Method for studying the autonomic reactivity

 

(57) Abstract:

The invention relates to medicine, and neurology. Spend cardiointervalography with the sample position. The sample position is carried out in the form of maximum bending forward of the head and hold it in this position for 5 minutes. Autonomic reactivity is determined by the dynamics of the index of tension of regulatory systems during the test. The method can be used to assess autonomic reactivity during the diagnosis of autonomic dysfunction.

The present invention relates to medicine, namely to neuropathology, and can be used to study autonomic reactivity during the diagnosis of autonomic dysfunction.

Studies of vegetative reactivity widely used during the diagnosis of autonomic disorders. Autonomic reactivity characterized by a vegetative reactions that occur in response to internal and external stimulation.

The following research methods of vegetative reactivity: pharmacological - introduction of epinephrine, insulin, mezatona, pilocarpine, atropine, histamine and other Physical - cold, heat tests, physical activity; the impact is. the LINIK. Diagnosis. Treatment. Edited by A. M. Wayne. M., 1998, Chapter 2.1.2). When tests for these methods in patients measure heart rate and blood pressure to the sample and after a certain period of time after exposure to pharmacological, physical or reflex stimulus, and the results obtained are compared with those in the control group.

However, these methods are not without drawbacks that limit their widespread use. Pharmacological test complex, require special medications can cause reactions on the components used in patients. Evaluation of the results of a very time-consuming: for 1.5 hours every 10 minutes registration required variation and AD.

When cold and thermal test requires continuous registration of blood pressure and heart rate and control the time of arrival to its initial level after changing under the influence of irritating factor that is also very time consuming.

A prototype of the invention is selected known method for studying the autonomic reactivity by holding kardiointervalografii (TG) determination of the magnitude of the index of tension of regulatory systems (INS) with the exception of the er M. B. M., 1987, T. 1, Chapter 7).

Check the CIG when you do this as follows: 1-I write TG (source) in the supine position; 2-I logged in standing position immediately after moving in a vertical position, in which the patient resides 10 minutes; 3rd entry KIT is for 1-2 minutes after returning to the horizontal position. Entry KIT is as ECG recording in the second standard lead. Then carry out arithmetic processing of the ECG with the definition of the R-R interval and calculated IN the formula:

where IN the index voltage regulating systems;

Mo - fashion - the most common value of R-R interval;

AMO - amplitude fashion - the number of cardiac intervals in percent, corresponding to a range of fashion;

BP - variational span - the difference between the maximum and minimum values of R-R interval.

Initial autonomic tone evaluate in the first dimension and IN distinguished: atonio (JN from 30 to 90.E.), sympathicotonia (JN from 90 to 160.E.), hypersympathicotonia (JN 161.E. and above) and vagotonic (JN 29.E. and below). Autonomic reactivity in the method prototype evaluated in relation IN/IN, i.e. compare the integral indicators of heart Onicescu and asiaticosides autonomic reactivity. Quantitative criteria: for example, if vagotonia (IN<30.E.), normal autonomic reactivity when IN/IN from 1.1 to 3; Hyper sympathicotonic - when IN/IN less than 1.1.

The disadvantage of the prototype method is the relative length and complexity. For the patient is uncomfortable with the necessity of changing the position from horizontal to vertical.

The objective of the proposed invention is based on a simplification and acceleration of way.

The task in the way that the study of the autonomic reactivity by conducting kardiointervalografii determining the value of the index of tension of regulatory systems (INS) when the test position is achieved by the fact that the sample position is carried out in the form of maximum bending forward of the head and hold it in this position for 5 minutes, IN set up to test (IN the original), after 1 minute and 5 minutes after flexion of the head and of the pathological disorders of the autonomic reactivity is measured by changes IN the sample compared to the initial value by more than 10.E. The method, characterized in that IN is determined by the formula:

where IN the index voltage regulating systems;

BP - variational span - the difference between the maximum and minimum values of R-R interval.

The authors of this application for the first time the possibility of studying the autonomic reactivity in a sample in the form of bending the head forward. During the development of the method was investigated several positions of flexion of the head: forward, backward, left, right. It was found that the overwhelming number of patients exactly the maximum bending head forward allows you to record fluctuations IN reflecting changes in autonomic reactivity. Other provisions of the head (back, left, right) are not allowed to clearly identify dysfunctional disorders. The optimal measurement time is IN 1 minute and 5 minutes after test, because this is enough time to fix the pathological variations IN their further deepening in response to a change in posture.

Informative and diagnostic value for the detection of impaired autonomic reactivity tests with bending the head forward, the authors of this application is associated with a set of their special influence of the position of the spine on the indices of autonomic dysfunction, as well as interconnection and vzaimovli were studied indicators of autonomic tone in patients with abnormal condition of the spine in cases of osteochondrosis of varying severity and established a clear relationship between the position of the spine and indicators of autonomic nervous system: abnormal condition of the spine, the quantitative magnitude of the studied indicators of autonomic tone on 30-47% more than in the control group. This suggests that changing the position of the spine in the study of autonomic reactivity may be a sensitive marker of the status of the adaptation mechanisms of the autonomic nervous system. Further, empirically it was found that the most sensitive marker is changing the position of the cervical spinal misalignments at the maximum tilt the head forward during the functional tests in the study of autonomic reactivity.

The proposed method is as follows.

First, investigate the source of the autonomic tone by holding kardiointervalografii. For this patient at rest record the ECG in the second standard lead and then spend mathematical computer processing ECG with counting the number of R-R interval and the subsequent definition IN according to the formula:

where IN the index voltage regulating systems;

Mo - fashion - the most common value of R-R interval;

AMO - amplitude fashion - the number of cardiac intervals in percent, corresponding to a range of fashion;

BP - variational span - the difference between the maximum and the minimum is IN from 30 to 90.E.), the vagotonic (IN less than 30 in.E.) and sympathicotonia (IN more than 90.E.). The state of vagotonia divided into three levels: easy (20-29,9 in.E.), moderate (10-19,9 in.E.) and expressed (0,1-9,9 have.e.); atonio on two levels: I (30-59,9 in.E.) and II (60-90.e.); allocate sympathicotonia (90,1-160.E.) and hypersympathicotonia (over 160.E.).

Then spend a study of autonomic reactivity. The patient offer the maximum bend forward head and stay in this position for 5 minutes. IN determine 1 minute and 5 minutes after flexion of the head and of the pathological disorders of the autonomic reactivity is measured by changes IN the sample compared to the initial value by more than 10.E. - pathological variant samples (PV). If in the course of the test varies between 10.E., it is treated as a normal variant samples (HB). When this degree of fluctuation IN their direction is judged on the severity of the violations, the degree of deepening identified by the source IN vagotonia (C) or rise sympathicotonia (C) to gipersimpatikotonia (HS), fluctuations eatonii (e) transition from one (source) into another state (VE; ES; SE; EV; SU; SV, etc).

Examples of specific use are given in the form of extracts from the history of the bol is the neurocirculatory dystonia of mixed type with cephalgia, vertigo on residual organic background perinatal origins, scoliotic posture. Complain of mild headaches, dizziness when you change body position in the transport, pain along the spine. From birth - hypotrophy, tempo delays in motor development, dyslalia. The above complaints concern within 5-7 years, increased in puberty.

Patients received cardiointervalography (TG No. 122) by the method described above. At three times the dimension identified the following indicators IN: IN - 50,7; IN - 90,0; IN - 70,9. Based on these data, the sample position is assessed as pathological with variation within atonia - PV:AA.

2) the Patient Anton B., 13.02.1981, R. (I. B. 6956) was sterlachini in SE to the CLINIC with 10.06.02 on 01.07.02 about neurocirculatory dystonia of mixed type with cephalgic, zerebrasteniceski syndromes on residual organic background of perinatal origin. Upon receipt complained of frequent headaches caused mental stress, reduced efficiency and performance. The medical history of birth in the form of Hyper excitability, sleep disturbances, frequent burping. Headaches came from the age of 7.

The patient is assigned to x-rays and ultrasound of the cervical spine, where found in the joint subluxation Crovella, instability C3-C4, C4-C5, increasing functional probes, reducing the height of the intervertebral discs at these levels.

3) the Patient Venus And., 08.05.67, R. (AMB.) was on the survey about post-traumatic encephalopathy with cephalgic and zerebrasteniceski syndromes neurocirculatory dystonia of hypotonic type. Complaints about persistent headaches, persistent decrease in working capacity, weakness, fatigue. 3 years ago suffered a closed head injury, brain contusion, mild.

When conducting kardiointervalografii (TG No. 121) by the above method, the following indicators IN: IN - 16,5; IN - 10,4; IN - 20,1. Based on these data, the sample position is estimated as the normal fluctuations within vagotonia - HB:WWWL.

Just offer a way to study autonomic reactivity in more than 200 patients of different ages. Received re the Oia vegetative reactivity by holding kardiointervalografii and the determination of the value of the index of tension of regulatory systems (IN the test position, characterized in that the sample position is carried out in the form of maximum bending forward of the head and hold it in this position for 5 min, IN set up to test (IN the original), after 1 min and after 5 min, after bending of the head and of the pathological disorders of the autonomic reactivity is measured by changes IN the sample compared to the initial value by more than 10.E.

 

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