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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2019, Vol. 16 ›› Issue (12) : 892 -898. doi: 10.3877/cma.j.issn.1672-6448.2019.12.003

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战术战伤救治中的超声技术应用专家共识
全军超声医学专业委员会, 中国医学装备协会应急救治装备分会   
  • 收稿日期:2019-11-04 出版日期:2019-12-01

Expert consensus on application of ultrasonic technology in tactical combat casualty care

Professional Committee of Ultrasound Medicine of Chinese PLA, Emergency Rescue and Treatment Equipment Branch of China Association of Medical Equipment   

  • Received:2019-11-04 Published:2019-12-01
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全军超声医学专业委员会, 中国医学装备协会应急救治装备分会. 战术战伤救治中的超声技术应用专家共识[J]. 中华医学超声杂志（电子版）, 2019, 16(12): 892-898.

Professional Committee of Ultrasound Medicine of Chinese PLA, Emergency Rescue and Treatment Equipment Branch of China Association of Medical Equipment. Expert consensus on application of ultrasonic technology in tactical combat casualty care[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(12): 892-898.

图1 腹腔积液超声表现。图a为超声显示右上腹积液无回声区（箭头所示）；图b为超声显示左上腹积液无回声区（箭头所示）；图c为超声显示下腹部盆腔积液无回声区（箭头所示）
图2 脾脏破裂常规超声及超声造影图像。图a为常规超声示脾脏实质回声不均，内可见不规则无回声区，边界不清（箭头所示）；图b为超声造影示脾脏创伤灶呈不规则低或无增强区（长箭头所示），其内见造影剂外溢及浓聚，提示存在活动性出血（短箭头所示）；图c为超声造影引导下，于创伤灶（长箭头所示）内多点注射止血剂（短箭头所示为穿刺注射针）
图3 胸腔积液超声图像。图a为超声显示肋膈角处正常胸腔，内未见积液（箭头所示）；图b为胸腔内可见积液无回声区（箭头所示）；图c为超声引导下胸腔穿刺置管引流（箭头所示为穿刺针）
图4 气胸的超声检查。图a为探头置于锁骨中线自上而下进行探查；图b为超声显示正常胸壁和胸膜结构，肺滑动形成深方"彗星尾"伪像（箭头所示）；图c为气胸时，超声动态观察肺滑动征消失，肺滑动形成的深方"彗星尾"伪像消失（箭头所示）
图5 肋间动脉破裂常规超声及超声造影图像。图a为超声显示胸壁软组织回声不均，可见胸腔积液（箭头所示）；图b为超声造影显示活动性出血部位造影剂溢出和浓聚（箭头所示）；图c为在超声造影引导下，采用穿刺针将止血胶推注至造影剂浓聚区（箭头所示），进行损伤控制
图6 心包积血的超声检查。图a为探头置于锁骨中线第5肋间进行探查；图b为超声显示心包积血（箭头所示）；图c为在超声引导下，穿刺针实时经胸壁抵达心包腔，实施穿刺减压（箭头所示为穿刺针）
图7 颅脑创伤出血的超声引导下损伤控制。图a为在头顶部脑的少功能区开放一直径1 cm的颅窗；图b为便携超声借此颅窗探查颅内血肿（箭头所示）；图c为超声引导下注射止血剂至出血部位进行损伤控制（箭头所示为穿刺针）
图8 肢体骨折的超声图像。图a为二维超声长轴切面显示骨皮质强回声连续性中断，并成角（箭头所示）；图b为超声短轴切面观察骨不连续的断端（箭头所示）；图c为超声显示骨折处软组织回声不均匀，可见血肿形成（箭头所示）
图9 骨筋膜间室综合征的超声检查。图a为创伤后肢体肿胀出现张力性水泡；图b为二维超声显示伤肢肌肉回声不均匀（箭头所示）；图c为频谱多普勒显示局部血流频谱形态异常，收缩期高尖，舒张期呈全期反向，随压力增高，表现为舒张期递减波形
图10 超声引导下外周静脉通道建立。图a为掌上超声探头置于上臂显示头静脉；图b为超声引导下外周静脉穿刺置管（箭头所示）
图11 股神经阻滞的超声图像。图示在彩色多普勒超声引导下进行股神经阻滞（箭头所示为股神经位于股动脉彩色血流旁）
图12 远程机器人超声技术。使用远程机器人超声对某岛礁患者会诊，左上屏幕显示患者端机器臂置于检查部位（患者位于岛礁），右上屏幕为医师端远程操作机器臂实时显示肝脏超声图像
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