Method for estimating arterial bloodstream tone

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

 

The invention relates to the field of medicine and more specifically to methods of assessing arterial tonus using devices that measure changes in peripheral impedance.

Assessment of vascular tone is the condition of the walls of arteries is of great importance for understanding the changes in the functional state of the cardiovascular system. There are methods of measuring vascular tone of the arterial bed as in the chronic experience(5, 6, 9, 13), and in clinical practice.

Known methods for determining vascular tone in the estimate of the average pressure, the elasticity of the arteries that surround the heart rate, etc.(1, 4, 10, 11, 12). Clinic blood pressure value is considered as an indicator of vascular tone.

Known methods are complex, require a large number of different measurements spaced in time, require additional time for data analysis and evaluation of vascular tone.

There is a method of determining vascular tone through the determination of the propagation velocity of the pulse wave, which is one of the most reliable indicators of a viscoelastic state of the vascular walls and allows with sufficient accuracy to quantitatively characterize the magnitude of the elastic stress of the vascular walls (11).

However, measuring the propagation velocity of pulse the wave in the arteries elastic and muscular type sphygmographic method (8) requires a large amount of time exploring, encounters certain difficulties due to the complexity of measurement.

There is a method of determining stroke volume of the heart, including the imposition of current electrodes on the right arm and on the left shoulder, the imposition of the measuring electrodes on the right shoulder and in the sixth intercostal space on the left anterior axillary line, registration rogramme and phonocardiogram, the definition of the base resistance, determining the time between the first and second heart sounds, body weight, hemoglobin, amplitude eographical complex and time of its achievements and these data carry out the calculation of the stroke volume by the formula. After calculating the stroke volume of the heart can assess the condition of the vascular tone of the arterial bed. EN 2134534 C1, 20.08.1999.

However, the known method is complex, requires a large number of different measurements, separated by time, requires additional time for data analysis and further assessment of arterial tone.

The known method of monitoring the functional state of the blood vessels, including periodic check-frequency sounds of Korotkoff using phonocardiography when using the device for measuring blood pressure according to the method Korotkova and comparison of this frequency in the diagnostic process, with the help of h is Lenogo frequency sounds of Korotkoff determine the modulus of elasticity of the blood vessel. EN 2141784 C1, 27.11.1999.

However, in this method there is the influence of the researcher on the end result, the pressure in the cuff on the artery, the inability to obtain a result when diastolic blood pressure falls to zero.

The objective of the invention is to develop reliable and easy to use method to estimate the state of the vascular tone of the arterial bed.

The technical result of the method is to increase the reliability of the assessment of vascular tone arterial bed.

To achieve the technical result of the method of assessment of vascular tone arterial bed includes simultaneous registration peripheral differential rogramme vessels of the upper limb and phonocardiogram, identifying the beginning point of the second tone phonocardiogram and the deepest point on rogramme and determining the time between the appearance of these points, and an evaluation of the tone of vascular arterial lead by the value of the obtained difference between the time of occurrence of the specified points.

In the proposed method on solid material it is shown that the measurement of the propagation time of the pulse wave electric impedance method (figure 1) in the form of our proposed metric, namely the propagation time fluctuations of the valves of the aorta (Aortic Valve Vibration Spread Time, AVVST) is the DOS is reliable enough to assess the condition of the vascular tone of the arterial bed.

Closure of the semilunar valves of the aorta, corresponding to the initial oscillations of the second tone phonocardiogram causes a wave propagating in a blood channel in the centrifugal direction and breast reogramme displayed as discretional waves (1, 4, 7), which corresponds to the deepest point on the differential reogramme. On the peripheral reogramme this wave is registered as microtecnica wave with characteristic changes in the differential curve. It should be noted that there is an opinion (11, 13) to consider peripheral microtechnique wave, as the wave is reflected and propagates in a centripetal direction and characteristic of peripheral pulse. However, ultrasonic doplerometriya peripheral arteries fails to confirm the presence of this phenomenon. It is also evident in the correlation relationship (r=0,5) between the time of the expulsion of blood from the left ventricle to the chest reogramme and systolic time period peripheral rogramme, the calculation of which are identical to the guidelines at the Central and peripheral rogramme: the beginning of the rapid rise of the differential curve and the deepest point of the differential rogramme corresponding to the second tone phonocardiogram (4, 8). Thus, we can conclude that the e deepest point on the thoracic and peripheral differential rogramme correspond to the second tone phonocardiogram. Fixing the delay time of the second tone photocarcinogenic on the periphery, we determine AVVST (figure 2). Registration methods of pulse wave focused on the measurement of arterial pulse when each contraction of the heart, corresponding to the first tone of phonocardiogram, increases the pressure in the arteries and increase their cross-section and subsequent restoration to their original state. Unlike other methods of determining AVVST has significant advantages: excluding the impact energy of contraction of the left ventricle, blood viscosity, heart rate; arterial tree with different structure of the vascular wall as a whole.

The method is as follows.

The study was conducted on recanalization RA-5-01 with application of the computer program System hemicircular". To determine the propagation time fluctuations of the valves of the aorta (AVVST) produce simultaneous registration of phonocardiogram and peripheral differential rogramme vessels of the index finger of the right hand electric impedance method in the four-electrode mode (figure 3). The path of the pulse wave includes blood vessels of various types: elastic type - aorta, muscle-elastic type - subclavian artery, musicnov the type axillary, brachial, radial, ulnar, the finger artery. Calculation AVVST conducted from the beginning of the second tone phonocardiogram (point a), which corresponds to the closure of the aortic valve, to the deepest point on the peripheral differential reogramme (point b) calculation of the delay time of the second tone in the periphery, in milliseconds (figure 2).

The processed data obtained after conducting 862 studies: including healthy pregnant executed 676 research; in pregnant women with hypertensive syndrome (mean arterial pressure of more than 106 mm RT. Art.) - 178 research. Examination results were processed by methods of variation statistics and correlation analysis using the Kolmogorov-Smirnov criterion, the criterion of student, centile method of data processing (3). Reference data served as the data about the tone of the arteries, obtained using sphygmomanometric tonometry, a method Korotkov (GARDEN - mean arterial pressure, mm Hg; SBP - systolic blood pressure, mm Hg; Add - diastolic blood pressure, mm Hg).

The data presented in the table. 1 indicate the presence of high negative vzaimosohranenii between AVVST and blood pressure (SBP, SBP, Add, Map) and no correlation between AVVST and main hemodynamic dormancy is the result (WALK, IOC, ARS, heart rate (HR) and confirm the generally accepted information: increasing the viscoelastic state of the walls of arteries leads to increased blood pressure and reduce the time of propagation of the pulse wave. A distinctive feature of the registration AVVST in this modification is the lack of influence of the force of heart contractions on the propagation time of the pulse wave. In contrast to the measurement of blood pressure sphygmomanometric method, method Korotkova, using the impedance method for registration AVVST to assess arterial tone eliminates the influence of the researcher on the end result, eliminates the influence of the pressure in the cuff on the artery during measurement of blood pressure, is one of the possible methods for the registration of a tone of arteries, when diastolic blood pressure falls to zero (in 15% of cases).

Search criteria high blood pressure, for example, in Perinatology remains relevant to this day. Researchers suggest as criteria of different levels of blood pressure, mainly GARDEN and Add (2). Determination of the upper limit of normal blood pressure methodologically correct to hold, comparing the numbers in blood pressure with the condition of the walls of arteries. Modern methods of assessment of sosudistogo allow such comparisons.

In tabla, b, C presents the correlation between AVVST and different levels of blood pressure (SBP, SBP, Add), divided into ranges with constant increase of 9-11 mm Hg Threshold levels of blood pressure in pregnant women, after which it is marked unchanged and statistically significant reduction of the time of propagation of the oscillations of the valves of the aorta (certificate tone of the arteries), as follows: for the average blood pressure of 105 mm Hg; blood pressure systolic blood pressure of 135 mm Hg; diastolic blood pressure 85 mm Hg, which corresponds to the values AVVST 128, 122, 128 msec (chart 1, 2, 3), 4, 5, 6. Thus, the criteria of hypertension can be considered values AVVST less than 126 MS (average), i.e. when there is a statistically significant simultaneous increase in blood pressure and decrease AVVST.

The information content and reliability of differences AVVST in healthy pregnant women and pregnant women with preeclampsia were investigated on the data obtained during the examination 480 healthy pregnant women and 61 pregnant with pre-eclampsia, using the nonparametric criterion, criterion Kolmogorov - Smirnov, and informational measures Kullback (3).

Figure AVVST, having a high level of informativeness and reliability in distinguishing between norms and preeclampsia (table. 3), may use the interference in diagnostic tables for the detection of preeclampsia.

When the correlation study of the interdependence of the GARDEN and hemodynamic parameters at different AVVST characterizing different status (standard or hypertonicity) of the arterial wall, it is revealed that when the normal tonus of vessels appears correlation between the GARDEN and the weight of the pregnant, the total volume of water and disappears relationship between the GARDEN and AVVST (chart 4), 7.

In order to clarify the influence of weight on blood pressure level, measured sphygmomanometric method, method Korotkova, studies have been conducted. They were conducted on two groups of pregnant women: the first group 121 pregnant with a weight of 90 kg or more, the second group of 87 women with weight less than 60 kg On chart 1 (figure 10) demonstrated the difference in the level of mean arterial pressure in women, the first and second groups during uncomplicated pregnancy. The average pressure in women weighing more than 90 kg during pregnancy is higher than the average pressure in women with a body weight less than 60 kg Schedule 2 (11) frequency distribution of mean arterial pressure in women of the first group toward the right, toward higher values of average pressure.

In view of the above, you must answer the following questions:

- If patient is overweight (over 90 kg) any peculiarities of functioning of the cardiovascular system, bleuse is on blood pressure?

- Does the change in blood pressure traditional method Korotkova on its value?

Identify the following factors that affect blood pressure:

1. Hemodynamic:

- The amount of blood flowing in the vascular system (stroke volume, minute volume of blood, and so on).

The intensity of blood flow to the periphery (peripheral vascular resistance).

The viscosity of the blood (hematocrit).

2. Vascular:

- Capacity arterial segment vasculature

Elastic resistance of the walls of the vasculature

3. Myocardial:

- The rate of blood during cardiac systole (the time of the expulsion of blood from the left ventricle)

The ratio of systole and diastole

- Heart rate

4. Mechanical:

- Circumference of shoulder

- The width of the cuff

In chart 3, 4, 5 (Fig, 13, 14) presents the frequency distribution of indicators related to hemodynamic factors. The differences of the distributions of scores among the two groups are not defined. In figure 6 (Fig) presents the frequency distribution of indicators related to myocardial factors. The divergence of the distributions is also not detected.

When determining the impact of the circumference of the shoulder on the blood pressure measured by the conventional method, it is revealed that there is a high corre who AZIA between the weight and arm circumference (r=0.82, chart 5), (Fig) and between arm circumference and average blood pressure (r=0.64, chart 6), (Fig.9).

Dependencies are allowed to calculate the following regression equation: (the program "STATISTICA": GARDEN=43,732+9,8540× radius arm circumference; GARDEN=63,770+0,37759× area of a circle shoulder; GARDEN=63,770+0,02697× the volume of the shoulder. The result is that the increase of the radius of the shoulder 1 cm or increase the diameter of the shoulder is about 2 cm, or increase the circumference of the shoulder 5 cm, or increase the area of the circumference of the shoulder 25 cm2or increase shoulder at 350 cm3leads to an increase in blood pressure, measured by the traditional method Korotkova, 10 mm RT. Art. Thus proved the influence of weight and arm circumference at the level of blood pressure measured by conventional tonometer. Hence the possible errors in the measurement of blood pressure, manifested either in the overdiagnosis of hypertension in group 1 or in the under-reading of hypertension in group 2.

In the assessment of vascular tone arterial bed by defining AVVST the influence of the weight and volume of the shoulder of the patient is not identified (figure 7, 8), (Fig, 17).

The analysis of the frequency distribution AVVST among the patients of the two groups also showed no differences distributions (figure 9), (Fig).

In addition, the use of them is hedenskog method for registration AVVST to assess arterial tone eliminates the influence of the researcher on the end result, eliminates the influence of the pressure in the cuff on the artery during measurement of blood pressure.

Literature

1. Heart disease and blood vessels, Ed. Ehitatava. - M., 1992, vol.1

2. Hypertensive disorders in pregnancy. Report of the study group who. J., 1979.

3. Gubler E.V. Computational methods of analysis and recognition of pathological processes. - L., 1978.

4. Instrumental methods of examination of the cardiovascular system /edited Tselinograd. - M., 1986.

5. Konradi G.P. Regulation of vascular tone. - L., 1973.

6. Osadchy LI cardiac function and vascular tone. - L., 1975.

7. Pervanidou PS, V.N. Demidov. Features functions of the circulatory system in pregnant childbirth and the puerperium. M., 1977.

8. Pressman Lpina sphygmography. - M., 1974.

9. Rasmer Russia, having got the Dynamics of the cardiovascular system: trans. from English. - M., 1981.

10. Manual of physiology. Physiology of blood circulation. Physiology of the heart. - M., 1980.

11. Savitsky NN. Biophysical bases of circulatory and methods of study of hemodynamics. - L., 1974.

12. Soloviev G.M., Radziwill, Blood loss and regulation of circulation during surgery. - M., 1973.

13. Folkow B., Neal E. Circulation: Per. s angl. - M., 1976.

The method of assessment of vascular tone arterial bed by simultaneous registration peripheral differential rogramme vessels of the upper limb and phonocardiogram, identify the starting point of the second tone phonocardiogram and the deepest point on rogramme, determine the time between the appearance of these points and estimates of the increase in vascular tone of the arterial bed to reduce the time of propagation of the pulse wave.



 

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