Method for predicting remote aftereffects of light close craniocerebral trauma in young people

FIELD: medicine, neurology.

SUBSTANCE: one should establish neurological status, bioelectric cerebral activity, availability of perinatal and ORL pathology in patients, establish their gradations and numerical values followed by calculation of prognostic coefficients F1 and F2 by the following formulas: F1=-31,42+1,49·a1-2,44·a2+0,2·а3+1,63·a4+0,62·а5+3,75·a6+1,8·а7-3,23·a8-0,8·а9-1,32·а10+3,26·а11+8,92·a12-2,0·a13+3,88·а14+1,79·a15+0,83·a16-2,78·a17; F2=-27,58+1,43·a1+3,31·а2+0,08·а3+3,05·а4-0,27·а5+2,69·а6+3,11·а7-6,47·a8-6,55·a9+1,99·а10+5,25·а11+7,07·a12-0,47·a13+0,13·a14+4,04·a15-1,0·a16-1,14·а17, correspondingly, where a1 - patient's age, a2 - studying either at the hospital or polyclinic, a3 - duration of stationary treatment (in days), a4 - unconscious period, a5 - terms of hospitalization since the moment of light close craniocerebral trauma, a6 - smoking, a7 - alcohol misuse, a8 - arterial hypertension, a9 - amnesia, a10 - close craniocerebral trauma in anamnesis, a11 - psychoemotional tension, a12 - meteolability, a13 - cervical osteochondrosis, a14 - ORL pathology, a15 - availability of perinatal trauma in anamnesis with pronounced hypertension-hydrocephalic syndrome, a16 - availability of paroxysmal activity, a17 - availability and manifestation value of dysfunction of diencephalic structures. At F1 ≥ F2 on should predict the development of remote aftereffects in young people due to evaluating premorbid background of a patients at the moment of trauma.

EFFECT: higher reliability of prediction.

2 ex, 1 tbl

 

The present invention relates to the field of medicine, namely, neurology, and can be used to predict the late effects of light closed craniocerebral injury (LCMT) among young people.

There are various ways of predicting the course of craniocerebral trauma (CCT).

So there is a method of predicting the course of brain injury, including echo electroencephalography (Echo-EG). The presence of sub - or epidural hematomas allows us to predict severe complications. When the concussion of the changes in the median brain structures (M-echo), as a rule, is not observed. The development of intracranial hypertension is characterized by an increase in the amplitude of pulsation of the echoes. Brain injury gives the offset of the M-echo, which usually do not exceed 3-5 mm and have a tendency to regress over the next 1-3 weeks after injury. The presence of supratentorial subdural and epidural hematomas causes displacement M-echo, reaching 6-15 mm. In contrast to the displacement at the bruises of the brain shifts during hematomas in the first hours after injury have a tendency to increase and show no retrogression in the next day observations (Zenkov LR, Ronkin M.A. // Functional diagnosis of nervous diseases (guidelines for clinicians), M - Medicine, 1991. S).

The disadvantages of this method include the fact that reclaime options are not prognostic criteria for determining the consequences of brain injury, and only allow you to diagnose acute trauma and complication of the acute period.

Closest to the present invention is a method of predicting the course of the outcomes of brain injury, including transcranial dopplerography (Agustina, Dsiebenh, Pundershaw and other predictor of outcome. IPC 7 And 61 In 8/13. Registration application number: 2000108110/14).

The known method of non-invasive prediction of outcome is that underwent transcranial ultrasound Doppler examination of the extracranial and intracranial cerebral vessels, thus determine the index Kindergarten and linear blood flow velocity by measuring the maximum systolic velocity, determine the asymmetry of blood flow in arteries of the same name and value systolicdiastolic index. Additional investigate in the dynamics of the overall condition of the brain and its individual parts by means of electromagnetic resonance impedancometry using two oscillating circuits. Measure the impedance of the oscillating circuit at the resonant frequency on the surface of each of the investigated surface area of the middle third of the thigh, calculate the ratio of the values obtained impedances each plot to the value of the impedance of the circuit at the hip. With increasing asymmetry of blood flow in arteries of the same name, increasing RA the values between the obtained index values Kindergarten and normal value, the increase in the difference between the obtained values of the linear blood flow velocity and rate, the decrease of the ratio of the magnitude of the impedance of the path from the head to the size of the thigh, the magnitude relationship of the impedances measured at symmetrical sites, and decreasing the values of impedance of each of the sites to the impedance of the hip, predict adverse outcome.

The disadvantages of this method include the inability to forecast the consequences of LZCNT, and allows us to predict only for CCT outcomes.

The known method is highly modern, technologically, however, its use in clinical neurological practice is limited by the need for sophisticated equipment and qualified specialist.

The task of the invention is to develop a method for predicting distant consequences LZCNT, allowing to assess the combination of factors affecting the development of these effects.

The technical result of the proposed method is to improve the accuracy of forecasting by estimating premorbid background of the patient at the time of injury.

The technical result of the proposed method is to improve the accuracy of forecasting by estimating premorbid background of the patient at the time of injury.

The technical result of the proposed method reaches the I, that method for predicting distant consequences of lightweight closed craniocerebral injury (LCMT) young people includes clinical and neurophysiological examination of a patient.

The difference of the proposed method lies in the fact that determine premorbid background (presence of perinatal pathology and the state of the nervous system), features of bioelectric activity of a brain of the patient and his social factor. To do this, define the neurological status, the bioelectrical activity of the brain, the presence of perinatal and ENT pathology in a patient, and then set the gradation of the obtained parameters and their numerical values, which I hope prognostic factors F1and F2.

The table below presents the risk factors for late effects LZCNT at a young age. The coefficients of the discriminant functions (K1j, K2j) set by the authors empirically.

Values of F1and F2determined by the formula:

F1=-31,42+1,49· a1-2,44· and2+0,2· and3+1,63· and4+0,62· and5+3,75· a6+1,8· a7-3,23· a8-0,8· a9-1,32· and10+3,26· and11 +8,92· a12-2,0· and13+3,88· and14+1,79· a15+0,83· a16-2,78· a17;

F2=-27,58+1,43· a1+3,31· a2+0,08· and3+3,05· and4-0,27· and5+2,69· and6+3,11· and7-6,47· a8-6,55· a9+1,99· and10+5,25· and11+7,07· a12-0,47· a13+0,13· a14+4,04· a15of-1.0· a16-1,14· a17.

The comparison of the values of F1and F2allows the prediction of the development of remote consequences LZCNT among young people.

So when the value of F1F2predict the development of distant consequences LZCNT at a young age, and a value of F2F1- the risk of late effects is unlikely.

Comparative analysis of the prototype showed that the proposed method differs from the known fact that to determine the presence of paroxysmal activity, the presence and severity of dysfunction diencephalic structures and risk factors including: age, stationary examination and treatment, duration of hospital treatment (in days), the unconscious period (in minutes)of hospitalization from the date of receipt LZCNT, Smoking, alcohol abuse, hypertension, amnesia, intracranial injury in the history of the, psycho-emotional stress, meterability, cervical osteochondrosis, ENT pathology (Fig. tonsillitis, XP. inflammation of the appendages of the sinuses), the presence of perinatal trauma history, manifested hypertensionabnormally syndrome, the presence of paroxysmal activity, the presence and severity of dysfunction diencephalic structures. Establish their grades and numeric values, and then determine the prognostic factors f1and F2the formulas. Consequently, the proposed solution meets the criteria of the invention of “novelty.”

The analysis of patent and literature the authors found that the inventive method has characteristics that distinguish it not only from the prototype, but also other technical solutions in this and related fields of medicine.

In the available literature is not found ways to predict distant consequences LZCNT at a young age. The proposed method allows to assess the combination of factors affecting the development of the consequences LZCNT at a young age, therefore, the method corresponds to the criterion of “inventive step”.

A method for predicting distant consequences LZCNT at persons of young age of the claimed invention is intended for use in health care. Implemented the e its capabilities confirmed as described in the application techniques and equipment. From the above it follows that the claimed invention meets the condition of patentability “industrial applicability”.

The proposed method is as follows. From the anamnesis of life of the patient identify the risk factors. Then spend a neurophysiological study and define the characteristics of bioelectric activity of a brain of the patient. Establish grades and numerical values of the obtained parameters. Then by the formulas calculate the prognostic factors F1and F2compare their numerical characteristics, which provide the forecast of development of remote consequences LZCNT among young people.

The proposed method for predicting distant consequences LZCNT among young people is illustrated by examples of specific performance.

Example 1.

Patient Z. Diagnosis: Closed craniocerebral injury, brain concussion (SGM).

From the anamnesis and clinical examination of the patient revealed the risk factors identified their grades and numeric values:

1. Age - 28 years, a1=28.

2. The stationary examination and treatment, and2=0 (no).

3. The duration of inpatient treatment (in days)=12 days and3=12.

4. Unconscious period - from 1 to 5 min, and4=1.

5. The length of hospitalization from the PTO is the receiving LZCNT - through the day, and5=1.

6. Smoking is, and6=1.

7. Alcohol abuse - no, and7=0.

8. Arterial hypertension - no, and8=0.

9. Amnesia - is, and9=1.

10. CMT in history - is, and10=1.

11. Emotional tension is there, and11=1.

12. Meterability - is, and12=1.

13. Cervical osteochondrosis is, a13=0.

14. ENT pathology (Fig. tonsillitis, XP. appendages of the sinuses), a14=1.

15. The presence of perinatal trauma history, manifested hypertensionabnormally syndrome - is, and15=1.

16. The presence of paroxysmal activity - no, a16=0.

17. The presence and severity of dysfunction diencephalic structures - moderately expressed, a17=1.

It is estimated prognostic factors f1and F2that amounted to: F1=31,65, F2=29,68, T.e.F1F2.

Conclusion: the patient is threatened by the development of adverse effects of light closed craniocerebral injury.

Note: the forecast was carried out according to the caregiver in 1999. In 2003, i.e. after 4 years LZCNT, the patient has long-term consequences LZCNT.

Diagnosis: long-term consequences of mild closed craniocerebral trauma (1999) hypertensionabnormally and asthenic syndrome.

Example 2

1. Age - 23 years, a1=23.

2. The stationary examination and treatment, (Yes), and2=0.

3. The duration of inpatient treatment (in days)=10 days, and3=10.

4. Unconscious period of 30 minutes or more, and4=3.

5. The length of hospitalization from the date of receipt LZCNT (two days after injury) and5=2.

6. Smoking is not, and6=0.

7. Alcohol abuse - no, and7=0.

8. Arterial hypertension - no, a8=0.

9. Amnesia - is, and9=1.

10. Intracranial injury history is, and10=1.

11. Psycho-emotional stress - no, and11=0.

12. Meterability - no, a12=0.

13. Cervical osteochondrosis - no, a13=0.

14. ENT pathology (Fig. tonsillitis, xp. appendages of the sinuses) - Yes, a14=1.

15. The presence of perinatal trauma history, manifested hypertensionabnormally syndrome - Yes, a15=1.

16. The presence of paroxysmal activity - no, a16=0.

17. The presence and severity of dysfunction diencephalic structures - moderately expressed, a17=l.

It is estimated prognostic factors f1and F2.

F1=11,75; F 2=17,73. F2F1.

Conclusion: the development of organic neurological symptoms in a patient with long-term consequences LZCNT unlikely.

Note: the forecast was carried out according to the caregiver in 1999. In 2003 (4 years after LCMT) the patient did not have clinical manifestations of remote consequences LZCNT.

Just by the present method were evaluated 121 patients with consequences LZCNT. The prediction was not confirmed in 19 people. The accuracy of prediction was 84,29%. The observation was carried out in 2001.

The proposed method makes it possible to predict in patients with long-term consequences LZCNT the occurrence of neurological symptoms prior to the development of its clinical manifestations. This allows a “threatened” patients active prevention, including the correction of the most significant “controlled” risk factors, as well as more frequent (2-3 times per year) examinations neurologist and paraclinical examinations.

A method for predicting distant consequences of lightweight closed craniocerebral injury (LCMT) in young patients, including clinical and neurophysiological examination of a patient, wherein determining the characteristics of the bioelectrical brain activity, establish the age, the stationary about the surveys, the duration of inpatient treatment, the unconscious period of hospitalization from the date of receipt LZCNT, Smoking, alcohol abuse, presence of hypertension, closed craniocerebral injury (intracranial injury) in history, psycho-emotional stress, metastability, cervical degenerative disc disease, perinatal trauma history, manifested hypertension-hydrocephalic syndrome ENT pathology; expect prognostic factors F1and F2according to the formula

F1=-31,42+1,49· a1-2,44· and2+0,2· and3+1,63· and4+0,62· and5+3,75· and6+1,8· and7-3,23· a8-0,8· a9-1,32· and10+3,26· and11+8,92· a12-2,0· and13+3,88· a14+1,79· a15+0,83· a16-2,78· a17;

F2=-27,58+1,43· a1+3,31· and2+0,08· and3+3,05· and4-0,27· and5+2,69· and6+3,11· and7-6,47· a8-6,55· and9+1,99· and10+5,25· and11+7,07· a12-0,47· a13+0,13· and14+4,04· a15of-1.0· a16-1,14· a17,

where

a1- the age of the studied;

and2- survey:

a2=“0” - in hospital,

and2=“1” - in clinic;

and3- length of alnost hospitalization in the day;

and4unconscious period in minutes:

and4=“0” - did not lose consciousness,

and4=“1” - loss of consciousness from 1 to 5 min,

a4=“2” - loss of consciousness from 5 to 30 min,

and4=“3” - 30 min or more;

a5the length of hospitalization from the date of receipt LZCNT in the day:

a5=“0” - on the first day after injury,

a5=“1” - one day after injury;

and6- Smoking:

and6=“0” - no,

and6=“1” -;

and7- alcohol:

and7=“0” - no,

and7=“1” -;

a8- arterial hypertension:

a8=“0” - no,

a8=“1” -;

and9- amnesia:

and9=“0” - no,

and9=“1” -;

and10- Intracranial injury history:

and10=“0” - no,

and10=“1” -;

and11- psycho-emotional stress:

and11=“0” - no,

and11=“1” -;

a12- meterability:

a12=“0” - no,

a12=“1” -;

a13- cervical osteochondrosis:

a13=“0” - no,

a13=“1” -;

a14- ENT pathology:

a14=“0” - no,

a14=“1” -;

p num="125"> a15- the presence of perinatal trauma history, manifested hypertension-hydrocephalic syndrome:

a15=“0” - no,

a15=“1” -;

and16- the presence of paroxysmal activity in the EEG:

a16=“0” - no,

a16=“1” - functional probes,

and16=“2” - recorded in the background;

a17- the presence and severity of dysfunction diencephalic structures in EEG:

a17=“0” - no,

a17=“1” - moderately expressed,

a17=“2” - pronounced

and when the value of F1F2predict the development of distant consequences LZCNT among young people.



 

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