Method for determining internal carotid artery tone

FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic examination of the internal carotid artery on neck in M-mode. Coefficient value is calculated as ratio of pulse wave anacrotism to general pulse wavelength. The calculated value being equal to 0.49±0.03 and lower, the tone is evaluated as high one.

EFFECT: high accuracy and informative validity of estimate.

2 dwg, 3 tbl

 

The invention relates to medicine, namely vascular neurosurgery and angioneurology, and can be used in the evaluation of the disease, determining the stage of the pathological process, and to assess the effectiveness of the treatment.

The development of most of intravascular lesions begins with changes in the functional state of the vascular wall, vascular tone. By definition, vascular tone is the degree of tension of the muscle cells of the vascular wall at this time.

There is a method of assessing vascular tone by ophthalmodynamometry (Mchedlishvili GI Study of cerebral circulation //Methods of clinical neurophysiology. Leningrad, 1977, s-161). The ophthalmic artery is a branch of the internal carotid artery, consequently, changes in intraocular pulsations may indirectly reflect the state of blood flow through these arteries. The common properties of the vascular regions of the brain and eyes also allows you to indirectly judge the state of the tone of cerebral vessels by visual estimation of blood vessels of the ocular fundus. However, the method is not sufficiently informative.

There is a method of assessing vascular tone by rheoencephalography (REG) (Mintz YA, Ronkin M.A. Eographically diagnosis of vascular diseases of the brain //Kiev, "Health", 1967, p.5-40), the cat is who gives the possibility to indirectly estimate the change in the tone of the arteries of the brain by measuring the time interval between the beginning of the wave REG and R-wave of the ECG, since the velocity of propagation of pulse waves in arteries depends on their tone. However, due to the fact that with the reduced caliber of the vessels of the velocity of propagation of pulse wave decreases, the error introduced due to such changes trunk and large PIAL arteries of the brain high. Furthermore, the method is insufficiently informative.

There is a method of indirect assessment of vascular tone by linear blood flow parameters (Leliuk VG, Leliuk SA Ultrasonic diagnosis //Real Time, Moscow, 2003, pp.86-87). During this acceleration time (at-acceleration time) and the index acceleration (AT-acceleration index) indirectly characterize the tone of the vascular wall. However, the method is inaccurate because it does not give sufficient information.

Closest to the claimed method is the evaluation of vascular tone carotid artery (Gaman S.A., Balakhonova T.V., V.E. Sinitsyn, Atkov O.Y Elasticity of the carotid arteries in patients with carotid atherosclerosis and coronary heart disease //4-th Congress of the Russian Association of specialists in ultrasound diagnostics in medicine, Moscow, 27-30 October, 2003, p.95) by study viscoelastic properties of the arterial wall, adopted for the prototype. When this is carried ultrasound of the common carotid artery on the neck in M-mode. Appreciate the difference artery diameter in systole and diastole and Rasch is primarily the young's modulus, the coefficient of diametrical expansion vessel and a coefficient characterizing the dependence of the stress-strain of the vessel wall.

The disadvantage of the prototype is the lack of accurate and informative way, since the degree of expansion of the artery depends not only on the tone, but also on the value of cardiac output.

The invention is directed to a method of assessing vascular tone of the internal carotid arteries, providing increased accuracy and informative way due to the leveling influence of cardiac output.

This technical result in the implementation of the invention is achieved in that in the known method of assessing vascular tone of the internal carotid artery, including ultrasound of the carotid artery in the neck in M-mode, the feature is that I expect the coefficient equal to the ratio of anekdoty pulse wave to the total length of the pulse wave, and when the value of the calculated coefficient of 0.53±0.03 and higher tone is assessed as normal, and a value of 0.49+0.03 and below the tone is assessed as high.

The method is as follows. The patient produce a standard ultrasound examination of the internal carotid artery in the neck with the affected side in M-mode, hold the location of the internal carotid artery at 1.5 cm - 2 cm above before the AI of the common carotid artery with the direction of the scanning plane is strictly perpendicular to the longitudinal axis of the artery. Obtained in the M-mode image is a wave-like oscillation of the arteries over time (on the scale of the abscissa is time, therefore, the length of the oscillations is the time interval). Measure the total length (time) of the pulse wave and the length (time) anocracy (the descending part of the pulse wave). Then calculate the coefficient (KS), is equal to the ratio of the length (time) of anekdoty pulse wave to the total length (time) of the pulse wave. When the value of the calculated coefficient (COP)equal to 0.53±0.03 and higher tone is assessed as normal, and a value of 0.49±0.03 and below, the tone is assessed as high. To improve the accuracy of the result, you can measure the length of the pulse wave and the length of anekdoty several times, and then calculate the arithmetic mean.

The inventive method is developed and clinically tested in the Polenov research neurosurgical Institute them. Professor and Operated in the examination of 10 patients with stenosing lesions of the arteries and 30 healthy volunteers, aged from 25 to 30 years old, without bad habits, without concomitant somatic pathology. Survey volunteers was performed to confirm the accepted norms of the indices: index ripple, the length of the pulse wave, the length of anocracy, factor (COP), which characterizes the ratio of the length of anocracy to the length of the pulse wave inside from the Noah artery.

The figures obtained are processed statistically and are summarized in table 1.

Table 1
The sampleCA-95,000%+95,000%Std.Dev.
volunteers300,533368430,520079580,546657290,0343
sick100,493514760,467108780,519920730,0316

The reliability of the difference between groups was proved by T-criterion with p=0,00576327.

These same persons, calculated the parameters specified in the method prototype. The reliability of the difference between the groups in this case was obtained only at the level of a trend (p=0,1119804).

Thus, the inventive method is more accurate for the assessment of vascular tone artery (p=0,00576327 the proposed method, p=0,1119804 of the prototype method).

Given the following examples:

Example 1. Patient M., 55 years old, and a/b No. 2215-2003. Cerebral atherosclerosis. Hypertension 2 tbsp. Repeated acute disorders of cerebral circulation but ischemic type in the pool of the left internal carotid artery from the 2002, 2003

According to the claimed method for assessing vascular tone of the internal carotid artery of the patient was performed ultrasound HV the internal carotid artery in the neck, on the affected side in M-mode. The resulting graphic image of the oscillations of the arterial wall in time is presented in figure 1. Quantify performance. The indicators are summarized in table 2.

Table 2
Length anekdoty240 ms
The length of the pulse wave507 ms
KS anocracy to pulse wave0,473

The resulting coefficient (KC)=0,473 that below 0,49, so the tone was assessed as high.

Example 2. Healthy volunteer P., 25 years old, without bad habits and without concomitant somatic pathology. According to the claimed method for assessing vascular tone of the internal carotid artery of the patient was performed ultrasound of the internal carotid artery in the neck in M-mode. The resulting graphic image of the oscillations of the arterial wall in time are presented in figure 2. Quantify performance. The indicators are summarized in table 3.

Table 3
Length anekdoty263 ms
The length of the pulse wave503 ms
KS anocracy to pulse wave0,523

The resulting coefficient is ecient (KS)=0,523, above 0,53-0,03, so the tone was assessed as normal.

Using the proposed method allows for precise, informative and non-invasive to assess the condition of the vascular tone of the internal carotid artery.

The method of assessing vascular tone of the internal carotid artery, including ultrasound of the carotid artery in the neck in M-mode, wherein the calculated ratio, the ratio of anekdoty pulse wave to the total length of the pulse wave, and when the value of the calculated coefficient of 0.49±0.03 and below the tone is assessed as high.



 

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