Method for detecting indications for correcting disorders of regional hemodynamics after reconstructive operations upon inferior limbs' arteries

FIELD: medicine, cardio-vascular surgery.

SUBSTANCE: in patients it is necessary to carry out ultrasound dopplerographic study of arterial circulation in inferior limbs after reconstructive operations. One should detect the value for the initial circulatory rate into systole (V0), maximal value for the linear circulatory rate (V1), minimal value the linear circulatory rate (V2), time (T1) for rate alteration from V0 to V1, time (T2) for rate alteration from V1 to V2. By original mathematical formula one should calculate the coefficient for blood flow power loss (Z) and by Z value it is possible to detect the necessity to correct regional hemodynamics. The innovation suggested enables to match optimal variant of therapy.

EFFECT: higher efficiency.

3 ex

 

The invention relates to medicine, more specifically to vascular surgery, and can be used in operations direct revascularization of the limb.

Atherosclerosis according to the world Health Organization ranks first among causes of death among the adult population of economically developed countries. One of the most common forms of the disease is atherosclerosis of vessels of lower extremities, which in 95% of cases leads to incapacitation. Therefore, the problem of improving the quality of reconstructive operations on the major arteries of the limbs as the main method of treatment of this disease stages pronounced manifestations of pathological manifestations and complications still remains an issue. The results of surgical treatment is quite limited in terms of efficiency. All designs direct revascularization of the limb operate up to 5-10 years, and often their "life" is much shorter. This is caused by a thrombosis in the background of the development of obliterate in the zone of distal anastomoses or plastic. The result is ischemia of the limb returns, sometimes in a more pronounced degree. At the heart of these phenomena are multifactorial causes, but the main is the status of regional hemodynamics. For the study there are several methods and methods.

Known the Yong way of learning regional hemodynamics in patients with obliterating diseases of arteries, proposed in 1971 R.G.Gosling, and in 1972 J.P.Woodcock [AAC, Objinit, Alavaikko, Antonicelli // Ultrasonic diagnosis of diseases of the abdominal aorta and arteries of the pelvis and lower extremities. Edited by Prof. Sukharev I.I. - http://ultrasound.net.ua/angiology/3/3_3 .htm.]. He is that patients spend Doppler assessment of peak systolic velocity (PSS), a maximum speed of retrograde flow (ORS) and time-averaged maximum blood flow velocity (CAMH), compute the index ripple (P1) by the formula P1=(PSS-ORS)/TAMH. Normal with a significant degree of conditionality consider the value of P1 up to 8-12 for the femoral artery, up to 20 - popliteal. But these figures are, unfortunately, can vary considerably depending on the conditions of research. According to the authors, the index P1 only indirectly reflects the peripheral resistance to blood flow.

In addition to the index ripple define derived from the P1 indicator is the damping factor (DF), characterizing the degree of attenuation Doppler signal through the ratio P1 of the two adjacent segments: DF=P1 of Proxim. / P1 distalen. For the mathematical description of the relationship between systolic and diastolic velocities is proposed to use the index resistivity (R1):

R1=(S-D)/S, where

S - peak systolic blood flow velocity;

D - the final Diaz is aliaska blood velocity.

However, the calculation of the index resistivity, or circular resistance, the analysis of the spectrograms of blood flow in arteries of the lower extremities only makes sense if poststenoticescuu or collateral type filling of the vessel, when logged diastolic phase. In other cases, these calculations are not meaningful, because it does not increase the accuracy of determining peripheral resistance in blood circulation. In this regard, the method has no practical significance for clinical practice and is of purely theoretical interest.

A known method of intraoperative flowmetry [Methodology flowmetry, issue 5, s-24, Moscow 2001], which, according to the authors, to provide substantial assistance in choosing the volume of transactions and the forecasting results. In the complex examination of patients necessarily includes performing floor dolerophanite, aorto-arteriography. Measurement of volumetric blood flow intraoperatively performed using an ultrasonic flowmeter. The authors have obtained the following parameters volumetric flow, providing good results arterial reconstruction:

1. The donor artery, iliac artery 280-350 ml/min, the common femoral - not less than 250 ml/min

2. Recipient artery below the distal anastomosis is common femoral who steria - 150-250 ml/min, superficial femoral artery - 110-130 ml/min (at passable deep femoral artery (GBA)GBA - 100 ml/min (occlusion of superficial femoral artery (PBA), popliteal artery -120 ml/min, crural artery - 50-70 ml/min

3. The blood flow in autovenous to shunt at least 120 ml/min

However, as the shortcomings of the method it should be noted indirection characteristics of peripheral resistance, which is subjectively judged by the results of volumetric blood flow, calculated using estimates of the diameter of the artery and the linear velocity of blood flow through it. The diameter of the artery, for example, is taken approximately equal to the scale set of sensors, the interval between which is equal to 2 mm Size, conventionally taken as the diameter of the artery, in addition, approximately only reflects the external diameter of the artery, but not internal, which can have significant individual variability. The measured value of the linear velocity of blood flow largely depends on the thickness and density of the arterial wall, and the angle between the directions of the sensor and arteries, which in turn is often determined anatomical features of the wound and localization in her vessel. All this indicates a very rough characterization peripheral resistance is possible and for this reason it cannot serve as an indication for the need of a particular treatment. Normal values of volumetric blood flow are considered in the femoral-popliteal segment more than 120 ml/min with regard to standards for Arcobaleno segment, such data in the available literature no.

There is a method of studying regional hemodynamics in patients with obliterating diseases of the lower extremities [SERGIY Ivanov and other Comparative information content of the Doppler rate of blood flow and pressure in the assessment of the degree of ischemia of the lower extremities. - Surgery. - 1995. - N-6. - page 11-13], namely, that patients assess the linear flow velocity, volumetric flow, and using the apparatus of Riva-Rocci and non-invasive ultrasonic sensor to determine regional arterial pressure (on the distal lower extremity arteries) and blood pressure on the shoulder, taking him by the system. After analyzing the data, interpret them as follows: the gradient (differential, difference) regional arterial pressure (BP) in different segments indicates the level of resistance arterial limb, and the ratio of regional arterial pressure and systemic blood pressure, called the shoulder-ankle index reflects the severity of peripheral arterial insufficiency. The volume of blood in the limb also indirectly to the characteristics of Arisue resistance arterial bed. Based on the analysis of these data, the authors conclude about the state of regional hemodynamics and when values of the shoulder-ankle index below 0.5 put indications to operative treatment.

This method was first objectively reflecting in digital form that the circulation of the lower extremities. However, it is not devoid of serious shortcomings. First, the volume of blood flow through the vessel is a calculated value, based on rounded data on the diameter of the artery, as well as data on the linear velocity of blood flow-dependent intravascular terrain proximal to, distal to, and place of measurement. Secondly, the definition of the gradient of blood pressure is not entirely correct, because the system is taken to be the HELL on the brachial artery is not always the arterial tree of the upper extremities accurately reflect the system pressure. Thirdly, the way, objectively reflect the status of the blood supply to the tissues of the limb and perfusion adequacy of the trunk of the arterial blood flow, allows you to make a decision about the necessity of surgical correction of perfusion of tissues, but does not allow one to objectively assess peripheral resistance in blood circulation of the lower extremities after surgery. These additional interventions are made in a timely manner, provide adequate crowood the distribution in the limbs and a significant lengthening of the duration of "life" is created during the operation of the structure. In this regard, this method, in our opinion, as above, it is not possible to reliably predict the development of atherosclerotic process based on the changed during the operation of hemodynamic conditions, and cannot be the basis for definition of tactics of treatment of patients in the postoperative period.

Closest to the present invention is previously developed by the authors of the present invention a method of determining the indications for surgical correction of abnormalities of regional hemodynamics in reconstructive surgery on the arteries of the lower extremities (RF Patent for invention N 2239373), including simultaneous registration of the arterial pressure and the electrocardiogram, and the AD register after revascularization of the limb directly in the studied artery invasive with the free flow and after clamping its distal sites, recorded in both cases barogram, determine the area under their curves during one cardiac cycle, find the difference of their values and if it is more - 1,0 kPa·consider surgical correction of regional hemodynamics appropriate.

Invasive registration of blood pressure in the artery (in the anastomosis) with the free flow and after cross-clamping allows to determine the integrated index regionalcooperation resistance vasculature, blood flow, named authors index of resistance (Andnom.)characterizing the degree of disturbance of regional hemodynamics. The definition Andnom.proximal and distal locations of surgery on the blood circulation of the patient allows for the difference of its values at the input and output created during the operation of a design to evaluate the hemodynamic characteristics of the artificial structures (autovenous graft, synthetic graft, plot plastics artery), which is very important in prognostic terms, as it gives the possibility of choosing the best for a specific patient and a specific anatomical situation, the option of surgical treatment.

However, the value of the prototype method reduces the possibility of its application only during the operation, because the study is invasive directly in the artery, which is impossible in the dynamics during the follow-up of the patient. Thus, the prototype method is practically not possible to adjust the treatment process in the late postoperative period, when over time, changing conditions of regional hemodynamics.

The technical result of the present invention is able to determine the necessary correction of abnormalities of regional hemodynamics at any time paleopalynology due to its non-invasive diagnostics.

This result is achieved by the fact that in the studied artery by ultrasonic dopplerography determine the value of the initial velocity of blood flow in systole (V0), the maximum value of the linear flow velocity (V1), the minimum value of the linear flow velocity (V2), time (T1between the change in velocity from V0to V1time (T2) changes the speed from V1to V2find the value of coefficient of power loss of blood flow Z in percentage according to the formula:

where X is the ratio of the velocity vector direction,

and when the Z value of 65% or more is considered a correction of regional hemodynamics appropriate.

Treating patients with impaired regional hemodynamics, we defined different indicators characterizing the state of an arterial channel. So, common of them V0- the value of the initial velocity of blood flow in systole gives an indirect view of the distal resistance vessels, V1- the maximum value of the linear velocity of blood flow indirectly reflects the degree of stenosis of the artery in the study location, V2- the minimum value of the linear velocity of blood flow can be considered as a subjective indicator of the presence of increased peripheral resistance to suck the E. These indicators allowed us to indirectly estimate the state of the peripheral arterial bed and the value of volumetric blood flow in the studied segment of the artery. However, the accumulation of these data and comparing them with the clinical observation of patients has convinced us in a small informative of these indicators as such. On the basis of further observations and logical thinking, we decided that more important to describe the state of the arterial bed may be the ratio of the power loss of blood flow Z, which we defined by the formula:

where V0- the value of the initial velocity of blood flow in systole;

V1- the maximum value of the linear velocity of blood flow;

V2- the minimum value of the linear velocity of blood flow;

T1the time between changes of blood flow velocity from V0to V1;

T2the time changes of blood flow velocity from V1to V2;

X - factor velocity vector direction, and it can be equal to +1 when V2and V1in the same direction may be equal to -1 when V2and V1differently and, finally, he may have a value of zero, if V2=0.

The resistance of peripheral arterial caused by many components: anatomical features is s (the presence and severity of pritokov and collaterals), the capacity of the vascular bed, localization and severity of atherosclerotic lesions of the arteries, hemodynamic conditions (inlet pressure in the arterial tree of the lower extremities, the correlation of phases ante - and retrograde flow of blood through the vessels), rheology, etc. Using the ratio of the power loss of blood flow, can not take into account the role of each of these constituent factors, agreeing to define integrated regional distal peripheral resistance measurement. In our opinion, this is the most appropriate solution for a specific task, as the actual role of each individual component of the resistance factor of no practical significance, while the value of their cumulative impact on the hemodynamics and it is difficult to overestimate. In addition, the definition of the coefficient of power loss on the same area of the artery and allows you to minimize error associated with a given artery diameter, the dimension of which in real terms is always approximate. Thus, we believe that we have developed a method for determining the metric to reflect, in our opinion, the resistance of the peripheral channel.

In preliminary studies we have carried out the determination of the coefficient of power loss of blood flow angiographically patients (i.e. people with known the gross anatomy of the arterial bed of the lower limbs) after operations direct revascularization of the lower extremities, as well as a group of people with varicose veins of the lower extremities, but without lesions of the lower limb arteries (control group). Smashing patient groups, we have obtained integral values of resistance in different parts of the arterial system of the lower limbs in normal and atherosclerotic peripheral arteries. We have also studied the possibility of correction of violations of regional hemodynamics in patients by creating them arteriovenous fistula distal artificial vascular structures, as well as the distal additional shunting and endarterectomy with plastics arteries, and to trace the duration of their operation. All this has allowed us to determine the values of the coefficient of power loss of blood flow, in which the necessary correction of regional hemodynamics. Empirically, on the basis of observations of distant results of the operated patients we were able to show that if the patient has a disorder of regional hemodynamics, the value of the coefficient of power loss of blood flow it is 65% or more. This, in our opinion, involves local barotrauma vascular wall, causing excessive proliferation of the endothelium, as well as poor conditions of local blood flow, leading to presevre nomu pathological intravascular thrombosis, that requires hemodynamic surgical correction. When the values of the coefficient of power loss of blood flow less than 65% of such violations is not observed and therefore additional surgical correction of hemodynamics in the test pool is not required.

Thus, registration of the linear blood flow velocity, determine its acceleration and calculating the ratio of the power loss of blood flow, reflecting local resistance directly in the studied artery after revascularization of the limb, characterizes, in our view, an objective picture of the situation after the start of blood flow through the newly created during the operation of the path, that allows to adjust the treatment process and determine the tactics of postoperative management of the patient practically at all stages of follow up for the patient.

Determination of the coefficient of power loss of blood flow proximal and distal to the place of surgery on the blood circulation of the patient allows for the difference of its values at the inlet and exit areas of the operation to assess the hemodynamic characteristics of the artificial structures (autovenous graft, synthetic graft, plot plastics artery), again at any time after surgery. This is very important in prognostic terms, the AK gives the possibility of choosing the best for a specific patient and a specific anatomical situation variant of the upcoming surgical treatment.

The essence of the method are as follows:

During the ultrasound Doppler studies performed after revascularization interested in the intervention area determine the value of the initial velocity of blood flow in systole (V0), the maximum value of the linear flow velocity (V1), the minimum value of the linear flow velocity (V2), time (T1between the change in velocity from V0to V1and time (T2) changes the speed from V1to V2and by the formula

find the ratio of the power loss of blood flow (Z), when it is 65% or more is considered a correction of regional hemodynamics appropriate.

Tactics of treatment in this case defines the indications for additional revascularization of the lower (II) floor arterial limb, the imposition of autovenous fistula distal artificial vascular structures, or lumbar sympathectomy, or expensive drug therapy. These additional activities are made in a timely manner, to provide adequate circulation in the limb, significant lengthen the duration of "life" is created during the operation of the structure.

If the value of the coefficient of power loss of blood flow less than 65%, then additional the Naya correction of hemodynamics, as we have shown, at this point in time in the test pool arterial bed is not required.

In addition, the study of the ratio of the power loss of blood flow proximal and distal to the place of surgery on the blood circulation of the patient allows to estimate the hemodynamic characteristics of the artificial structures (shunt, graft, plot plastics artery).

The essence of the method is illustrated by examples.

Example 1.

Patient K., aged 54, was admitted to the vascular surgery Department of the Leningrad regional clinical hospital 14.05.2004 was diagnosed with Obliterating atherosclerosis of vessels of lower extremities II b Art. Occlusion of the femoral-popliteal segment on the left. Patients considered themselves to be about 2 years before admission, when he began to notice alternating lameness when walking at a distance of 300 meters. About 2 months prior to admission the maximum distance walk has decreased to 70 meters

Upon admission to the ward the patient was performed ultrasonic dopplerography (USDG) arteries of the lower extremities and angiography of the aorta and lower limb arteries. Revealed occlusion powerhnostnoj femoral artery to the left from the mouth to n/3 right thigh. Shoulder-ankle index: right - 0,84; left - 0,34. Final diagnosis: Obliterating atherosclerosis of vessels of lower extremities II b senior JCC is use femoro-popliteal segment on the left.

The patient was offered surgical treatment and 28.05.2004, operation: semi-closed loop endarterectomy of powerhnostnoj femoral artery (PBA) to the left, autovenous plastic arteriotomy holes in the PBA. Through 5 days after the operation the patient underwent USDG study identifying indicators of blood flow: the initial velocity of blood flow in systole: V0=0 m/s, the maximum value of the linear blood flow velocity: V1=0,61 m/s, the minimum value of the linear blood flow velocity: V2=-0,12 m/s, X=-1, the time between the change in velocity from V0to V: T1=0,11, speed changes from V1to V2: T2=0,52 C. According to the formula

received the value 78,03%.

The patient was offered a choice of either the imposition of autovenous distal to the fistula construction, or treatment with expensive medication "Vazaprostan". The patient from the correction of hemodynamic refused and after 3 months was admitted with clinical thrombosis powerhnostnoj femoral artery to the left in the background of reocclusion in the field of plastics distal PBA.

2.09.2004, the patient underwent repeated surgical treatment: semi-closed loop endarterectomy of powerhnostnoj femoral artery (PBA) to the left, continue autovenous plastic arteriotomy holes in the PB is with the transitions on the popliteal artery in n/3 left thigh and on the common femoral artery to the left, what was the corrective hemodynamics surgical interventions. Through 5 days after the operation the patient underwent USDG study identifying indicators of blood flow: the initial velocity of blood flow in systole: V0=0 m/s, the maximum value of the linear blood flow velocity: V1=0,61 m/s, the minimum value of the linear blood flow velocity: V2=of-0.2 m/s, X=-1, the time between the change in velocity from V0to V: T1=0,09, speed changes from V1to V2: T2=0,23 C. According to the formula

received the value of 56.7%of that at this point in time, treatment is not required. The patient offered follow-up every 6 months. Up to the present time negative dynamics in the field of arterial structures not identified.

Example 2.

Patient N., 46 years old, was admitted to the vascular surgery Department of the Leningrad regional clinical hospital 08.06.2003 was diagnosed with Obliterating atherosclerosis of vessels of lower extremities II b Art. Patients considered themselves to be about 2 years before admission, when he began to notice alternating lameness when walking at a distance of 500 meters. About 2 months prior to admission, the maximum distance of the walk was down to 50 meters

Upon admission to the ward the patient has performed the ultrasound Doppler examination of the lower limb arteries is angiography of the aorta and lower extremities. Revealed occlusion of the common iliac artery on the right. Shoulder-ankle indexes: left - 0,93; right - of 0.36. Final diagnosis: Obliterating atherosclerosis of vessels of lower extremities II b Art. Occlusion of the common iliac artery on the right. The patient was offered surgical treatment and 16.06.2003, operation: aorta-femoral monolateral bypass right prosthesis "North", diameter 10 mm After 7 days after surgery the patient underwent USDG study identifying indicators of blood flow in the common femoral artery to the left: the initial velocity of blood flow in systole: V0=0 m/s, the maximum value of the linear blood flow velocity: V1=0,50 m/s, the minimum value of the linear blood flow velocity: V2=0 m/s, X=0, the time between the change in velocity from V0to V: T1=0,07, speed changes from V1to V2: T2=0,19 C. According to the formula

received the value 63,16%. As a result of the study, in our opinion, was a frontier, the patient was offered conservative treatment, but the patient refused. After 14 months he has been with the clinic thrombosis of the shunt on the background of reocclusion in the area of the distal anastomosis. 2.09.2004, the patient was re-operative treatment: thrombectomy of the prosthesis aorto-femoral bypass. Re-the-waves in the zone of arterial structures are not carried out due to the fact, what hemodynamic changes in the system are made. In February 2005, the patient must enroll for a course of conservative therapy drug "Vazaprostan", the mechanism of pharmacological action of which is directed at reducing peripheral resistance in blood circulation.

Example 3.

From the anamnesis: the patient F., 63 years old, was admitted to the vascular surgery Department of the Leningrad regional clinical hospital 12.04.1992 was diagnosed with Obliterating atherosclerosis of vessels of lower extremities II b Art. Patients considered themselves to be about 4 years prior to admission, when he began to notice alternating lameness when walking at a distance of 300 meters. About 3 months prior to admission, the maximum distance of the walk was down to 50 meters

Upon admission to the ward the patient has performed the ultrasound Doppler examination of the lower limb arteries and angiography of the aorta and lower extremities. Identified Leriche syndrome, occlusion of the common iliac arteries with 2 sides. Shoulder-ankle indexes: left - 0,42; right - of 0.38. Final diagnosis: Obliterating atherosclerosis of vessels of lower extremities II b Art. Leriche Syndrome. The patient was offered surgical treatment and 20.04.1992, operation: aorta-femoral bypass bifurcation prosthesis "North", diameter 20,10,10 mm Patient was discharged to outpatient treatment with good clinches the m result. Was observed in the vascular surgeon on an outpatient basis. 12.01.2005, the patient is in the process of dispensary observation came at the next inspection. He was made USDG study identifying indicators of blood flow in the common femoral artery to the left: the initial velocity of blood flow in systole: V0=0 m/s, the maximum value of the linear blood flow velocity: V1=0,53 m/s, the minimum value of the linear blood flow velocity: V2=0 m/s, X=0, the time between the change in velocity from V0to V: T1=0,11, speed changes from V1to V2: T2=0,23 C. According to the formula

received the value 52,17%, in the common femoral artery to the right: the initial velocity of blood flow in systole: V0=0 m/s, the maximum value of the linear blood flow velocity: V1=0,41 m/s, the minimum value of the linear blood flow velocity: V2=0 m/s, X=0, the time between the change in velocity from V0to V: T1=0.1 s, the time of speed change from V1to V2: T2=0,2 s Z Value amounted to 50.0%. According to the USDG previously received a positive clinical result is stored.

This example shows that the presence of normal peripheral resistance in the arteries of the lower extremities causes such a lasting positive effect in operated patients with obliterating atherosclerosis.bacteria lower limbs.

To date, the proposed method is examined 84 patients. All suffered obliterating atherosclerosis of the lower extremities. In 36 patients the ratio of the power loss of blood flow was more than 65%, and in those patients who abandoned the proposed additional treatment, there were problems in the postoperative period in a period of 3 months. up to 1 year. All patients every 6 months continue to occur.

The proposed method is compared with the known has several advantages:

1. First unambiguous definition of tactics of treatment in the postoperative period in any period of dispensary observation of patients with obliterating atherosclerosis of the lower limbs undergoing reconstructive surgery on major arteries, while the prototype method and other known methods do not provide such opportunities.

2. The determination of the coefficient of power loss of blood flow at the point of entry and exit from the created during the operation of construction is made possible to objectively assess hemodynamic characteristics themselves vascular structures created during the direct revascularization of the limb, and to carry out the correction of regional hemodynamics in any term follow-up of surgical or conservative ways, allowing maksimalno keep the good results of surgical treatment and to avoid amputations of limbs, resulting in 40% of patients to death in the first year of life.

The method developed by the authors: Maistrenko Dmitry Nikolaevich and Maistrenko Alexei Dmitrievich and was clinically tested in the vascular surgery Department of the Leningrad regional clinical hospital in 84 patients with a positive result.

The method for determining the indications for the correction of violations of regional hemodynamics after the reconstructive surgery on the arteries of the lower extremities by ultrasonic Doppler blood flow studies in them, characterized in that to determine the value of the initial velocity of blood flow in systole (V0), the maximum value of the linear flow velocity (V1), the minimum value of the linear flow velocity (V2), time (T1) changes the speed from V0to V1time (T2) changes the speed from V1to V2determine the ratio of the power loss of blood flow (Z) in percentage according to the formula

where X is the ratio of the velocity vector direction,

and when the value Z=65% or more is considered a correction of regional hemodynamics appropriate.



 

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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

FIELD: medicine.

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.

FIELD: medicine.

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

FIELD: medicine.

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.

4 tbl

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.

3 ex

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

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