Method for diagnosing cerebral blood flow autoregulation disorders

FIELD: medicine.

SUBSTANCE: method involves recording blood circulation rate in large arteries of brain base in continuous bilateral mode. Spectral density of linear blood circulation rate B-waves is estimated in the range of 0.008-0.033 Hz. Spectral density of B-waves growing above 1000 (cm/s)2/Hz proves cerebral blood flow autoregulation disorders to take place.

EFFECT: high accuracy of diagnosis.

6 dwg

 

The invention relates to medicine and can be used for non-invasive diagnosis of disorders of cerebral autoregulation (ARMC).

Violation ARMS occurs in various diseases of the brain, largely determining their course. Timely diagnosis violations ARMS allows for adequate treatment and preventive measures to prevent the development of neurological complications and improve outcomes.

A known method for the diagnosis of disorders ARMS using radioisotopic methods of registration of cerebral blood flow for a given step change in systemic blood pressure (SBP) or cerebral perfusion pressure by pharmacological means (Arutyunov A.I. Konovalov A.N., Shakhnovich, A.R., Dadiani, L.N., Salolikin V., Fedorov S.V., Filatov, Y.M. self-Regulation of cerebral blood flow and its disorders after neurosurgical operations// Matters. on neurosurgery. - 1972. No. 1. - P.3-6). However, this method has a high invasiveness, a large length of time, and also requires external influences on systemic and cerebral hemodynamics.

A known method for the diagnosis of disorders ARMS based on continuous recording linear blood flow velocity (BFV) in the major arteries of the base of the brain by the method of TRANS analnoe Doppler (TCD) with cuff test - test transient arterial hypotension (Aaslid R., Lindergaard K., Sortberg W., Nomes H. Cerebral autoregulation dynamics in humans // Stroke. - 1989. - Vol.20. - P.45-52). However, this method has several disadvantages. It requires long-term clamping of pneumatic cuffs femoral arteries (4 minutes) until complete disappearance of pulsation in the lower extremities distal to the compression, which is not always adequately tolerated by subjects. In some cases it is necessary several times to repeat the sleeve test to obtain true results. Abrupt cessation of clamping the femoral artery leads to a significant decrease in the GARDEN, postischemic acidosis, which are not indifferent to the whole organism, and cerebral hemodynamics in particular. The use of a cuff test unsafe in patients with occlusive lesions of the vessels of the lower limbs, with severe cardiovascular disorders, including those with unstable systemic hemodynamics. Moreover, the method for the diagnosis of disorders ARMC also requires external effects on systemic hemodynamics despite the fact that it is more physiological than when diagnosing disorders ARMS radioisotope method.

Closest to the claimed method is a method of diagnosing disorders ARMC based crossspectral analysis of spontaneous edit the deposits (for the period from 1 to 180 minutes) BFV and GARDEN, registered with long-term monitoring of these indicators, without any external dynamic effects on systemic hemodynamics (Giller C.A. The frequency-dependent behavior of cerebral autoregulation. // Neurosurgery. - 3990. - Vol.27. - P.362-368)adopted for the prototype. The method consists in the spectral decomposition of spontaneous changes in BFV and GARDEN on the harmonic oscillations of different frequencies specified in the time series and subsequent calculation of correlation coefficients between the LSC and the GROUNDS for each frequency, but without analysis of its spectrum of indicators. As the correlation coefficient using the coefficient of coherence, as the most informative criteria in conducting crossspectral analysis, the values of which range from 0 to 1. The degree of correlation is in direct proportionality coefficient of coherence: the higher the coefficient of coherence, the higher the correlation between the fluctuations of one time series with fluctuations of another time series and Vice versa. In patients with intracranial aneurysms surveyed in terms of up to three weeks after subarachnoid hemorrhage, the average values of the coefficient of coherence between BFV oscillations and GARDEN are 0.45±0.1, which indicates a high correlation BFV oscillations with oscillations of the GARDEN and, therefore, the violation of ARMS. The patient is in no diseases cerebrovascular average values of the coefficient of coherence between BFV oscillations and GARDEN significantly lower (p< 0.01) and make 0.21±0.05, which indicates the absence of a violation ARMS.

The disadvantages of the prototype is that it, along with non-invasive assessment of cerebral blood flow using a simple and accessible method TCD, providing the possibility of continuous registration BFV also require a continuous registration of the GARDEN, which technically is not always feasible. In addition, the calculation of the coefficient of coherence between BFV oscillations and GARDEN requires more complex mathematical calculations and comparison of the obtained data, which can lead to unavoidable errors in obtaining the final results. However, there is no specific guidance on the choice of the time interval for analysis and diagnosis of disorders ARMS, in the present work, we present the averaged data crossspectral analysis of different time intervals, varying in a wide range (from 1 to 180 minutes).

The invention is directed to a method of diagnosing disorders ARMS which would increase the accuracy of diagnosing disorders ARMS while reducing the number of analyzed parameters and a corresponding reduction in the number of mathematical calculations.

The essence of the proposed method is to quantify the spectral tightly the ti intracranial In-waves (oscillation period is 30-120 s) - one of the indicators of the functional state of the cerebral circulation system (D.Newell, R.Aaslid, R.Stoose, H.Reulen. The relationship of blood flow velocity fluctuations to intracranial pressure B-waves // J.Neurosurgery. - 1992. - Vol.76. - P.415-421.). It is determined when the spectral decomposition using the method of one-dimensional spectral Fourier analysis of time series, represented by the values of ISC in the major arteries of the base of the brain. Spectral density intracranial In-waves, expressed in (cm/s)2/Hz, diagnose violation ARMS. The increase of the spectral density In waves over 1000 (cm/s)2/Hz indicates a violation ARMC and the development of neurological symptoms at various adverse external influences and pathological conditions.

The inventive method differs from the prototype in that analyze time series BFV in the range 240-280 seconds, calculate the spectral density of intracranial In-waves BFV in the frequency range 0.0083-0.033 Hz and with increasing spectral density intracranial In waves over 1000 (cm/s)2Hz diagnosed with impaired cerebral autoregulation.

The method is as follows. Using system Multi Dop X (DWL, Germany) conduct TCD that allows you to perform long-term bilateral monitoring BFV in the major arteries of the base of the brain. When executed and monitoring of the recorded performance is investigated in a horizontal position with a raised 30° the head end. Continuous registration is done within 10 minutes at rest while maintaining spontaneous breathing.

Spectral analysis performed according to the standard algorithm using the software package Statistica 6.0 for Windows" in the module "Time series and forecasting". To study the spectrum of lbfv allocated time series in the interval from 240 to 300 seconds. The choice for the analysis of this time interval due to the fact that according to theorem Nyquist-Shannon to assess the spectrum of low-frequency vibrations necessary time series analysis for the period exceeding the maximum period of low-frequency vibrations (In-waves - 120 seconds) not less than two times. Before performing spectral analysis in order to achieve stationarity of the time series produce a subtraction of the average value of a number. To eliminate random noise, reducing the scattering of a time series and identify frequencies with large spectral densities, which make the largest contribution to the periodic behavior of the whole number, carry out the smoothing values periodogram conversion using the weighted moving average of the Hamming window. Then calculate the spectral density of all fluctuations in the selected time interval, including in the range of intracranial In-waves (0.0083-0.033 Hz). The increase of the spectral density inside the skull In waves over 1000 (cm/s) 2/Hz indicates a violation ARMS.

The inventive method developed in the Polenov research neurosurgical Institute them. Professor and Operated and clinically tested in the survey of 15 healthy volunteers (age from 23 to 60 years, men's 10, women's 5) and 32 neurosurgical patients (aged from 25 to 60 years, 20 men, 12 women).

In healthy volunteers spectral density intracranial In-waves BFV in the middle cerebral artery (MCA) does not exceed 1000 (cm/s)2/Hz and is 216±35 (cm/c)2/Hz on the right, 227±45 (cm/s)2/Hz.

Studies of the spectral density In intracranial waves BFV in the SMA conducted in 32 patients with intracranial aneurysms at different times hemorrhage, confirm the possibility of using the results of the spectral Fourier analysis in the perioperative period for the diagnosis of disorders ARMS.

Examples of extracts from the histories.

Example 1. Patient L., aged 27, and a/b No. 1337 - 2000. Clinical diagnosis of Saccular aneurysm of the large size of the junction of the left MCA. Complications during the hemorrhagic period parenchymal-subarachnoid hemorrhage with the development of signs of moderate intracranial hypertension, expressed vascular spasm. The severity of the condition on a scale of hunt-Hess - III degree. The study was performed on the fourth day after the bleeding before item is oodinium anesthetic management and surgical intervention. According to the claimed method monitored BFV in the left MCA and diagnose disorders ARMS using spectral analysis, in which there was a significant increase in the density of intracranial In-waves up to 7200 (cm/s)2Hz, which is almost 7 times higher than the upper limit of normal values. The dynamics of the LSC in the left MCA and its spectral density in the frequency range from 0.0035 to 0.2 Hz is shown in figure 1, a And B.

Example 2. Patient K., 22, and/b No. 785-2001. Clinical diagnosis: Giant aneurysm of the cavernous Department right internal carotid artery (ICA). Remote period bleeding. Neurological symptoms are minimum oculomotor disorders, not limiting self-service patient. Before the operation the patient was carried out compression tests on the neck, which has a low functional importance of the right ICA. This allowed us to predict a favorable postoperative course in the case of occlusion along with aneurysms carrying her vessel (cavernous Department right ICA).

According to the claimed method monitored LSC in the right MCA and diagnose disorders ARMS using spectral analysis of ISC in the range intracranial In waves.

During the examination before vnutrisosudistoi operations hemodynamics in the right MCA (lbfv - 59 cm/s, the pool is salony index (PI) - 0.73) and the spectral density of intracranial In-waves LCS was within the normal range (figure 2, a, B).

During endovascular interventions, carried out in conditions of analgesia-sedation (Diprivan, dormicum, fentanyl intravenous, standard dosage), significant changes in BFV and PI in the right MCA was not observed (lbfv - 51 cm/s, PI - 0.76)were reduced spectral density intracranial In-waves (figure 3, a And B). Manipulation of ICA in the implementation of the access to the aneurysm was not accompanied by any neurological symptoms. The patient underwent surgery, the aneurysm occlusion balloon latex. Within minutes after occlusion of the aneurysm at control angiography aneurysm not contrastives, and at the level of its cavernous segment of the ICA identified stop contrast. Figure 4 (a, B) shows the dynamics of the LSC and its spectral density in the frequency range from 0.0035 to 0.2 Hz after surgery. There is an increase of ISC and PI in the right MCA (lbfv - 86 cm/s, PI - 0.90) without significant changes in the spectral density intracranial In-waves, which indirectly may indicate the absence of a violation ARMS despite the changing hemodynamic conditions in the cerebral circulation system. Nearest postoperative period was favourable neurological complications was not.

Example 3. Patient W., 42 year is, and/b No. 2083-2002. Clinical diagnosis of Saccular aneurysm of the large size artherial division of the left ICA. By the time of surgical intervention, a month after the hemorrhage, objective signs of intracranial hypertension, vascular spasm is not marked. Was slightly expressed by the human psyche in the frontal type, motor, sensitive no violations. The patient performed endovascular surgery embolization of the left ICA mechanically detachable coils. For anesthetic management of surgical intervention was initially applied analgesia-sedation in standard dosages.

According to the claimed method monitored BFV in the left MCA and diagnose disorders ARMS using spectral analysis of ISC in the range intracranial In waves.

Before the operation begins at a relatively normal values of ISC and PI in the left MCA (lbfv - 79 cm/s, PI - 0.70), there was a marked increase of the spectral density In intracranial waves to 2218 (cm/s)2/Hz (figure 5, a, B), which can be considered as an adverse prognostic sign, indicating the violation ARMS.

When making approach to intracranial part of the left ICA, the patient appeared headache, agitation, nausea, vomiting. Monitoring data at the moment of time and, immediately preceding described deterioration, did not reveal significant changes in BFV in the left MCA (lbfv - 71 cm/s, PI - 0.71), at the same time, there was a further increase of the spectral density of intracranial In-waves (6, a, B).

In connection with the danger of further deterioration of the patient, re-rupture of the aneurysm was decided to continue the operation in the conditions of total intravenous anesthesia with artificial ventilation of the lungs. The aneurysm was completely turned off from circulation. When the control carotid angiography left traced the shadow of the spiral in the cavity of the aneurysm, which by contrast is not populated. Vascular spasm no. After the operation the patient during the day was in the ICU, where he conducted intensive infusion therapy. In the neurological examination was marked increase in mental disorders in the frontal type (disinhibition, africell, inadequacy, disorientation in time, place), which regressed during the week prior to the preoperative level.

Thus, the proposed method for the diagnosis of disorders ARMS spectral density intracranial In-waves BFV in the major arteries of the base of the brain, which is calculated using the method of spectral Fourier analysis, is safe and adequate FPIC is BOM, allowing a high degree of probability in advance to detect a breach ARMS to the development of neurological complications without some external influence on systemic and cerebral circulation. The results of the analysis can be used for the correction of preventive and curative interventions to prevent complications caused by the violation ARMS, patients with neurosurgical pathology at various stages of treatment. The advantages of the proposed method are its simplicity, sufficient sensitivity and informative, and, therefore, higher efficiency in the early diagnosis of disorders ARMS.

Method for the diagnosis of disorders of cerebral autoregulation, including continuous bilateral registration of the linear blood flow velocity in major arteries of the base of the brain, characterized in that the analyzing time series linear blood flow velocity in the range 240-280 to calculate the spectral density of intracranial In-waves linear blood flow velocity in the frequency range 0.0083-0.033 Hz and with increasing spectral density intracranial In waves over 1000 (cm/s)2/Hz diagnosed with impaired cerebral autoregulation.



 

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