Method for diagnosing the cases of severe lower extremities ischemia

FIELD: medicine.

SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.

EFFECT: enhanced effectiveness in recognizing patient group suffering from severe lower extremities ischemia.

6 dwg

 

The invention relates to medicine, namely to surgery, and can be used for the diagnosis of severe stages of ischemia of the lower extremities.

Closest to the claimed solution is to use rheovasography of patients with obliterating atherosclerosis of the lower extremities (Vinogradova T.S. Instrumental methods of examination of the cardiovascular system. - M.: Medicine, 1986. - s), however this method does not take into account the functional characteristics of the hemodynamics of the lower extremities in increasing venous hypertension, as well as functional unloading of the venous system that occurs in severe ischemia of the lower extremities.

The important part of the pathogenesis of chronic ischemia of the lower extremities of atherosclerotic Genesis is venous hypertension (Vstavali, Vmesci; Critical ischemia of the lower extremities. Moscow: Medicine, 1997) and thereby the deterioration of the venous outflow. In turn, the unloading of the venous system promotes blood flow.

The objective of the invention is to select the category of patients with severe ischemia of the lower extremities, which shows a therapy aimed at the regulation of the venous outflow.

This object is achieved in that for select patients with severe ischemia of the lower extremities, which shows therapy, e.g. the run on the regulation of the venous outflow used in addition to standardized methods (Vinogradova T.S. Instrumental methods of examination of the cardiovascular system. - M.: Medicine 1986. - s.) check eographically curve with the lower extremities (feet and legs), raised and fixed at an angle of 45°after solidification saphenous vein (functional unloading of the venous system), and with bowed legs after 5 minutes under the condition of filling saphenous vein blood on the breath (venous hypertension). Eographically curve is recorded on the rheography REO-Range NA 1005, Neurosoft, Russia. For better representativeness of the indicators used developed an index of the functional reserve of the blood flow (IFRC), which is the product of division and difference eographical index registered in terms of functional unloading of the venous system (RVS) and venous hypertension (SH): IFRC=RIRs/Riug·(RIRs-Riwg).

The method is as follows. In a room with a temperature of 22°after a 15 minute rest, on an empty stomach or 2 hours after a meal check eographically curve with the lower extremities (feet and legs), raised and fixed at an angle of 45°after solidification saphenous vein (functional unloading of the venous system), and with bowed legs after 5 minutes under the condition of filling is placed saphenous vein blood on the breath (venous hypertension). For better representativeness of the indicators used developed an index of the functional reserve of the blood flow (IFRC), which is the product of division and difference eographical index registered in terms of functional unloading of the venous system (RVS) and venous hypertension (SH): IFRC=RIRs/Riug·(RIRs-Riwg)

This technique was applied in 105 patients with obliterating atherosclerosis of vessels of lower extremities with II, III, IV degrees of ischemia (Avitoscana) 35 persons respectively, treated at the Department of vascular surgery Bureau, Kursk (Fig.1-6).

The following results are obtained: it is Established that in terms of functional unloading of the venous system (RVS) statistically significantly (p<0,01) increased eographically index (RI), which has a strong tendency to decrease as functional venous hypertension (SH), and the difference in index correlates with the severity of arterial lesions. For stage II lower limb ischemia characterized by higher rates of IFRC. Stage III-IV was characterized by the distribution of the patients into two groups: those with initial low IFRC (tends to 0) and with a pronounced increase in IFRC (more than 1), with an increase of the degree of ischemia prevailed the first group.

Low values of IFRC prognostically, th is indicates the depletion of the reserve capacity of the body and the circulatory decompensation. It is advisable to use IFRC for a more adequate characterization of insufficient blood flow. We believe that in the treatment of obliterating atherosclerosis of vessels of lower extremities should take into account IFRC to select patients who have shown therapy aimed at the regulation of venous tone and acceleration of the venous outflow.

Method for the diagnosis of severe ischemia of the lower limbs in impaired venous outflow, characterized in that a registration eographically curve from the feet and legs, raised and fixed at an angle of 45°after solidification saphenous vein, and with bowed legs in a vertical position after 5 min on the breath, using the index of the functional reserve of the blood flow, which is the product of division and difference eographical index registered with raised and lowered vertically lower limbs.



 

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