Method for prediction of state of newborns of women suffering bronchial asthma with underlying prevailing effect of sympathetic vegetative nervous system

FIELD: medicine.

SUBSTANCE: invention refers to medicine, pulmonology and perinatology. A pregnant woman suffering bronchial asthma of slight severity, in an attack-free period is examined for the functional state of the vegetative nervous system by cardiorhythmography. Detecting a prevailing effect of the sympathetic nervous system by regional lung rheography technique is used to determine a degree of involvement (%) of a medium region of a left lung in air fill (DOmrll%) and a pulse wave propagation time between the heart and the medium region of the left lung (gamrll). It is followed by a discriminant equation: D=-0.054×DOmrll%-11.781×gamrll. If the value D is equal to or more than -2.55, a baby in a in satisfactory condition is expected to be born, while D being less than -2.55, a baby in asphyxia is predicted.

EFFECT: method provides higher prediction reliability.

1 ex

 

The invention relates to medicine, namely to pulmonology and neonatology.

Bronchial asthma is one of the most serious chronic diseases of the respiratory system. Share it among pregnant women ranges from 0.4 to 1% [1] 4% [2]. The most serious factor affecting during gestation on the condition of the newborn in women with bronchial asthma caused by this disease hypoxia. Forecasting the newborn in this category of patients is important, its solution already during pregnancy will help to take preventive measures aimed at improving conditions for the development of the fetus and the normalization condition of newborns.

There is a method of predicting the state of newborns from women with bronchial asthma [3], based on the determination at the time of gestation using the method of spirography in nepristupny period state ventilation and lung function in patients with bronchial asthma of mild severity.

The disadvantages of this method:

1. Does not take into account the functional state of the autonomic nervous system, regulating the status of bronchial obstruction and reversibility restriction of air flow.

2. Requires active participation pregnant, especially when performing the forced expiratory maneuver to assess the status of the function is nesnera breath, which may introduce an element of error.

3. Execution spirographis research is associated with a rapid increase in intra-abdominal pressure, which is an undesirable point in some pregnant women (for example, when threatened miscarriage, miscarriage).

The aim of the invention is to improve the accuracy of predicting the state of the newborn in the first few minutes of life in women with bronchial asthma of mild severity, with the prevailing influence of the sympathetic division of the autonomic nervous system.

The objective is achieved through determination during pregnancy in patients with mild bronchial asthma in nepristupny period of the functional state of the autonomic nervous system by the method of cardiotocography (kardiointervalografii) [4] and the overwhelming influence of the sympathetic - participation (in %) of the Central zone of the left lung in vozduhonosnye lungs, as well as the time of propagation of the pulse wave from the heart to this zone, defined by the methodology zonal rheography of the lungs [5]. After that, using the discriminant equation, which includes the designated indicators predict the condition of the newborn.

The method includes the following techniques:

a) using cardiotocography determine the state of the autonomic nervous system;

b) the women with predominant influence of the sympathetic division of the autonomic nervous system in the supine through methods zonal rheography lungs register rogramme ventilation all six zones of the lungs;

C) determine the total (from all six zones) eographically rate tidal volume;

g) determine the degree of participation (%) in vozduhonosnye light of the Central zone of the left lung (UP toSSL%);

d) determine the propagation time of the pulse wave from the heart to the middle zone of the left lung (qaSSL);

e) using discriminant of the equation

D=-0,054×TOSSL%-11,781×qaSSL

determine the forecast for the newborn:

when D is equal to or more -2,55 predict the birth of a child in a satisfactory condition, when D is less -2,55 predict the birth of a child in a state of asphyxia.

The probability of correct prediction is 86%.

To illustrate the effectiveness of the proposed method here are clinical examples.

Example 1. Pregnant A., 23 years. Bronchial asthma (mild persistent) suffers 6 years. The second pregnancy, history 1 medical abortion when pregnancy 9 weeks without complications. Outside of pregnancy seizures shortness of breath occurred up to 6 times per month, including 3-4 times at night. Outside attacks indices of bronchial obstruction within normal values. In the first 16 weeks of pregnancy seizures developed less frequently than before pregnancy, starting with a 17-week course of the disease was the same as before pregnancy.

p> Chronic disease (except asthma) no. During pregnancy, acute respiratory diseases was not, on the day of the survey (gestation 27 weeks) had no complaints.

In the assessment of regional lung function found that the degree of participation of the Central zone of the left lung in General vozduhonosnye lungs (TOSSL%) amounted to 18.0%, and the propagation time of the pulse wave from the heart to the middle zone of the left lung - qaSSL- 0,125 C.

Discriminant function was -2,44.

It was predicted that the child will be born in a satisfactory condition.

Odoratissimus in term of live full-term girl weight 3350 g in a satisfactory state (score on scale Apgar was in the first minute of life 9 points in the fifth minute - 9 points).

Example 2. Pregnant K., 26 years. Sick of a bronchial asthma (mild intermittent flow) of 4 years. This third pregnancy, childbirth coming first in history 2 medical abortion when pregnancy 3-4 weeks without complications. Outside of pregnancy seizures shortness of breath occurred 2-3 times per month, including 1-2 times at night. In nepristupny period bronchial obstruction were within predicted values. During pregnancy, the disease has not changed.

Chronic diseases (except bronchia Inoi asthma) no. During pregnancy, acute respiratory diseases was not, on the day of the survey had no complaints. Regional lung function was assessed with gestational age 25 weeks, the following results are obtained: the degree of participation of the Central zone of the left lung in General vozduhonosnye lungs (TOSSL%) accounted for 19.1 per cent, and the propagation time of the pulse wave from the heart to the middle zone of the left lung - qaSSL- 0,130 C.

Discriminant function was -2,56.

It was predicted that the child will be born in a state of asphyxia.

Odoratissimus in term of live full-term girl with the weight of 3100 g in a state of asphyxia moderate severity (score on scale Apgar was in the first minute of life 6 points, in the fifth minute - 6 points).

The above examples illustrate the accuracy of prediction using the proposed method status of newborns from mothers with bronchial asthma, with the prevailing influence of the sympathetic division of the autonomic nervous system. The method has been tested in the clinic, institution of the Russian Academy of medical Sciences, far Eastern scientific center of physiology and pathology of respiration SB RAMS. With its help a forecasting state 63 newborns. Correct prediction was determined in 88.9% of cases, which confirms the high effektivnostdannogo method.

Bibliography

1. Mahmuthodjaev INC. Bronchial asthma in pregnancy // lung Disease in pregnancy / edited Achocalla, Vignanello, Respecshow. M: "ATMOSPHERE", 2002. - P.59-70.

2. Paleev NR, Chereiskaya R.K., shows and N.A., Spinnin ACTING /Doctor/. 2001. No. 11. P.12-15.

3. Perelman, Y.M., Nachamkin L.G. Method of predicting the state of newborns from women with bronchial asthma / Pat. 2328215 IPC RU AV 5/08 No. 2007113070/14. Declared 09.04.2007; Publ. 10.07.2008 // bul. No. 19.

4. Bondarenko V.V. Autonomic regulation of the heart and hemodynamics in pregnant women with the syndrome of hypertension / abstract. dis. ... candles. the honey. Sciences. Vladivostok. 1995. 26 C.

5. Nachamkin G., Perelman, Y.M. Regional features of ventilation and hemodynamics of the pulmonary circulation in patients with uncomplicated pregnancy // human Physiology. 1988, C. No. 3. S-459.

A method for predicting the condition of newborns from women with bronchial asthma of mild severity, by studies of regional lung function, characterized in that in pregnant women, patients with bronchial asthma of mild severity, in nepristupny period determine the functional state of the autonomic nervous system by the method of cardiotocography and the overwhelming influence of the sympathetic, through techniques of zonulin the th rheography of the lungs the degree of participation (in %) of the Central zone of the left lung in vozduhonosnye lungs (TOSSL%) and the propagation time of the pulse wave from the heart to the middle zone of the left lung (qaSSL), and then determine the forecast for the newborn with discriminant equation:
D=-0,054·TOSSL%-11,781·qaSSLwhen D is equal to or more -2,55 predict the birth of a child in a satisfactory condition, when D is less -2,55 predict the birth of a child in a state of asphyxia.



 

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