How to change the function of external respiration and pressure gradients in the circulatory system

 

The invention relates to medicine and is intended to improve the functions of circulation and respiration in patients with a decrease in these functions in the various branches of the profile, and can also be used for resuscitation measures. Patient is placed on his stomach and hands, clenched into fists, the doctor carries out the pressure on vertebrocostal coupling the left and right of the spine of the patient at an angle of 30-45oin Caudalie-cranial direction, starting with the first thoracic segment 12 segment with a force equal to half of the weight of the patient, when the pressure on vertebrocostal articulation of the patient actively provide passive exhalation or breathing out through the mouth, when resuscitation procedure is carried out until a steady self-breathing and sustainable ripple on the great vessels. The method promotes the discharge of mucus, increases the speed of blood flow, provides vital capacity of the lungs. 1 C.p. f-crystals, 1 table.

The invention relates to medicine and can be used in various offices profile for improving functions of respiration and circulation in patients with a decrease in these functions, and tachocline different profile, often to the fore the problem of breathing and blood circulation associated with injury or disease (1, 5). The long-lying patients there is a lack of or decrease the cough reflex, lack of involvement of the middle and upper parts of the chest in the act of breathing, which leads to reduction of external respiration function (5), increases hypoxemia and tissue hypoxia (5, 6, 7). Hemodynamic characterized by slow blood flow and deposition of blood in the venous section.

The known method of mechanical impact on the chest lying on the back of the patient in order to restore the functions of respiration and circulation, namely, that the physician carries out the pressure of the hands on the lower third of the sternum in the area of projection of the heart of the patient and periodically makes breaths mouth-to mouth or mouth to nose with a frequency of 4/1, simulating heart rhythm of the patient and his breathing rhythm (5).

However, the disadvantages of this method are low efficiency, high likelihood of fractures of the ribs and sternum, the complexity of the execution method for individuals who do not have medical education, how hard it is to make one person, because the person okazyvaetsya method is difficult to reproduce by persons with high disgust, as it requires a contact of his lips with a lip or nose of the patient. Even if the lips and nose of the patient to impose the headscarf, seeping through the material discharge from the nasopharynx force many to abandon this method of assistance. Also often when pressing on the sternum occurs regurgitation vomit, which not only adds to the disgust, but may cause aspiration of vomit into the respiratory tract. This method cannot be used to improve the reduced functions of respiration and circulation, it is used only in the absence of the functions of respiration and circulation.

The objective of the invention is the creation of an effective, noninvasive method of exposure on the chest of the sick, precluding contact of the lips of the doctor and the patient, minimizing the risk of aspiration of vomit, with the aim of improving reduced the function of external respiration and circulation, and to restore these functions in their absence.

The problem is solved in that way change the function of external respiration and changes in pressure gradients in the circulatory system by pressure on the chest of the patient lying differs in that the patient is laid on his stomach on the couch or raspolagaetsja to the left of the patient at the level of the line, through his hips, face toward the patient's head. Hands, clenched into fists, the doctor carries out the pressure on vertebrocostal coupling the left and right of the spine of the patient in Caudalie-cranial direction at an angle of 30-45ostarting with the first thoracic segment. When the pressure on vertebrocostal articulation patient performs active or passive exhale through an open mouth. The doctor then moves the fists along the spine of the patient on one segment below and again carries out the pressure on vertebrocostal joints, the patient again has an active or passive exhale through an open mouth.

Impact on vertebrocostal joints are made up of 12 segments with the force of pressure, equal to about half the weight of the patient. Then, the head of the patient is turned in the opposite direction, laid on the other cheek and again carries out the pressure on vertebrocostal coupling the left and right of the spine of the patient at an angle of 30-45ostarting with the first thoracic segment to the level 12 of the segment. This procedure is carried out once.

Criteria positive impact during the procedure are: poaul the e sputum or the appearance of cough in patients. Positive criteria for the application of the method after the procedure are increasing the speed of blood flow in blood vessels, a change of pressure in the major arteries and inferior Vena cava, the increased excursion of the chest, vital capacity (VC), minute volume of respiration (MOD).

At carrying out resuscitation pre-clean the oral cavity from foreign objects, the victim is also placed on the abdomen, and the impact on the patient by pressure on vertebrocostal articulation with 1 to 12 thoracic segments are carried out repeatedly until the active resistance on the part of the thorax of the patient, the emergence of self-sustaining breath and sustainable ripple on the main arteries.

The advantage of the described method of resuscitation.

1. Atraumatic. When the pressure on vertebrocostal articulation angle of 30-45oon the back is practically eliminated the occurrence of fractures of the ribs, so this effect simulates the physiological rotation of the ribs, which allows to use the method even if there are cracks in the ribs.

2. No contact with mucous and air of the patient. Application etologicheskie barrier in the assistance, and also advantageous in hygienic and anti-infective.

3. Simplicity of execution. Requires no special medical training.

4. Ergonomic.

5. More effective than existing methods resuscitation (see examples).

It is known that the basis of the act of breathing is a change in volume of the thorax, which varies with the movement of the ribs, the mechanism of reciprocal innervation of the external and internal intercostal muscles and the diaphragm. When the breath is rising edges, which results in increasing the volume of the thoracic cavity. When you exhale, the ribs are omitted, the thorax decreases in volume, increasing the pressure in the alveoli and air pneumatic paths out of the lungs (2-7).

The mechanism of cough is a sharp increase in air pressure in the pneumatic paths, due to spasm of the glottis and contraction of the striated muscles of the chest. This excess pressure and provides an increase in the rate of exhalation of air evacuation of debris and mucus from the respiratory tract (5, 6, 7).

In patients in the ICU, in the foreground the problem of breathing and blood circulation associated with injury or disease (1, 5). At long lying sick dopolnitelnye lack of involvement of the middle and upper parts of the chest in the act of breathing, which leads to the decline of respiratory function (5), increases hypoxemia and tissue hypoxia (5, 6, 7). The absence or decrease the cough reflex, rigidity of the muscles of the thorax is not allowed to create excessive pressure in the lungs exhale, cough becomes productive in the bronchi accumulated mucus (5, 6).

Thus, if passively to simulate the change in the volume of the thoracic cavity, it is possible to change the pressure in the thoracic cavity and to simulate the mechanism of inhalation and exhalation, as well as the mechanism of cough.

Modeling mechanisms of breath and cough is produced by exposure to vertebrocostal articulation by the above method. These impacts lead to passive rotation of the ribs around the transverse axis, the volume changes in the thoracic cavity, passive stretching of the lungs and increase their original volume, resulting in the alveoli increases the excess pressure. This excess pressure when active go passive exhalation arising from the pressure of the doctor on the chest in the area vertebrocostal joints, promotes evacuation of mucus from the small bronchi in larger and more of them out (5, 6, 7).

The application of the method leads to reduction of the kyphotic deformity in eniah. Objectively observed increase in the excursions of the thorax in patients, increased cough, mucus secretion, the increase of parameters of external respiration function (see examples).

In accordance with the fundamental laws of physics and physiology, the driving force of blood flow is the arteriovenous pressure gradient (7). The valve apparatus veins provides flow only toward the heart and prevent retrograde blood flow in the veins. The movement of blood through the veins due to respiratory movements of the thorax and diaphragm (suction effect) (7).

In place of passage through the aperture and the pressure in the inferior Vena cava abruptly falls from 10 mm RT.article in a caudal direction to 5 mm RT.article above the level of the diaphragm (7). This venous gradient provides and describes the state of blood flow. In clinical and biological death, no circulation and the venous gradient equal to zero.

In heavy conditions in patients is determined by the reduction of circulating blood volume (CBV). When this is expressed in the overflow of the venous system (1, 5), which confirms the reduction of arteriovenous gradients and pressure gradients in the inferior Vena cava above and below the diaphragm.

The main mechanisms obespechenie heart respiratory pump (7).

However, the long-lying sick and immobile patients in a coma there is a decrease in the leading role of the muscle pump, because active muscle contractions are absent.

Measurements show that suction the role of the heart in comparison with muscle and respiratory pump is very small and does not have host values (7).

Thus, on the first plan in the maintenance of arteriovenous gradient and pressure gradients in the veins enters the respiratory pump, but its function in critically ill reduced, as it is written above.

If you increase the function of the respiratory pump, simulating respiratory motion by the described method, it is against the background of increasing volumes of breathing will improve the suction function of the chest, will change the pressure gradients in the venous system and arteriovenous gradients, which will lead to an increase in the speed of blood flow and improve hemodynamic parameters.

The basis of resuscitation is to restore the functions of respiration and circulation. Applying the above method, the doctor simulates the function of breathing and creates a pressure gradient, restoring blood flow.

Clinical examples 1. In intensive care units, surgical and t is the volume of breathing (MOD), changes the speed of blood flow in the inferior Vena cava (NIP) above (VD) and below the diaphragm (nd), the monitor has measured the blood pressure the blood pressure at the brachial artery before applying the method after 10 min (1 dimension), 30 min (2 dimension), 1 hour (3rd dimension), 3 h (4 dimension) and next day (5th dimension) after the application of the method. Then the indicators were compared with the data before application of the method and was calculated percentages (see table).

These data indicate a high efficiency of the applied method, as conventional methods of treatment do not lead to such a sharp increase in the functions of respiration and circulation. The table also shows the long-lasting aftereffects: the increase of parameters of the function of respiration and circulation is maintained through day after exposure, although there is a slight reduction.

2. Application of the method for the intensive care unit at strangulation asphyxia July 1994, the Victim I., 32, Acute suicide. Stay in the loop at least 20 minutes Breathing, no heartbeat. Neck deep strangulation furrow. Above the furrow skin of cyanotic, they are numerous petechial rash. On the sclera of the eye Nehawka on call resuscitation team for 10 min spent resuscitation according to the standard technique. However, the result was not. Found death in strangulation asphyxia. After the departure of the brigade relatives asked the inventor, who was next to continue resuscitation. According to the above method, the author has continued the intensive care unit. After 5-7 min, the patient appeared wheezing while breathing in that moment, when was the pressure on vertebrocostal articulation. After 10 min from the start of application of the method exhale was moaning and appeared in opposition from the chest when pressed on it. When checking pupillary reflexes, not turning the patient was weak reaction to light. On the carotid artery have a faint ripple. Unexpectedly, the patient became loud with a groan to inhale and exhale air. Appeared clinico-tonic convulsive twitching of the thorax, head, and facial muscles. Markedly decreased depth strangulation furrow. Called again resuscitation team was hospitalized And. in the intensive care unit, where she died, having lived for 2 months.

This example illustrates the effectiveness of the proposed method in comparison with the previously known methods of resuscitation and the ability vosstanovit in a state of clinical death.

3. Resuscitation at the drowning 1992, the Victim B., 40 years. Clinical death as a result of asphyxia caused by aspiration of fresh water when drowning. Stay under the water and before resuscitation is not less than 30-40 minutes

In spite of the common events doctor rescue station for 20 min, heart rate and respiration, the patient is not appeared. The skin is cyanotic, cold. Pupils dilated. Reflexes not. The author suggested to use your method. The patient turned on his stomach and applied the method described above. In the first minutes when the pressure on vertebrocostal junction at the mouth of the patient began to receive water with foam. After 5 minutes has been resistance from the chest in response to pressure and weak passive breaths. After continued resuscitation copyright way for another 10 min recovered spontaneous breathing, appeared heartbeat, eyes narrowed. Came trembling, sometimes turning into convulsions. The patient continued to lay on his stomach, appeared continuous cough, was once vomiting. The body of the patient rubbed vodka, well wrapped. Hospitalized brigade SMP. Fate is unknown.

Dannunzio the tracheobronchial tree when aspirating water and vomit.

References 1. Giles B., Traumatic shock. Moscow, 1992, S. 26.

2. Sapin, M. R. human Anatomy. - M - "Medicine" - 1993. - T. 1, -S. 176-180.

3. Sapin, M. R. human Anatomy. - M - "Medicine" - 1993. - T. 1, - S. 255-260.

4. Sinelnikov R. D. Atlas of human anatomy. - M - "Medicine" - 1978.- So 1,- S. 196-198.

5. Thorns K. S., Butylin Y. P., Bobylev Y. I. Emergency conditions. Kiev Storv I", 1984.

6. Chuchalin A., Bronchial asthma. - M - Medicine - 1985.- C. 36-56.

7. Schmidt R. , TEWS, human Physiology. - M - 1996. - So 2, - S. 566-625.

Claims

1. How to change the function of external respiration and changes in pressure gradients in the circulatory system by mechanical impact on the chest lying patient, wherein the patient with reduced functions of respiration and circulation are placed on the abdomen, head turn and stack for example, on the left cheek, the hand of the patient come along the body, the doctor hands, clenched into fists, exercises pressure on vertebrocostal coupling the left and right of the spine of the patient at an angle of 30-45oin Caudalie-cranial direction, starting with the first thoracic segment 12 segment, with a force approximately equal to p the steel coupling with the first thoracic segment to the level 12 of the segment, when the pressure on vertebrocostal articulation patient performs active or passive exhale through an open mouth, the procedure is carried out once.

2. The method according to p. 1, characterized in that, in the absence of respiration and circulation in a patient at carrying out resuscitation procedure pressure on vertebrocostal articulation is carried out repeatedly until a steady self-breathing and sustainable ripple on the main arteries.

 

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