The way to diagnose level of autoregulation of vascular bed vertebrobasilar basin brain
The method relates to medicine, namely to methods of diagnosis and functional assessment of the vascular bed. Perform transcranial Doppler sonography. Produce compression of the brachial artery. This was followed by decompression and compare the recovery time linear flow velocity to the initial level by the posterior cerebral artery with its normal time. The method improves the accuracy of diagnosis.
The proposed method relates to medicine, namely to methods of diagnosis and functional assessment of the vascular bed.
The prevalence of occlusive-stenotic lesions of the brachiocephalic arteries reaches 27% in the General structure of vascular diseases. One of the earliest signs of chronic brain ischemia on preclinical stage is impaired autoregulation in carotid and vertebrobasilar basin.
Autoregulatory - the brain's ability to maintain a relatively constant level of blood flow in a wide range of blood pressure. This mechanism is performed by spasm or dilatation of cerebral arterioles. In patients with cerebrovascular lesions, long-term the development of transient ischemic attacks and stroke.
However, to date there is no method for early and accurate assessment of the level of autoregulation in VB.
There is a method of assessment of cerebral autoregulation in carotid pool: on the hips of the patient are superimposed inflatable cuff. After achieving the sustainable location of the middle cerebral artery (David W. Newell, MD, Colleen Douville RVT - The Cerebrovascular Laboratory: Harborview Medical Center and UW Medical Center Seattle, Washington http://depts. washington. edu/uwtcdlab/autoreg.html) or posterior cerebral arteries (Lavrent'ev A. C. Ultrasound diagnosis of intracranial lesions of the cerebral vessels, pages 225-239 in the book. Functional diagnostics in cardiology: Ed. by L. A. Bockeria, E. H. Gorohovoi, A. Century of Ivanitsky. 2 so So 2. - M.: Publishing house Bakulev A. N. Bakulev Russian Academy of medical Sciences, 2003. - S.) hold fast inflating cuff above systolic blood pressure and abrupt release of pressure in them. While systolic systemic pressure transient is reduced by 12-20 mm Od. The velocity of blood flow in the detected arteries also declining for some time, but returned to baseline within a few seconds with intact autoregulation. When the return speed of blood flow passively follows the return of blood pressure (up to several minutes), autoregulatory exhausted. Normal time disadvantages: the test is the system pressure drop, and given that the brain krovosnabzhayutsya in the norm of 4 arteries (2 sleepy 2 vertebrates) and intracranial they all are connected to each other through the so-called "willisau circle", the result is known samples reflects the state of the autoregulation of vascular brain as a whole, despite the fact that locating the study subjected to one particular artery.
The objective of the invention is to increase the specificity and accuracy of diagnosis of the existing level of autoregulation vertebrobasilar basin brain.
The essence of the proposed method lies in the fact that to achieve specificity effects on blood flow in the vertebrobasilar basin at constant rates of blood flow in the carotid arteries, two inflatable arterial cuff placed on both shoulders. By using the apparatus of transcranial Doppler achieve sustainable locations posterior cerebral arteries. After that make simultaneous inflating cuffs, reaching overlapping arterial blood flow in both upper extremities. After sudden decompression of the cuff on the shoulders define the rate of decline of blood flow velocity in the posterior cerebral artery and its cooldown AI in vertebrobasilar basin as normal, and in pathological conditions and lesions of the vertebral arteries, basilar artery and rear cerebral arteries.
The technical result is achieved due to the selective pressure of blood in the vertebral arteries (vertebrobasilar basin) during reactive hyperemia in both upper extremities. Both vertebral arteries depart from the subclavian arteries, the sharp increase of blood flow in the brachial artery causes relative hijacking of blood flow in vertebrate arteries.
The method is as follows: the position of the subject is any. Two inflatable arterial cuff placed on both shoulders. By using the apparatus of transcranial Doppler achieve sustainable locations posterior cerebral arteries. After that producing simultaneous inflating cuffs, reaching overlapping arterial blood flow in both upper extremities. After sudden decompression of the cuff on the shoulders define the rate of decline of blood flow velocity in the posterior cerebral arteries and the time it is restored to the initial level.
Patient K., aged 52. According to the duplex scanning were identified: hemodynamically significant stenosis of the right vertebral who and. The intracranial vessels Department - without hemodynamically significant changes.
For the test to determine the level of autoregulation in the vertebrobasilar basin (UBB) on both shoulders of the patient were imposed pneumatic cuff. After achieving sustainable locations posterior cerebral artery (PCA) using transcranial Doppler, linear blood flow velocity (BFV) which amounted to 28 cm/s, produced simultaneously inflating the cuff to achieve AD above systolic pressure by 20 mm RT. Art. (comprimere brachial artery, we have provided thereby stealing from blood flow in VB).
After a sharp simultaneous deflation of cuffs for permanent monitoring, first right, then left ZMA was registered short-term decrease in BFV right ZMA before 22-21 cm/s, and the time of its restoration to its original level was 10 (when the accepted norm cooldown 51). BFV on ZMA left the original was 25 cm/s, after decompression decreased to 21 cm/s, and the time of recovery to the original BFV was 7 C.
According to the results of the sample can be judged from the decrease in the level of vascular autoregulation in VBB more on the side of hemodynamically significant stenosis allow golovnogo brain, includes compression of the limb arteries, transcranial Doppler, decompression and comparison with normal recovery time linear flow velocity to the initial level, characterized in that the produce compression of the brachial artery, and the recovery time is the linear flow velocity is determined by the posterior cerebral artery.
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