Method for predicting cardiorespiratory disorders in postoperative period in pulmonary cancer patients after radical operation
SUBSTANCE: method involves determining microcirculation indices in rest state by applying Doppler laser flowmetry method and capillary blood circulation reserve indices in occlusion sample under cuff pressure being 30 mm of mercury column as high as the systolic patient blood pressure during 3 min. Cardiorespiratory disorders development is predicted in postoperative period, The microcirculation indices being greater than 6.0 perfusion units in combination with capillary blood circulation reserve indices being greater than 300% or microcirculation indices being below than 4.5 perfusion units in combination with capillary blood circulation reserve indices being greater than 200%.
EFFECT: high accuracy of prognosis.
The invention relates to medicine, namely to functional diagnostics, and can be used to predict cardiorespiratory disorders in patients with lung cancer after radical operations
The methods for predicting cardiorespiratory disorders in patients with lung cancer after radical operations are not described in literature.
The invention is aimed at solving problems: the possibility of forecasting the future of cardiovascular and pulmonary complications in lung cancer patients in the postoperative period.
The method consists in using the method of laser Doppler flowmetry (LDF) to predict cardiorespiratory disorders in patients with lung cancer in the postoperative period by calculating the index of microcirculation (PM) alone and indicator reserve capillary blood flow (PKK) in occlusal sample. When the PM value above 6.0 perfusion units in combination with RCM above 300% or PM below 4.5 perfusion units in combination with RCM above 200% predict the development of cardiorespiratory disorders in the postoperative period.
The method is as follows.
In the preoperative period lying within 10 minutes of the patient through the installation point of the laser on the skin of the back surface of the brush at a point between I and II metacarpal bones method the hole is Noah Doppler flowmetry to measure within 2 minutes of the initial level of the microcirculation. Data processed by the personal computer: hold frequency and harmonic analysis of fluctuations. Then the cuff of the sphygmomanometer create an occlusion of arterial blood flow by raising the pressure in the cuff to 30 mm RT. Art. above the systolic pressure of the patient, the occlusion continue for 3 minutes, after which the blood flow in the brachial artery is restored. All this time the registration parameters of microcirculation: basal level (during occlusion), postocclusion flushing and restoring blood flow to the original level. Recording is carried out for 3 minutes. Maximum postocclusive hyperemia characterizes the number of non-functioning of vessels and their ability to open in response to postocclusion the flow of blood. One of the measured characteristics are: value PM - characterizes the flow of red blood cells per unit time in the amount of the sensed tissue and ALAC - % the ratio of the maximum value of the index of microcirculation during reactive postocclusive hyperemia to the original value of the microcirculation (before occlusion).
When determining a patient of PM values above 6.0 perfusion units in combination with RCM below 200%, the PM values from 4.5 to 6.0 perfusion units in combination ALAC 200-300%, PM values below 4.5 perfusion units in combination with ALAC more than 300%, a value which deposits PM less than 4.5 perfusion units in combination with RCM below 200% predict no cardiorespiratory disorders in the postoperative period when the standard patient management in the intensive care unit. When determining a patient of PM values above 6.0 perfusion units in combination with RCM above 300% or PM values below 4.5 perfusion units in combination with RCM above 200% predict the development of cardiorespiratory disorders in the early postoperative period in the standard management of the patient in the intensive care unit.
The study was conducted with the apparatus LACC-01 production SPE "Lazma" , Moscow.
The advantage of this method lies in the possibility of predicting cardiorespiratory disorders in the early postoperative period in patients undergoing radical surgery for cancer of the lung without the burdened history.
Examples of specific performance.
Example 1. Patient CWF, 66 years. Diagnosis: squamous cell usernotification adenocarcinoma of the right upper lobe bronchus. T2N2Mx. 12.05.03 was held LDF with occlusive breakdown: defined values PM=6,64 perfusion units in combination with RCM=435,35%, i.e. the patient has a poor prognosis for the development of cardiorespiratory disorders in the postoperative period. 13.05.2003, the standard pulmonate right, under endotracheal anesthesia. Intraoperative period without complications. 15.05.03, with a smooth postoperative period and standard therapy marked cardio-respiratory disorders: Mercan the e fibrillation, tachysystolic form, frequency of contractions of the ventricles - 120-130 per minute, shortness of breath up to 30 breaths a minute, acrocyanosis, cold moist skin.
Example 2. Patient XAI, 61 years. Diagnosis: squamous cell usernotification adenocarcinoma of the proximal bronchus on the left. T2N1M0. 26.05.2003 was held LDF with occlusive breakdown: defined values PM=7,63 perfusion units in combination with RCM=302,42%, i.e. the patient has a poor prognosis for the development of cardiorespiratory disorders in the postoperative period. 27.05.03, made extended pulmonate left. In the postoperative period of severe respiratory failure requiring prolonged mechanical ventilation within 8 hours, stabilization of hemodynamics by sympathomimetics. Maintaining cardiorespiratory disorders to 11 days after surgery: a feeling of lack of air, BH up to 28 per minute, tachycardia-104 min, hypotension, acrocyanosis.
Example 3. Patient VDK, 61. Diagnosis: squamous cell usernotification adenocarcinoma of the proximal bronchus left with the transition to the orifice of the left main bronchus T3N2M0. 03.04.2003 was held LDF with occlusive breakdown: set PM=8,763 perfusion units in combination with RCM=199,8% patient no data about the development of cardiorespiratory disorders in poslove the sure period. 04.04.03, made extended pulmonate left without features. Anaesthesia smooth. Postoperative period was unremarkable.
The use of the proposed method to predict cardiorespiratory disorders of lung cancer patients in the postoperative period, which shows radical surgery, and their prevention in the preoperative period.
A method for predicting cardiorespiratory disorders in the postoperative period in patients with lung cancer after radical intervention is by definition in the preoperative period by laser Doppler flowmetry of the microcirculation index (PM) alone and indicator reserve capillary blood flow (PKK) in occlusal sample when the pressure in the cuff to 30 mm RT. Art. above the systolic pressure of the patient duration of 3 min and forecasting development of cardiorespiratory disorders in the postoperative period when the PM value above 6.0 perfusion units in combination with RCM above 300% or PM below 4.5 perfusion units in combination with RCM above 200%.
SUBSTANCE: method involves carrying out visual and rectal examination. Peripheral blood circulation speed is measured in rectovaginal partition blood vessels. Rectovaginal partition folds are detected and increase in its thickness. Levators separation exceeding 20 mm is determined. Fibrous degeneration of rectovaginal partition is detected. Reduced blood circulation speed in levators is detected. Anterior rectocele is diagnosed. Values are measured by introducing ultrasonic transducer into the rectum. One of versions assumes introduction of hygienic intravaginal tampon into the vagina.
EFFECT: high reliability of diagnosis.
2 cl, 8 dwg
SUBSTANCE: method involves examining retina light sensitivity degree using computer-aided perimetry approach within 60° bandwidth from fixation point. Direct orbital muscle thickness and retrobulbar space volume is additionally determined by applying ultrasonic b-scanning method. Linear blood circulation speed and resistance index are also determined in the central retinal artery and posterior short ciliary arteries. Macular or general light sensitivity reduction 25% and more relative to age-specific norm being observed together with 50% growth and more in direct orbital muscle thickness, retrobulbar space volume growth by more than 35% in combination with linear blood circulation speed reduction in the central retinal artery and posterior short ciliary arteries by 40% and more and increasing resistance index by 20% and more relative to physiologic norm, optic nerve abnormality is diagnosed at early disease stages.
EFFECT: high reliability of diagnosis.
SUBSTANCE: method involves diagnosing gestosis severity degree with clinical signs and blood circulation being studied. Ultrasonic examination with Doppler color mapping is carried out in female patients manifesting fuzzy clinical symptoms. Intrarenal artery resistance index is determined. The value being within 0.62-0.65%, mild gestosis is to be diagnosed. The value being within 0.66-0.69%, moderate severity degree gestosis is to be diagnosed. The intrarenal artery resistance index being equal to or greater than 0.7%, severe gestosis cases are to be diagnosed.
EFFECT: high accuracy of diagnosis; noninvasive diagnosis method.
SUBSTANCE: method involves making lumbar puncture and measuring liquor pressure, taking pleocytosis into account, making ultrasonic transcranial Doppler flowmetric examination of brain, determining linear blood circulation speed on interior carotid artery and posterior cerebral artery, detecting intracranial venous discharge disorders through orbital and vertebral veins. Regression coefficient is calculated from a formula
where X1 is patient age (in years); X2 is the pleocytosis in the first lumbar sample (in cells number per 1 mcl of liquor); X3 is the meningitis symptoms duration (in days); X4 is the focal symptoms availability (1- yes, 0- no); X5 is the general cerebral symptoms duration (in days); X6 is the liquor pressure when taking the first lumbar puncture (in mm of mercury column); X7 is the linear blood circulation speed in interior carotid artery (in Hz/s); X8 is the linear blood circulation speed in posterior cerebral artery (in Hz/s); X9 is the intracranial venous discharge disorders based on ultrasonic transcranial Doppler flowmetric examination data; retrograde discharge through orbital veins, increased one through vertebral veins and others (1- yes, 0- no). Value of y≤0.5, unfavorable outcome is to be predicted with cerebroasthenic, asthenoneurotic and hypertension syndromes being formed. If y>0.5, favorable infectious process outcome is to be predicted.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, ophthalmology.
SUBSTANCE: the present innovation deals with methods for diagnostics of vascular pathology of optic nerve (ischemic opticopathies) and, also, predicting vascular pathology of optic nerve lesion and counterlateral eyeball. One should perform dopplerographic registration of circulatory parameters: peak systolic velocity PSV cm/sec and end diastolic velocity EDV cm/sec on the 2nd, 3d min both before and at the background of functional loading: dealing with lifting legs up to 90° in area of internal carotid artery, central retinal artery and ciliary artery. Moreover, calculation of resistant index RI c. u. should be performed by the following formula (PSV cm/sec - EDV cm/sec)/PSV cm/sec and reactivity index RY c.u. by the following formula PSV cm/sec after loading/PSV cm/sec before loading. At RI value being above 0.7 and RY value being below 1.0 one should detect deterioration of visual functions and the absence of circulatory reserves in tested eye and counterlateral one. At RI value being below 0.7 and RY value being above 1.0 it is possible to detect the maintenance of visual functions and circulatory reserves in tested and counterlateral eyes. The innovation enables to accelerate and simplify the trial and carry out it with available physical loading for a patient without applying any additional appliances and medicinal preparations.
EFFECT: higher efficiency and accuracy of diagnostics and prediction.
6 dwg, 3 ex, 2 tbl
FIELD: medicine, cardio-vascular surgery.
SUBSTANCE: one should perform ultrasound scanning of the 1st volar metacarpal artery both before and at the background of radial artery compression, moreover, at decreased peak systolic rate of circulation in the 1st volar metacarpal artery at the background of compression by 40% or less against peak systolic rate of circulation before compression one should diagnose ulnar type of wrist's circulation and at decreased peak systolic rate of circulation at the background of compression by more than 40% against peak systolic rate of circulation before compression or at appearance of retrograde circulation one should diagnose radial type of wrist's circulation.
EFFECT: higher efficiency and accuracy of diagnostics.
6 dwg, 2 ex
FIELD: medicine, otorhinolaryngology.
SUBSTANCE: one should detect amplitude-frequency circulatory characteristics in mucosal microcirculation system of inferior concha at the side of lesion due to laser Doppler flowmetry: AmaxCF/σ - circulatory fluctuations synchronized with cardiorhythm; IFM - index of flux motions, the ratio between active and passive mechanisms of circulatory regulation in microcirculation system. In 3-4 d all measurements should be repeated. If AmaxCF/σ value is increased at simultaneous decrease of IFM value one should consider the treatment to be efficient. The present innovation enables to obtain objective parameters of maxillary sinus state.
EFFECT: higher accuracy of detection.
FIELD: medicine, cardiology.
SUBSTANCE: one should perform colored duplex sonography by measuring the resistance index in tibial arteries to evaluate the degree of functional insufficiency in lower limbs, that is at R1 being above 1.0 - the first stage, at R1 being 1.0-0.4 - the second stage, at R1 being below 0.4 and up to 0.2 - the third stage and at R1 being below 0.2 - the fourth stage should be detected. The method enables to objectively and quantitatively evaluate ischemic stages in case of occluding arterial diseases of lower limbs.
EFFECT: higher efficiency of evaluation.
12 dwg, 2 ex, 1 tbl
FIELD: medicine, juvenile neurology.
SUBSTANCE: one should measure the values of cerebral hemodynamics, calculate the index of resistance (IR) in fetal internal carotid artery in pregnant woman at 38-41-wk-long gestation due to ultrasound dopplerography. At IR values ranged 0.8 and higher one should predict the development of perinatal cerebral lesion of light and average severity degree, and at 0.6 and lower - severe degree. The method applies more adequate value of circulation.
EFFECT: higher accuracy of prediction.
3 ex, 1 tbl
SUBSTANCE: method involves making clinical investigation of digestive apparatus. Doppler flowmetric examination of main visceral arteries and biochemical blood test are carried out. Blood circulation speed drop in abdominal aorta being found to be equal to or greater than 9%, in celiac trunk 33.6% and more, in superior mesenteric artery 25% and more, and cholesterol concentration growth being greater than 38% and triglyceride 23% and more, chronic digestive apparatus ischemia is to be diagnosed.
EFFECT: high diagnosis accuracy.
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, urology.
SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.
EFFECT: more reliable and objective information.
1 ex, 1 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves applying ultrasonic Doppler echolocation techniques for scanning blood circulation at selected area of cardiovascular system, determining blood circulation velocity vector projections and calculating blood circulation speed. Echolocation is carried out by using at least three non-complanar probing ultrasonic rays set at angles relative to selected area of cardiovascular system in the range of 0-±80°. Selected blood circulation area orientation angles are measured relative to scanning ultrasonic rays and Doppler frequency shifts in each measuring channel are determined. Blood circulation speed is calculated as where ω0i is the radiation frequency of ultrasonic oscillation in ray I, Δωi is the Doppler frequency shifts in measuring channel i, V is the ultrasonic wave propagation speed in the medium, ϑk is the blood circulation speed in selected area, ϑki is the blood circulation velocity projection to scanning ray i, a,b,c,h,k,n11,n12,n13 are the coefficients depending on ultrasonic rays orientation. The device has measuring unit having ultrasonic transducers and electronic unit having switch, high frequency oscillator, calculating unit, indication and control unit. The measuring unit is manufactured as bracelet which segments are connected to each other by means of adjustable hinges and has gages for measuring lateral segment orientation angles relative to the central segment and gages for measuring ultrasonic transducer orientation angles relative to the i-th segment where i = 1,2,3, connected to calculating unit, switch, indication and control unit connected to high frequency oscillator, ultrasonic transducers of the measuring unit are connected via the switch to the high frequency oscillator.
EFFECT: high accuracy of measurements; wide range of functional applications.
2 cl, 2 dwg
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.
SUBSTANCE: method involves measuring forced exhalation volume per 1 s (FEV1) in l, full right ventricle evacuation time (RVE) in ms and angiotensin II value (AII) in ng/l. Discriminant relationship is built as D=0.504·RVE+3.038·FEV1 - 2.0·AII. D being less than 83.88, pulmonary hypertension occurrence is predicted within 1 year. D being equal to or greater than 83.88, no pulmonary hypertension is predicted to occur.
EFFECT: enhanced accuracy of prediction.
FIELD: medicine, nephrology.
SUBSTANCE: one should detect circulation rate characteristics and vessel's diameter due to dopplerography, moreover, on should measure vessel's diameter directly in area of anastomosis, as for circulation rate characteristics they should be determined in constant-wave Doppler mode in area of circulation's maximal rate. Moreover, one should measure anastomosis' cross-sectional area and heart rate, moreover, one should calculate circulatory volume through anastomosis by the following formula: V(ml/min) = A VTI HR, where A - anastomosis' cross-sectional area (sq. cm), VTI - integral of circulatory linear rate through anastomosis (cm), HR - heart rate.
EFFECT: higher accuracy of detection.
4 ex, 1 tbl
SUBSTANCE: method involves determining linear blood circulation speed above and below diaphragm using dopplerography approach. State severity class is determined as healthy, recovering and heavy from measured linear velocities ratio. Applied therapy effectiveness is determined on the measured linear velocities ratio exiting beyond the scope of severity class range, when analyzing patient state dynamics.
EFFECT: high accuracy in estimating patient health state.
FIELD: medicine, hepatology.
SUBSTANCE: one should detect splenic length in mm (X1) and circulation in portal vein, moreover, additionally, on should detect volumetric circulation in splenic vein in cu. cm/min. (X2), the index for the ratio of volumetric circulation in splenic vein to the area of longitudinal splenic section (X3), circulatory direction in left-hand gastric vein (X4) by establishing its direction towards the liver to be 1, from the liver to be 2, diameter of splenic artery in cm (X5) and transhepatic portal volumetric circulation in cu. cm/min. (X6), then one should calculate discriminant function Z = 15.9850 - 0.0187X1 + 0.2006X3 - 1.9025X4 - 19.0493X5 - 0.0025X6, where Z - the criterion for predicting "healthy-sick" state; then it is necessary to detect the group with hepatic diseases by the value of Z ≤ 1.621 to calculate for them discriminant function Y = 9.7396 - 0.0279X1 - 0.0018X2 + 0.1873X3 - 4.9174X4, where Y - the criterion to predict "patients with chronic hepatitis - patients with cirrhosis" state and at Y > 1.239 one should diagnose chronic hepatitis, at Y ≤ 1.239 - cirrhosis.
EFFECT: higher efficiency of diagnostics.
FIELD: medicine, cardiology, endocrinology, gynecology.
SUBSTANCE: one should detect informational-valuable signs of patient's state, such as either the presence or absence of hypertonic disease and uterine extirpation together with adnexa, the value of body weight index, predominance of disorders according to modified menopausal index (MMI)such as autonomic, metabolic-endocrine or psycho-emotional ones, the type of metabolic structures of blood serum, moreover, it is necessary to echocardiographically detect stroke volume, cardiac index and systemic vascular resistance (SVR), at ultrasound testing one should detect maximal linear rate of circulation (LRC max) by medial cerebral artery and thyroid alterations, rheovasographically one should detect specific circulation (SC) of shins, at testing laser doppler flowmetry one should detect microcirculation index, biochemically it is necessary to detect the value of beta-adrenoreactivity, cholesterol level and that of B-lipoproteides, crystallographically - the presence of serotonin and dopamine crystals, due to immunoenzymatic assay on should detect the values by Table 1 and then after obtaining the values of diagnostic coefficients of every parameter it is necessary to summarize them and obtain diagnostic index (DI), at its value being below 10 one should state no alteration, at its value 10-10 - undetermined state, at its value being 21-30 - the 2nd severity degree of disorders, and at DI value being above 31 one should state the 3d severity degree of disorders available.
EFFECT: higher accuracy of evaluation.
5 ex, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: one should study circulation in one of fetal renal arteries during the second half of third trimester of pregnancy. At increased resistance index from 0.81 and higher and, correspondingly, systolodiastolic ratio - from 5.1 and higher - one should fix the presence of fetal hypoxia and the necessity for urgent correction of this state. The suggested method increases the number diagnostic preparations and enables to increase the significance of predicting the state of neonatals.
EFFECT: higher accuracy of evaluation and prediction.
5 dwg, 5 ex, 1 tbl