section> <h3> Discussion</h3> <p>The mean liver stiffness of 4.30 ± 0.96k Pa in the control group showed a high probability of being normal as per guidelines. Conversely, the mean liver stiffness of 5.26 ± 1.63 kPa in the COVID-19 group exhibited a statistically significant increase compared to the control group. However, compensated advanced chronic liver disease was ruled out without other known clinical signs, as per guidelines.</p> </section> <section> <h3> Conclusion</h3> <p>A statistically significant increase in liver stiffness value was observed in the post-COVID-19 infection group compared to the group who had never been infected. This highlights the potential for short-term impact on liver stiffness associa

冠状病毒病（COVID-19）是一种广泛传播的病毒性传染病，可影响包括肝脏在内的多个器官。据报道，COVID-19 患者的肝酶升高；然而，病毒感染后肝脏僵硬度的潜在变化仍不确定。本试验研究的主要目的是确定从未感染过 COVID-19 的人与感染 COVID-19 不到 6 个月但只有轻微症状的人之间的肝脏硬度是否存在显著差异。次要目的是比较感染COVID-19后不同时间段参与者的肝脏硬度。34名参与者感染过COVID-19（感染时间均小于6个月）（COVID-19组），另外34名参与者从未感染过COVID-19（对照组）。COVID-19 组和对照组的平均二维-SWE 测量值通过独立 t 检验进行比较。COVID-19亚组A（＜2个月）、B（2至＜4个月）和C（4至＜6个月）的平均二维-SWE测量值采用单因素方差分析进行比较（P＜0.05）。COVID-19组的（平均值±标准差）肝脏硬度（kPa）（5.26 ± 1.63 kPa）明显高于对照组（4.30 ± 0.96 kPa）（P = 0.005）。A 亚组（5.20 ± 1.79 kPa）、B 亚组（4.70 ± 1.53 kPa）和 C 亚组（5.96 ± 1.48 kPa）的肝脏硬度没有明显差异（P = 0.143）。相反，与对照组相比，COVID-19 组的平均肝硬度为 5.26 ± 1.63 kPa，在统计学上有显著增加。然而，根据指南，在没有其他已知临床症状的情况下，排除了代偿性晚期慢性肝病的可能性。与从未感染过 COVID-19 的组别相比，感染后的组别肝硬度值出现了统计学意义上的显著增加。这表明感染 COVID-19 可能会对肝脏硬度产生短期影响。不过，目前还不清楚肝脏硬度的这些变化是否与肝损伤有关。有必要进一步研究 COVID-19 感染的影响及其对肝脏的长期影响。

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引用次数: 0

Comparing short-axis versus long-axis ultrasound-guided techniques for internal jugular vein cannulation: A meta-analysis of clinical outcomes and safety 比较颈内静脉插管的短轴与长轴超声引导技术：临床结果和安全性的荟萃分析

Q3 Medicine

Australasian Journal of Ultrasound in Medicine

Pub Date : 2024-04-29 DOI: 10.1002/ajum.12385

Faisal AlGhamdi, Nasser AlJoaib, Ali Aldawood, Mohammed AlGhamdi, Abdullah AlMulhim

Introduction

Central venous access plays a crucial role in various clinical settings, and ultrasound guidance has become increasingly popular for improving its safety and success rates. The aim of this meta-analysis was to compare the short-axis (SAX) and long-axis (LAX) ultrasound-guided techniques for internal jugular vein (IJV) cannulation in terms of first needle pass success rate, number of cannulation attempts, access time, guidewire insertion time, posterior IJV wall puncture, arterial puncture, haematoma and catheter-related bloodstream infection.

Methods

A comprehensive literature search was conducted, and randomised controlled trials (RCTs) comparing SAX and LAX techniques for IJV cannulation on adults were included.

Results

A total of 11 RCTs involving 1183 patients were included in the meta-analysis. The SAX technique demonstrated a significantly greater first needle pass success rate and faster IJV access time compared to the LAX technique. However, more posterior IJV wall puncture was significantly associated with the SAX technique. There was no significant difference between the two techniques in terms of number of cannulation attempts, guidewire insertion time, arterial puncture, haematoma and catheter-related bloodstream infection.

Conclusion

This meta-analysis suggests that the SAX technique may have advantages over the LAX technique in terms of first needle pass success rate and potentially reducing cannulation attempts and access time. However, the occurrence of posterior IJV wall puncture raises concerns. The decision on the choice of technique should be based on individual patient factors and operator proficiency.

导言中心静脉通路在各种临床环境中发挥着至关重要的作用，而超声引导技术在提高其安全性和成功率方面越来越受欢迎。本荟萃分析旨在比较颈内静脉（IJV）插管的短轴（SAX）和长轴（LAX）超声引导技术的首次针穿刺成功率、插管尝试次数、通路时间、导丝插入时间、颈内静脉后壁穿刺、动脉穿刺、血肿和导管相关血流感染。方法进行了全面的文献检索，并纳入了比较 SAX 和 LAX 技术为成人进行 IJV 插管的随机对照试验 (RCT)。结果共纳入 11 项随机对照试验，涉及 1183 名患者。与 LAX 技术相比，SAX 技术的首次进针成功率明显更高，而且 IJV 进入时间更短。不过，SAX 技术与穿刺更多的 IJV 后壁明显相关。两种技术在插管尝试次数、导丝插入时间、动脉穿刺、血肿和导管相关血流感染方面没有明显差异。结论该荟萃分析表明，SAX 技术在首次穿刺针成功率方面可能比 LAX 技术更有优势，并有可能减少插管次数和插管时间。然而，后静脉壁穿刺的发生率令人担忧。应根据患者的个体因素和操作者的熟练程度来决定选择哪种技术。

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引用次数: 0