A method for diagnosing the degree of vibration disease

 

The invention relates to medicine and can be used to diagnose the degree of vibration disease. Spend triplex scanning of arteries of the upper extremities at rest and after carrying out functional tests with static load on the working hand (SNR). Determine the blood flow indices, namely, end-diastolic velocity (Ved) and the index resistivity (RI) in their own Palmar digital arteries (PA) at the level of the proximal phalanx with the radial side (PA LU) and the ulnar side (PA LO) and the distal phalanx (remote) 3rd finger, and the radial artery (BEAM) and ulnar artery (LOCT) at the level of the wrist joint working hands. Compare Ved and RI, obtained after sampling SNR, with similar results obtained at rest. In the absence of changes in finger arteries and increase Ved and lower RI in radial and ulnar arteries diagnosed individual signs of the influence of vibration (OPW). With increasing Ved and lower RI in all arteries diagnose vibration disease 1 degree (WB 1st century). If there are no changes Ved and RI diagnose vibration disease 2nd degree (WB 2nd century). The method allows for early diagnosis, to improve its accuracy and �data/84/843363.gif" border="0">

The invention relates to medicine, namely to the diagnosis of radiation.

Vibration disease in the conditions of modern production is one of the most common forms of occupational pathology (Izmerov N. F., 2000, Artamonova C. T., 2000, Tarasova, L. A., 2000). High-frequency vibration generated by manual machines, impact primarily on the contact area and on the distal upper extremities, causing mainly of neurovascular disorders of the hands and forearms (Boulders C. D., 1998, Melman I. C., 1999, Gorenkov R. C., 2000). Circulatory disorders, manifested in the form of peripheral angiopathies syndrome, leads workers of working age to permanent disability, the cost of the courses of rehabilitation that emphasizes not only the medical but also the socio-economic aspect of this problem. This necessitates the introduction of new non-invasive diagnostic methods, which allows to study the quantitative hemodynamic parameters at different stages of the disease.

There is a method of studying the changes of Central hemodynamics method of transcranial dopplerosonography patients melody in patients with vibration disease from exposure to local vibration by transcranial dopplerosonography // EMS Journal Neurophysiology Neurosonology Scientific reports. - 1997. - June. - S. 47-49). However, this method allows to evaluate the hemodynamic changes in the vertebrobasilar basin, which is typical for a moderately pronounced forms of the disease (vibration disease 2 degrees).

There is also known a method of determining diastolic velocity of the arterial blood flow of the radial artery in the wrist Doppler ultrasonography (Malyutina, M. M., Gogoleva O. I., Melman I. C. a method for the diagnosis of vibration disease. - 1999. no application 97119129). The disadvantage of this method is the inability to visualize the vascular wall and mapping of blood flow, which reduces the accuracy of measurement of hemodynamics and informative results.

The closest technical solution is the method for determining the hemodynamic method duplex scanning unpaired visceral branches of the abdominal aorta, common carotid arteries in patients with vibration disease, which was calculated linear velocity of blood flow, the diameter of the vessels and the peripheral resistance index RI, in the common carotid arteries were revealed stenosis of vessels of varying severity, the presence of restenosis plaques was determined by the thickness of the intima-media complex. In Nevern the blood flow velocity and some expansion of the diameter of the vessels; atherosclerotic changes of the common carotid artery in the form of stenosis and plaques, thickening of the intima-media from the duplex scanning revealed in 23.6% of patients with vibration disease (Gorenkov R. C., Lyubchenko, P. N., Malyshev, I. Y. and other Ultrasound examination of some of the great vessels in patients with vibration disease // occupational Medicine and industrial ecology. - 1999. No. 2. - S. 12-16).

The disadvantage of this method is the remoteness of the locate points investigated arteries (common carotid, unpaired visceral branches of the abdominal aorta) from hands, that is the site of direct contact with fibrogenesis technique, a limited number of point locations, the lack of study of the reactivity of the studied arteries after functional loading tests.

The objective of the proposed method lies in early diagnosis and improve the accuracy of diagnosis and the identification of the degree of hemodynamic changes in patients with vibration disease by measurement of blood flow directly at the point of impact to local vibration, as the fingers closest to vibrating equipment, and changes in them will begin earlier than in more remote vascular regions. Improving the accuracy of analnoe tests with static load as most accurately reflecting the kind of load that the miners at work.

The task is achieved by the fact that they triplex scanning of arteries of the upper extremities at rest and after further carrying out functional tests with static load on the working hand (SNR) and determine the blood flow indices, namely, end-diastolic velocity (Ved) and the index resistivity (RI) in their own Palmar digital arteries (PA) at the level of the proximal phalanx with the radial side (PA LU) and the ulnar side (PA LO) and the distal phalanx (remote) 3rd finger in the radial artery (BEAM) and ulnar artery (LOCT) at the level of the wrist joint working hands at rest and after samples with SNR. When comparing the Ved and RI indicators alone in the absence of changes in finger arteries and increase Ved and lower RI in radial and ulnar arteries diagnosed individual signs of the influence of vibration (OPW), with increasing Ved and lower RI in all arteries diagnose vibration disease 1 degree (WB 1st century), in the absence of changes Ved and RI diagnose vibration disease 2 degrees (WB 2nd century).

Novelty:

1. Define two measures of blood flow, namely Ved and RI.

2. Examine these figures in their own Palmar digital arteries at the level of the proximal phalanx with radiation and the ava on handedness.

3. Conducting a study of finger arteries on the sides of the 3rd finger from two sides - from the side of the radial artery and from the ulnar artery.

4. Survey the arteries on handedness alone, and then after functional tests with static load on the working hand.

5. Analysis of the obtained results is performed by comparing values obtained after the samples with SNR values obtained at rest, and by the nature of the changes to Ved and RI diagnose some signs of vibration disease, the 1st degree of vibration disease and the 2nd degree of vibration disease.

The method is illustrated in the drawing, which shows point locations own Palmar digital artery from the radial artery (PA LU) 1, from the ulnar artery (PA LO) 2, artery distal phalanx (remote) 3, the radial artery (BEAM) 4 and ulnar artery 5.

The method is as follows. The study is conducted in a room with a constant temperature of 22°C. the Position of the patient sitting on a chair, putting his forearms on the couch in front of him. Arms bent at the elbows at 90 degrees, palms up. A study conduct by the method triplex scanning vklyuchavshego three modes gotovogo Doppler mapping), for example, the ultrasound system Acuson 128 XP" linear transducer with a frequency of 7 MHz. The sensor is installed on the side surface of the 3rd finger of the working hand at the level of the proximal phalanx from the radial artery 1, where detected in longitudinal section own Palmar finger artery (PA LU). Evaluate the qualitative and quantitative measurement of the characteristics of the Doppler spectrum frequency shift - end-diastolic velocity (Ved) and index resistivity (RI). The next step is to obtain images, and a similar evaluation of the spectral characteristics of blood flow from the side surfaces of the same finger on the same level from the ulnar artery (PA LO) 2. Then the sensor is installed on the Palmar surface of the distal phalanx of the 3rd finger 3, where the detected own Palmar digital artery (remote) and evaluate the quality and measure the above-mentioned quantitative indicators of blood flow. At the final stage, the detected radial artery (BEAM) in longitudinal section at the level of the wrist joint 4 and the ulnar artery (LOCT) at the level of the wrist joint 5, where we assess the qualitative and quantitative measure of the characteristics of the Doppler spectrum frequency shift.

To develop a diagnostic algorithm, we have examined 86 miners vibration threatening professions. The study included miners coming in IFL (State research and clinical center for health of miners) , Leninsk-Kuznetsk on suspicion of vibration disease. By profession they were p is Tamaulipas in accordance with generally accepted classification of vibration disease from exposure to local vibration (vibration Classification of disease from exposure to local vibration: Methodical recommendations. - M., 1985. - 19 S.).

If diagnosed separate signs of the influence of vibration include work experience in contact with the vibration, the severity of the individual syndromes.

All surveyed men aged from 36 to 60 years, mean age of patients WB 1 tbsp. 48,2±0.9 years, patients WB 2 tbsp. 51±5.1 years, miners from OPW 44,2±0,8 years. The control group consisted of 38 healthy men aged 31 to 56 years (mean age of 45.5±0.6 years).

All subjects were surveyed triplex ultrasound scanning (TCB) own Palmar digital arteries, radial and ulnar arteries at rest and after functional tests with SNR.

The survey studied the performance - peak systolic velocity (Vps), end diastolic velocity (Ved), time-averaged maximum blood flow velocity (CAMH), index resistivity (RI), pulsatile index (PI), systolicdiastolic ratio (SD).

As a result of the examination by miners revealed changes of hemodynamic parameters, with the most significantly changing indicators are the minimum blood flow velocity (Ved, cm/s) and index resistivity (RI, srvc. units).

After functional tests with SNR datiles Ved and decreased RI in all the studied arteries, and in patients WB 2nd century, there were no changes to Ved and RI in all the studied arteries. The increase in Ved and decreased RI is associated with increased perfusion and increased collateral circulation in patients with OPW and WB 1 Art. No change of indicators of blood flow and RI Ved at WB 2nd century can be explained by the lack of reaction of arterial tone static load due to degenerative changes in the wall of arteries.

Thus, the proposed method is evaluated functional status of the vascular bed in the example of the arteries of the hand and forearm, the method is applicable to clinical situations, accompanied by the defeat of vessels in the WB. It is known that WB is a system amyotrophies and defeat affects many organs and systems, and the degree of vascular lesions of different. When this identification of early signs of the disease contributes to a more accurate diagnosis and timely and adequate medical tactics.

Example 1.

Patient A., aged 47, drifter, hospitalized in the Department of pathology diagnosed with vibration disease 1 tbsp. Underground experience 22 years experience in contact with the vibration of 18. Subjective: sweating of the palms, the whitening of the distal phalanges II-IV of fingers in contact with some. Objective: reduced vibration sensitivity at 125 and 250 Hz on both hands; the lower the initial temperature of the brushes to 33.5 degrees C; the recovery time temperature after cold test 40 minutes; adrenaline sample - 9 points (whitening of three phalanges).

Conducting a survey on the proposed method. To do this, after a 10-minute adaptation of the patient conducted a study of the arteries handedness method TCB. Position the patient sitting on a chair, putting his forearms on the couch in front of him. Arms bent at the elbows at 90 degrees, palms up. The study was performed on the ultrasound system Acuson 128 XP" linear sensor frequency of 7 MHz. The sensor was installed on the side surface of the 3rd finger of the right hand at the level of the proximal phalanx from the radial artery, where aziraphale PA LU, assessed the quality and measurement of the Doppler spectrum frequency shift - Vps (cm/s), Ved (cm/s), TMH (cm/s), PI (srvc. units), RI (srvc. units) and SD (sm. units). Then aziraphale with the side surface of the same finger on the same level from the ulnar artery PA LO and carried out a similar evaluation of qualitative and quantitative indicators. Then on the Palmar surface of the distal Foca. At the final stage aziraphale BEAM at the level of the wrist joint and LOCK at the level of the wrist joint, where were evaluated by qualitative and quantitative characteristics of the Doppler spectrum frequency shift. After that, hemodynamic parameters are entered into the table. 1.

Then the patient was performed functional test with SNR. Static load was determined and set by using a torque tester digital TDC 87.02. The patient has identified the MMC equal to 40 kg, automatically set the level of static load 75% of MMS, which the patient survived for 30 seconds. Upon expiry of this time was spent evaluating quantitative indicators of blood flow in the PA LU PA LO, diest, RAY, LOST handedness derived hemodynamic parameters are entered into the table. 1 and compared with the figures alone.

Conclusion. After the samples with SNR there is an increase in end-diastolic velocity and the decrease in resistivity in finger arteries, radial and ulnar arteries. Signs of vibration disease 1 degree. Recommendation: to improve peripheral circulation vasoactive drug injections drugs (pentoxifylline), antispasmodics (galidor), tradefacilitate in the Department of pathology diagnosed with vibration disease 2 tbsp. Underground experience 28 years experience in contact with the vibration of 22 years. Subjective: pain in the muscles of the forearms and joints of the upper extremities that occur after the load and worse at night, whitening of the fingers in contact with cold, limitation of motion in the wrist joints. Objective: reduced vibration sensitivity on 63,125 250 Hz; the lower the initial temperature of the brushes to 33 degrees C, the recovery time temperature after cold test 55 minutes; the adrenaline test - 9 points, vascular reaction to the wrist joint. Manifestations amiodaronesee syndrome, syndrome vegetarianpie with persistent disorders of the musculoskeletal system.

Conducting a survey on the proposed method. To do this, after a 10-minute adaptation of the patient conducted a study of the arteries handedness method TCB. Position the patient sitting on a chair, putting his forearms on the couch in front of him. Arms bent at the elbows at 90 degrees, palms up. The study was performed on the ultrasound system Acuson 128 XP" linear sensor frequency of 7 MHz. The sensor was installed on the side surface of the 3rd finger of the right hand at the level of the proximal phalanx from the radial artery, g is the spectrum of the frequency shift is Vps (cm/s), Ved (cm/s), TMH (cm/s), PI (srvc. units), RI (srvc. units) and SD (sm. units). Then aziraphale with the side surface of the same finger on the same level from the ulnar artery PA LO and carried out a similar evaluation of qualitative and quantitative indicators. Then on the Palmar surface of the distal phalanx of the 3rd finger aziraphale remote and evaluated the above quantitative and qualitative indicators of blood flow. At the final stage aziraphale BEAM at the level of the wrist joint and LOCK at the level of the wrist joint, where were evaluated by qualitative and quantitative characteristics of the Doppler spectrum frequency shift. After that, hemodynamic parameters are entered into the table. 2.

Then the patient was performed functional test with SNR. Static load was determined and set by using a torque tester digital TDC 87.02. The patient has identified the MMC equal to 30 kg, automatically set the level of static load 75% of MMS, which the patient survived for 30 seconds. Upon expiry of this time was spent evaluating quantitative indicators of blood flow in the PA LU PA LO, diest, RAY, LOST handedness derived hemodynamic parameters are entered into the table. 2 and compared with the performance alone is lei and indexes of peripheral resistance is not observed. Signs of vibration disease 2 degrees. Recommended: nonsteroidal anti-inflammatory drugs (indomethacin), physiotherapy (ultrasound on the region of the elbow and wrist joints).

Example 3

Patient K., 34, drifter, hospitalized in the Department of pathology suspected vibration disease. Underground experience 14 years experience in contact with the vibration 13 years. Subjective: chilly hands, sweating of the palms. Objective: vibration sensitivity on both hands is not reduced; the initial temperature of the brushes 35 degrees C; the recovery time temperature after cold test 30 minutes; the adrenaline test - 3 points (whitening of the distal phalanx).

Conducting a survey on the proposed method. To do this, after a 10-minute adaptation of the patient conducted a study of the arteries handedness method TCB. Position the patient sitting on a chair, putting his forearms on the couch in front of him. Arms bent at the elbows at 90 degrees, palms up. The study was performed on the ultrasound system Acuson 128 XP" linear sensor frequency of 7 MHz. The sensor was installed on the side surface of the 3rd finger of the right hand at the level of the proximal phalanx by radiation jarovskogo spectrum frequency shift - Vps (cm/s), Ved (cm/s), TMH (cm/s), PI (srvc. units), RI (srvc. units) and SD (sm. units). Then aziraphale with the side surface of the same finger on the same level from the ulnar artery PA LO and carried out a similar evaluation of qualitative and quantitative indicators. Then on the Palmar surface of the distal phalanx of the 3rd finger aziraphale remote and evaluated the above quantitative and qualitative indicators of blood flow. At the final stage aziraphale BEAM at the level of the wrist joint and LOCK at the level of the wrist joint, where were evaluated by qualitative and quantitative characteristics of the Doppler spectrum frequency shift. After that, hemodynamic parameters are entered into the table. 3.

Then the patient was performed functional test with SNR. Static load was determined and set by using a torque tester digital TDC 87.02. The patient has identified the MMC equal to 40 kg, automatically set the level of static load 75% of MMS, which the patient survived for 30 seconds. At the expiration of this time was spent evaluating quantitative indicators of blood flow in the PA LU PA LO, diest, RAY, LOST handedness derived hemodynamic parameters are entered into the table. 3 and compared with the performance alone is Noah speed and the decrease in resistivity in the radial and ulnar arteries handedness. Individual signs of the influence of vibration. Recommended: - control study (triplex ultrasound scan) after 1 year.

Thus, the application of these essential features avoids the drawbacks and prototype and to achieve the project objectives. Integrated ultrasonic assessment of changes in hemodynamic performance at rest and in response to functional test with static load on working hand allows a more complete characterization of the regional vascular disorders in vibration disease.

Claims

A method for diagnosing the degree of vibration disease by assessing peripheral blood flow, including triplex ultrasound scan of the arteries of the upper extremities at rest, characterized in that it further conduct functional test with static load on the working hand (SNR) and determine the blood flow indices, namely, end-diastolic velocity (Ved) and the index resistivity (RI) in their own Palmar digital arteries (PA) at the level of the proximal phalanx with the radial side (PA LU) and the ulnar side (PA LO) and the distal phalanx (remote) 3rd finger in the radial ar is whose hands and in the absence of changes in finger arteries and increase Ved and lower RI in radial and ulnar arteries compared with the corresponding figures alone diagnose the stage of illness - some signs of exposure to vibration (OPW), with increasing Ved and lower RI in all the studied arteries diagnose vibration disease 1-St degree (WB 1st century), in the absence of changes Ved and RI in all the studied arteries diagnose vibration disease 2nd degree (WB 2nd century).



 

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