Majekiseni emhando yepamusoro ekudzivirira musiyano—kusanganisirajekiseni reCT rimwe chete, Majekiseni eCT ane misoro miviri, Majekiseni eMRIuyemajekiseni ekudzivirira kumanikidzwa kwakanyanya kwe angiography—zvakakosha pakuongorora mifananidzo. Zvisinei, kushandiswa kwavo zvisina kunaka kunogona kukonzera matambudziko akakomba akadai sekubuda kwemavara akasiyana-siyana, kupararira kwemasero, kana kuti kusawirirana kwemuviri. Kutevedzera matanho ekudzivirira akavakirwa pauchapupu kunoita kuti murwere agare akachengeteka uye kuti mifananidzo ishande zvakanaka.
1. Kuongorora uye Kugadzirira Murwere
Kuongorora Basa reItsvo & Kupatsanurwa kweNjodzi
Kuongororwa kweGFR: Kune mishonga inobva kugadolinium (MRI), ongorora varwere kuti vaone kana paine kukuvara kwakanyanya kweitsvo kana chirwere cheitsvo chisingaperi (GFR <30 mL/min/1.73 m²). Dzivisai kupiwa mushonga kunze kwekunge zvakanakira kuongororwa zvichidarika njodzi dzeNSF (nephrogenic systemic fibrosis).
Vanhu Vane Njodzi Yakanyanya: Vane chirwere cheshuga, vane BP, uye vakwegura (vane makore anopfuura makumi matanhatu) vanoda kuongororwa mashandiro eitsvo vasati vaongororwa. Kuti uwane iyodhini ine iodine (CT/angiography), ongorora nhoroondo ye contrast-induced nephropathy.
Kuongorora Kurwara uye Kurwara Kwezvirwere
- Nyora mafambiro akamboitika kare (semuenzaniso, urticaria, bronchospasm). Shandisa corticosteroids/antihistamines kuti ushandise mishonga yekare.
- Dzivisa zvidzidzo zvekusarudza kusiyana kwezviratidzo muasthma isina kugadzikana, active heart failure, kana pheochromocytoma.
Kusarudzwa Kwekupinda Kwetsinga Dzeropa
Saizi yeCatheter & Catheter: Shandisa macatheter e18–20G IV mutsinga dzepamberi pechizvaro kana dzeruoko. Dzivisa majoini, tsinga dzeruoko/dzeruoko, kana makumbo ane ropa rakakanganisika (semuenzaniso, mushure mekuvhiyiwa, dialysis fistulas). Kune mafambiro emvura >3 mL/sekondi, macatheter e≥20G anosungirwa.
Kuiswa kweCatheter: Isa ≥2.5 cm mutsinga. Edza patency ne saline flush uchitarisa zvakananga. Ramba macatheter ane resistance kana kurwadziwa panguva yekusuka.
2. Midziyo uye Kugadzirira Kusiyanisa Midhiya
Kubata Nemumiririri Wekusiyanisa Zvinhu
Kudzora Tembiricha: Kupisa zvinhu zvine iodine kusvika ~37°C kuderedza njodzi yekusviba uye kubuda kwemvura mumuviri.
Kusarudzwa kweAgent: Sarudza mishonga ye iso-osmolar kana low-osmolar (semuenzaniso, iodixanol, iohexol) kune varwere vane njodzi huru. Kune MRI, mishonga ye macrocyclic gadolinium (semuenzaniso, gadoterate meglumine) inoderedza gadolinium retention.
Kugadziriswa kweInjector & Kubviswa kweMhepo
Miganhu Yekudzvanyirira: Isa ziviso dzemuganho (kazhinji 300–325 psi) kuti uone kupinda kwemhepo nekukurumidza.
Nzira yekubvisa mweya: Isa machubhu, bvisa mweya uchishandisa saline, uye simbisa mitsetse isina mabubble. Kune majekiseni eMRI, chengetedza zvinhu zvisina ferromagnetic (semuenzaniso, Shenzhen Kenid's H15) kudzivirira njodzi dzema projectile.
Tafura: Magadzirirwo Ejekiseni Anokurudzirwa Nekushandisa Modality
| Maitiro | Mwero weKuyerera | Kusiyanisa Vhoriyamu | Kutsvaga Saline |
|————————|——————|———————|——————-|
| CT Angiography | 4–5 mL/s | 70–100 mL | 30–50 mL |
| MRI (Neuro) | 2–3 mL/s | 0.1 mmol/kg Gd | 20–30 mL |
| Peripheral Angio | 2–4 mL/s | 40–60 mL | 20 mL |
3. Matekiniki eKubaya Majekiseni Akachengeteka uye Kutarisa
Jekiseni rekuyedza uye Nzvimbo Yaro
- Ita majekiseni ekuongorora saline pa 0.5 mL/s yakakwira kupfuura kuyerera kwe contrast kwakarongwa kuti usimbise patency yemutsara uye kuiswa pasina extravasation.
- Dzima makumbo nemaoko uchishandisa ma splints/tepi; dzivisa kugonya ruoko panguva yekuskena chipfuva/dumbu.
Kutaurirana uye Kutarisa Munguva Yechokwadi
- Shandisa maintercom pakutaurirana nemurwere. Rayira varwere kuti vataure nezvekurwadziwa, kudziya, kana kuzvimba nekukasika.
- Tarisa nzvimbo dzinobayiwa jekiseni nemaziso panguva dzisina otomatiki. Pakuita kuti CT automated triggering, isa vashandi kuti vaone vari kure.
Kufunga Nezvekuwana Kwakakosha
Mitsetse Yepakati: Shandisa maPICC/CVC anobayiwa nemagetsi chete (akayerwa ≥300 psi). Edza kudzoka kweropa uye kushambidzika kwemunyu.
Mitsetse yemudumbu (IO): Chengeta nguva yekukurumidzira. Deredza mwero wemushonga kusvika ≤5 mL/s; rapa ne lidocaine kuti uderedze marwadzo.
4. Kugadzirira Panjodzi uye Kuderedza Zviitiko Zvakaipa
Nzira yekuwedzera musiyano
Mhinduro Yekukurumidza: Mira kubaya jekiseni, simudza gumbo, isa madzvinyiriro anotonhora. Kana paine huwandu hunopfuura 50 mL kana kuzvimba kwakanyanya, bvunza chiremba.
Kurapa Neganda: Shandisa dimethylsulfoxide (DMSO) gel kana dexamethasone-soaked gauze. Dzivisa kupfekedzwa zvine simba.
Anaphylaxis uye Kudzivirira NSF
- Chengetedza makit ekukurumidzira (epinephrine, bronchodilators) ari nyore kusvika. Dzidzisai vashandi muACLS kuti vaone kana paine matambudziko makuru (0.04%).
- Ongorora mashandiro eitsvo usati watanga MRI; dzivisa zvinhu zvinoshandisa gadolinium muvarwere vanovimba nedialysis.
Magwaro uye Mvumo Yakavakirwa Paruzivo
- Taura njodzi: mhedzisiro inokurumidza (kuda kurutsa, mapundu), NSF, kana kubuda ropa. Nyora mvumo uye nhamba dzemumiriri/nzvimbo.
Pfupiso
Majekiseni ekudzivirira musiyano ane simba guru anoda mitemo yakasimba yekuchengetedza:
Kutarisirwa kwakatarisana nemurwere: Kuronga njodzi (dzeitsvo/allergy), kuwana mukana wakasimba wekupinda mutsinga, uye kuwana mvumo yeruzivo.
Kunyatsorongeka kwehunyanzvi: Kuenzanisa majekiseni, kusimbisa mitsetse isina mhepo, uye kugadzirisa ma parameter ekuyerera kwemvura.
Kuchenjerera: Tarisa panguva chaiyo, gadzirira njodzi, uye tevedzera nhungamiro dzinoenderana nemumiririri.
Nekubatanidza matanho aya ekudzivirira, zvikwata zve radiology zvinoderedza njodzi ukuwo zvichivandudza kugona kwekuongorora chirwere—zvichivimbisa kuti kuchengetedzeka kwevarwere kunoramba kuri chinhu chakakosha mumifananidzo ine njodzi huru.
"Musiyano uripo pakati pemaitiro enguva dzose nechiitiko chakakosha uri mumashoko ekugadzirira." — Yakagadziridzwa kubva muACR Contrast Manual, 2023.
LnkMed
Nekuvandudzwa kwetekinoroji yemifananidzo yekurapa, kune makambani akawanda anogona kupa zvigadzirwa zvemifananidzo, zvakaita semajekiseni nemasirinji.LnkMedTekinoroji yezvekurapa ndeimwe yacho. Tinopa huwandu hwakazara hwezvigadzirwa zvekubatsira pakuongorora chirwere:jekiseni reCT rimwe chete，jekiseni reCT remusoro miviri,Jekiseni reMRIuyeJekiseni reDSA rinodzvanywa zvakanyanya. Dzinoshanda zvakanaka nemarudzi akasiyana-siyana eCT/MRI scanner akadai seGE, Philips, Siemens. Kunze kweinjector, tinopawo sirinji nechubhu zvinoshandiswa pamhando dzakasiyana dzeinjector dzinosanganisira Medrad/Bayer, Mallinckrodt/Guerbet, Nemoto, Medtron, Ulrich.
Izvi ndizvo zvatinogona kuita: nguva yekutumira nekukurumidza; Zvitupa zvakakwana, makore mazhinji eruzivo rwekutumira kunze kwenyika, maitiro ekuongorora emhando yepamusoro, zvigadzirwa zvinoshanda zvizere, tinogamuchira nemufaro mubvunzo wako.
Nguva yekutumira: Chikunguru-19-2025
