Method for predicting chronic pulmonary heart

FIELD: medicine.

SUBSTANCE: method involves measuring forced exhalation volume per 1 s. Systolic pressure in pulmonary artery and ratio of maximum blood circulation speeds through tricuspid valve into diastole. Prediction is carried out on basis of value calculated from mathematical formula including measured and calculated parameters.

EFFECT: enhanced effectiveness of prediction.

 

The invention relates to medicine, namely, pulmonology, and can be used to predict chronic pulmonary heart in patients with chronic obstructive lung diseases.

The prototype was elected as a method for predicting respiratory and heart failure in patients with chronic bronchopulmonary diseases using a system of integrated clinical factors (Waagnatie. The principles of a systematic approach when studying the formation and evolution of respiratory and heart failure in patients with chronic bronchopulmonary diseases. //Geriatric clinical pulmonology." L., 1990. - S-107). The method consists in the fact that calculate the sum in units of priority clinical factors contributing to the progression of respiratory failure and related disorders of the circulatory system, compare it with the conventional scale and by comparing the results give the forecast.

The known method has the following disadvantages:

1. Based only on the clinical prognostic factors and their quality characteristics.

2. Does not take into account the degree of disturbance of bronchial obstruction.

3. Does not take into account the level of pressure in the pulmonary artery.

4. Does not take into account the essential role of diastolic function of the right ventricle in the Genesis of hronicheskogo pulmonary heart.

5. Does not involve the timing of the forecast.

The purpose of the invention is to improve the efficiency of the prediction of chronic pulmonary heart through integrated assessment of bronchial obstruction, the pressure in the pulmonary artery and diastolic function of the right ventricle (PI) of the heart.

The objective is achieved by the fact that the assessment of bronchial obstruction, the pressure in the pulmonary artery and diastolic functions of the mud of the heart is performed based on the measurement values of forced expiratory volume in 1 second (FEV1), systolic pressure in the pulmonary artery (SDLA) and the ratio of maximum velocity transtricuspid blood flow in diastole (E/A, where E is the maximum flow velocity in the phase of early diastolic filling mud, And the maximum blood flow velocity during systole of the right ventricle in the late phase of diastolic filling mud).

The inventive method has the following methods:

a) using spirometry determine FEV1measured in litres;

b) using Doppler echocardiography to determine SDLA, measured in mm Hg;

C) using Doppler echocardiography to determine the ratio of maximum velocity transtricuspid blood flow in diastole, E/A;

g) integrated assessment of bronchial obstruction, the pressure in the pulmonary artery and diastole eskay functions mud hearts to predict chronic pulmonary heart is performed by solving the discriminant of the equation (E):

D=4,615·E/A+2,055·FEV1-0,013·SDL,

where D is the discriminant function, the boundary value of which 10,98.

The emergence of chronic pulmonary heart during the year is predicted when the value D is less than the boundary value, and when D is greater than or equal 10,98 predicted the absence of chronic pulmonary heart.

Below are two examples of using the proposed method.

Example 1. B., 28 years old, diagnosis: Bronchial asthma. Mixed form. Moderate severity. The remission phase. NAM I.

Forced expiratory volume in 1 second he was 2.96 l; the values of systolic pressure in the pulmonary artery was 18.5 mm Hg; the value of the ratio of maximum velocity transtricuspid blood flow in diastole was 1.3. The initial value of the thickness of the anterior wall of mud in diastole was 3.5 mm

In order to predict chronic pulmonary heart resolved discriminant equation:

D=4,615·1,3+2,055·2,96-0,013·18,5=11,83.

Because discriminant function more boundary values 10,98, predicted nephaline chronic pulmonary heart. During the 12 months of observation, the magnitude of the thickness of the front wall of mud was 3.5 mm, chronic pulmonary heart undiagnosed.

Example 2. K., 39 years old, diagnosis: Bronchial asthma. Mixed form. Moderate Majesties remission. NAM II.

Forced expiratory volume in 1 second (1.9 l; the values of systolic pressure in the pulmonary artery amounted to 31.2 mm Hg; the value of the ratio of maximum velocity transtricuspid blood flow in diastole was 1.06. The initial value of the thickness of the anterior wall of mud in diastole was 3.6 mm

In order to predict chronic pulmonary heart resolved discriminant equation:

D=4,615·1,06+2,055·1,9-0,013·31,2=scored 8.38.

Since the discriminant function is less than the boundary values 10,98 were predicted to result in chronic pulmonary heart. After 11 months, the patient was diagnosed with chronic pulmonary heart. The magnitude of the thickness of the front wall of mud in diastole was 4.5 mm

The proposed method was tested at the clinic of the far Eastern scientific center of physiology and pathology of respiration SB RAMS. Using a forecasting method of chronic pulmonary heart disease among 18 patients with bronchial asthma.

The results of the validation of the proposed method has shown its effectiveness. Correct prediction was determined in 81.5% of cases.

A method for predicting chronic pulmonary heart disease among patients with chronic obstructive lung disease, characterized in that examine the original values of forced expiratory volume in 1 s (the PV 1in l, systolic pulmonary artery pressure (SDLA) in mm Hg and the ratio of maximum velocity transtricuspid blood flow in diastole (E/A, where E is the maximum flow velocity in the phase of early diastolic filling of the right ventricle of the heart (PJ), And the maximum flow velocity in the late phase of diastolic filling mud during diastole right atrium) and solve the discriminant equation

D=4,615×E/A+2,055·FEV1-0,013·SDL,

when the value D < 10,98 predict the emergence of chronic pulmonary heart for years, and when the value D ≥ 10,98 predict the absence of chronic pulmonary heart.



 

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