Method for integral evaluation of peripheral blood flow distal lower extremities

 

(57) Abstract:

The invention relates to medicine, cardiovascular disease. Register photoplethysmogram of the big toe. Determine the amplitude of photoplethysmogram, systolic blood pressure. Calculate the index of photoplethysmography IFPGon a mathematical formula. The index value photoplethysmography judge the violation of microcirculation and arterial flow in the lower extremities or absence of a pathology of peripheral blood flow. The method allows reliable recording changes in peripheral blood flow and conduct of its quantitative evaluation.

The invention relates to medicine, namely to functional diagnostics, and can be used in surgical wards, departments of vascular surgery, the Department of functional diagnostics of hospitals and clinics for the assessment of peripheral blood flow with obliterating diseases of lower limb arteries and to study the results of treatment.

Currently, there are quite a number of various techniques, in varying degrees, allowing to evaluate peripheral blood flow and the condition microcirculatory tactics of patients with obliterating diseases of lower limb arteries, associated with conservative or surgical treatment.

Considered until recently as the “gold standard” x-ray contrast angiography has largely given way to the ultrasonic duplex scanning (De Smet AAEA, Visser K, Kitslaar PJEHM. Duplex scanning for grading aortoiliac obstructive disease and guiding treatment // Eur. J Vase Surg. - 1994. No. 8. - S. 711-715; C. A. Advani, E., artyukhina, D. A. Ulyanov. The value of duplex scanning for choice of surgical tactics with obliterating atherosclerosis of lower limb arteries // Angiology and vascular surgery. - 1999. - So 5, No. 1. - S. 42-49). The main advantage of the DRC before angiography is the ability to evaluate patterns of intravascular changes, the study of hemodynamics in real-time, diagnostic stenochlaena lesions of different pools, accompanied by changes of the vascular wall, deformation, malformation of blood vessels, aneurysms, arteriovenous shunts and malformations. However, despite the huge benefits, duplex scanning, as with all ultrasonic technique has shortcomings. First of all, it's huge dependence of the data from the experience of the operator and resolution ultrasound scanner (Ridley E. L. Ultrasound angiograms map signal strenght. Diagn. - M.: Vidar. - 1997. - 388 C.). In addition, when the distal vascular lesions informative duplex ultrasound scanning is sharply reduced. Indications for angiography due to its invasive nature and possible complications always remained severely limited. Moreover, angiography provides only anatomical information, while the hemodynamic consequences of stenosis can only be implied (B. H. P. Allsman, B. K. Akerboom, D. A., Legemate, R. Mayer (B. H. P. Elsman, B. C. Eikelboom, D. A. Legemate, R. Meyer) Color duplex scanning with arterial diseases of lower extremities // Angiology and vascular surgery. - 1996. No. 1. - S. 20-32). The use of arteriography currently often difficult and not cost-effective because of the increasing cost method.

Other known methods of research, such as rheovasography, capillaroscopy, only indirectly reflect changes in regional blood flow and due to the small informative are rarely used. Thermal imaging method of research, having recently received a fairly wide distribution, gives only a qualitative description of the changes in peripheral blood flow and does not allow dostoverno the surgery. - M.: Medicine. - 1998. - 168 C.).

Method photoplethysmography (photos - light) - indirect method of assessing the blood supply to part of the body, in which a research object, skipped the light rays. At the same time as the receiver of the light energy passing through the object of research or reflected from it, used the Converter light energy into electrical energy (solar cell, photoresistor). Therefore, this method is another name - photoelectrochemistry (B. I., Maibach. Oscillatoria blood vessels of the extremities. - Novosibirsk: Nauka. - 1990. - 152 C.). The method differs from other methods of investigation simplicity, availability, noninvasiveness, the possibility of obtaining quantitative characteristics and use in immunocompromised patients.

The problem of creating a non-invasive method of registration peripheral and, above all, the distal blood flow, suitable for wide practical application, up to the present time retains its relevance. Its acuteness partially charged photoplethysmographic method of continuous recording of pulse pressure curve in the finger artery. The method is based on the stabilization of the volume of the finger phalanx special camera-Brisbane when the blood supply, which is immediately converted into electrical oscillations, and projected on the screen of the computer monitor in the form of a pulse curve of blood pressure.

However, the most common in medical instrumentation photoplethysmogram are devices for measuring blood pressure. Researchers have always been attracted by the prospect of continuous recording of blood pressure in the finger arteries brush, allowing thus to monitor the changes of Central hemodynamics. Using photoplethysmography for registration and assessment of peripheral blood flow in the lower extremities as an independent method of assessing blood flow was not applied (lukyanyuk C. J., Kotovsky A. L., Ville-Williams, I. F., Netak L., Penias F. Mikhailov, C. M., Litters Y. D., George C. S., Nikolashin C. F., Cousin, C. I., Prediction of the human condition in terms of the gravitational redistribution of blood on the basis of continuous non-invasive blood pressure measurement method Penyata // Space biology and aerospace medicine. - 1990. - So 24, No. 5. - S. 30-34; M. SC.Veselovsky Photoplethysmography method for continuous recording of blood pressure in the artery of the finger: sopostavleniia registration of blood pressure in the finger artery, at which track the pulsation of blood pressure in the following way. The photosensor is the removal of information about a large volume of blood in the finger brush. Digital photo sensor is structurally designed in the form of a metallic cylindrical body with inside elastic cuff and sensitive elements in the form of two GaAs led and a silicon photodiode. The emission spectrum of the LEDs is in the near infrared region. Finger cuff is located at the second phalanx of the index finger so that the emission of the LEDs and the receiving surface of the photodiode converts to the inner surface of the finger. The control signals that specify the external effects generated by the control unit. Conclusion measurement data by using the processing unit and display (C. M. Agutin, S. C. Rvachev, Century A. Chashchin, V. M. Shcherbakov. Photoplethysmogram for the study of the vascular system and measurement of hemodynamics // Medical equipment. - 1991. No. 1. - S. 7-10). After the command "start" on the control unit in the finger cuff pressure. As the growth pressure is an increase in the amplitude of pulsation of blood are mapped to two adjacent cycles of cardiac contractions, and determines the time of occurrence of maximum pulsation. This point corresponds to the achievement of the cuff to the values of mean arterial pressure. The maximum amplitude is stored in the control unit, and turns on the tracking system, ensuring that vessels of the finger in this state, when all further changes in blood pressure. Is the principle of "compensation volume, and the pressure in the cuff repeats all changes in blood pressure. This method of obtaining information about blood finger and the state of peripheral blood flow is taken as a prototype.

The disadvantages of this method is that used at the same time 2 cuff to determine the brachial and finger pressure of the upper limb are connected in a single system, with fixed indicators that assess changes of Central hemodynamics (blood pressure, the velocity of propagation of pulse wave, venous pressure) and not evaluated peripheral blood flow and microcirculatory bed of the lower extremities.

Thus, photoplethysmography method currently used to measure Central blood is used to assess the state of peripheral blood circulation of the lower extremities. This method is not used to detect pathology of the diseases of lower limb arteries and as a method of assessing the effectiveness of the treatment. Not used the computer data processing photoplethysmography, not formed integral rate of blood flow, which makes it difficult processing and interpretation of the results and is one of the aspects of the invention.

The technical result, which directed the establishment of this invention is to obtain reliable quantitative data on the status of peripheral blood flow and microcirculation in patients with peripheral occlusive arterial diseases of the lower extremities, detection using this method, arterial pathology of the lower limbs, control over the course of the pathological process, as well as improving the efficiency comprehensive evaluation of the treatment.

The technical result is achieved in that in the method for integral evaluation of peripheral blood flow distal lower extremities based on the use of photoplethysmography, register photoplethysmogram of the big toe, is determined by the formula:

where a is the amplitude of photoplethysmogram;

HELLsist- systolic blood pressure;

K=100 is fixed magnification,

further, when the value of the index photoplethysmography IFPG 246,86±16,399 judge about the absence of pathology of peripheral blood flow and microcirculation, and when the index value photoplethysmography IFPG<246,86±16,399 judge the violation of microcirculation and arterial flow in the lower extremities.

These measurements were carried out in subjects healthy individuals not suffering from vascular disease, and in groups of patients with obliterating atherosclerosis of lower limb arteries before treatment and after treatment. Comparative characteristic index photoplethysmography patients and healthy individuals not suffering from disorders of the lower limb arteries.

Obtained before and after treatment of the index change photoplethysmography allowed comparisons to quantify changes in regional blood flow, collateral circulation and microcirculation that when using other methods is difficult.

Method for integral evaluation of peripherisation uses a special measuring plateau photoplethysmographic consoles to the PC. This device converts the signal from digital infrared sensor in digital form in the RS-232 standard. Together with computer photoplethysmographic console allows you to get the display photoplethysmogram in graphical mode and provides the possibility to print the results. In addition, developed a special program allows you to calculate the amplitude photoplethysmogram, index photoplethysmography IFPGand display the results in the form of different graphs in the standard computer program “Microsoft Excel”.

Have made the analysis of peripheral blood by the method of photoplethysmography in 31 patients aged from 19 to 72 years, not suffering from disease of the arteries of the lower extremities, with the definition of IFPG. The survey revealed that the average values of IFPGthe first toes of both feet were equal 246,86 16,399. This is and was a defining criterion of the presence or absence of pathology of peripheral blood flow distal lower extremities.

Example. Patient S., aged 65, with obliterating atherosclerosis of lower limb arteries IIB stage with Leriche's syndrome, occlusion of the femoral, superficial femoral and Podkolodny the big toe of both feet. The value of the index photoplethysmography was equal to the right 76,7 left - 83,3. Thus, the average value of IFPGwas $ 80. After the course the gravitational therapy on the short radius centrifuge (R. A. Galkin, G. P. Kotelnikov, I. C. Makarov, A. N. Oparin. The use of gravitational overloads in the treatment of obliterating atherosclerosis of lower limb arteries // journal of surgery. - 2003. - T. 162, No. 1. - S. 82-85) showed a significant clinical improvement. The distance “painless” walk increased from 100 m to treatment, up to 350 m after treatment, the absolute distance walk from 150 to 400 m Foot became warm, appeared absent before treatment the pulse of the right hind tibia artery. Increased values placelocation index, determined by ultrasound Doppler right from 0,48 to 0.5, left from 0.33 to 0.4. Index photoplethysmography increased right up to 320, left to 277, the average value of IFPGequal 298,5, which was higher values of IFPG, which is the determining factor in assessing the pathology of peripheral arterial blood flow and testified about the effectiveness of the treatment and improvement of peripheral blood flow distal lower krasnostein.

Thus, you can determine the pathology of peripheral blood flow and microcirculation, that gives the possibility to use this method as a reliable method for the diagnosis of obliterative arterial diseases of the lower extremities, including preventive examinations among different population groups. This method can serve as a method for quantitative evaluation of the effectiveness of treatment of these patients. Due to the affordability, simplicity, non-invasive and informative photoplethysmography can be widely used for these purposes in polyclinic conditions. Therefore, the method for integral evaluation of peripheral blood flow distal lower extremities is a reliable way to diagnose and quantify pathology of peripheral arteries and distal blood flow and can serve as an objective criterion for the effectiveness of treatment.

Certified applicants search for scientific-technical and patent information sources and selected from the list of analogues of the prototype revealed distinctive features in the claimed technical solution, therefore, the claimed method for the diagnosis of diseases of lower limb arteries meets the criteria of the invention “novelty”. And spent an additional search is known is presented technical solutions comparison of the properties of the inventive and well-known technical solutions, due to the presence of these features showed that the proposed method of treatment of manifest properties that do not match the properties shown above-mentioned features in the known technical solutions than due to the achievement of the claimed positive effect.

Therefore, the claimed method for the diagnosis meets the criteria of the invention “inventive step”.

The criteria of the invention “industrial applicability” is confirmed by the fact that the proposed method for the diagnosis of diseases of lower limb arteries can be successfully used in medical institutions of Russia and CIS.

Method for integral evaluation of peripheral blood flow distal lower extremities based on the use of photoplethysmography, characterized in that the register photoplethysmogram big toe, determine the amplitude of photoplethysmogram, systolic blood pressure and the index photoplethysmography IFPGaccording to the formula

where a is the amplitude of photoplethysmogram;

HELLsist- systolic blood pressure;

K=100 - POS 16,399 judge about the absence of pathology of peripheral blood flow and microcirculation, and when the index value photoplethysmography IFPG<246,8616,399 judge the violation of microcirculation and arterial flow in the lower extremities.

 

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1 tbl

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