A method for predicting the risk of development and course of cardiovascular disorders in patients with leptospirosis
(57) Abstract:The invention relates to the field of medicine. The essence of the invention is that in the serum of patients with leptospirosis determine the content of cardiac troponin-T and significantly greater than normal (p<0,05) values predict the risk of sudden heart weakness in the acute period of the disease, and in people who have had this disease, the formation of chronic diseases of the cardiovascular system (HSSS). Indicators kardeogemodyinamiki (stroke volume, minute volume of blood, systolic index, total peripheral vascular resistance, specific peripheral vascular resistance which significantly differs from the norm, predict the development of shock. The method allows to predict and efficiently nausea (restore) declining heart function, prevent shock, and other cardiovascular complications. 1 Il., table 2. The invention relates to medicine, namely to predict the risk of development and current frequent cardiovascular disorders in patients with leptospirosis in acute and reconvalescence period of the disease.There is a method of diagnostics is [Drankin D. I. , Godlevskaya M. C. Leptospirosis. - Saratov.1988 at M.V.Lomonosov, - s.; Pupkewitz-Diamond J. C. et al. Electrocardiographic changes during leptospirosis //Clinically. medicine. - 1990.- 3, - S. 82-86, etc].However, to predict the occurrence, course and outcomes of cardiovascular disorders only with the diagnosis it is impossible. The main reason for this is that to date, the mechanism for the development of dysfunction of the cardiovascular system when leptospirosis infection has not been studied. In addition, the typical clinical symptoms of leptospirosis because of its exclusivity as "blinds" cardiovascular disorders and drives the doctor towards the provision of emergency relief pronounced and acute renal acute renal and hepatic failure. While existing cardiovascular pathology is perceived as normal, i.e. not different from those with other infectious diseases.The appearance of patients with leptospirosis in the midst of illness such clinical signs such as tachycardia, cyanosis and acrocyanosis, dizziness, deafness and arrhythmia of heart sounds, hypotension, low voltage on the ECG, the interval offset from ST contours, the inversion of the A.At the same time these symptoms appear, patients not in the early days, when especially pronounced fever, intoxication, headaches, muscle pain, and after 6-10 days from the onset of the disease, when normalized temperature and showed signs of acute renal and acute renal and hepatic failure (ARF, OPN). In essence, marked cardiovascular disorders develop on the background of endotoxemia, is neither a synonym nor by analogy, neither clinical-pathogenetic model ITSH [Weil M. N. Shubin N. Diagnosis and treatment of Shok /The Wilkins Co.- Baltimore.-1967. - 354 p.].This means that the person with the problem has not been studied. Not also studied the nature and mechanisms of the development of cardiovascular disorders in young patients with good cardiac history who have had leptospirosis. Diagnosed in them myocarditis, cardiomyopathy, ischemic heart disease, arterial hypertension are not only significant frequency, and adverse outcomes [Miller, C., Leonova, T. C. Residual effects transferred leptospirosis MRF. - 1989.-8.-p. 3].Sources of information that reveal the prediction of the risk of development and course of cardiovascular disorders in patients with leptospirosis, known to the applicants, the AI does not exist.The task of the invention: reducing mortality from leptospirosis in the acute period of the disease and the prevention of chronic diseases of the cardiovascular system (HSSS) in people who have had this infection through early detection of the nature of cardiovascular lesions and prognosis of their course.The technical essence of the invention is that seen in patients with leptospirosis cardiovascular disorders, myalgia, ARF and OPEN pathogenetically linked and interdependent. These symptoms are the result of damage leptospirae and their toxins in the muscle tissue. This is evidenced by the penetration of the blood flow is not peculiar to the blood of the muscle protein myoglobin. The lack of it in the urine of patients indicates that he cannot overcome kidney filter, thus creating the phenomenon of crash syndrome in the form of ARF [Miller, C. et al. The value of myoglobin in the pathogenesis of leptospirosis //Therapist, archive. - 1997.- 4. - S. 69-72; Miller, C. et al. Liver damage when leptospirosis Kuban. Nauch.-the honey. Herald. - 1999. - 7. - c. 87-90; Miller, C. et al. New in the pathogenesis of leptospirosis. Act. Problems of infectious pathology. - Kazan. - 2000. - S. 138-140.]
In the pathogenetic complex leptospirosis.To prove the truth of cardiomyocyte when leptospirosis availability of myoglobulinuria, it seems to us, is not enough. And while the content of serum myoglobin is possible to judge the degree of myocardial damage [old believers, I. I. et al. Serum myoglobin in acute myocardial infarction //Therapist. archive. - 1980.-so 52 - 12 - C. 22-25], however, found it necessary to conduct a special investigation.The technical novelty of the invention is:
Determination in serum of patients with leptospirosis in the 1st week of illness (onset), 2 weeks (the height of the disease) and 3 weeks (recovery period) level of cardiac troponin-T as a marker of necrosis of the heart muscle and the simultaneous determination of indices of Central and peripheral hemodynamics and subject to the excess of the content of the level of cardiac troponin-T relative to the standards and availability of geodinamicheskogo type hemodynamics identify the risk of cardiovascular disorders in patients with leptospirosis.The method of determination of cardiac troponin-T osushestvliayut in the following way:
From the cubital vein of the patient with leptospirosis take in sterile conditions 3-4 ml of blood and through 1-1,5 hours defending otbu (ELISA). It is based on the use of sorbed on the solid phase (solid pellets) is known component (antibody or antigen).In this invention the solid phase is taken antibody, i.e. cardiac troponin-T. Other constituents of the reaction, including test serum, add sequentially in a liquid soluble form [Van Weeman C. K., Schunrs A. H. Jmmunoassay usinq antiqen - enzyme conjuqates FEBS //Letters. - 1971. - v.l5.- p.232-240; Enqvall E., Penman P. Enzyme-Linked immunoqlobulin //G. Immynochemistry. -1971. -v. 8. -p. 871-874.].Solving a problem is detected in patients with leptospirosis with jaundice and Busselton form of the disease, regardless of its severity, high concentrations of cardiac troponin-T, significantly exceeding the norm (table. 1).The data obtained indicate that, in leptospirosis in the myocardium are necrosis of cardiomyocytes due to leptospirosis cardiomyocytes.Example:
Patient A. , 61, admitted in IB, Krasnodar on the 3rd day of illness in a serious condition. Based on clinical, epidemiological, hematological and biochemical study results patient diagnosed with Leptospirosis. Busselton form. Complication: ITSH-lcm-2cm. The disease typically.In programme without significant changes. Total bilirubin of 13.8 mmol/l, direct - 0; Alat - 0.5 mmol/l, prothrombin index - 56%.The diagnosis of leptospirosis was confirmed serologically (HOTEL detected antibodies to L. Icterohaemoragiae in titer 1:400).The main complaints of the patient at the time of admission were fever, myalgia, severe weakness and shortness of breath. Temperature 37,2oC.Objectively: the patient is lethargic, dinamico, with work focused in time and space. The skin is cyanotic, pale. Pulse 140 1 min, soft, arrhythmic. Heart sounds deaf, arrhythmic, left margin expanded by 0.5 see HELL 80/40 mm RT.article.The content of cardiac troponin T in serum on day 4 of illness 0.15 ug/l (norm - 0,01 µg/l).After an active basic therapy and resuscitation events on the 10th day of the disease the symptoms of leptospirosis cropped, the patient out of shock, however, began to complain of pain in the heart, continued shortness of breath with slight physical voltage (rising from bed, once physiological needs), ECG immediately is tvetenia below the contour transition border V3-V4.On the 21st day of inpatient treatment the patient was discharged with improvement. However, with high levels of cardiac troponin T in serum, the patient was recommended targeted treatment in the clinic with the purpose of eliminating the effects of leptospiroses of cardiomyocyte.It must be emphasized that the necrosis in the myocardium with their subsequent abscess formation we have found on autopsy the deceased from leptospirosis patient J., 35 (see drawing).This means that without targeted and adequate treatment natural developing necrotic lesions of the myocardium, which we first identified, there is the risk of developing cardiogenic shock. It is also quite possible shock mixed Genesis, i.e. cardiogenic and ITSH. Investigated using TGR indicators kardeogemodyinamiki (PL.2) confirm this position.With high concentrations of cardiac troponin T in the blood of patients with leptospirosis compared to the norm (table. 1) in the first days of the disease, predicted the risk of necrosis in the myocardium with subsequent sudden cardiac weakness. Continuing in the dynamics of disease high is perosa.Indicators kardeogemodyinamiki, significantly different from the norm, evaluated the work of the heart and the severity of the weakness of the heart muscle. It was also a forecast of the development of shock and adverse outcome of leptospirosis.Thus, determination of cardiac troponin-T was given the opportunity to disclose a cause of cardiovascular disorders in patients with leptospirosis based development which is specific leptospirosis cardiomyopath, and on this basis to predict the risk of sudden heart failure in the acute period of the disease, and in people who have had this disease is the formation of HSCS. A method for predicting the risk of development and course of cardiovascular disorders in patients with leptospirosis, including early diagnosis of leptospirosis, characterized in that the serum define the content of cardiac troponin - T and its values significantly greater than normal (p<0.05), and predict the risk of sudden heart weakness in the acute period of the disease, and in people who have had this disease, the formation of chronic diseases of the cardiovascular system (HSSS).
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.
FIELD: medicine; medical engineering.
SUBSTANCE: method involves doing multi-channel recording of electroencephalogram and carrying out functional tests. Recording and storing rheoencephalograms is carried out additionally with multi-channel recording of electroencephalogram synchronously and in real time mode in carotid and vertebral arteries. Electroencephalograms and rheoencephalograms are visualized in single window with single time axis. Functional brain state is evaluated from synchronous changes of electroencephalograms, rheoencephalograms and electrocardiograms in response to functional test. The device has electrode unit 1 for recording bioelectric brain activity signals, electrode unit 2 for recording electric cardiac activity signals, current and potential electrode unit 3 for recording rheosignals, leads commutator 4, current rheosignal oscillator 5, synchronous rheosignal detector 6, multi-channel bioelectric brain activity signals amplifier 7, electrophysiological signal amplifier 8, demultiplexer 9, multi-channel rheosignal amplifier 10, multi-channel analog-to-digital converter 11, micro-computer 12 having galvanically isolated input/output port and personal computer 13 of standard configuration.
EFFECT: enhanced effectiveness of differential diagnosis-making.
11 cl, 6 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves irradiating blood-carrying tissue area under control with luminous flow, receiving scattered luminous flow modulated with blood filling changes in blood vessels and capillaries of blood-carrying tissue and forming electric signal of pulse wave. Deviation signal of light-emitting and light-receiving transducers of optoelectronic converter relative to blood-carrying tissue area under control based on difference between the current and preceding values of impedance signal on the area under control. The signal being observed, prohibition signal is produced on pulse wave electric signal passage for excluding errors caused by motion artifacts from its following processing. The device has optoelectronic converter having light-emitting and light-receiving transducers and unit for producing pulse wave signal, which input is connected to light-receiving transducer output. Unit for forming deviation signal has two measuring electrodes connected to separate comparator inputs which output being deviation signal former output, is connected to control input of key. Information input of the key is connected to pulse wave signal former output.
EFFECT: improved noise immunity.
3 cl, 3 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.
EFFECT: wide range of functional applications.
15 cl, 10 dwg
FIELD: medicine, surgery.
SUBSTANCE: one should evaluate clinical state of a patient and as objective parameters one should calculate rheological and brachio-malleolar indices, detect fractional tension of oxygen in capillary blood. At observing clinical improvement accompanied by increased rheological and brachio-malleolar indices by more than 0.1, increased blood saturation with oxygen by more than 10 mm mercury column one should state upon a "good" therapeutic effect. At detecting clinical improvement accompanied by the increase of either one or several objective parameters, or if dynamics of these values is not available - effect should be considered as a "satisfactory" one. At kept ischemic pain at rest without decrease of its intensity, impossibility to keep a limb in horizontal position for a long period of time, the absence of positive dynamics of trophic disorders, at kept ischemic edema and at no alterations in objective parameters - should be determined as "no dynamics". In case of enhanced ischemic pain and edema of foot, at progressing necrotic alterations in foot - one should detect "deterioration" of patient's state. The method increases the number of diagnostic means.
EFFECT: higher accuracy of evaluation.
1 ex, 1 tbl
SUBSTANCE: method involves recording peripheral differential upper extremity blood vessel rheogram and phonocardiogram in synchronous way. The second phonocardiogram beginning and the deepest rheogram points are detected. Pulse way propagation time reduction being found, arterial bloodstream tone growth conclusions are drawn.
EFFECT: high reliability of the results.
18 dwg, 3 tbl
FIELD: medicine, neurology.
SUBSTANCE: a patient should be in initial position when his/her sight is directed towards the ceiling and in 3-5 min it is necessary to register a background rheoencephalogram, then a patient should fix the sight at a pointer's tip being at the distance of about 30 cm against the bridge of nose along the middle line, then the sight should be directed into marginal position due to shifting pointer to the left. Then the sight should be returned into initial position and 3 min later it is necessary to register rheoencephalogram of vertebro-basilar circulation, calculate rheographic index (RI), coefficient for RI ratio on returning the sight from left-hand marginal position into initial one (k2) and at k2>1.098 from the left and (or) k2>1.085 from the right one should detect alteration in vertebro-basilar circulation by reflector mechanism. The method excludes biomechanical impact in stimulating proprioceptive receptors of muscular-ligamentous system under stretching.
EFFECT: higher accuracy and reliability of detection.
2 ex, 2 tbl
FIELD: medicine, resuscitation.
SUBSTANCE: one should detect cerebral perfusion pressure (CPP), intracranial pressure (ICP), values for blood saturation with oxygen in radial artery and jugular vein bulb (SaO2, SjO2), additionally one should study lactate level in jugular vein bulb and radial artery, calculate venous-arterial difference according to lactate (▵lactate), cardiac ejection (CE) due to thermodilution and hemoglobin level. Values for cerebral oxygen transport function should be calculated by the following formulas: mĎO2 = 0.15 x CE x CaO2 x 10; mVO2 = 015 x CE x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SaO2; CjO2 = 1.3 x Hb x SjO2. In case of noninvasive detection - due to pulsoxymetry one should measure peripheral saturation (SpO2), due to parainfrared spectroscopy - cerebral oxygenation (rSO2) and cardiac ejection due to tetrapolar rheovasography (CEr), detect and calculate the values of cerebral oxygen transport system according to the following formulas: mĎO2 = 0.15 x CEr x CaO2 x 10; mVO2 = 0.15 x CEr x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SpO2; CjO2 = 1.3 x Hb x rSO2. At the value of mĎO2 86-186 ml/min and more, MVO2 33 - 73 ml/min, ▵lactate below 0.4 mM/l one should evaluate cerebral oxygen transport system to be normal and the absence of cerebral metabolic disorders. At mĎO2 values below 86 ml/min, mVO2 being 33-73 ml/minO2, ▵lactate below 0.4 mM/l one should state upon compensated cerebral oxygen transport system and the absence of metabolic disorders. At mĎO2 being below 86 ml/min, mVO2 below 33 mM/l, ▵lactate below 0.4 mM/l one should conclude upon cerebral oxygen transport system to be subcompensated at decreased metabolism. At the values of mĎO2 being 86-186 ml/min and more, MVO2 below 33 ml/min, ▵lactate below 0.4 mM/l one should establish subcompensated cerebral oxygen transport system at decreased metabolism. At values of lactate being above 0.4 mM/l and any values of mĎO2 and mVO2 one should point out the state of decompensation in cerebral oxygen transport system and its metabolism. The innovation enables to diagnose disorders and decrease the risk for the development of secondary complications.
EFFECT: higher efficiency and accuracy of evaluation.
1 cl, 3 ex, 1 tbl
SUBSTANCE: method involves setting a patient in vertical posture with stabilogram and rheoencephalogram being concurrently recorded with frontomastoid and accipitomastoid leads being used retaining head position with stressed neck extensor muscles state and head position with relaxed neck extensor muscles state. Stabilogram parameters characterizing vertical posture stability and rheographic index of each of four brain basins. When combining better filling of cerebral basins with blood and higher standing stability, training is carried out in keeping head positions allowing better filling of cerebral basins. If better filling of cerebral basins with blood follows with no increased standing stability, the trainings are carried out in keeping head position with stressed neck extensor muscles state. The training sessions are given twice a day for 15 min during two weeks.
EFFECT: enhanced effectiveness of treatment.
2 cl, 3 tbl
SUBSTANCE: method involves determining pulsating arterial blood flow parameters. To do it, measuring electrodes are applied in main liver body mass location zone. Electrode-to-electrode distance is additionally measured and hepatic index is calculated from formula HI=ρ*L2*Ad*ET*HBR/Z2*1000*S, where HI is the hepatic index (l/min/m2), ρ is the constant reflecting volume blood resistance (150 Ohm cm), L is electrode-to-electrode distance (cm), Z is the base impedance (Ohm), Ad is the differential rheogram amplitude (Ohm/s), ET is blood expulsion time (s), HBR is heart beat rate per 1 min, S is the body surface (m2), 1000 is the coefficient for converting to liters. HI value being greater than 0.225 l/min/m2, porto-portal and/or porto-central hepatic fibrosis is diagnosed.
EFFECT: wide range of functional applications.