Method for detecting the degree of polyfunctional insufficiency manifestation in senile patients with polymorbidity

FIELD: medicine, functional diagnostics, clinical geriatrics.

SUBSTANCE: one should register functional values of different systems: cardio-vascular, respiratory, autonomic and muscular, calculate the deviation of absolute value in every tested parameter (X1) against normative value (X0), values for each concrete parameter should be taken out of table 1. Then one should calculate the deviation of function value against standardized value (%) by taking into consideration that X0 being equal to 3δ corresponds to 100%-measurement of the parameter, then one should calculate the value for the stability of systemic organization of functions (VSSOF) which is equal to the sum of deviation squares of all relative values of tested parameters referred to the number of tested parameters. If VSSOP is below 920 one should detect relative norm, at VSSOF ranged 920-1380 - I degree of polyfunctional insufficiency manifestation, and at VSSOF ranged 1380-1840 - II degree, and VSSOF above 1840 - III degree. The method enables to improve evaluation of complex functional disorders based upon detection of functional state in senile patients with polymorbidity at conducting medico-social examination and to control the efficiency of restorative therapy.

EFFECT: decreased functional disorders.

3 tbl

 

The invention relates to medicine, functional diagnostics, clinical geriatrics, and is intended to improve the assessment of complex functional disorders on the basis of the determination of the functional status of elderly patients with polymorbidity medical and social expertise, to monitor the effectiveness of rehabilitation treatment aimed at reduction of functional disorders. Existing approaches in determining the severity of functional impairments in elderly people with polymorbidity not take into account their politicamente on the background involutive changes in the body.

There is a method of assessing the functional state of human organism, which consists in the simultaneous recording of ECG, respiratory rate, electromyograms of the neck muscles, blood pressure, body temperature, with the subsequent definition deviates from the normalized values and setting of function, limiting the functional state of the organism as a whole unit. certificate No. 1692548 A1, A 61 5/ 02 - the prototype.

Functional failure in the elderly due to the involutive changes and state polymorbidity that leads to the formation of polyfunctional failure (PFN).

For implementing the method conduct a comprehensive functional obledo the tion, including electrocardiography (ECG), spirometry with samples on the breath on the inhale (SDD) and exhalation (ZDV), reovasographiya vessels of the lower extremities and the head, cardiometry, dynamometry, measurement of blood pressure and body mass index.

The survey results are statistically treated using a system of multivariate analysis (Biaglow, Hepatalgia, Mwhoa, 1994) [3], carried out the selection of indicators that have the highest weighting factor and, therefore, which have the most significant effect on the formation of polyfunctional failure for their subsequent use in determining the level of functional status.

To assess the degree of PFN on the level of the functional state count rate stability system organization functions (PSSI), characterizing the stability of their relationship (Tsarev A.N., Zavialov AV, 1998) [1]. Its magnitude is directly proportional to the degree of imbalance of the functional inter-relationships and stress regulatory mechanisms.

The method of determining the functional state of the body in old age largest PSOF takes to assess PFN, due to a combination of polymorbidity and involutive changes in the various systems and organs, to objectify the assessment of the degree of severity of PHN patients on elago age.

To calculate PSOF first by calculating the relative comparable (dimensionless) parameters, taking into account variability (variability) of each sign. Deviation indicator X1from its standard value (X0)equal to 3δthat is assessed as 100% change (accepted normative parameters of functions in the elderly without polymorbidity) (Table 1).

Table 1.

Normalized values of functional performance in the elderly
Functional indicatorsX0; δ
HR71; 11
GARDEN, mm Hg138,2; 12
DBP, mm Hg82,6; 7,8
VC, l27; 07
Sdvd, s37,8; 19,7
ZDV sec28,6; 14,8
RI legs0,68; 0,15
RI stop0,81; 0,13
RI Sutil. region0,64; 0,1
Dynamometry right hand (kg)26; and 7.7
Dynamometry left hand (kg)23,3; 8,2
Body weight, kg71,1; 12

PSOF equal to the sum of the squared deviations of all otnositel the x values of the investigated functions of their medium, correlated to the number of the studied functions. Its value is directly proportional to the degree of imbalance intersystem integration functions, what they are, the greater the imbalance. The determination of the degree of polyfunctional insufficiency largest PSOF is suggested in accordance with the selected levels of PFN on the basis of the degree of deviation of the functional parameters from their normalized values: deviation less than 50%, PSOF less than 920 - relative norm; deviation 50-75%, PSOF from 920 up to 1380 - I degree, deviation 75-100%, PSOF from 1380 until 1840 - II degree; a deviation of more than 100%, PSOF more 1840 - III degree. For regulatory accepted values PSOF persons in the comparison group in 837±61; δ-334. Note that the normative values PSOF depend on the environmental situation of the region, which contributes to the pace of development evolutionay component of PFN. Therefore calculation of standard values PSSI should be carried out on the population living in this territory.

The proposed method is used to determine the severity of PPHN 68 older people (aged 60-74 years, the average age 67,3±3,4 years) with polymorbidity, the index number of diseases/one patient (Lubny, 2000) [2] - 4,8±0.7 and 32 persons of similar age without polymorbidity (comparison group). Values PSSI was calculated using programmepaulgoriup (table 2).

Examples of calculation PSOF in elderly people with polymorbidity women 63 years (W 63) with a diagnosis of CHD. Atrial fibrillation, tachysystolic form, N IIA. Atherosclerosis of cerebral vessels. Dyscirculatory encephalopathy I tbsp. Widespread osteochondrosis in men 65 years (M 65) with a diagnosis of Chronic obstructive bronchitis. Emphysema NAM I. Obliterating atherosclerosis of vessels of lower extremities II senior Osteochondrosis of the cervical spine. Atherosclerosis of cerebral vessels Art. I

Table 2.
GroupValues PSOF, M±mP
Comparison, n=32837±61<0.001
Persons with PFN-I Art. n=221174±22<0.001
Persons with PFN-II Art. n=251617±29<0.001
Persons with PFN-III Art. n=212172±43<0.001

After conducting functional studies and determine the weights of indicators for further calculations we used the following: heart rate (HR), the values of systolic (SBP) and diastolic (DBP) blood pressure, vital capacity (VC), the duration of the breath is the breath (SDD) and exhalation (ZDV), eographically index (RI) of the blood vessels of the legs, feet and back of the head, the rate of dynamometry (DM) both brushes, body weight (MT) (see table 3).

Conclusion: Based on the calculated values PSOF and in accordance with the proposed ranges of estimates, the woman 63 years you can set III the severity of PPHN, men 65 years of age - first degree.

The severity installed polyfunctional violations should be taken into account when making clinical and functional diagnosis of medical-social examination of elderly patients.

LITERATURE

1. Zavialov, A.V. Perspective the use of integral indicators of the system organization of physiological functions to assess the functional state of operating in the conditions of influence of production factors. / Avishalom, All, Viglacera, Antares. - Sat. scientific papers on selected issues of medicine. Scientific research, creativity and memory. Kursk, 1999. Pp.5-36.

2. Practical geriatrics / Ed. by Prof. Lublanka. - M., 2002.

3. Angles, B.A... fundamentals of statistical analysis and mathematical modeling in biomedical research. / Baglow,. Hepatalgia, Mwhaa - Samara. - 1994. - 67 C.

The way to define the population of severity polyfunctional failure in the elderly with polymorbidity, which consists in registration of the functional parameters of various systems: cardiovascular, respiratory, autonomic and muscular, characterized in that the calculated deviation of the absolute values of each of the studied parameters (X1from normative values (X0)whose values for each indicator selected from table 1, then compute the variance of the indicator function of the normalized values (%), assuming that X0equal 3δ 100% corresponds to the variable, and then calculate the index of stability of the system organization functions (PSSI), which is equal to the sum of the squared deviations of all the relative values of the studied parameters are related to the number of parameters and the value PSOF less than 920 determine the relative norm, PSOF from 920 up to 1380 - I severity of polyfunctional failure, PSOF from 1380 until 1840 - II degree, PSOF more 1840 - III degree.



 

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