Method for predicting microcirculatory disorders in bronchial mucosa in patients with bronchial asthma

FIELD: medicine.

SUBSTANCE: the present innovation deals with studying the system of microhemocirculation. Moreover, it is necessary to introduce a laser light guide probe of a special device (LAKK-02) into biopsy canal of a fibrobronchoscope to apply it at certain part of bronchial mucosa being 1.0 cm above the carina of right-hand upper lobar bronchus. Then one should register and analyze the data obtained that enables to exclude the error in the course of trial implementation.

EFFECT: higher accuracy of diagnostics.

6 ex

 

The invention relates to the field of medicine. Used in pulmonology for the diagnosis of microcirculation disorders in the bronchial mucosa in patients with bronchial asthma.

In practical medicine diagnostic techniques for investigating the functional ability of the microvasculature, a little, and it is caused mainly morphological characteristics of microvessels: small size and a significant diversification within the organ of vascular networks. However, the study of microcirculation in patients with bronchial asthma is required, especially in the bronchial mucosa that is the site of allergic inflammation, as microcirculatory disorders reduce the effectiveness of pathogenetic therapy, worsen the clinical course of the disease, are one of the important factors in the progression of the pathological process.

To well-known methods of assessment of microcirculation include nuclear imaging gamma camera, which allows you to explore the capillary blood flow in the lungs and directly into the bronchi, but its disadvantages are the length of time manipulation and unwanted radiation exposure of the patient [1].

A known method for the diagnosis of microcirculatory disorders - direct non-invasive vital biomicroscopy is injunctive eyeball, with the help of which you are able to thoroughly assess the condition of individual-level microvasculature and perivascular space [2]. The benefits of co biomicroscopy is the availability of the investigated object and good contractionist erythrocyte flow on a white background sclera. The disadvantages of the method is the absence of strict specificity detected microcirculatory disorders for specific diseases. The study does not target organ in patients with bronchial asthma gives only an indirect idea of endobronchial microvessels. In addition, conjunctival biomicroscopy refers to morphometric methods and does not allow to study the functional activity of microcirculatory vessels.

The known method of the microcirculation with laser Doppler flowmetry laser analyzer capillary blood flow LACC - 02 [3]. This method makes it possible to obtain information not only about the nature of the blood flow at the level of the microvasculature, but also on the mechanisms of vascular tone regulation, including the ability of endothelial cells to the production of the vasodilator nitric oxide (NO).

The way LDF was used for diagnosis in patients with bronchial asthma to determine the total microcirculatory disorders. In these IP is the studies recording of blood flow parameters was carried out with the skin of the forearm [4]. However, in patients with BA according to the cutaneous LDF cannot fully assess the blood flow in endobronchial microvessels.

A method of diagnosis of microcirculation disorders in the bronchial mucosa in patients with bronchial asthma, allow to record the parameters of the microcirculation directly in the mucous membrane of the bronchial tree during fibrobronchoscopy. The method is non-invasive, objective, simple to use, briefly. Advantage for practical medicine is its ability to play in the dynamics of each patient on the background of therapy. The apparatus LACC-02 was made special experimental laser fiber probe [3]. The probe used for the diagnosis of microcirculatory disorders directly in the mucous membrane of the bronchi.

The method is as follows.

After visual inspection of the mucosa tracheobronchial wood fibrobronchoscopy in the biopsy channel of the last injected laser fiber probe and establish on the part of the mucous membrane of 1.0 cm above the Carina of the right upper lobe bronchus. Such installation of the probe provides its rectilinear direction and eliminates errors when performing research. After installation of the fiber and stabilization of emodine the practical parameters hold the record for 3 minutes. Then the performance of the device.

Example 1

Patient B., 48 years old, was in the pulmonary Department of the Amur regional clinical hospital with a diagnosis of Bronchial asthma, mixed, severe, worsening. Chronic catarrhal bronchitis, exacerbation. Emphysema. Diffuse pneumosclerosis. NAM II Art. This patient it was necessary to make a correction of medication due to the fact that on a background of adequate basic therapy continued clinical symptoms: daily asthma up to 5-7 times per day, cough, shortness of breath. This patient was performed fibrobronchoscopy, during which a biopsy channel of fibrobronchoscopy was injected laser light guide probe LACC-02 and set on a plot of mucosa - 1.0 cm above the right upper lobe bronchus. Produced record dopplergram by application of a computer program within 3 minutes, the obtained data were analyzed. Based on the results of the study the patient was corrected microcirculation disorders, achieved clinical improvement, confirmed by functional tests. Before discharge from hospital the patient had endobronchial laser Doppler flowmetry again, at which a marked decline witnessed the Xia previously microcirculation disorders in the mucous membranes of the respiratory tract. This clinical example confirms the feasibility and effectiveness of conducting LDF patients with bronchial asthma for the diagnosis of microcirculation disorders in bronchial mucosa and holding pathogenetically justified medical treatment.

Example 2

Patient D., 42 years old, was in the pulmonology Department with a diagnosis of Bronchial asthma, mixed, severe, steroid-dependent option aggravation. The patient was performed fibrobronchoscopy, during which a biopsy channel of the bronchoscope was introduced laser light guide probe LACC-02 and was set at 3 cm distal to the spurs right upper lobe bronchus, however, such localization of the probe was increased bending of the latter, decreased the angle of incidence of the laser radiation and the Doppler frequency shift (the maximum Doppler frequency shift occurs when the direction vectors of the radiation wavelength and the speed of movement of the formed elements in parallel) and, accordingly, there were errors in the study. Upon further advancement of the probe and attempt to fix the bending and tension increased.

Example 3

Patient M., aged 45, was in the pulmonology Department with a diagnosis of Bronchial asthma, mixed shape, moderate severity, exacerbation. B is lemu was performed fibrobronchoscopy, during which a biopsy channel of the bronchoscope was introduced laser light guide probe LACC-02 and installed on the mucous membrane of the right main bronchus. The probe in this localization was rectilinear direction, however, increased the likelihood of "slippage". Given that the method of laser Doppler flowmetry is extremely sensitive to external influences, any interference contribute to the research results.

Example 4

Patient B., 48 years old, was in the pulmonology Department with a diagnosis of Bronchial asthma, mixed, severe, worsening. This patient was performed fibrobronchoscopy, during which a biopsy channel of fibrobronchoscopy was injected laser light guide probe LACC-02 and set on a plot of mucosa - 1.0 cm above the right upper lobe bronchus. It is with this installation of the probe creates an ideal environment for conducting research. In our proposed scope probe has a rectilinear direction, it is stable, it does not occur "slippage" and the tension vectors radiation wavelength and the speed of movement of the formed elements parallel to each other, also in this area are not great vessels, no reflex zones, there is no pulsation of the aorta, thus, the external interference investigated the Yu is minimized.

Example 5

Patient B., 36 years old, was hospitalized in the pulmonary Department of OKB about bronchial asthma exacerbation. The patient was performed fibrobronchoscopy, during which a biopsy channel of fibrobronchoscopy was injected laser light guide probe LACC-02 and installed on the portion of the mucous membrane of the left upper lobe bronchus. The recording was made within 3 minutes, but dopplergram contained a considerable number of artifacts due to the ripple next to the left departments of the tracheobronchial tree of the aorta, therefore, the deciphering and interpretation of research results correctly to produce failed. In addition, the diameter of the left main bronchus narrow angle of divergence of the left upper lobe bronchus acute, and therefore had difficulty installing probe (increased bending and tension of the probe).

Example 6

Patient K., age 19, was in the pulmonology Department with the diagnosis: Bronchial asthma, allergic form, moderate severity, exacerbation. The patient was performed fibrobronchoscopy, during which a biopsy channel of fibrobronchoscopy was injected laser light guide probe LACC-02 and installed on the mucosa of the spurs right upper lobe bronchus, after which produced the recording of the LDF. However, the blood flow in the great vessels of megregian spurs and high activity tussigenic zones contributed interference in the study and the validity of the results. In addition, the installation of the probe in spore difficult due to the high probability of "slippage".

Literature

1. Aesomee, Wearisome and other Assessment radioactive hazards when conducting scintigraphy respiratory organs. Bulletin of new medical technologies. 2000, Vol.7, No. 3/4. P.34-35.

2. Diagnostic possibilities of the method conjunctival microscopy. Proceedings of the international conference on microcirculation M 1997; s-111.

3. Passport laser analyzer of blood microcirculation LACC-02 IABG 9413-030-00-05 PS.

4. Nespereira, Aigrain and other State pulmonary blood flow in bronchial asthma in children. Abstracts of the 13th National Congress on respiratory diseases. St. Petersburg, 10-14 November, 2003.

The method of study of microcirculation disorders in the bronchial mucosa in patients with bronchial asthma, including system study of the microcirculation, characterized in that a biopsy channel of fibrobronchoscopy injected laser light guide probe LACC-02 and install it on the part of the mucous membrane of the bronchi - 1.0 cm above the Carina of the right upper lobe bronchus, then make for the of n and analysis of indicators.



 

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