Method for vegetative balance correction in patients with acute myocardial infarction

FIELD: medicine.

SUBSTANCE: invention refers to rehabilitation and preventive medicine, cardiology, therapy. It involves drug-induced therapy and a course of cardiorespiratory training with biological feedback (BF) presenting a cardiorhythmography (CRG) and a reference cyclic curve (RCC) to the patient to be matched under continuous visual control. It is followed by active (BF-assisted) and non-active (BF-unassisted) 2-minute tests with the first and last test of each session are non-active (NT). The first NT involves recording reference data of patient's cardiorespiratory system with evaluating the parameters as follows: RCC amplitude, period and continuous component matched with average heart rate on the following active test (AT). The test are automatic, individual for the patient as for the moment of testing with the use of an apparatus for functional psychophysiological correction comprising units described in the patent claim. Each following AT requires forming RCC with the use of average heart rate, amplitude and period on the basis of spectral analysis of CRG and CC of the previous AT. In the beginning of the procedure, the patient is set up to successful completion of the task, 5 s after the beginning of each AT, an audio signal (1 kHz, 300 ms, 30 dB above a threshold of audibility) is supplied. Before the beginning of the course and after each session and the whole course, the patient is tested to determine a level of reactive and personal anxiety and depression by stating the required number of sessions for recovery of cardiorespiratory synchronisation and normal heart rate and blood pressure. Before the first NT and after each AT, capnometry is used to determine the concentration of CO2 in expired air. If observing decrease, respiratory depth is corrected. If maintaining CO2 in expired air after each following AT less than 95% from reference, respiratory depth is corrected during the following AT under control of capnometry to achieve the concentration of not less than 95% from reference. The therapeutic course includes at least 5 sessions, 1 session daily or every second day to recover the respiratory pattern lost due to the disease and the biorhythmological structure of heart rate.

EFFECT: method eliminates subjectivity of the respiratory parameters specified by a searcher, and hyperventilation syndrome due to objective control of respiratory depth with improved heart rate variability.

1 ex, 3 tbl, 3 dwg

 

The invention relates to medicine, particularly cardiology, therapy, rehabilitation and preventive medicine, and can be used for disorders of functional status, as well as organic pathology, for example, the cardiovascular system, in particular, in patients with acute myocardial infarction (AMI) for the correction of vegetative balance, namely to restore the parasympathetic activity of the autonomic nervous system.

Autonomic balance in patients with AMI is changed in the direction of increasing the activity of the sympathetic division of the autonomic nervous system. This is reflected in a reduced heart rate variability (HRV), which is an independent negative prognostic factor in patients after myocardial infarction.

There are ways of medication used in patients with myocardial infarction, in order to compensate hemodynamics, relapse prevention, prevention of possible complications, such as early post-infarction angina, arrhythmias and conduction, and ventricular arrhythmias (extrasystoles, tachycardia, ventricular fibrillation). The latter is due to autonomic imbalance that occurs in conditions of myocardial damage.

The set of drugs may undergo various changed who I am depending on hemodynamic parameters (blood pressure - HELL, heart rate - heart rate, presence of comorbidity, underlying disease course (AMI) and possible complications at different stages of the disease [Selected questions of practical cardiology. Aiyasi and other SRF. State medical Academy named after I.I. Mechnikov. SPb. 2001, s-115].

Medication used in myocardial infarction with the goal of improving existing autonomic imbalance, limited to the application of blockers of beta-adrenergic receptors and, to a certain extent, angiotensin-converting enzyme inhibitors/receptor blockers angiotensin II (ACEI/ARA), acting mainly on the sympathetic branch of the autonomic nervous system (ANS), reducing its activity, but did not affect the increased activity of the parasympathetic division of the ANS.

In addition to drug therapy of AMI, you can use methods of adaptive psychophysiological support standard treatment regimens (combined effect), potentiating the action of drugs, using hardware and software.

As a prototype for closest to the technical nature of our chosen way of correcting physiological condition using the method of biofeedback (BFB). The correction method of the autonomic balance in patients with acute myocardial infarction" [SPO is about the correction of autonomic balance in patients with acute myocardial infarction. RF patent №2249427. Publ. 10.04.2005. Bull. No. 10]. The method is performed by a visual presentation to the patient of his own cardiotocogram (CWG). As the target functions use the frequency variations of the rhythm, and breath is produced by raising the heart rate, and breathing out is produced by reducing the heart rate. During the session, breathing exercise, inhale and exhale made on the account, and the inhalation and exhalation should be equal in length and are each 1/2 period of the respiratory wave cardiotocogram, and during the first session the patient spends respiratory movements without biofeedback under the supervision of a physician. Subsequent sessions of the course correction is performed with the synchronization of breathing and heart frequency variability. The method is carried out, starting with 7-10 days of acute myocardial infarction background drug exposure, the correction course of 8-10 sessions. Before and after a course correction on a 5-minute records ongoing assessment of heart rate variability and evaluate the effectiveness of the training.

Significant disadvantages of this method are:

- Subjectivity asked the specialist respiration parameters

In fact, the pattern of breathing (frequency, depth, the ratio of the phases of inhalation and exhalation) forms the special the sheet, conducting a correction procedure. The doctor does not know the value of the period own harmonic CRF patient. The absence of respiratory waves in cardiotocogram, due to the rigidity of the heart rhythm in patients with AMI in conditions of imbalance in the autonomic nervous system, makes the combination of private CRF and the reference periodic curve, which almost all patients experience excessive stress during training, especially at the first session.

In addition, it is not considered state neurohumoral link the regulation of heart rhythm (SR), which polyharmonically process that leads to the real possibility of a discrepancy between the rhythm of breathing, asked these operations, with the range of oscillations of the CF, which took place before the disease of the individual patient.

Thus, subjectively set by the specialist respiration parameters may not correspond to or contradict the individual features of the respiratory pattern of the patient, which could cause hyperventilation.

- The lack of objective control of the depth of respiration

Due to the lack of objective control of the depth of breathing some patients may develop hyperventilation syndrome, which can manifest symptomatic hypotension, dizziness is, angina, arrythmia.

Thus, the method chosen as a prototype, not fully realizes the potentialities of cardiorespiratory training (therapeutic, prophylactic or diagnostic effect), security treatment of the patient, which limits its application in organic diseases of the cardiovascular system, namely in patients with AMI.

The objective of the invention is to increase the efficiency of correction of autonomic balance using cardiorespiratory training in patients with AMI due to the improvement of heart rate variability.

The technical result of the invention is the elimination of subjectivity asked the specialist respiration parameters due to the automatic selection of the parameters of the reference periodic curve and the exception hyperventilation syndrome due to objective control of the depth of breathing when performing correction of autonomic balance in patients with AMI.

The technical result is achieved in that the method consists of medical treatment and of course cardiorespiratory training with biofeedback, which includes a visual presentation of the patient's own cardiotocogram and the reference periodic curve with continuous visual control by the patient alignment actually is cardiotocogram and the reference periodic curve. The sessions consist of active using biofeedback and inactive, without its use, two-minute samples, while the first and last sample of each session are inactive. When the first functional test record source data cardiorespiratory system of the patient at this point in time, and based on these data, determine the parameters of the reference periodic curve is the amplitude, period, and the DC component corresponding to the average heart rate on the next test. Each test session cardiotraining carried out automatically for each individual patient's condition at the time of the sample through the device for the implementation of functional physiological correction of the human condition, including the breath sensor and the sensor cardiomegaly installed on the patient, the amplifier block cardiomegaly and formation of cardiotocogram, block statistical and spectral analysis of heart rhythm, the block determination period/frequency of the reference periodic curve in the range of fast and slow waves, the block determining the amplitude of the reference periodic curve, the block determining the DC component of the reference periodic curve, the block normative physiological parameter values of heart rate and store the results statistics is systematic and spectral analysis of cardiotocograms the patient, the unit generating the reference periodic curve with the given parameters, the monitor unit calculation of the coefficient of crosscorrelation (QC), between cardiotocograms patient (CWG) and the reference periodic curve, the unit QC comparison with the tabulated value at the significance level of differences at 0.05, electronic keys, mode switch. To build the reference periodic curve for each of the next active samples the parameters of this curve is the average heart rate, amplitude and period is automatically formed on the basis of spectral analysis of cardiotocograms (CWG) and coefficient of crosscorrelation previous active samples. At the beginning of the procedure, the patient is set up on the successful execution of the job based on the combination of their own cardiotocogram with reference periodic curve, then after 5 seconds from the beginning of each active sample automatically include the audio frequency signal of 1 kHz, pulse duration of 300 MS, the intensity of 30 dB above the threshold of human audibility, signaling the beginning of the active phase of the sample. Before the course cardiorespiratory training provide individual psychological testing of the patient that determines the level of reactive and personal anxiety and depression caused by painful condition of the patient, with repeat testing after the end of active sampling session and of course Cardi is respiratory training, the results of which are set individually the required number of sessions, providing support to restore or create cardiorespiratory synchronization with the achievement of normal values of heart rate and blood pressure. Before the first inactive samples are capnometry, which consists in determining the concentration of carbon dioxide in the exhaled breath of the patient air. After conducting each active sample also measure the concentration of carbon dioxide in the exhaled breath of the patient air and decreasing from the initial value correction of deep breathing. After correction of respiration depth, provided the continuing concentration of carbon dioxide in the exhaled breath of the patient air of less than 95% of the initial value measured after each subsequent active samples, correction of deep breathing during the next active samples under the control of capnometry. Correction depth breath, held after each regular active samples, carry out to achieve the concentration of carbon dioxide in the exhaled breath of the patient air of at least 95% of the original value. The course includes at least 5 sessions to restore the patient lost due to disease of the breathing pattern and restore bioecological patterns serdechnog the rhythm of the patient.

The method is as follows.

Physiological effects of exercise on the background of the medication, including beta blockers-adrenergic receptors, angiotensin converting enzyme inhibitors or antagonists of angiotensin II receptors, disaggregants, statins.

The method is implemented using the devices: 1) a Device for implementing the functional physiological correction of the human condition. RF patent for useful model №43143. Publ. 10.01.2005. Bull. No. 1. 2) Ultrasonic capnometer KP-01 - LAMED".

The structural scheme of the device represented in figure 1, where 1-14 - blocks of device:

1 - sensor cardiomegaly installed on the patient, 2 - block amplifier cardiomegaly and formation of cardiotocogram, 3 - unit statistical and spectral analysis of cardiotocograms, 4-block determination period/frequency of the reference periodic curve in the range of fast and slow waves, 5 - unit determine the amplitude of the reference periodic curve, 6 - block determine the DC component of the reference periodic curve, 7 - block normative physiological parameter values of heart rate and storing the results of the statistical and spectral analysis of cardiotocograms patient, an 8 - unit generating a periodic reference curve, 9 monitor 10 to the computing unit coeff is the patient should therefore be crosscorrelation (CC) between the KRG and the reference periodic curve, 11 is a block QC comparison with the tabulated value at the significance level of differences at 0.05, 12 and 13 of the electronic key 14 - mode switch (source and a control sample position key down, active training samples - up).

The principle of operation of the utility model. To conduct training (active) sample records information about the source patient. From patient 1 electrocardiogram entered in block 2, where it is amplified and is formed corresponding cardiotocogram (CWG), the latter comes on the screen of the monitor 9 and the unit of statistical and spectral analysis of cardiotocograms 3, which is connected an electrical links information via the mode switch 14 (down position) blocks 4, 5, 6, and direct connections to the unit 7. Data statistical and spectral analysis in the form of electrical signals are entered in the block normative physiological parameter values of heart rate and storing the results of the statistical and spectral analysis of cardiotocograms patient 7, the frequency response range AWG patient arrives in the block definition of the period/frequency of the reference periodic curve in the range of fast and slow waves 4, amplitude characteristics range AWG come to block determine the amplitude of the reference periodic curve 5, the Yaya variation is introduced in the definition block DC component of the reference periodic curve 6. The block 7 is connected to the electrical information ties with blocks 4, 5, 6, which in turn is connected to the unit 8. In unit 4 is determined by the fundamental harmonic AWG (maximum amplitude) in the range that captures the slow and fast waves (4-12 seconds), the unit 7 determines whether the harmonica to a range of respiratory waves. If "Yes", then its period equal to the period of the periodic reference curve shown in the first training sample, if "no", then automatically selected harmonic component with the maximum amplitude is related to the range of respiratory waves and its period equal to the period of the periodic reference curve shown in the first training sample. Physically this is done through the communication unit 4 unit 8. In block 5 determines the maximum amplitude of the harmonics from a range of respiratory waves. If this amplitude does not exceed the limits of variation of the scale CWG stored in block 7, then it equals the amplitude of the periodic reference curve shown in the first training sample. Physically this is done through the communication block 5 block 8. In block 6 is determined by the average heart rate in the original sample. If the average heart rate lies within the physiological norm controlled by the block 7, it determines the level of the DC component of the reference if the ow curve, if the average heart rate in the original sample is above or below the physiological norm, the level of the DC component of the reference periodic curve for a first training sample set, respectively, above or below the average heart rate in the original sample by 5%. Physically this is done through the connection block 6 block 8. Thus, in block 8 is automatically generated reference periodic curve with the given parameters, which in practice (active) the sample is introduced onto the screen of the monitor 9 simultaneously with the KRG. The task of the patient is to use continuous visual feedback for combining two curves, one of which is cardiotocogram can be arbitrarily changed by the patient's breath (breath, heart rate increases, CWG goes up; when you exhale the heart rate decreases, the CWG goes down).

In practice mode, sampling unit amplification and formation AWG 2 is connected with the computing unit factor crosscorrelation 10, and the unit of analysis 3 through the switch 14 (up) and through the electronic switches 12 and 13 are connected to the blocks 4, 5, 6. Reference periodic curve with unit 8 enters the unit 10, calculates the coefficient of crosscorrelation between the KRG and the reference periodic curve, the value of which in the block 11 is compared to the table at a confidence level of significance of differences at 0.05.

E. what if after the first and subsequent training samples CRF patient and the reference periodic curve correlated among themselves on the level of probability of significance of differences less than 0.05, that is, there was significant correlation between CRF and the reference periodic curve (the task has completed successfully), the electrical signal from the unit 11 opens the electronic key 12. Then the unit 3 through the switch 14 (up) is connected to the inputs of blocks 4, 5, 6, which, together with the block 7 to produce an automatic adjustment of the parameters of the reference periodic curve for the next training sample by minor complications - saving period, the increase in amplitude within the variation of the scale, but not more than 5%, the reduction or increase in the permanent component is also within 5%, if the average heart rate is above or below the physiological norm. Electric information communication blocks 4, 5, 6 unit 8 organize the generation of the reference periodic curve with the new settings for future training samples. If after the first and subsequent training samples CRF patient and the reference periodic curve is not correlated with each other (probability level of significance of differences of more than 0.05), there was a difference between the CRF and the reference periodic curve (the task is not completed), then the electrical signal from the unit 11 opens the electronic key 13. Then the unit 3 through the switch 14 (up) is connected to the other inputs of blocks 4, 5, 6, which, together with the block 7 produce avtomaticheskie parameters of the reference periodic curve for the next training sample by a slight simplification.

The main reason for the lack of correlation between CRF and the reference periodic curve is the difference (discrepancy) their main periods (harmonics with maximum amplitude), so the period of the periodic reference curve in subsequent training sample is changed to the value of the period of the neighboring harmonics in the spectrum to the right or to the left from what was specified in the previous training sample within the range of 4 to 12 seconds. The amplitude falls within the variation of the amplitude is not more than 5%, the DC component is reduced or increased by 5%, if the average heart rate is above or below the physiological norm. Such a selection is made for each sample in all sessions.

Targeted psychophysiological effect is due to the alternating visual biofeedback on heart rate correction depth breathing using capnometry (figure 2, figure 3).

Figure 2 presents the structural scheme for the implementation of the method, where a 15 - patient; 1 - sensors for registration of cardiotocogram; 9 - computer monitor; 16 - a device of the utility model; 17 - set reference periodic curve (sine wave); 18 - cardiotocogram patient; 19 - mask capnometer; 20 - capnometer.

Figure 3 - option graphical information on the screen of the monitor 9, where 17 - cardiotocogram patient in 68 procardiaordering training; 18 - specified reference periodic curve.

Before cardiorespiratory training conduct psychological testing of the patient to determine the level of reactive and personal anxiety (test of Spilberger Hanina) and depression (test HADS)due to his ill health. Sessions cardiorespiratory training is carried out in a moderately lit, soundproof, well-ventilated room with a comfortable temperature. Patient 15 (nasal passages it should be free, clothes not to hamper normal breathing and circulation) seated in a comfortable chair at a distance of 1.5-2 m from the screen of the monitor 9. Domestic processed degreasing composition, the surface of the forearms impose fixed with an elastic band, not tightening hands, sensors 1, with which the electrocardiogram enters the blocks of the device of the utility model 16.

The patient is given 5-10 minutes to get used to the situation. Measure blood pressure (BP). To create the internal attitude of successful tasks and maintain the motivation of the patient 15 to explain the purpose and objectives of the training, presenting on the screen of the monitor 9 of his own cardiotocogram 17 associated with the condition of the body and having a form of a curve (figure 2 and figure 3), and pay attention to the dependence of its fluctuations from periodicaliy amplitude of breathing. It also stresses the need maximum relaxation during the trial of each session.

Cardiorespiratory training carried out daily or every other day and the course consists of not less than 5 sessions, each of them consists of 8-12 samples (trial duration 120 seconds), the first of which is the source or background (inactive), and the last control (inactive). In the inactive samples the patient is in a state of relaxed wakefulness with eyes closed (visual feedback is absent). In the intermediate training (active) samples using visual feedback due to the breathing of the patient influences the fluctuations of their own cardiotocogram 17, trying to combine them with the fluctuations of a given periodic reference curve 8.

Before the first inactive samples are capnometry, which consists in determining the concentration of carbon dioxide in the exhaled breath of the patient air (FetCO2) using ultrasonic capnometer KP-01 - LAMED" 20. To do this, the patient is at rest within one minute to produce a nose inhale and exhale in the individual mask capnometer 19 tightly against the nasolabial triangle faces. The registration device capnometer in real-time allows us to estimate FetCO2 each respiratory cycle, and software about the provisions accumulate capnogram each patient in the database and perform calculations with them. The definition of the original FetCO2 before you start training, you need to define conditional rules for this patient during this session to control the training process.

The initial stage of each two-minute sample session cardiotraining as follows: after 5 seconds from the start of registration automatically include the audio frequency signal of 1 kHz, pulse duration of 300 MS, the intensity of 30 dB above the hearing threshold of a person who signals the beginning of the active sample.

When conducting cardiorespiratory training by the present method automatic selection of the rhythm of the breath is carried out for each sample in all sessions throughout the course cardiorespiratory training.

In active training samples of each session the patient visually tracks presented on the monitor screen of the reference periodic curve 18. The patient sees on the screen oscillations his cardiotocogram 17, which is close to the period of the tempo of his breathing, allowing the patient to spontaneously adapt to presented on the screen of the reference periodic curve. The patient carries out the adjustment due to muscle relaxation, frequency and depth of breathing.

After conducting each active sample also measure the concentration of carbon dioxide in the exhaled breath of the patient is th air and decreasing less than 95% of the initial value correction of deep breathing. After correction of respiration depth, provided the continuing concentration of carbon dioxide in the exhaled breath of the patient air of less than 95% of the initial value measured after each subsequent active samples, correction of deep breathing during the next active samples under the control of capnometry. Correction depth breath, held after each regular active samples, carry out to achieve the concentration of carbon dioxide in the exhaled breath of the patient air of at least 95% of the original value.

Thus, the patient in the course of cardiorespiratory training with biofeedback method provide the ability to account for arbitrary modulation breathing automatically come to an adequate for him to parameters of the reference periodic curve by period (4-12 seconds), the constant part of (60-75 beats per minute) and amplitude.

After each sample, measure blood pressure and impose its values in the computer memory. During the measurement the patient should rest with eyes closed for 2-3 minutes.

Psychological testing is repeated at the end of each session and total cardiorespiratory training.

The number of sessions carried out daily or every other day, maybe during the course of treatment from 5 to 20, and more before recovery, the patient lost due to the disease pattern of water the project and restore bioecological structure of the cardiac rhythm of the patient, favorable diagnostic sign of which is respiratory sinus arrhythmia. The number of sessions depends on the patient's diagnosis and his / her personal data : gender, height, weight, age, profession (physical or mental work), results of psychological testing, the initial state of the patient and its dynamics on the results of the training on the basis of objective data, computer analysis, presented in the form of various information materials: charts, tables, text conclusions on the monitor or printed on a printer self-assessment of the patient and doctor.

Distinguishing the essential features of the invention and the causal link between them and achieve

Sessions consist of active using biofeedback and inactive without using the two-minute samples, while the first and last sample of each session are inactive.

The presence in each session, the first inactive samples allows you to set the initial parameters of the cardiovascular system of the patient alone for their analysis and generate the reference periodic curve for subsequent active samples using an automated device.

The presence of each session last inactive samples allows you to monitor the cardiorespiratory training - cash is Chiyo cardiorespiratory synchronization without biofeedback.

- Each test session cardiorespiratory training carried out automatically for each individual patient's condition at the time of the sample through the device for the implementation of functional physiological correction of the human condition, including the breath sensor and the sensor cardiomegaly installed on the patient, the amplifier block cardiomegaly and forming cardiotocogram, block statistical and spectral analysis of heart rhythm, the block determination period (frequency) of the reference periodic curve in the range of fast and slow waves, the block determining the amplitude of the reference periodic curve, the block determining the DC component of the reference periodic curve, the block normative physiological parameter values of heart rate and storing the results of the statistical and spectral analysis cardiotocogram patient, the unit generating the reference periodic curve with the given parameters, the monitor unit calculation of the coefficient of crosscorrelation (QC) between (CWG) and the reference periodic curve, the unit QC comparison with the tabulated value at the significance level of differences at 0.05, electronic keys, mode switch.

Thanks to this device the correction method of vegetative balance with biofeedback on heart RIT is on the background of medication flows through the individual for a particular patient to the law of regulation of functional normalization parameters of the cardiovascular system. However due to the automatic selection of the parameters of the reference periodic curve sets the most suitable for a particular patient, the respiratory rhythm by which normal bioritmologicheskikh the structure of his heart rhythm, and in the state of relaxed wakefulness with eyes closed is restored (formed) cardiorespiratory synchronization.

Individual selection of the duration of the training ensures the safety of correction of autonomic balance, which is especially important for patients with rigid heart rate and anxiety-depressive disorders.

Due to computing and logical blocks in the process of using the device is implemented procedure targeted vozdeistvyia on the Central nervous system, the sympathetic and parasympathetic divisions of the autonomic nervous system, minimizing the chance of the subjective factor in the form of unintentional incorrect actions of the person conducting the procedure, which may require patient effort beyond its physiological range. It is important for patients with AMI, as the rehabilitation process flows individually.

Unit statistical and spectral analysis of cardiotocograms allows to estimate the average heart rate and spectral characteristics of heart rhythm - period value, and s is litude most pronounced harmonics of cardiotocogram (in the range of fast and slow waves) in the source and control samples held in the state of relaxed wakefulness with eyes closed, and all training (active) samples.

In the computing unit factor crosscorrelation between private CRF and the reference periodic curve is determined by the degree of success of the job based on the combination of both curves after each training active samples, and, accordingly, changing the amplitude and frequency parameters of the reference periodic curve.

On the basis of spectral analysis of CRF and coefficient of crosscorrelation formed the parameters of the reference periodic curve shown in each of the next training sample: constant component representing a specified average heart rate, amplitude and period (frequency).

Due to the presence of the block normative physiological parameter values of heart rate and storing the results of the statistical and spectral analysis of cardiotocograms patient, containing information about the proper values of physiological parameters of the heart rate, the device prevents the exit status of the patient within the limits of physiological norm.

At the beginning of the procedure, the patient is set up on the successful execution of the job based on the combination of their own cardiotocogram with reference periodic curve.

It is necessary to increase the motivation of the patient is and, that provides a more rapid and sustained formation of cardiorespiratory synchronization, and therefore more effective correction of vegetative balance.

- After 5 seconds from the beginning of each active sample automatically include a sound signal.

It is known that to focus on the execution of some task, that is, psychological preferences, needs 3-5 seconds. Therefore, in each of the active two-minute sample session cardiorespiratory training after 5 seconds from the start of registration active samples automatically include a sound signal, which signals the beginning of the active sample. This allows constrait the rhythm of the breath with the reference periodic curve. If the sample start without 5 seconds prior, the patient should immediately be included in the tracking mode the reference periodic curve. In the few seconds active samples are "blurred", and the end result of a particular sample is worse. When processing the results of the procedure the first 5 seconds of each active samples excluded from the analysis. Thus, there is motivation of the patient to the most successful task execution.

- The audio frequency signal of 1 kHz, pulse duration of 300 MS, the intensity of 30 dB above the threshold of human audibility, signaling the beginning of the active sample.

The audio signal, to the which signals the beginning of the active samples, has technical parameters (frequency of 1 kHz, a duration of 300 MS, the intensity of 30 dB above the hearing threshold of a person), due to audiometric data conversational speech. The value of the threshold of audibility is expressed in decibels, with zero sound pressure level is taken 2×10-4H/m2at a frequency of 1 kHz [L. Beranek Acoustic measurements. TRANS. from English. M, 1952, mainly 4, §4]. The duration of the signal is such that it is impossible to miss and, at the same time, it is quite short and almost does not reduce the duration of active samples. The intensity of 30 dB above the hearing threshold of a person chosen because according to the scale degrees of hearing loss the patient's hearing is normal, if at all frequencies thresholds of audibility does not exceed 25 dB.

- Before starting the course cardiorespiratory training provide individual psychological testing of the patient that determines the level of reactive and personal anxiety and depression caused by painful condition of the patient, with repeat testing at the end of each session and of course cardiorespiratory training, the results of which are set individually the required number of sessions, providing support to restore and/or create cardiorespiratory synchronization with the achievement of the values of the heart rate of C and blood pressure are normal.

It is known that patients with anxiety and depressive disorders is more pronounced autonomic imbalance and more complications in the course of myocardial infarction. It is also known beneficial effect of training method of biological feedback on the psychological status of patients with anxiety and depressive disorders. Psychological testing allows you to monitor the status of patients in the dynamics and to make an individual selection duration cardiorespiratory training.

- Before carrying out the first inactive samples are capnometry, which consists in determining the concentration of carbon dioxide in the exhaled breath of the patient air.

Capnometry, or measuring the concentration of carbon dioxide in the exhaled air (FetCO2), objectively reflects a measure of the adequacy of the minute ventilation quantity delivered by the blood to the lungs carbon dioxide.

Determining the concentration of carbon dioxide in the exhaled breath of the patient air before you start training, you need to determine the conditional norms for the patient to control the training process.

- After carrying out each of the active samples also measure the concentration of carbon dioxide in the exhaled breath of the patient air and decreasing from the initial value correction of deep breathing.

During the two-minute active training samples the patient combines curve, appearing in real time, with a reference periodic curve (for this particular sample) by changing the breathing pattern. The most common adverse event during the training is hyperventilation (increased minute volume of breathing by increasing the frequency and/or depth of breathing). It is a violation of the breathing pattern of Central origin, leading to an inadequate increase in alveolar ventilation.

Deliberate hyperventilation is falsely presented by the patient way to solve the tasks (matching curves on the screen). Unconsciously hyperventilation is one of the false ways of solving the problem caused by emotional stress. Hyperventilation leads to a change in the gas composition of the blood, namely the reduction of carbon dioxide tension in arterial blood (Rasa), as judged by reduction FetCO2. Despite the sluggishness of the testimony FetCO2 changes in minute volume of respiration affect the concentration of carbon dioxide in the exhaled air through several breathing cycles, sometimes after 1-2 minutes Hyperventilation, depending on the degree of reduction FetCO2 can lead to clinical manifestations of hyperventilation syndrome, such as dizziness, decreased systemic blood pressure, syncope; reduced coronary blood flow with the advent of minasny pain and arrhythmia.

To prevent development of undesirable hyperventilation syndrome need capnometry after each active sample. In the case of reducing FetCO2 more than 5% from the original values it is necessary to perform correction of the depth and frequency of breathing with the aim of understanding by the patient of their importance.

After correction of respiration depth, provided the continuing concentration of carbon dioxide in the exhaled breath of the patient air of less than 95% of the initial value measured after each subsequent active samples, correction of deep breathing during the next active samples under the control of capnometry; and a correction depth breath, held after each regular active samples, carry out to achieve the concentration of carbon dioxide in the exhaled breath of the patient air of at least 95% of the original value.

If after subsequent active samples FetCO2 remains lower than 95% of the original, then spend capnometry during the next active samples in order to correct depth and rate of breathing, that is the perception by the patient of their importance.

Capnometry carried out after each active sample or during each active sample as long as the patient does not possess the skill training in the absence of reducing the concentration of carbon dioxide in the exhaled air.

Course cardiorespiratory consists of not less than 5 sessions. Less than 5 sessions inefficient way. The number of sessions may reach 20 or more to restore lost due to disease of the breathing pattern and recovering bioecological patterns his heart rate, favorable diagnostic sign of which is respiratory sinus arrhythmia (cardiorespiratory synchronization).

Here is an example of executing the method.

The patient Pp.62 years (And a/b No. 20294), with a long Smoking history, burdened heart costitem diseases heredity, dyslipidemia entered an emergency order from a prolonged attack of angina pain. Given the clinical findings, ECG changes (Q wave and ST elevation in leads II, III, aVF), positive markers of necrosis of the myocardium, was verified myocardial infarction lower posterior wall of the left ventricle (LV). In the hospital the patient was assigned to standard medical therapy, including beta-blockers (egilok 25 mg/day), and ACE (Charter 2.5 mg/day), disaggregants (trombas 100 mg/day, silt 75 mg/day), statins (simvasta 10 mg/day), blocker aldosterone receptors (verospiron 25 mg/day), in the first day - nitropropionate (nitroglycerin) and direct anticoagulants (heparin) intravenous (IV). On the background of therapy of angina pain not had anticipated, and on the third day the patient was transferred from the division of resuscitation and intensive care units (ICUs) in the chamber of the cardiology Department. The increase in movement mode was carried out in a planned manner. The patient's condition and hemodynamics were stable. On

7 days of inpatient treatment were carried out surveys echocardiography (EchoCG), revealed dyskinesia basal segment of the posterior wall of LV, hypokinesia basal segments of the lower side and the lateral walls of the left ventricle when the safe ejection fraction (EF)equal to 72%and daily monitoring of ECG (SEE ECG), which were registered single ventricular premature beats (4 per day), steam ventricular premature beats (1 per day), paroxysmal supraventricular tachycardia (1 per day) and have not been registered ischemic ST segment changes. On the 8th day of inpatient treatment after explaining the objectives of the task and the nature of the proceeding adaptive biofeedback on heart rate the patient on a voluntary agreement started developing cardiorespiratory training, during which he received all scheduled drugs. The course duration was 7 days (with daily conduct 1 session). During this time the patient has completed 65 two-minute samples, 14 of which were inactive (first and last sample of each session).

Before cardiorespiratory training was conducted psychological testing: the level of personal anxiety (LT) SOS the start-UPS amounted to 38 points, the level of reactive anxiety (RT) - 46 points, the level of anxiety (A) on a scale HADS was 8 points, the level of depression (D) - 3 points.

Before cardiorespiratory training was evaluated by heart rate variability (HRV) stationary five-minute ECG recording at rest. Assessed the temporal and spectral indices of HRV: RRav - 1099 MS, AMO - 41%, SDNN - 40 MS, RMSSD - 17 MS, NN50 - 2, pNN50 - 0,73%, OHM - 1129 MS2, VLF - 419 MS2, LF - 695 MS2, HF - 15 MS2, LF/HF - 45,85.

Sessions cardiorespiratory training was conducted in conditions of relative peace (in the second half of the day, 1.5 hours after lunch) in a special room (in a moderately lit, soundproof, well-ventilated room with a comfortable temperature). The nasal passages of the patient were free, the clothes are not shy of normal breathing and circulation. The patient was seated in a comfortable chair at a distance of 1.5-2 meters from the screen. Domestic processed degreasing composition, the surface of the forearms imposed fastened with an elastic band, not constricted hand, sensors, from which the electrocardiogram was admitted to a device for implementing the functional physiological correction of the human condition.

All sessions began with background samples in the state of relaxed wakefulness with closed the eyes (without feedback), in which were recorded the original data cardiorespiratory system of the patient at a given time. Cardiotocogram (CWG) was formed from a variational series of RR-intervals of the electrocardiogram. Based on these data, a device for the implementation of functional physiological correction of the human condition is automatically determined parameters of the reference periodic curve (amplitude, period, and the DC component corresponding to the average heart rate (HR) to the next (active) sample.

Before performing the first background sample patient C. was capnometry using ultrasonic capnometer KP-01 - LAMED". Baseline FetCO2 was 4.6%.

In the beginning of the procedure the patient was set up on the successful execution of the job based on the combination of their own cardiotocogram with reference periodic curve. All tests were carried out in the state of relaxed wakefulness during visual presentation of the patient's own cardiotocogram and the reference periodic curve. During active samples, i.e. samples with biofeedback (with continuous visual control), the patient had to combine cardiotocogram with reference periodic curve. After 5 seconds from the beginning of each active sample is automatically included audio signal is astotal 1 kHz, duration of 300 MS, the intensity of 30 dB above the threshold of human audibility, signalisierung about the beginning of the active sample. After the first inactive and each sample session cardiorespiratory training automatically using devices individually for this patient as at the time given the success of the job was adjusted period random modulation of respiration within 4-12 seconds, amplitude, constant component within 60-75 beats per minute.

At the end of each sample, the patient was carried out measurement of HELL. During blood pressure measurement, the patient was sitting with his eyes closed.

At the end of the first active sample level FetCO2 according to capnometry was 4.1 percent, which accounted for 89% of the initial index FetCO2. As this rate was less than 95% of the original made the correction respiration depth with the aim of understanding by the patient of its importance. After the second active sample level FetCO2 (3,8%) amounted to 82.6% from the original. Next, the third active test was carried out under the control of capnometry with immediate correction of the depth of breathing in real time. At the end of the third active sample is FetCO2 was equal to 4.7%. After the fourth active sample is FetCO2 were 5.0%. In further capnometry while samples cardiotraining was not conducted because EIT is possible FetCO2 after an active samples did not fall below 95% of the initial index. Before the first inactive samples following sessions cardiorespiratory training was again carried out capnometry with the definition of initial values FetCO2. Capnometry after an active trial session cardiotraining values FetCO2 was not decreased below 95% of the initial index.

Each session ended with a background account without biofeedback in the state of relaxed wakefulness with eyes closed.

Own harmonic cardiotocogram inactive samples were detected after the first two sessions. In the active samples of the first session is the period of the harmonic of the reference periodic curve was 10,71 with and 11,78 with amplitude 0,020-0,028 C. In the samples of the last two sessions (as in the active sample and background) program is clearly distinguished private harmonic of the reference periodic curve: period 9,81 with and 10,71 and amplitude 0,040-0,059 C. At the first session after the first inactive samples the HELL was 108/72 mm Hg, heart rate of 50 per minute, at the last session after the last inactive sample AD 102/74 mm Hg and heart rate at 65 per minute.

During the course of cardiorespiratory training deterioration of health, symptoms of hyperventilation (symptomatic hypotension, dizziness, angina, arrhythmia), deterioration of psychological testing were noted.

The results of the latter the CSOs testing upon completion of the course cardiorespiratory training were the following: the level of personal anxiety (LT) - 33 points the level of reactive anxiety (RT) - 36 points, the level of anxiety (A) on a scale HADS was 5 points, the level of depression (D) - 2 points.

Also at the end of cardiorespiratory training was evaluated by heart rate variability (HRV) stationary five-minute ECG recording at rest. Assessed the temporal and spectral indices of HRV: RRav - 975 MS, AMO - 35%, SDNN - 45 MS, RMSSD - 20 MS, NN50 - 3, pNN50 - 0.97%, and OM - 2107 MS2, VLF - 407 MS2, LF - MS2, HF - 55 MS2, LF/HF - 29,48.

On the background of cardiorespiratory training and medical treatment for myocardial infarction was without complications. Recovery of motor activity corresponded to the timing of rehabilitation. HELL was stabilized at 110 or 115/75 mm Hg, symptoms of congestive heart failure were not found. In the clinical analysis of blood normalized number of cells (9*10*9/l to 5.9*10*9/l), normalized ESR (11 mm/h). Normalized Cfabs and CPK-MB. ECG was recorded natural dynamics of the QRS-T in leads II, III, aVF. According to the re-CM-ECG registrations extrasystoles was no significant change (single supraventricular 7 per day, paired supraventricular extrasystoles 2 per day), ischemic ST changes were not registered.

On the 15th day of inpatient treatment and uncomplicated myocardial MIC is RDA the patient was discharged to outpatient rehabilitation stage.

The inventive method was tested in 23 patients with AMI. The comparison group (method prototype) was 27 patients with AMI.

Table 1 presents characteristics of the examined patients. Group of AMI patients was not significantly different nor by sex and age characteristics, either on clinical grounds or by the structure of the resulting drug therapy.

Table 2 shows the comparison of heart rate variability by the present method and the method prototype. As seen from the tabular data, baseline HRV in a group of patients by the present method and by the method prototype was not significantly different. After cardiorespiratory training in the "present method" more indices of HRV has a significant positive dynamics than in the group on the way to the prototype. Namely, in this group of patients showed significant decrease in AIA and JOHN (suggest a decrease sympathetic activity ANS), the increase RRav, RMSSD, NN50 and pNN50 (indicate increased activity of the parasympathetic ANS), as well as the increase in SDNN, CV, Ω, VLF, LF, HF (characterized by the increase in total heart rate variability and backup capabilities by increasing the total level of vegetative regulation), while in group "is the procedure prototype" there was a significant increase only RMSSD and OM, and improve other indicators of HRV was observed as a trend. After cardiorespiratory training indicators NN50 and pNN50, indicating parasympathetic influences ANS, significantly were higher in the group "the present method".

Table 3 presents comparative data on manifestations of hyperventilation syndrome "claimed method" and "method prototype". As seen from the tabular data, the groups significantly differed on undesirable manifestations. In the group of patients "in the way the prototype was observed in 6 cases out of 27 symptoms of hyperventilation syndrome: 1 - dizziness without reducing HELL lower than 90/60 mm Hg, 2 cases reduce blood pressure below 90/60 mm Hg without other clinical manifestations, 1 case of occurrence of anginal pain at follow-up in hospital, 2 cases of occurrence of arrhythmia during cardiorespiratory training. In the "present method" symptoms of hyperventilation syndrome was not observed.

Thus, the inventive method of correction of autonomic balance in patients with acute myocardial infarction eliminates hyperventilation syndrome due to objective control of the depth of breathing when performing correction of autonomic balance in patients with AMI, and also to eliminate subjectivity asked the technician couples the meters of breath due to the automatic selection of the parameters of the reference periodic curve, that, in turn, improves heart rate variability and increases the efficiency of correction of vegetative balance in these patients.

Table 1
Characteristics of the examined patients.
SignsBy the present method (n=23)According to the method prototype (n=27)
Age52,26±1,63 years53,38±1,49 years
Gender male2126
Front of THEM1014
Q-IM1822
GB1620
Drugs:
β-blockers2327
ACEI/ARA2327
disaggregants2327
statins2027

Table 2
Comparative data on the heart rate variability by the present method and the method prototype
Indices of HRVBy the present method (n=23)According to the method prototype (n=27)
toaftertoafter
RRav, MS958,50±47,601041,66±60,17*915,10±22,77913,30±20,35
AMO, %65,16±3,2453,33±4,05*60,40±2,6358,70±3,47
SDNN,MSof 25.66±of 2.5133,00±3,61*23,90±1,9126,80±2,38
CV %2,66±0,16 3,12±0,19*2,62±0,212,91±0,22
RMSSD, MSequal to 16.83±1,6222,00±2,66*15,24±1,9618,42±2,47*
NN502,33±0,8210,50±4,07*5,50±2,586,20±2,61
pNN50,%0,86±0,334,48±2,01*1,78±0,852,11±0,93**
JOHN264,50±32,90164,83±24,21*242,04±28,39226,61±33,64**
MD, MS2564,16±101,481003,00±253,16*499,90±80,58696,50±132,42*
VLF, MS2374,16±88,08655,50±229,66260,71±32,37343,98±61,46
LF, MS2129,00±23,33242,33±56.78 has*162,43±32,85258,96±70,05
HF, MC 51,00±9,59105,16±19,85*76,93±20,2593,81±26,53
LF, %66,22±3,3866,12±5,0668,79±3,2669,41±3,69
HF, %33,77±3,3833,87±5,0631,20±3,2630,58±3,69
LF/HF2,33±0,372,91±0,653,11±0,56with 4.64±1,27
* - p<0,05 when comparing one group before and after cardiorespiratory training
** p<0,05 when comparing the two groups before and after cardiorespiratory training

Table 3
Comparative data on manifestations of hyperventilation syndrome by the present method and the method prototype
The symptoms of hyperventilation syndromeBy the present method(n=23)Along with the person prototype (n=27)
Dizziness01
The reduction of blood pressure<90/60 mm Hg02
Angina01
Arrythmia02
Only06*
* - p<0,05 when comparing two groups

The correction method of the autonomic balance in patients with acute myocardial infarction, including drug treatment and rate of cardiorespiratory training with biofeedback, which includes a visual presentation of the patient's own cardiotocogram and the reference periodic curve with continuous visual control by the patient alignment own cardiotocogram and the reference periodic curve, characterized in that the sessions consist of active using biofeedback and inactive without its use - two-minute samples, while the first and last sample of each session are inactive; and when the first inactive sample fix the source data of cardio-respiratory system of the patient at a given time, and based on these data, determine the parameters of the reference periodic curve is the amplitude, period, and the DC component corresponding to the average heart rate on the next sample; each sample session carried out automatically for each individual patient's condition at the time of the sample through the device for the implementation of functional physiological correction of the human condition, including the breath sensor and the sensor cardiomegaly installed on the patient, the amplifier block cardiomegaly and formation of cardiotocogram, block statistical and spectral analysis of heart rhythm, the block determination period/frequency of the reference periodic curve in the range of fast and slow waves, the block determining the amplitude of the reference periodic curve unit definition a permanent part of the reference periodic curve, the block normative physiological parameter values of heart rate and storing the results of the statistical and spectral analysis of cardiotocograms patient, the unit generating the reference periodic curve with the given parameters, the monitor unit calculation of the coefficient of crosscorrelation (QC) between cardiotocograms patient (CWG) and the reference periodic curve, the unit QC comparison with the tabulated value at the significance level of discern which of 0.05, electronic keys, mode switch, and to build a reference periodic curve for each of the next active samples the parameters of this curve is the average heart rate, amplitude and period are automatically formed on the basis of spectral analysis of cardiotocograms (CWG) and coefficient of crosscorrelation previous active samples; at the beginning of the procedure, the patient is set up on the successful execution of the job based on the combination of their own cardiotocogram with reference periodic curve, then after 5 sec after the start of each active sample automatically include the audio frequency signal of 1 kHz, pulse duration of 300 MS, the intensity of 30 dB above the threshold of human audibility, signaling the beginning of the active phase samples; the beginning of the course cardiorespiratory training provide individual psychological testing of the patient that determines the level of reactive and personal anxiety and depression caused by painful condition of the patient, with the repetition of alloying at the end of each session and of course cardiorespiratory training, the results of which are set individually the required number of sessions, providing support to restore or create cardiorespiratory synchronization with the achievement of normal values of heart rate and blood pressure;before the first inactive samples are capnometry, consisting in the determination of the concentration of carbon dioxide in the exhaled breath of the patient air, after carrying out each of the active samples also measure the concentration of carbon dioxide in the exhaled breath of the patient air, and decreasing from the initial value correction of deep breathing, which provided continuing concentration of carbon dioxide in the exhaled breath of the patient air of less than 95% of the initial value measured after each subsequent active samples, correction of deep breathing during the next active samples under the control of capnometry, and the correction depth breath, held after each regular active samples, carry out to achieve the concentration of carbon dioxide in the exhaled breath of the patient air not less than 95% of the initial value; a correction course - at least 5 sessions, held on 1 session every day or two to restore the patient lost due to disease of the breathing pattern and restore bioecological structure of the cardiac rhythm of the patient.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to pulmonology. By method of spirometry volume of forced exhalation for 1 second (CFE1) in % from proper values is determined. By means of questionnaires of general and specific life quality (LQ) Medikal Outcome Study SF-36, (MOS SF-36) and St. George's Respiratory Questionnaire (SGRQ) parameters of scales: mental health (MH), social activity (SA), impact in points are determined. Discriminant equation: D=3.495·Impact+1.876·SA+3.039·MH-1.128·CFE1 is solved and if D value is lower than 355.16, positive type of motivation sphere to training in patients with COLD is diagnosed, if D value equals or is higher than 355.16, negative type of motivation sphere is diagnosed.

EFFECT: method ensures increased efficiency in diagnostics of type of motivation sphere to training in patients with chronic obstructive lung disease.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to methods of estimating degree of impairment of life activity in category "ability to self-service" in children of different age. By means of testing the following criteria are estimated: washing; care for parts of body, physiological functions, dressing, intake of food, drinking, care of their health, everyday life, each criterion of estimation of said abilities being evaluated in 4-point system. Testing is carried out for three age periods, previous to child's age at the moment of examination. Correspondence of criterion to age period in norm is evaluated as 3 points, lack of correspondence of criterion to age period in norm or delay in performance by one age period is evaluated as 2 points. Delay in performance by two age periods is evaluated as 1 point, delay by three age periods is evaluated as 0 points. Obtained points are summed up, total number of points, obtained in testing serves as estimation of degree of life activity limitations in said category in each age period. Deviation from maximal sum of points is calculated in percent and reduction of number of obtained points by 0-4% is classified as absence of life activity limitations, reduction by 5-24% - as insignificant limitations 1 degree, reduction by 25-49% - as moderately expressed limitations - 2 degree, reduction by 50-95% - as severe limitations - 3 degree, by 96-100% - as absolute limitation of life activity.

EFFECT: method makes it possible to determine life activity limitations in category ability to self-service in children of different age, as well as compose individual programme of rehabilitation.

1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to methods of estimating degree of life activity limitations in category "ability to orientate themselves" in children of different age. Testing by criteria, which characterise ability to orientate themselves is carried out. Estimated are: determination of time by surrounding signs, determination of location, determination of location of external objects, events and themselves with respect to time and space reference points, awareness of their own personality, mental image, scheme of body and its parts, perception and adequate response to coming information. Correspondence of criterion to age period in norm is evaluated as 3 points. Lack of correspondence of criterion to age period in norm or delay in performance by one age period is evaluated as 2 points. Delay in performance by two age periods is evaluated as 1 point, and delay by three age periods is evaluated as 0 points. Obtained points are summed up, total number of points, obtained in testing serving as estimation of degree of life activity limitations in said category in each age period. Deviation from maximal sum of points is calculated in percent and reduction of number of obtained points by 0-4% is classified as absence of life activity limitations, reduction by 5-24% - as insignificant limitations 1 degree, reduction by 25-49% - as moderately expressed limitations - 2 degree, reduction by 50-95% - as severe limitations - 3 degree, by 96-100% - as absolute limitation of life activity.

EFFECT: method makes it possible to determine degree of impairment of ability to orientate themselves in children of different age.

1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to methods of estimating degree of life activity limitations. Elaborated is point system of estimating degree of impairment of ability of control their behaviour in children of different age. Each criterion is evaluated by 4-point system, testing is carried out for three age periods, previous to child's age at the moment of examination. Correspondence of criterion to age period in norm is evaluated as 3 points. Lack of correspondence of criterion to age period in norm or delay in performance by one age period is evaluated as 2 points. Delay in performance by two age periods is evaluated as 1 point, and delay by three age periods is evaluated as 0 points. Obtained points are summed up, total number of points, obtained in testing serving as estimation of degree of life activity limitations in said category in each age period. Deviation from maximal sum of points is calculated in percent and reduction of number of obtained points by 0-4% is classified as absence of life activity limitations, reduction by 5-24% - as insignificant limitations 1 degree, reduction by 25-49% - as moderately expressed limitations - 2 degree, reduction by 50-95% - as severe limitations - 3 degree, by 96-100% - as absolute limitation of life activity.

EFFECT: method makes it possible to determine degree of impairment of ability to control their behaviour in children of different age.

1 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular, to medical physiology and laboratory diagnostics, and can be used for estimation of student's ability to form pathologic reactions (distress) in response to psychoemotional examination stress. In period of examination session levels of the following parameters are determined in blood of students: cortisol, IgM, IgA, amylase in blood serum, leptin in blood plasma, number of erythrocytes and lymphocytes in whole blood. Obtained results are evaluated, comparing obtained results of indices with three standards of distress criteria: standard 1: level of leptin lower than 3.6 ng/ml before exam and lower than 3.2 ng/ml after exam; level of IgM is lower than 1.5 g/l before exam and lower than 1.8 g/l after exam; level of IgA is lower than 1.4 g/l before exam; number of erythrocytes is higher than 4.8*1012 /l after exam; standard 2: level of cortisol is lower than 75 ng/ml before and after exam; level of leptin is lower than 3.6 ng/ml before exam and lower than 3.2 ng/ml after exam; level of IgM is lower than 1.8 g/l after exam; standard 3: level of cortisol is lower than 75 ng/ml before and after exam; level of lymphocytes is higher than 40% before exam; number of erythrocytes is lower than 4.5*1012 /l after exam; level of amylase is lower than 80 U/l after exam; level of IgM is lower than 1.8 g/l after exam. If results of testing correspond to at least one of standards of criterion values by 80% and higher, conclusion about predisposition of student to distress is made.

EFFECT: method makes it possible to predict unfavourable sequences of examination stress after several years of studying at higher educational establishment.

4 tbl, 3 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to functional diagnostics. Values of physiological parameters {Di, for each physiological parameter Di are determined. Boundaries of individual physiological norm are calculated in form of maximal (MAXp) and minimal (MINp) permissible values of this parameter. For each Di boundaries of group physiological norm are determined in form of maximal (MAXg) and minimal (MINg) permissible values of this parameter in group of people working under complex technogenic conditions. Value Fi is determined equal 0, if for parameter Di fulfilled is or respectively, is not fulfilled condition min<Di<max, where value MIN equals maximal of values of MINp and MINg, and value MAX equals minimal of values of MAXp and MAXg. Suitability of person for work under complex technogenic conditions is determined in cases when value of parameter G, calculated by formula does not exceed threshold value Gnop, where Ci are coefficients, whose values satisfy condition 0<Ci<0.5, N is number of physiological parameters.

EFFECT: method makes it possible to increase reliability of determination of person's suitability for work under thechnogenic conditions.

3 cl

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to neurology, neuropsychology and occupational pathology. Neuropsychological testing is performed with determination of indices of analytical and synthetic thinking, indices of calculation system: triple calculation, simple calculation operations; indices of conceptual thinking by selection of opposites in passive and active terms; visual and long-term memory; dynamic and spatial praxis; indices of visual gnosis: recognition of crosses images, recognition of superimposed images, finger gnosis. After that, discriminant function F is calculated, obtained result is compared with the constant and if F is higher than the constant, trained workers are referred to risk group, if F is lower or equals the constant - to group without signs of mercury impact on organism.

EFFECT: method makes it possible to increase accuracy of selection due to differentiation of genesis of brain injuries.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology, psychiatry and medical psychology, and can be used for prediction of efficiency of pharmacological correction of psychosomatic disorders in women in postmenaopausal period with arterial hypertension. Results of psychometric scales and questionnaires during the first visit: hospital scale of anxiety and depression HADS, Spielberger questionnaire, questionnaire for identification of signs of vegetative changes, scale of asthenic state (SAS), short scale of psychic status estimation (SSPSE), visual-analogous scale for estimation of expression of dream disturbance, "HAM" test. Coefficient of efficiency Cef is determined by means of the following equation: Cef=12.2677-0.00679756*age -0.158645*anxiety - 0.102177* depression+0.00839559* situation anxiety - 0.0124299* personality anxiety - 0.0240099* - vegetative disorders - 0.00929817* asthenia -0.195727* cognitive sphere - 0.00576782* dream disturbances + 0.0286554* health-0.0142442*activity - 0.00360372*mood. If coefficient is lower than 3.1 presumed efficiency of treatment with adaptol is estimated as low. If Cef is from 3.2 to 3.7, presumed efficiency of treatment with adaptol is estimated as satisfactory. If Cef is higher than 3.7, presumed efficiency of treatment with adaptol is estimated as high.

EFFECT: method makes it possible to ensure creation of diagnostic criterion for prediction of adaptol application efficiency in women in postmenopausal period with arterial hypertension in case of identification of psychosomatic disorders by testing.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to pedagogics, social sphere and can be used in work of institutions that deal with teaching, rehabilitation of maladjusted children and teenagers including socially neglected teenagers, unsuccessful, unaccepted in reference group and being in difficult life situation. Testing is carried out by selection of colour associated with being in said group. Testing is performed thrice. During testing members of the group choose cards of rectangular shape of preferred colour, maladjusted teenager chooses a card in shape of a circle of preferred colour, associated with being in said group. Cards are placed on tree crown. Tested member of the group can change position of card on the crown during their stay in the group. Transparent stencil in form of circle with radius equal to height of four rectangular cards is applied on the tree crown. Stencil centre is matched with the card of maladjusted teenager. Number of cards in the zone of circle is calculated and if in the zone of circle there are 50-100% of cards of the group members, group is considered cohesive, maladjusted teenager is considered to be integrated into the group. If in the zone of circle there are less than 50% of cards, the group is considered to be dissociated, and maladjusted teenager not sufficiently integrated into the group. Red, orange and yellow are considered to be positively stimulating colours, green is considered to be stabilising, violet, black are considered to be negative, adynamic. If maladjusted teenager chooses card of positively-stimulating or stabilising colour, their state is considered to be comfort, in case if negative colour is selected their state is considered to be non-comfort. Number of cards of each colour on the tree is calculated and number of cards of positively-stimulating and stabilising colour is determined and if their number is higher than 60%, staying of tested members of the group with maladjusted teenager in said group is considered to be comfort, if it is equal 60% or lower, staying in tested members of the group with maladjusted teenager in said group is considered to be non-comfort.

EFFECT: method makes it possible to obtain clear picture, reflecting relationship in the group and their development in the group in dynamics, estimation of process of maladjusted teenager socialisation in the group, as well as obtain objective assessment of formed relationship in the group resulting from the work of teachers and experts.

2 tbl, 4 dwg, 2 ex

FIELD: sports.

SUBSTANCE: invention relates to medicine and is designed to evaluate the accuracy of motor actions of an athlete of playing sports. A circle is shown to the testee on the screen of the monitor on which a label is placed and a point object moving at a given speed in a circle. The testee, observing the motion of the point object, at the time of the alleged coincidence of a moving point object with the label stops the movement of a point object in a circle by pressing the button "Stop". Then the error of non-matching of the point object and the label is calculated - the time of delay error with positive or pre-emption with negative sign, and after a specified time the motion of the point object in a circle is resumed. The testee performs the above procedure a given number of times, and then the maximum absolute value of the error of non-matching of the point object and the label is determined. Assessment of accuracy of the test motor action of the testee is taken equal to the maximum absolute value of the error of non-matching of the point object and the label.

EFFECT: method enables to evaluate the correctness of the decision-making and accuracy of motor actions of an athlete of playing sports, thus ensuring the reliability of the estimate.

8 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: continuous electrocardiosignal is recorded, filtered and presented as discrete records. In all derivations, the discrete records are summed over modulus. A threshold level is formed to be compared to a value of the sum over modulus of the discrete records of electrocardiosignal. A cardicycle, QRS-complex electrocardiosignal and R-R interval are extracted. In the extracted cardiocycle, values of derivatives Y' of the discrete records of electrocardiosignal are calculated. It is followed with extracting an interval of the values of an electrocardiosignal derivative belonging to the QRS-complex electrocardiosignal with the beginning and termination of the extracted interval of the values of the electrocardiosignal derivative are the beginning and termination of the QRS-complex electrocardiosignal.

EFFECT: more precise extraction of the beginning and termination of the QRS-complex.

3 cl, 11 dwg

FIELD: medicine.

SUBSTANCE: method involves determining hemoglobin concentration and leukocytes and monocytes content in 1 mm3 of peripheral blood. Rhythmocardiogram indices like all RxR intervals mean square value, total spectrum power, low frequency waves power in 0.15-0.04 Hz bandwidth are determined. Standardized index values are determined relative to their boundary values. Difference of peripheral blood and rhythmocardiogram standardized values sums is calculated. The difference being growing above zero, cardiac ischemia disease risk growing proportionally to difference value is diagnosed.

EFFECT: high prognosis accuracy.

2 tbl

FIELD: medicine, sports medicine.

SUBSTANCE: one should study the values for variability of cardiac rhythm at detecting standard deviation against mean arithmetic duration of the next R-R intervals per period of investigation (SDNN) and/or square root out of mean sum of differences squares between the next R-R intervals (r-MSSD) and/or spirography at detecting mean volumetric rate of output (MVR 25-75%) and/or calculating Tiffno's index determined as the ratio of forced expiratory volume (FEV)/sec (FEV1) to vital capacity (VC): (VC)-(FEV1/VC). In case of decreased SDNN value being below 100 msec and/or r-MSSD value being below 80 msec, and/or increased MVR 25-75% up to 120% and more against due value and/or decreased Tiffno's index being below 70% one should consider the prediction for the growth of professional skills of future ballet's artists to be unfavorable. The innovation provides an opportunity for objective prediction of skill growth based upon accurate quantitative criteria reflecting interaction between tonicity of autonomic nervous system and parasympathetic department of regulation against physical adaptation abilities of the body.

EFFECT: higher accuracy of prediction.

7 ex, 15 tbl

The invention relates to the field of medicine and is intended to determine the RR-intervals on the electrocardiogram

The invention relates to medicine, namely to anesthesiology, and can be used in various surgical manipulation, requiring anesthesia

The invention relates to medicine, namely cardiology, and can be used when conducting stress tests (VEM-test) for the diagnosis of coronary pathology

The invention relates to medical equipment, namely, devices for selection of characteristic points of ECG signal

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine and medical equipment, namely, to systems of image obtaining, in particular, to computed tomography. In first version of implementation system of image obtaining contains component of window management, which receives ECG signal, which contains premature cardiac cycle and preliminarily obtained X-ray projection data of beating heart. ECGF signal is synchronised with the time of preliminarily obtained X-ray projection data of beating heart. Component of window management places first reconstruction window within the limits of the first cardiac cycle to correspond desirable cardiac phase of preliminarily obtained X-ray projection data, when premature cardiac cycle ensures correspondence of the first reconstruction window to another cardiac phase. Such system contains device of reconstruction which reconstructs projection data, corresponding to multitude of windows of reconstruction of different cardiac cycles to create image data, characteristic of desirable heart phase. In second version of implementation system contains component of window management which deletes first reconstruction window corresponding to suboptimal cardiac phase of preliminarily obtained X-ray projection data of beating heart resulting from abnormal signal in ECG signal. ECG signal is presented in time with preliminarily obtained X-ray projection data of beating heart on multitude of heart cycles, and component of window management adds replacing reconstruction window to optimise set of data for reconstruction, basing on abnormal signal and available preliminarily obtained projection. System also contains reconstruction device which reconstructs set of data for reconstruction in order to create image data characteristic of desirable phase of heart beating. In third version of implementation system contains recommendation component which recommends reconstruction window for cardiac phase within the multitude of preliminarily obtained successive cardiac cycles based on ECG signal and arrhythmia in it, and device of reconstruction, which reconstruct data corresponding to data for each cycle, corresponding to reconstruction window. ECG signal is obtained with simultaneous scanning of beating heart by of computed tomographic scanner. In fourth version of implementation system contains component of window management which automatically changes location or moves first window of reconstruction for cardiac cycle on the basis of premature cardiac cycle within ECG, which is signal synchronised with preliminarily obtained X-ray projection data of beating heart; recommendation component which automatically recommends, at least, one additional reconstruction window, on the basis of premature cardiac cycle; and reconstruction device which reconstructs data, corresponding to reconstruction windows. In order to obtain image received is ECG signal which contains premature cardiac cycle, ECG signal is synchronised in time with preliminarily obtained X-ray projection data of beating heart by multitude of cycles of heart beating. After that, first reconstruction window is moved within the limits of first cardiac cycle, which corresponds to data, different from desirable cardiac phase as a result of premature cardiac cycle. Each from multitude of cardiac cycles contains reconstruction window. Then preliminarily obtained projection data, corresponding to multitude of reconstruction windows, are reconstructed to create image data, characteristic of desirable phase of heart beating. Group of inventions also contains computer-readable data carrier, which stores commands, which, when performed by computer, make computer perform claimed method of image obtaining.

EFFECT: application of claimed group of inventions will make it possible to increase quality of resulting data of reconstructed image.

34 cl, 10 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to pediatrics. In children of pre-school age with tuberculosis of intrathotacic lymph nodes indices of heart rhythm variability are determined: rhythmograms - interinterval differences RMSSD (ms), coefficient of variability CV (%), spectrograms - total spectrum power TR (ms2), very low frequency waves of spectrum VLF (ms2), low frequency waves of spectrum LF (ms2), high frequency waves of spectrum HF (ms2). If their values equal: interinterval differences RMSSD - 76.8±3.92, coefficient of variability CV - 9.9±0.50, total spectrum power TR - 3437±175.3, very low frequency waves of spectrum VLF - 1067±54.4, low frequency waves of spectrum LF - 1003±51.2, high frequency waves of spectrum HF - 1900.2±96,9 vegetative dysfunction is diagnosed.

EFFECT: method increases reliability of diagnostics of impairment of vegetative regulation in children with tuberculosis.

1 tbl, 1 ex

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