The method of measuring cardiac ejection and designed for this device

 

The invention relates to medicine and are designed for continuous determination of cardiac output. The way in which the volume of blood ejected by the left ventricle (LSV), or the volume of blood ejected by the right ventricle (RSV), expressed and calculated as a function of at least one of the indicators of the area under the curve of the pressure recorded by an appropriate sensor and as a function of hydraulic impedance and cardiac output Q calculated in accordance with the ratio Q=LSV·HR (or Q=RSV·HR), where HR is heart rate. The device provides a signal processing and calculation. The invention allows to increase the reliability of measurement results. 2 N. and 8 C.p. f-crystals., 21 Il.

The scope of the invention

This invention relates to a method and apparatus for determining the stroke volume of the heart, i.e. the volume of blood ejected from the left ventricle (LSV), and the volume of blood ejected from the right ventricle (RSV), and therefore the continuous determination of cardiac ejection Q, i.e. parameter, which is the product of stroke volume and heart frequency is about, to provide the possibility of determining this important hemodynamic parameter in various clinical and non-clinical situations, as well as during ergometrically tests.

The level of technology

The most widely currently used invasive methods of measuring cardiac output Q are the way thermodilution (TDM, Thermodilution Method), method Fika (Fick''s Method, FM) and the method called by the method of contour lines pulse (PCM - Pulse Contour Method), which uses the blood pressure signal p(t), measured in the aorta or pulmonary artery.

The specified method of using a blood pressure signal, not very reliable and therefore requires calibration. This is typically done using TDM. However, currently, this method does not provide reliable results.

The basis of the above-mentioned method RSM is an original idea herd (Herd J. A. et al., 1864) and theory Windkassel (translated from German means “air chamber”), developed by Frank (Frank O., 1930) and is based on the existence of a relationship between the volume of blood ejected by the left ventricle (LSV), or the volume of blood ejected by the right ventricle (RSV), and area under the curve of pressure p(t). The main value used is d ' under the curve of pressure p(t) (see Fig.A1), and Z0, expressed in [mm RT.art./cm/t], is a hydraulic impedance, which depends on the dynamic resistance and flexibility of the arteries.

LSV is measured in [cm3] (see Fig.A1), therefore, the value of Q=LSV·HR is a cardiac output, expressed in liters per minute, if the heart rate is expressed by the number of beats per minute. In this regard, note that the dependence of blood pressure of time is determined by the value of the LSV and vascular impedance. Therefore, in the method of contour lines heartbeat want to share and analyze these two components; however, this method cannot identify these two components as independent functions of time.

Many studies, using the principles of theory of aerial cameras were aimed at the definition of LSV only by results of the analysis of the form of pressure waves, as well as characteristics associated with the passage of the wave in the aorta or pulmonary artery [Remington J. W., et al., 1948; Wamer H. R. et al., 1953; J. A. Herd, et al., 1966; Kouchoukos, N. T. et al., 1970].

Subsequently, for several years, was used on the original idea of Frank [Franck], which made it possible to obtain estimates of the magnitude of LSV in the continuous mode on the basis of the measurement signal is ako for specific applications in different clinical situations, the method of contour lines pulse requires “calibration” for calculation of hydraulic impedance. For calibration typically use one of the two above-mentioned methods, i.e. the method of thermodilution or the way of the flick, or use the method of linear regression that takes account of the aorta, as its diameter, as well as age, gender, height and weight of the patient.

Unfortunately, the coefficients obtained from the calibration and regression, are inaccurate, given that in turn inaccurate ways in which they are received, and that regression in all cases receive a limited number of objects, and therefore acceptable only as an average, but not the true values of the tested value.

In fact, the estimated value of cardiac output, obtained using the method of thermodilution and method of the flick, not always consistent with clinical parameters obtained using other methods of diagnosis; this happens mostly in case studies of patients with certain forms of heart disease, such as dilatation of the heart, alulama cardiopathy and cardiac fibrillation.

As an example, consider the two possible signal in the aorta studied between the opening and closing of the ventricle. Typically, these signals have the same area, but different the x lines of the pulse gives the same exact measurement result (the same integral), calculated on the basis of the impedance calibration. However, it is obvious that the signals of different shapes must be different impedance values, which cannot be calculated.

Thus, restrictions invasive technique currently used are: a) low attainable accuracy in the assessment of cardiac output in the case of clinical disease; (b) complete unfitness in the case of pathological condition of the patient and (C) the impossibility of using these invasive methods, for example, during ergometrically tests.

The purpose of the invention

The first aim of the invention is the ability to continuously obtain the measurement results more reliable than those that are currently using invasive and non-invasive methods.

The second objective of the invention is to provide the measurement results are essentially independent from the point of application of the sensor due to changes in special formula and without any prior calibration measurements.

The invention

The above objectives are achieved by the present invention, using a method that directly get the values is also in the femoral, brachial, radial artery, or measured by non-invasive, for example, in the arterioles of the fingers, using a meter with a cuff. In accordance with this method, the resonance points of the signal to calculate the impedance of the pressure signal by comparing this signal with the signal from the flow in an elastic tube, and the young's modulus constant and believe in the particular case equal to one. Thus cardiac output can be calculated based solely on the analysis of the pressure wave and its characteristics, without the need for additional holding various calibration.

In the preferred case, the hydraulic impedance calculated by analyzing the first and second derivatives in time of the recorded pressure signal.

In accordance with another aspect of the invention also make an amendment to the average pressure, designed for use in calculating LSV, in order to take into account the attenuation values specified pressure in those various points where it is possible to check the signal.

In accordance with another aspect of the invention, the signal that was obtained from a finger (or some other point non-invasive method), this method makes it possible not the Oia cardiac output.

More specifically, to obtain an estimate of SV in accordance with the invention, the recorded pressure waves in the ascending aorta and/or pulmonary artery compliance (E) artery and peripheral resistance (R). Therefore, taken into account that: 1) SV depends on the pressure changes that occur when opening the valve ventricle (which is the difference between systolic and diastolic pressure divided by the time interval between the moments of systole and diastole), and 2) SV due to the values of E and R To obtain these components should take into account the amount dicrotism pressure and other characteristic points between systolic and mikrotechnik pressure (magnitude of this pressure must be divided by the time which is a time interval between the end of the heart to contract and when the events considered).

Therefore, SV is considered as a variable determined by three parameters: 1) the volume ejected by the ventricle blood; 2) reaction of the walls of the aorta; 3) resistance caused by peripheral arterial cycle. Since the pressure at the point of measurement is the result of simultaneous action of these three components, our system RA is the major, defined by a set E and R, and the first impact is determined by the above paragraph 1), and the second, i.e. the combination of E and R, mainly contributes to the closing of the valve (point dicrotism pressure). The point of the last event due to a number of perturbations acting on the pressure signal after passing through the heart valve, depending on the vessel, which must pass, and the path length. It is necessary to take into account not only the summand made above systole and dicrotism, but the term secondary disturbances, if present.

In conclusion, we note that all taken into account quantum dots represent the times at which there is equilibrium between different points (blood ejected by the ventricle-E-R): “the principle of” equilibrium points (systolic and microtecnica point) can “accompany” or not to “accompany” the other equilibrium points (how to analyze them and do I need to do this, described below). All this information can be found in the pressure wave, which occurs after the creation of the ventricle (right or left).

The advantage of the proposed method is that it allows you to set the ratio mizuuchi), which include stage calibration of the recorded signal, in which the component corresponding to the area under the curve of pressure, is considered to be time-varying, and the component of the impedance can only be regarded as constant.

More specifically, by means of the proposed method (hereinafter referred to as pulse analysis method (PAS)) you can: a) determine the SV signal pressure in the ascending aorta and pulmonary artery, recorded by invasive; b) to determine the SV signal in blood pressure, recorded by invasive (brachial, radial and femoral arteries) and recorded by non-invasive (for example, the pressure signal received oscillometric way of the arterioles of the fingers).

Thus we estimate the LSV and RSV and determine the true value of Q in a way that does not require any calibration. Therefore, these results are only achieved by analysis of the pressure wave depends only on the moments in which it is measured).

In accordance with the invention, the proposed device for implementing the method.

The device contains a microprocessor unit, is made capable of receiving the signal of blood pressure and getpattern embodiment, the device further comprises a sensor in the form of a measuring cuff, made with the possibility of the imposition of the finger and signaled blood pressure.

Brief description of drawings

Fig.A1 explains the analysis of the cardiac pressure signal, carried out by the method known from the prior art.

Fig.1-19 depict graphs of the cardiac pressure signal, and first and second derivatives of the signal, and the signal is cleared at various points.

Fig.20 explains the reconstruction of the signal in the aorta, produced in accordance with the proposed method according to the pressure signal, captured with the arterioles of the fingers.

Detailed description of the invention

Below, with reference to the attached drawings, the various examples of the method.

Example 1

A) the ratio between the LSV and the pressure measured in the ascending aorta (Pulse analysis Method for Aorta: PASS) (Fig.1-6).

I) PASS determines cardiac output Q in liters per minute using the following General relationship (the pressure signal was removed from the ascending aorta at a frequency of 1000 Hz);

where K=1 and has the dimension [(m·sqrt(2p/()·Vm], expressed in [I3/t2].

m - medium wavelength of Tosti blood;

And the integral over the curve of pressure p(t), expressed in [mm RT.article·MS] and calculated the time interval between the time t1 (the time of occurrence of diastolic pulse in milliseconds [MS]) and tdic (the time of appearance dicrotism pressure in milliseconds [MS]), (Fig.1);

K1=100, expressed in [mm RT.article] and represents the correction factor for medium pressure;

Za1=(Psys-R(1))/tsys, expressed in [mm RT.art./MS];

Za2=(Pdic/tfinal-tdic), expressed in [mm RT.art./MS];

and Pm=(psys+2P(1))/3, see note 1 below:

tfinal - adopted in calculation time reduction (start time t1 and end tfinal). In line with this, the cardiac output Q=LSV·HR;

where Q is expressed in [l/min];

HR=60000/T;

and the T - period heart rate, expressed in [MS].

This ratio was used in those cases where the pressure curve and the corresponding average values of tangents (i.e. the first derivative d’) at 21 sites, as well as the average values of tangents in 21 point from the average values of tangents (i.e. the second derivatives d") were as shown in Fig.2 and 3, and can be associated with points, which produced a record.

II) using Za3.

When the pressure curves in the ascending aorta have the form shown in Fig.4, and the corresponding first and what I resonance, the ratio takes the form:

where the symbols have the same meaning as in equation [1], and where t3 represents the time in [MS], in which the value of d has a minimum value between tsys and tdic, and R3 is the corresponding pressure at the time t3, expressed in [mm RT.CT.], (see Fig.6) and Zf3=(P3/(tfinal-t3)) mm RT.article /MS.

Similarly, one can calculate Q=LSV·HR.

Note 1

Medium pressure to the pressure measured in the ascending aorta, it is necessary to understand the actual pressure for the interval 90-110 mm RT.article; for medium pressure between 110-120 and 90-80 mm RT.article it should be seen in 50% (for example, for RM=118 mm RT.article on our way we get 114 mm RT.CT.); for values of the average pressure between 120-130 mm RT.article it should be seen in 25%, for values of the average pressure greater than or equal to 130 and less than or equal to 70 mm RT.art., it should be considered in 13%.

Example II

C) the ratio between the RSV and the pressure measured in the pulmonary artery (Pulse analysis Method. Pulmonary: PASL)

The ratio between the volume of blood ejected from the right ventricle RSV, and the pressure measured in the pulmonary artery. The corresponding pressure signal similar to the signal prdy cardiac output Q in litres using the following General relationship (pressure reading was shot in the pulmonary artery at a frequency of 1000 Hz):

I) Case with a mean pulmonary artery pressure, greater than or equal to 19 mm RT.article.

where K=1, has the dimension [m·sqrt(2P/()·Vm] and is expressed in [I3/t2],

is the density of blood;

And the integral over the curve of pressure P(t), expressed in [mm RT.article ·MS] and calculated the time interval between the time t1 (time in [MS] the appearance of diastolic pulse) and tdic (time in [MS] when the second extension artery in dicrotism pulse);

K1=12, expressed in [mm RT.V.];

Za1=(psys)/tsys, expressed in [mm RT.art./MS];

Za2=(Pdic/tfinal-tdic) is expressed in [mm RT.art./MS];

and Pm=(Psys+2P(1)/3); see the following comment 2,

Q=RSV·HR, where Q is expressed in [l/min];

HR=60000/T;

and T is the period of cardiac contractions in [MS].

In Fig.7 shows the pressure signal, shot in the pulmonary artery. For the pressure in the pulmonary artery has change d’ and d’, similar to those observed in the case of the aorta. Consequently, the definition of a point dicrotism pressure (Pdic), systolic pressure (Psys), diastolic pressure (P(1)) and associated time indicators produced as described above.

II) the Case of PMM RT. century, the ratio takes the form:

The symbols have the same meaning as in the previous cases. In the same way you can calculate Q=RSV·HR.

Note 2

Medium pressure to the pressure measured in the pulmonary artery, it is necessary to understand the actual pressure for the interval 19-28 mm RT.article; for values of the average pressure between 28-33 mm RT.article it should be considered 50%; for values of the average pressure greater than 33 mm RT.art., it should be seen in 25% (e.g., RM=43 mm RT.article for our method is 33 mm RT.CT.); values less than 19 mm RT.art., refer to case II), and therefore we do not use the average pressure.

Example III

(C) the Ratio between the LSV and the pressure in the arterioles of the fingers registered non-invasive way (Pulse analysis Method Finger: PASP)

A direct relation

I) ASP allows you to determine cardiac output Q in litres using the following General relation (pressure reading was taken off the finger of the left hand at a frequency of 1000 Hz):

where (see Fig.8):

K=1, has the dimension of [(m·sqrt(2p/()·Vm] and is expressed in [I3/t2];

K1=90, expressed in [mm RT.V.];

Zf1=(Psys-P(1))/tsys, expressed in [mm RT.art./MS];

Zf2=Pdic/(tfinal-tdic), expressed in [mm RT.art./MS];

and RM=(Psys+2P(1))/3, see the following note 3.

The adjusted value of the volume of blood ejected from the left ventricle (LSVC), has the form:

where: (Pd1-Pdic) is the deviation of the pressure in discretional point (Pdic) from its maximum value (Pd1), expressed in [mm RT.article]. Such an amendment is introduced only when there is an increase in pressure after dicrotism pressure: ((Pd1-Pdic)>0). In cases where the pressure increase does not occur ((Pd1-Pdic)0), we get LSV=LSVC.

Psys - systolic pressure [mm RT.V.];

Pdias - diastolic pressure [mm RT.V.];

member Pd1 expect immediately after discretional point, it is the maximum value after (Pdic);

Q=LSVC·HR,

where Q is expressed in [l/min];

HR=60000/T;

and T is the period of cardiac contractions in [MS].

The above ratio was used in cases where the pressure curve and the corresponding first and second derivatives of d’ and d’ had the appearance shown in Fig.9 and 10.

II) application - Zf3.

When the pressure curves such that the 12 and 13, the dependence takes the form:

where: Zf3=P3(tfinal-t3)

the symbols have the same meaning as before, a t3 is the time in [MS], where d is the minimum value between tsys and tdic, R3 is the corresponding pressure [mm RT.article] at time t3 (see Fig.11).

In the same way we can calculate Q=LSVC·HR.

III) application - 2Zf3.

When the pressure curves like the one shown in Fig.14, and the corresponding first and second derivatives of d’ and d’ such as those depicted in Fig.15 and 16, the ratio takes the form:

where Zf3=P3/(tfinal-t3), the symbols have the same meaning as before, a t3 is the time in [MS], where d is the minimum value between tsys and tdic, P3 is the corresponding pressure at time t3, expressed in [mm RT.article] (see Fig.14).

In the same way we can calculate Q=LSVC·HR, expressed in liters per minute.

IV) using 2Zf3-Zf5

When the pressure curves like the one shown in Fig.17 and the corresponding first and second derivatives of d’ and d’ are similar to those, /(tfinal-t3), Zf5=P5/(tfinall-t5), the symbols have the same meaning as before, t5 is the time in [MS], where d is the minimum value between tsys and tdic, a P5 - appropriate pressure at time t5, expressed in [mm RT.article] (see Fig.17).

In the same way we can calculate Q=LSV·HR, expressed in liters per minute.

Note 3

Medium pressure to the pressure measured in the arterioles of the fingers, a non-invasive method, you should understand the actual pressure for an interval of medium pressure 70-110 mm RT.article; for values of the average pressure between 110-150 40 and 70 mm RT.article it should be seen in 50% (e.g., RM=128 for our method is a = 119 mm RT.CT.); for values of the average pressure greater than 150 and less 40, it should be seen in 25%.

v) reconstruction of the signal pressure in the ascending aorta by means of multiple linear regression in the time domain using Zf1-Zf5.

In this reconstruction, typically use multiple linear regression. In order for arterial signal recorded in a continuous mode using a small cuff that is wrapped around the middle finger of the left hand, to reconstruct the signal, zapisywai the significant linear regression, when the reconstruction of the pressure signal was carried out in two successive stages:

1. Estimated average for the period of the cardiac cycle the pressure in the ascending aorta (or pulmonary artery) was obtained from finger to signal receipt of the magnitude of the Pmf (the average pressure in the aorta was estimated based on data taken from the finger), which was calculated based on the formulas used in the various cases, analysis of the arterial signal, refer to the previous points:

2. Reconstruction of the waveform in the ascending aorta (or pulmonary artery) was performed by approximation, using the following parameters:

y=a0·Pmf+a1·fin+a2·abs(derfin)+a3·abs(der2fin)+a4·abs(der3fin)+a5·(intfin)+a6·slope·abs(derfin)+a7·slope·zZf1+a8·slope+a9·maxfin+a10·minfin+a11·HR·(intfin(to this point))+a12·areaf+a13·zZf1+a14·zZf2+a15zz3f+a16·zz4fa7·Zf5

where Zf5 and n=0, 1 and 2 in accordance with the previously described criteria;

zz4f=Pd1/(tfinale-td1) (Fig.14);

- fin - pressure in the finger;

- abs(derfin) - the absolute value of the first derivative in the point curve pressure;

- abs(der2fin) is the absolute value of the second derivative in the point curve pressure;

- the signal filmed with a finger, the upper limit of which is the considered point;

- slope - the angle between the horizontal axis and a straight line passing through the points of minima on the left and on the right the curve portions of the cardiac cycle;

- maxfin and minfin - correspond to the systolic pressure and diastolic pressure;

- areaf - full area under the curve of the pressure signal;

other symbols have the same meaning as before.

Several reconstructed dependency is shown in Fig.20.

Deviations between the reconstructed waveform obtained by non-invasive, and the curve, which is made according to the data measured directly from the ascending aorta, are:

SD represents standard deviation: when reconstructing the minimum numerical interval between the curves obtained in the vicinity of the point of diastolic pressure, the maximum value of the difference obtained in the neighborhood of systolic pressure.

Max - interval, on which the evaluation of the reconstructed pressure point under consideration exceeds the pressure actually measured by means of a catheter within the heart to contract: the minimum value of nie difference obtained in the neighborhood of systolic pressure.

Min - interval, on which the evaluation of the reconstructed pressure point under consideration is less than the pressure that is actually measured by means of a catheter within the heart to contract: the minimum value of this interval is obtained by reconstruction in the vicinity of the point of diastolic pressure, the maximum value of the difference obtained in the neighborhood of systolic pressure.

In this calculation are important values Zf1, Zf2, Zf3, Zf5, discussed in paragraph (C): they are required to obtain a satisfactory result.

D) the ratio between the LSV and recorded invasive way pressure in the femoral artery or other peripheral point, such as the brachial or radial artery (Pulse analysis Method, Brachial, Radial and Femoral, PAS (PLB)).

For these cases are found to be using formulas similar to those used in the case of non-invasive measurements, but involves making the following clarifications:

I) K1 for these invasive signals need to take is equal to 100;

II) note 3 remains valid.

The proposed method can be applied in combination with conventional methods (such as method of thermodilution) containing phase gratui the AK changing in time, and the component corresponding to the impedance, considered only as a constant.

In this case, the proposed method also makes it possible to take into account even the most significant deviation in the heart rate, the pressure and the shape of the pressure wave to calculate the impedance.

In this regard, we can conclude that the examination of healthy people, and for examination of patients with various pathological manifestations, the proposed method is effective and has the advantage diagnostic tool for determination of cardiac ejection invasive and non-invasive way.

In addition, the method can be applied to healthy people, and those who are cardiocirculatory changes and passes ergometrine tests aimed at determining the level of hemodynamic response during these tests.

It should be particularly emphasized that the proposed method is based exclusively on the study of the pressure signal (captured by invasive pulmonary artery, aortic arch, or any other vessel's main arteries, or removed by non-invasive finger) and is not dependent on anthropometric data and age what about the release, containing at least one sensor signal of blood pressure and computing unit associated with the specified sensor for settlements described above and provided with at least one output device for issuing the measured values.

In the preferred case, the device comprises a means of storing information with the downloaded program implementing the method, which corresponds to at least one of items 1-12 of the claims. In addition, the invention discloses a computer program loaded into the computing unit for implementing the method.

Claims

1. The method of measuring cardiac output (SV) in a patient, including the measurement of arterial blood pressure and convert this pressure into a pressure signal, the calculation of stroke volume, which calculate the area under the curve of the pressure signal between the time of occurrence of diastolic pulse and the time of occurrence of dicrotism pressure, calculate the selected impedance values of the pressure signal and calculate the value of the stroke volume as a function of the relationship between the calculated area and vechicle is of the heart rate.

2. The method according to p. 1, where calculating the value of the stroke volume calculated average value of the pressure according to the pressure signal and corrects the calculated value of the stroke volume.

3. The method according to p. 1, in which the calculation of the value of ST is performed based on the pressure signal during one cardiac cycle.

4. The method according to p. 1, in which arterial blood pressure is measured non-invasive by using an external sensor.

5. The method according to p. 4, in which arterial blood pressure is measured using a pressure sensor mounted on the finger.

6. The method according to p. 1, in which the phase measurement of arterial blood pressure includes an introduction into an artery of the patient pressure sensor mounted on the catheter.

7. The method according to p. 6, in which the radial artery is the artery of the patient.

8. The method according to p. 6, in which the pulmonary artery is the artery of the patient.

9. The method according to p. 6, in which the artery is the femoral artery of the patient.

10. Device for measuring cardiac output, characterized in that it comprises at least one sensor signal of blood pressure and computing unit associated with the specified sensor, to make payments in accordance sleepy for the issuance of measured values.



 

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15 cl, 10 dwg

FIELD: medicine, surgery.

SUBSTANCE: one should evaluate clinical state of a patient and as objective parameters one should calculate rheological and brachio-malleolar indices, detect fractional tension of oxygen in capillary blood. At observing clinical improvement accompanied by increased rheological and brachio-malleolar indices by more than 0.1, increased blood saturation with oxygen by more than 10 mm mercury column one should state upon a "good" therapeutic effect. At detecting clinical improvement accompanied by the increase of either one or several objective parameters, or if dynamics of these values is not available - effect should be considered as a "satisfactory" one. At kept ischemic pain at rest without decrease of its intensity, impossibility to keep a limb in horizontal position for a long period of time, the absence of positive dynamics of trophic disorders, at kept ischemic edema and at no alterations in objective parameters - should be determined as "no dynamics". In case of enhanced ischemic pain and edema of foot, at progressing necrotic alterations in foot - one should detect "deterioration" of patient's state. The method increases the number of diagnostic means.

EFFECT: higher accuracy of evaluation.

1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves recording peripheral differential upper extremity blood vessel rheogram and phonocardiogram in synchronous way. The second phonocardiogram beginning and the deepest rheogram points are detected. Pulse way propagation time reduction being found, arterial bloodstream tone growth conclusions are drawn.

EFFECT: high reliability of the results.

18 dwg, 3 tbl

FIELD: medicine, neurology.

SUBSTANCE: a patient should be in initial position when his/her sight is directed towards the ceiling and in 3-5 min it is necessary to register a background rheoencephalogram, then a patient should fix the sight at a pointer's tip being at the distance of about 30 cm against the bridge of nose along the middle line, then the sight should be directed into marginal position due to shifting pointer to the left. Then the sight should be returned into initial position and 3 min later it is necessary to register rheoencephalogram of vertebro-basilar circulation, calculate rheographic index (RI), coefficient for RI ratio on returning the sight from left-hand marginal position into initial one (k2) and at k2>1.098 from the left and (or) k2>1.085 from the right one should detect alteration in vertebro-basilar circulation by reflector mechanism. The method excludes biomechanical impact in stimulating proprioceptive receptors of muscular-ligamentous system under stretching.

EFFECT: higher accuracy and reliability of detection.

2 ex, 2 tbl

FIELD: medicine, resuscitation.

SUBSTANCE: one should detect cerebral perfusion pressure (CPP), intracranial pressure (ICP), values for blood saturation with oxygen in radial artery and jugular vein bulb (SaO2, SjO2), additionally one should study lactate level in jugular vein bulb and radial artery, calculate venous-arterial difference according to lactate (▵lactate), cardiac ejection (CE) due to thermodilution and hemoglobin level. Values for cerebral oxygen transport function should be calculated by the following formulas: mĎO2 = 0.15 x CE x CaO2 x 10; mVO2 = 015 x CE x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SaO2; CjO2 = 1.3 x Hb x SjO2. In case of noninvasive detection - due to pulsoxymetry one should measure peripheral saturation (SpO2), due to parainfrared spectroscopy - cerebral oxygenation (rSO2) and cardiac ejection due to tetrapolar rheovasography (CEr), detect and calculate the values of cerebral oxygen transport system according to the following formulas: mĎO2 = 0.15 x CEr x CaO2 x 10; mVO2 = 0.15 x CEr x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SpO2; CjO2 = 1.3 x Hb x rSO2. At the value of mĎO2 86-186 ml/min and more, MVO2 33 - 73 ml/min, ▵lactate below 0.4 mM/l one should evaluate cerebral oxygen transport system to be normal and the absence of cerebral metabolic disorders. At mĎO2 values below 86 ml/min, mVO2 being 33-73 ml/minO2, ▵lactate below 0.4 mM/l one should state upon compensated cerebral oxygen transport system and the absence of metabolic disorders. At mĎO2 being below 86 ml/min, mVO2 below 33 mM/l, ▵lactate below 0.4 mM/l one should conclude upon cerebral oxygen transport system to be subcompensated at decreased metabolism. At the values of mĎO2 being 86-186 ml/min and more, MVO2 below 33 ml/min, ▵lactate below 0.4 mM/l one should establish subcompensated cerebral oxygen transport system at decreased metabolism. At values of lactate being above 0.4 mM/l and any values of mĎO2 and mVO2 one should point out the state of decompensation in cerebral oxygen transport system and its metabolism. The innovation enables to diagnose disorders and decrease the risk for the development of secondary complications.

EFFECT: higher efficiency and accuracy of evaluation.

1 cl, 3 ex, 1 tbl

FIELD: medicine, cardiology.

SUBSTANCE: the present innovation deals with ways for ultrasound diagnostics of cardiac contractile function. It includes Doppler tissue myocardial studying followed by detecting regional value of deformation and myocardial deformation rate into diastole at curved M-mode Strain Rate, performing quantitative analysis at Strain mode, moreover one should calculate myocardial deformation value into diastole at ECG at the level of P tooth and at its value being above 5% it is possible to diagnose the syndrome of incomplete diastole.

EFFECT: higher accuracy and efficiency of diagnostics.

6 dwg, 1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves setting a patient in vertical posture with stabilogram and rheoencephalogram being concurrently recorded with frontomastoid and accipitomastoid leads being used retaining head position with stressed neck extensor muscles state and head position with relaxed neck extensor muscles state. Stabilogram parameters characterizing vertical posture stability and rheographic index of each of four brain basins. When combining better filling of cerebral basins with blood and higher standing stability, training is carried out in keeping head positions allowing better filling of cerebral basins. If better filling of cerebral basins with blood follows with no increased standing stability, the trainings are carried out in keeping head position with stressed neck extensor muscles state. The training sessions are given twice a day for 15 min during two weeks.

EFFECT: enhanced effectiveness of treatment.

2 cl, 3 tbl

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