The way to assess changes in blood flow in the major arteries of the head

 

(57) Abstract:

The invention relates to medicine, cardiology. Healthy and diseased arterial hypertension conduct ultrasonic Doppler pool common carotid arteries before and after functional tests. Determine the values of the linear blood flow velocity, indexes circulatory resistance (R1), perfusion pressure (IAP), the ratio of systole-diastolic (S/D) pressure common carotid arteries. According to the degree of change of these indicators when the load is judged on the severity of cerebral disorders and hypertension. The method reflects including consultee stages of maladjustment extracranial circulation in the pool of common carotid arteries.

The invention relates to medicine, namely cardiology, and its relevance lies in the fact that arterial hypertension (AH) affects 40% of the population, 1/3 of them develops in the cerebral circulation of varying severity due to deterioration of blood flow in the major arteries of the head and criteria early (consultee) diagnostics are insufficiently developed. The latter is important not only for expert assessment of cerebral manifestations rasstroistva change indicators ultrasonic dopplerography (USDG) in response to active multiple (10-15 times) change orthogonalities position.

It should be noted that only the original data USDG is not always possible to accurately judge the state of the extracranial circulation. For a more detailed view about the functionality of cerebral hemodynamics were studied blood flow not only alone, but also on the physiological background of the test load.

Similar to the proposed by the author of the method can be considered research, described Baker, S. E., Vorozhtsova I. N., The Semka, C. and others (the Effect of ramipril on the volumetric rate of blood flow in the internal carotid arteries in patients with essential hypertension//Cardiology. - 1996. No. 10.- S. 29-31), according to which the estimated dynamics of the volume rate of flow of the basin of the internal carotid arteries in response to exchange application Rami-pril. However, we can make certain observations, explanatory not wide enough application USDG in the modification of these authors:

1) is the volumetric blood flow at rest and only at the level of the internal carotid arteries, and not through the main arteries of the head;

2) Doppler ultrasound is used to assess the effect on the flow of a hypotensive drug, and not the functional t is selected AG;

4) in addition, one indicator is difficult to judge the change in the tonic properties of the vascular wall.

The prototype of studies to assess changes in blood flow in the major arteries of the head may be research Dmitrieva centuries, Kurkova, K. S., Arabidze gg, etc. (Lomir in the treatment of patients with essential hypertension and rehabilitation of patients after acute ischemic stroke//Ter. arch. - 1994. No. 4. - 15 C. for the study of Central hemodynamics and the linear flow velocity in the middle cerebral artery using the method of transcranial Doppler in the course of treatment lomira patients with hypertension after acute ischemic stroke.

Unlike our proposed method is as follows:

1) the location of the middle cerebral artery on the technique of transcranial dopplerography paired with certain technical difficulties due to the anatomical course of the artery, a small area of the acoustic window, the required skills of the researcher and time-consuming;

2) of the indicators USDG in analog studies use only the linear blood flow velocity, which depend on the option centralbatagen linear flow velocity indicators, characterizing the change in the tone of the vascular wall.

3) there are no instructions on the use of the USDG for comparative evaluation of action on extracranial blood flow to the physical test load in the form of active, multiple shifts orthogonalities provisions in healthy and sick AG;

4) there are no options hemodynamic disorders at the level of the main arteries of the head (the MAGICIAN) and the degree of their manifestation in response to the ongoing trial.

The author offers a way to assess extracranial blood flow in healthy and sick AG for the study of the dynamics of multiple indicators USDG pool common carotid arteries on the functional tests.

Surveyed 50 healthy individuals (male 20, female 30; age 48±2.5 years) with normal BP levels (125±1, 1/82±1.2 mm RT.cent.). Before the breakdown of all patients was measured HELL, and was recorded performance USDG pool common carotid arteries by calculating the average linear flow velocity (BFV) in cm/s, indexes circulatory resistance (RI), the ratio of systole-diastolic (S/D) and perfusion pressure (IAP). Functional test included active and multiple (10-15 times) change orthogonalities is decina, 1991. - S. 62-66). Accordingly, the health test was interrupted and re USDG was registered previously. The test results were evaluated according to the change of state of health, the dynamics of the AD and indicators USDG.

It turned out that all healthy individuals when conducting such a test HELL was slightly increased, reaching 132±1,3/84±1.1 mm RT.art., and there were adaptive changes USDG pool common carotid artery, which was reflected in higher mean BFV (25±0.7 cm/s to 33±0.5 cm/s) and increasing S/D from 3.7±0,1 to 4.6±0,3 (p<0,001) without changes characterizing the tonic tension of blood vessels: RI respectively amounted to 0.68±0,001 and 0.69±0,002, SDI-2,8±0,4 and 2.9±0.5 in.

Thus, in healthy individuals after applying functional tests showed increase in blood flow in the pool of common carotid arteries without changing their tone. This is evidence of adaptive changes at the level of the main arteries of the head.

Surveyed 260 patients with hypertension (men 100 women 160; age 55±0,5 years). According to the who classification (1997), the 1st stage was 76 (29,3%), 2-I - 102 (39,2%), 3-I - 82 (31.5 per cent).

As indicated by the observations, to conduct functional tests sick AG complained of headache, dizziness, flashing flies lane who was 152±1,3/94±1,1, 164±1,2/102±1.0 and 178±0,7/108±1.1 mm RT.article.

It turned out that when AG 1st stage in 68% of the surveyed indicators USDG pool WASP as healthy, wore adaptive character: there was a reliable increase in the average BFV 21±0.5 cm/s to 29±0.7 cm/s (p<0,001), S/D from 3.8±0.1 to 4,6±0,2 (p<0.01) for unmodified RI (respectively 0,68±0,003 and 0.67±0,005) and SDI (respectively of 2.7±0.4 and 3,0±0,2). In 32% appeared the initial signs of inadequate increase blood flow on OSA: increased not only mean BFV (22±0.7 to 28±0.9 cm/s; p<0,001), but RI from 0.71±0,002 to 0.76±0,003 (p<0,001), SDI - from 5.6±0.4 to 8,7±0,5 (p<0,001), S/D from 3.7±0,4 4,1±0,6 (p>0,05), testified to the increased tone of the vascular wall, and the reaction was regarded as hypertonic-spastic. The level of HELL was 158±1,2/96±1.1 mm RT.article.

Thus, 32% of patients with arterial hypertension of the 1st stage after application of functional tests is celebrated not only increase blood flow, and improving the tone of the common carotid arteries, which indicates the occurrence of the first against non-adaptable to changes at the level of the main arteries of the head.

In patients with hypertension stage 2 in 46% of cases the TST wore even more pronounced: increased RI with 0,76±0,008 to 0.80±0,006 (p<0.01), and SDI with 8.0±0.4 to 1 is arizoa hypertonic-constrictive type of maladjustment extracranial blood flow. In 30% of cases during and after the samples were observed increasing cerebral symptoms (dizziness, tinnitus, ringing in the ears); the AD was 174±1,1/105±1,0 (p<0,01) mm RT.article.

Thus, in patients with hypertension stage 2 after applying functional tests there has been a significant increase in tone of the pool of common carotid arteries without significant changes in the linear velocity of blood flow, which indicates the growing against non-adaptable to changes at the level of the main arteries of the head.

In patients 3 stage against non-adaptable reaction was detected in 58% of cases and differed the most significant increase in SDI with 12.0±0.2 17±0,4 (p<0,001), a sharp decline in mean BFV (14±0.8 to 10±0.6 cm/s; p<0,001), with little changing in comparison with the 2nd stage, the indicators RI (from 0.77±0,004 to 0.81±0,002; p<0,001) and S/D (3.5 ą 0.3 to 3.8±0,4; p>0,05), describing hypertonic-stenosing type. Almost all the patients showed increased symptoms of cerebrovascular insufficiency; BP levels were 188±0,5/110±1.0 mm RT.article.

Thus, in patients with arterial hypertension of the 3rd stage after applying functional tests there is a significant violation of blood circulation in the pool of common carotid arteries in the form of reducing the linear velocity of blood flow and bralnik disorders, indicating the presence of pronounced against non-adaptable to changes at the level of the main arteries of the head.

Dynamics USDG in response to functional samples from healthy individuals and patients with hypertension is characterized by a specific reaction to the common carotid arteries, which indicates a gradually progressive changes in the blood flow, which coincides with the sequential features of the current AG and prognostic reflecting consultee stages of maladjustment extracranial circulation in the MAGICIAN from hypertonic-spasticescoe (1st stage) to hypertonic-constrictive (2) to hypertonic-stenoziruyuschego (3) type of reaction. Given the shifts reveal the dynamics of the pathogenetic mechanisms underlying the development of decompensation at the level of the MAGICIAN and justifying the intensity of the anti-hypertensive and vasoactive therapy.

Thus, the proposed by the author a way to assess changes in blood flow in the major arteries of the head has some differences from existing analogues and prototypes.

1. The proposed method gives a possibility to judge about the change of indicators of not only the system, but also regional, in particular the basin of the common carotid arterially AG under the influence of the change orthogonalities position.

3. The proposed method is the use of Doppler ultrasound to assess changes in blood flow in the major arteries of the head in healthy and patients with hypertension according to the USDG to calculate the most informative parameters (ISC, RI, S/D, SDI) reflects not only the adaptive nature of the changes of blood flow in the major arteries of the head, but also against non-adaptable violations depending on the stage of hypertension.

4. Suggested by the author approach showed different changes of indicators USDG depending on the stage AG: when the 1st stage has only increased the mean BFV, S/D and increasing RI, SDI; stage 2 - significant increase in RI, UMI no significant changes in mean BFV and S/D; 3rd stage - reduction of mean BFV, increasing RI, SDI without changing the S/D.

5. According to the degree of change indicators USDG in response to a change orthogonalities position to judge the severity of cerebral disorders in AG and to predict the need does improve perfusion of the brain.

As an example, here is clinical and functional outcomes one-time functional test in patients with hypertension.

Patient S., 35 years old, working, suffering AG 1st stage within 3 years. Periodically b the disease.

Objectively: the right physique, high power. The frequency of 18 breaths per minute Percutere above the light lung sound auscultation breath vesicular. Pulse 82 / min, rhythmic, satisfactory properties. HELL 160/95 mm RT.article Borders of the heart is not changed, the colours are muted, rhythmic accent P tone of the aorta. Abdomen palpation soft, painless. Liver and spleen not palpable. In the blood and urine of pathological changes.

ECG sinus rhythm 87 min, the correct direction of the electric axis of the heart.

The average USDG pool common carotid arteries: mean BFV - 20 cm/s, RI - 0,72, SDI - 6,0, S/D and 3.8.

After applying functional tests: AD - 167/98 mm RT.article; the average USDG pool common carotid arteries: mean BFV - 26 cm/s, RI - 0,76, SDI - 9,0, S/D - 4,2.

Patient D., aged 45, a milkmaid, suffers from hypertension stage 2 for 8 years. Worries headache, dizziness, noise in the head and ears, flashing "flies" before the eyes, and unpleasant sensations in the heart area. Heredity aggravated by hypertension.

Objectively: the right physique, high power. The frequency of 18 breaths per minute Percutere over legs. HELL 165/100 mm RT.article The left border of relative cardiac dullness is 1.5 cm left from sredine-clavicle line. Muffled heart sounds, rhythmic, the focus of the 2nd tone of the aorta. Abdomen palpation soft painless. Liver and spleen not palpable. In the blood and urine of pathological changes.

ECG sinus rhythm 89 min, the horizontal direction of the electric axis of the heart, signs of left ventricular hypertrophy.

The fundus of the eye: signs of hypertensive retinopathy 1st stage.

The average USDG pool common carotid arteries: mean BFV-18 cm/s, RI-0,76, SDI-8,0, S/D is 3.7.

After applying functional tests: AD - 175/104 mm RT.article; the average USDG pool common carotid arteries: mean BFV - 19 cm/s, RI - 0,79, SDI - 13,0, S/D to 4.0.

Patient C., 56 years old, an employee suffers AG 3rd stage for 7 years. Worries headache, dizziness, noise in the head and ears, flashing "flies" before the eyes, pain, pressing nature in the heart when walking on flat terrain through 300 meters of Heredity aggravated by hypertension.

Objectively: the right physique, high power. The frequency of 18 breaths in mi the instrumental properties. HELL 175/105 mm RT.article The left border of relative cardiac dullness is at 2.5 cm left from sredine-clavicle line. Muffled heart sounds, rhythmic, the focus of the 2nd tone of the aorta. Abdomen palpation soft, painless. Liver and spleen not palpable. In the blood and urine of pathological changes.

ECG sinus rhythm 89 min, the deviation of the electric axis of the heart to the left, signs of left ventricular hypertrophy with impaired repolarization processes.

The fundus of the eye: signs of hypertensive retinopathy 3rd stage.

The average USDG pool common carotid arteries: mean BFV - 14 cm/s, RI - 0,78, SDI - 12, 0mm, S/D and 3.5.

After applying functional tests: there is a growing headache, dizziness and increased AD - 185/114 mm RT.article; the average USDG pool common carotid arteries: mean BFV - 10 cm/s, RI - 0,83, SDI - 17,0, S/D is 3.7.

The way to assess changes in blood flow in the major arteries of the head, including the measurement of the rate of linear blood flow velocity (BFV) in the quiescent state with the help of ultrasonic dopplerography (USDG), characterized in that measure performance, UZG - BFV, indexes circulatory resistance (R is e effects functional test, assess their dynamics in healthy and patients with arterial hypertension (AH) depending on the stage of the disease, and for stage I hypertension is characterized by increased lbfv to 29±0.7 cm/s, S/D to 4.6±0,2 without changing the tone of the vascular wall R1 - 0,67±0,005, SDI - 3,0±0,2, describing the adaptive response of the main arteries of the head in response to the functional test; for stage II hypertension - increase R1 to 0.80±0,006, SDI to 14±0.7 at a little changing mean BFV - 20±0.8 cm/s, S/D - 4,2±0,2; for stage III AG - a sharp decrease in BFV to 10±0.6 cm/s, S/D to 3.8±0,4, combined with increasing R1 to 0.81±0,002, SDI to 17±0,4, reflecting consultee stages of maladjustment extracranial circulation in the pool of common carotid arteries.



 

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