Method for the diagnosis of disorders of the cardiovascular system in newborns from group perinatal risk
The invention relates to medicine, neonatology. Newborns carried ultrasound of Central hemodynamics. Determine the speed pozdnevizantiiskogo and renevations filling of the left ventricle. Compute their ratio. The latest value diagnose the posthypoxic cardiopathy or transient ischemia of the myocardium. The method is simple, can prevent the development of severe hemodynamic changes.
The invention relates to medicine, namely to Pediatrics, and can be used to diagnose disorders of the cardiovascular system in the newborn group perinatal risk.
In recent years, the prevalence of perinatal hypoxia caused by abnormalities of the mother and complication of pregnancy, has a strong tendency to increase, and therefore the problem of the formation of posthypoxic cardiopathy - cardinalini pathology hypoxic Genesis, not associated with structural abnormalities and inflammatory heart disease in children of early age takes in modern Pediatrics one of the leading places (C. A. Tabolin et al., 1998; J. A. Won the years of heart disease at an older age, therefore cardiac pathology hypoxic Genesis is a big and serious problem not only of neonatology, and Pediatrics in General.
To date perioxidase cardiopathy an understudied problem of cardiology early childhood, often creating serious differential diagnostic difficulties due to the lack of clear criteria. Literature data about the state of the cardiovascular system in children undergoing perinatalogy hypoxia, devoted, mainly, to the disorders of cardiac function due to suffering a severe intrauterine hypoxia (S. L. Kavra et.al., 1988; N. G.Makarenko et al., 1998; P. B. Tsyvyan, 1998). However, there is a fairly large group of children born in complicated pregnancy and undergoing chronic perinatal hypoxia, however, born with estimation on Apgar scale 8-10 points without clear clinical manifestations of disorders of the Central nervous system and visceral organs. These newborns are at risk for the formation of the subsequent various pathological conditions, including cardio-vascular system (N. N. Lagumina, 1998; S. Estay system. Emerging on its background metabolic and degenerative changes in the myocardium leads to the formation of posthypoxic cardiomyopathy, differential diagnosis with transient myocardial ischemia in newborn populations perinatal risk, as a rule, represents a significant challenge, but has practical importance, because it determines the scope, nature and duration of therapy.
The lack of clear clinical manifestations in infants with this disease can lead to diagnostic errors.
Currently, for the diagnosis of post-hypoxic changes of the myocardium using various biochemical criteria: determination of the activity of the isoenzymes of lactate dehydrogenase, cardiac isoenzyme of creatine phosphokinase (CPK-MB), myoglobin, etc.
The known Method differentsialnoi diagnosis of organic and non-organic diseases of the myocardium (A. S. No. 1204214), consisting in the fact that in the study of blood on 2-3 week of the disease produce lymphocytes that detect the presence of sensitization to the antigen necrotizing infarction in the reaction E-rosethorne and when the number of rosette lymphocytes more than 10% compared with the SP is wdaemon, does not have sufficient specificity, does not allow early diagnosis, because the research is conducted on 2-3 week of the disease.
There is a Method of predicting the state of the cardiovascular system of the newborn (Patent No. 2168179) and the Method of differential diagnosis of myocardial lesions in newborns (patent No. 2089900) providing for the determination of the activity of creatine phosphokinase in the blood.
Disadvantages of the method: the need for intravenous blood sampling, traumatic for children and the use of rare and expensive sets to determine the level of enzymes.
Up to the present time in adults and older children, the main diagnostic significance of electrocardiographic changes, characterized by ST segment elevation from contour lines, wave inversion T. However, in newborns, these changes are not clear diagnostic criteria ishemicheskogo myocardial damage even in cases of extensive infarctions (Arch Mal Coner, - 1985. Vol. 79. - R. 633-638; Y. M. Belozerov. Grew up with. West. perinat and pediatrician, 1995, No. 3. - S. 41-48).
In recent decades, retain their popularity ULTRASONIC methods for the examination of the heart. For example, the definition of the echocardiography of hyperkinesia the em to diagnose dysfunction of the cardiovascular system (N.R. Buzhinsky. Echocardiographic characteristics of contractility: author Diss. the candidate honey. Sciences. - Kharkov, 1986). However, this method does not differentiate between post-hypoxic damage is not possible to predict the duration of post-hypoxic changes.
As a prototype of the invention was elected as a Method for the diagnosis of ischemic lesion of myocardium of infants undergoing antenatal hypoxia (patent No. 2154992).
The method chosen as a prototype, is that during ultrasound examination of the heart determine the end-systolic diameter left ventricular fraction shortening of the fibers of the left ventricle, the flow rate of diastolic filling through the tricuspid valve and determine the diagnostic index Y by the formula:
and when Y>diagnose ischemic heart damage, and when the <O make a reliable conclusion about the absence of organic lesions of the heart.
The method chosen as the prototype, has a number of imperfections: allows you to predict just enough gross organic lesions of the heart; prevents cons who CLASS="ptx2">The objective of the invention is to develop a simple effective method for the diagnosis of disorders of the cardiovascular system in newborns from group perinatal risk to reveal the nature and long-term post-hypoxic changes of the myocardium and assign pathogenetic therapy.
Put in the invention the task is solved by the fact that the babies of the group perinatal risk using ultrasound assess diastolic function of the left ventricle, calculate the ratio of peak velocity of late and early diastolic filling through the mitral valve and when the value of the coefficient of 1,2-1,4 diagnose the posthypoxic cardiopathy, when the factor of 1.1-1,19 - transient ischemia, infarction, and by a factor of 0.9 to 1.0 to make the conclusion about the absence of dysfunction of the cardiovascular system.
Determining the ratio of velocities pozdnevizantiiskogo and renevations filling of the left ventricle as a distinctive feature of the proposed method due to the fact that diastolic dysfunction occurs before systolic dysfunction, as diastole is more sensitive to ischemia and its disorders mogotlane showed that a breach of the processes of relaxation of the left ventricle is reflected in the spectrum of blood flow across the mitral valve in the form of changes in the ratio of speeds of late (M2) and early (M1) diastolic blood flow in the direction of increasing the ratio M2/M1. It is established that there is a good correlative relationship between the indices of diastolic function of the left ventricle and the level of CPK - MB in the blood. Cited specific examples, confirming the efficiency of the method.
Baby b was born 13.10.95 (East. delivery no 634/5163) from 1 pregnancy, 1 term births by caesarean section among women 19 years of age, suffering from myopia in both eyes moderate. Pregnancy proceeded against the background of MT. colpitis, PNP. Birth weight of 4000 g, length 54 cm, score on a scale Hangar - 8-9.
During the neonatal period assessed as satisfactory, however, in the first three days were observed: transient perioral cyanosis, muting tones of the heart, soft systolic murmur at the apex.
Diastolic function with Doppler assess, exploring the dynamics of filling of the left ventricle by a standard method on the unit Sum 5000 PLUS (Russia-Italy), combining two-dimensional izobiluyut four-chamber image of the heart (achieved good visualization as the left ventricular cavity, and the maximum excursion of the mitral valves), control volume placed at the level of the mitral ring and got the image transmitral blood flow. The first peak Ml characterizes passive diastolic filling, the second peak of the M2 - atrial systole. Three complexes calculate the ratio M2/M1.
Dopplerechocardiography: M2/M1=1,4. Conclusion: diastolic dysfunction of LV characteristic posttipoksicheskim cardiopathy.
Electrocardiography: HR=126 in minutes sinus Rhythm. Incomplete blockade of the right bundle branch. The reduction of ST segment below the contour and smoothness of the T wave in all chest leads.
Further observation of the child within 12 months. revealed the preservation of diastolic dysfunction, which confirmed the initial diagnosis and the long-term changes in the myocardium.
Child D. was born 15.09.95 (East. delivery no 537/4151) from 1 pregnancy, 1 urgent delivery by caesarean section in women 22 years of age, suffering from chronic obesity. The pregnancy proceeded with chronic intrauterine hypoxia. At birth, the weight of 3600 g, length 53 cm, score on a scale Hangar - 8-9.
During the neonatal period assessed as satisfactorily the symbolic murmur at the apex.
1 day: according to the described method performed Doppler echocardiography: M2/M1=1,19 Conclusion: diastolic LV dysfunction characteristic of transient myocardial ischemia.
ECG: heart rate=124 minutes sinus Rhythm. Incomplete blockade of the right bundle branch. The reduction of ST segment below the contour and smoothness of the T wave in all chest leads.
Further observation of the child showed the disappearance of 9 months signs of diastolic dysfunction, which confirmed the short duration of the detected transient myocardial ischemia.
Thus the results of the study showed that the speed ratio pozdnevizantiiskogo and renevations filling of the left ventricle is a reliable indicator of character, long-term post-hypoxic changes of the myocardium and allows the selection of children for the purpose of pathogenetic therapy in the neonatal period.
The proposed method has several advantages:
- helps prevent the development of severe hemodynamic and reduce drug burden on the child;
retraumatized, has no contraindications;
- simple and available in pediatric practice.
The way oprobirovavshih system in newborns from group perinatal risk by ultrasound examination of Central hemodynamics, characterized in that the determined speed pozdnevizantiiskogo and renevations filling of the left ventricle, compute their ratio and its significance 1,2-1,4 diagnose the posthypoxic cardiopathy, when the value of 1,1-1,19 - transient ischemia of the myocardium.
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, urology.
SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.
EFFECT: more reliable and objective information.
1 ex, 1 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves applying ultrasonic Doppler echolocation techniques for scanning blood circulation at selected area of cardiovascular system, determining blood circulation velocity vector projections and calculating blood circulation speed. Echolocation is carried out by using at least three non-complanar probing ultrasonic rays set at angles relative to selected area of cardiovascular system in the range of 0-±80°. Selected blood circulation area orientation angles are measured relative to scanning ultrasonic rays and Doppler frequency shifts in each measuring channel are determined. Blood circulation speed is calculated as where ω0i is the radiation frequency of ultrasonic oscillation in ray I, Δωi is the Doppler frequency shifts in measuring channel i, V is the ultrasonic wave propagation speed in the medium, ϑk is the blood circulation speed in selected area, ϑki is the blood circulation velocity projection to scanning ray i, a,b,c,h,k,n11,n12,n13 are the coefficients depending on ultrasonic rays orientation. The device has measuring unit having ultrasonic transducers and electronic unit having switch, high frequency oscillator, calculating unit, indication and control unit. The measuring unit is manufactured as bracelet which segments are connected to each other by means of adjustable hinges and has gages for measuring lateral segment orientation angles relative to the central segment and gages for measuring ultrasonic transducer orientation angles relative to the i-th segment where i = 1,2,3, connected to calculating unit, switch, indication and control unit connected to high frequency oscillator, ultrasonic transducers of the measuring unit are connected via the switch to the high frequency oscillator.
EFFECT: high accuracy of measurements; wide range of functional applications.
2 cl, 2 dwg
SUBSTANCE: method involves measuring forced exhalation volume per 1 s. Systolic pressure in pulmonary artery and ratio of maximum blood circulation speeds through tricuspid valve into diastole. Prediction is carried out on basis of value calculated from mathematical formula including measured and calculated parameters.
EFFECT: enhanced effectiveness of prediction.
SUBSTANCE: method involves measuring forced exhalation volume per 1 s (FEV1) in l, full right ventricle evacuation time (RVE) in ms and angiotensin II value (AII) in ng/l. Discriminant relationship is built as D=0.504·RVE+3.038·FEV1 - 2.0·AII. D being less than 83.88, pulmonary hypertension occurrence is predicted within 1 year. D being equal to or greater than 83.88, no pulmonary hypertension is predicted to occur.
EFFECT: enhanced accuracy of prediction.
FIELD: medicine, nephrology.
SUBSTANCE: one should detect circulation rate characteristics and vessel's diameter due to dopplerography, moreover, on should measure vessel's diameter directly in area of anastomosis, as for circulation rate characteristics they should be determined in constant-wave Doppler mode in area of circulation's maximal rate. Moreover, one should measure anastomosis' cross-sectional area and heart rate, moreover, one should calculate circulatory volume through anastomosis by the following formula: V(ml/min) = A VTI HR, where A - anastomosis' cross-sectional area (sq. cm), VTI - integral of circulatory linear rate through anastomosis (cm), HR - heart rate.
EFFECT: higher accuracy of detection.
4 ex, 1 tbl
SUBSTANCE: method involves determining linear blood circulation speed above and below diaphragm using dopplerography approach. State severity class is determined as healthy, recovering and heavy from measured linear velocities ratio. Applied therapy effectiveness is determined on the measured linear velocities ratio exiting beyond the scope of severity class range, when analyzing patient state dynamics.
EFFECT: high accuracy in estimating patient health state.
FIELD: medicine, hepatology.
SUBSTANCE: one should detect splenic length in mm (X1) and circulation in portal vein, moreover, additionally, on should detect volumetric circulation in splenic vein in cu. cm/min. (X2), the index for the ratio of volumetric circulation in splenic vein to the area of longitudinal splenic section (X3), circulatory direction in left-hand gastric vein (X4) by establishing its direction towards the liver to be 1, from the liver to be 2, diameter of splenic artery in cm (X5) and transhepatic portal volumetric circulation in cu. cm/min. (X6), then one should calculate discriminant function Z = 15.9850 - 0.0187X1 + 0.2006X3 - 1.9025X4 - 19.0493X5 - 0.0025X6, where Z - the criterion for predicting "healthy-sick" state; then it is necessary to detect the group with hepatic diseases by the value of Z ≤ 1.621 to calculate for them discriminant function Y = 9.7396 - 0.0279X1 - 0.0018X2 + 0.1873X3 - 4.9174X4, where Y - the criterion to predict "patients with chronic hepatitis - patients with cirrhosis" state and at Y > 1.239 one should diagnose chronic hepatitis, at Y ≤ 1.239 - cirrhosis.
EFFECT: higher efficiency of diagnostics.
FIELD: medicine, cardiology, endocrinology, gynecology.
SUBSTANCE: one should detect informational-valuable signs of patient's state, such as either the presence or absence of hypertonic disease and uterine extirpation together with adnexa, the value of body weight index, predominance of disorders according to modified menopausal index (MMI)such as autonomic, metabolic-endocrine or psycho-emotional ones, the type of metabolic structures of blood serum, moreover, it is necessary to echocardiographically detect stroke volume, cardiac index and systemic vascular resistance (SVR), at ultrasound testing one should detect maximal linear rate of circulation (LRC max) by medial cerebral artery and thyroid alterations, rheovasographically one should detect specific circulation (SC) of shins, at testing laser doppler flowmetry one should detect microcirculation index, biochemically it is necessary to detect the value of beta-adrenoreactivity, cholesterol level and that of B-lipoproteides, crystallographically - the presence of serotonin and dopamine crystals, due to immunoenzymatic assay on should detect the values by Table 1 and then after obtaining the values of diagnostic coefficients of every parameter it is necessary to summarize them and obtain diagnostic index (DI), at its value being below 10 one should state no alteration, at its value 10-10 - undetermined state, at its value being 21-30 - the 2nd severity degree of disorders, and at DI value being above 31 one should state the 3d severity degree of disorders available.
EFFECT: higher accuracy of evaluation.
5 ex, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: one should study circulation in one of fetal renal arteries during the second half of third trimester of pregnancy. At increased resistance index from 0.81 and higher and, correspondingly, systolodiastolic ratio - from 5.1 and higher - one should fix the presence of fetal hypoxia and the necessity for urgent correction of this state. The suggested method increases the number diagnostic preparations and enables to increase the significance of predicting the state of neonatals.
EFFECT: higher accuracy of evaluation and prediction.
5 dwg, 5 ex, 1 tbl