Method of predicting formation of infantile cerebral paralysis in children with extremely low and very low body weight at birth
SUBSTANCE: invention relates to filed of medicine, namely to pediatric neurology. Electroencephalographic examination of children's brain is performed in mode of drug-free afternoon sleep in corrected age of one month. In the phase of slow sleep quantity of sigma-spindles per one minute and their duration are determined. If quantity of sigma-spindles equals 2 and lower with duration 1 sec and shorter, formation of ICP in children with extremely low and very low body weight at birth is predicted.
EFFECT: method extends arsenal of means for prediction of formation of infantile cerebral paralysis in children with extremely low and very low body weight at birth.
2 tbl, 4 ex
The invention relates to medicine, namely to pediatric neurology, and allows us to predict the formation of cerebral palsy (CP) by the end of the 1st year of life in infants with extremely low and very low body weight at birth (Very low body weight at birth - weight less than 1500, Extremely low body weight at birth - weight of less than 1000 g).
The relevance of the proposed method is determined by the fact that at the present time have increased the survival rates of extremely premature infants. It is known that the role of the perinatal period in the formation of the pathology of the nervous system, enhancing the quality of life, high (1, 2). The frequency of perinatal CNS lesions in these children, according to various authors, ranges from 50% to 80%, and the percentage of severe neurological abnormalities ranges from 12% to 32% (3). Therefore, the prediction of such persistent neurological disorders like cerebral palsy, is an important task.
A known method for predicting cerebral palsy in term infants by determining the amount of diagnostic factors of a set of indicators (the duration of the dry period, the score on the Apgar scale, the use of dopamine or epinephrine, seduksen in 1-7 days of life, the presence of tracheal intubations, holding mask mechanical ventilation in the delivery room, the use of alpr the eve acid in 1-30 days of life) (Patent No. 2357655. Of The Russian Federation. A method for predicting cerebral palsy in term infants / Ironskin E.V., Shershnev NR. // Of the invention. The utility model. - 2009. No. 16). If the amount of diagnostic factors in descending order of information content at a certain step of the analysis is not less 0,68 patient is referred to the group of cerebral palsy. If the amount of diagnostic ratios equal to or less than (-) 1, 2, the patient is referred to the group for adults with cerebral palsy.
The disadvantages of the method:
1. The method is applicable only in term infants.
2. For predicting cerebral palsy is complex nonspecific indicators.
3. A high percentage of false-positive results.
A known method for predicting cerebral palsy by definition shmarikova acid in the urine (Lilin IT, ivanytska I.N. Current views on the etiology of cerebral palsy//Russian journal of pediatric. - 2002. No. 3. - P.35-40). At lower shmarikova acid in the urine predict the formation of cerebral palsy.
The disadvantages of the method:
1. The formation of cerebral palsy indirectly predicted by nonspecific indicator.
2. The method requires special reagents.
3. The implementation of the method is fraught with technical difficulties.
4. The lack of data on the accuracy of the method.
On the closer technical solution is a method for predicting cerebral palsy in children by conducting EEG studies in monitoring drug-free day dream the corrected age of 1 month (Adjusted age=gestational age (weeks) + chronological age (weeks) 40. (Degtyarev MG, Stroganova T.A., Rogatkin S.O., Volodin N.N., 2005) (Degtyarev MG, Stroganova T.A., Rogatkin S.O., Volodin N.N. Clinical and neurophysiological aspects of assessing the severity of post-hypoxic perinatal CNS lesions in newborns // Questions of gynecology, obstetrics and Perinatology. - 2005. - V.4, No. 1. - P.57-65), namely on the basis of visual expert assessment of the overall EEG sleep pattern, including Sigma-rhythm. The authors have developed a typological classification of EEG pattern in children adjusted age 1 month, reflecting a consistent grading the severity of violations of the functional state of the brain, with increasing severity from I to V type. In the presence of EEG - pattern IV and V type the baby the corrected age of 1 month of life predict the formation of cerebral palsy by the end of the first year of life.
The disadvantages of the method:
1. The authors do not take into account your way of children with extremely low body weight at birth, having features maturation of bioelectric activity of the brain.
2. The authors use a qualitative assessment of EEG indicators (presence or absence of basic rhythms, the main phases of sleep, zoned RA the differences bioelectric activity), that does not exclude subjectivity.
3. The method requires the determination of a large number of indicators, making it difficult to assess the results of EEG studies.
The technical result is to achieve a high accuracy of predicting the formation of cerebral palsy in infants with extremely low and very low body weight at birth and expansion of the Arsenal prognostic tools of this pathology.
The technical result of the proposed method is achieved by the fact that children with extremely low and very low body weight at birth in adjusted age 1 month perform electroencephalographic study of the brain with the characterization of Sigma-rhythm (Sigma-spindles): number of Sigma spindles for 1 minutes and their duration and the number of Sigma spindles equal to 2 or less, and the duration of 1 sec or less predict the formation of cerebral palsy.
The novelty of the method lies in the fact that for the first time to predict the formation of cerebral palsy in infants with extremely low and very low body weight at birth is suggested to use the quantitative characteristics of the Sigma-rhythm according to EEG studies.
Earlier qualitative characteristics of the Sigma-rhythm in combination with the results of visual analysis of General Algaterra sleep was used to assess the severity of post-hypoxic perinatal CNS lesions and predict its course in children born with different gestational age, corrected age of 1 month of life (3, 4).
As a criterion for predicting the formation of cerebral palsy in extremely premature infants selected quantitative electroencephalographic indicator Sigma-rhythm, because it allows us to estimate the functional state of the Central nervous system of the child and to obtain information about the formation of a brake functions of the cerebral cortex, in particular neurotransmitter GABA system. According to different authors, it is normal for children to age-adjusted to 1.5-2 months of life several times increases the density of GABAergic receptors in the cortex of the brain is the formation of infantile EEG pattern in a cycle of sleep-wakefulness, characterized by the appearance of the Sigma-rhythm (3, 5). Most extremely premature infants has complicated the period of postnatal adaptation and perinatal hypoxia. Apparently, these children with the immaturity of the brain when exposed to hypoxia develops an imbalance between the exciting and braking systems of the brain, impairing the formation of cortical brake systems, which is reflected in the quantitative characteristics of the Sigma-rhythm. This can lead to failure of reparative processes, resulting in functional changes occur glial cells and possibly GI is the fir part of them (4, 6). In turn, this leads to the violation of children's processes of myelination of the afferent and efferent primarily pyramidal pathways and, further, to the adverse outcome of perinatal CNS damage in the form of cerebral palsy.
The method is as follows.
The child in the adjusted age 1 month perform electroencephalographic study on modified international scheme with a reduced number of electrodes (7) drug-free mode daytime sleep using EEG "Neuron-spectrum 2" Neurosoft company (Russia). Register the slow-wave sleep with the definition of the duration of Sigma spindles and their number per 1 minute
Distinctive features of the way. Proposed prognostic parameter to determine the number of Sigma spindles for 1 minutes and their duration in slow-wave sleep. When the number of Sigma spindles equal to 2 or less for 1 min, and duration of 1 sec or less predict the formation of cerebral palsy in infants with extremely low and very low body weight at birth.
For objectifying data in parallel with application of the proposed method was carried out clinical observation and examination of children 1 year of life with other paraclinical methods: neurosonography (people's Assembly), the prototype method.
Being sposobnaya the following examples:
Example 1. Baby A. was born in gestation 29 weeks, weighing 1300 g with estimation on Apgar scale 2-2 score in a serious condition. Was in children's intensive care unit, conducted a ventilator for 4 days 1 hours At the examination of the child at the corrected age of 1 month revealed the following pathological symptoms: eyes were fixed, traced the subject of short-term and impermanent, symptom (s-m) Gref (+), muscle tone was diffuse moderately increased in the flexors, traction grouped bad, never kept, labyrinth tonic reflex (+), asymmetric tonic reflex (+), reflex (p-C) Moro (+), p-C Babkina (+), bearing weak p-Perez (+), Galil, revitalizing complex (+) estimated without reaction. According to neurosonography (people's Assembly) revealed a slight expansion of the ventricular system in the field of median structures hyperechoic education 3×3 mm On the basis of clinical data and an infringement of the people's Assembly and delayed motor development. According to the proposed method, the child in the corrected age of 1 month duration Sigma-rhythm was 0 sec, amount per 1 min - 0, which corresponds to the claimed parameters of the formation of cerebral palsy.
Conclusion: the predicted formation of cerebral palsy-year life.
When you use the method-prototype predicted the formation of cerebral palsy (EEG pattern type IV).
In clinical neurological examination of the child at the age of 1 year of life, there was an increase of muscle tone along the pyramidal type, delay reduction of spinal motor and pastanesi attitudes, delay the formation of static skills - not upside down, not sitting, not standing, items in hand took mainly the left hand, the beginning of the talk. According to the people's Assembly revealed a slight enlargement of the lateral ventricles. Diagnosis: cerebral palsy, spastic tetraparesis. The forecast by the present method and the method prototype has confirmed.
Example 2. Baby b was born in the period of 27 weeks weighing 990 g estimation on Apgar scale 1-1 score. At birth the child is regarded as heavy, was receiving treatment at the children's intensive care unit, conducted a ventilator for 2 days 20 hours 20 minutes At clinical-neurological examination of the child at the corrected age of 1 month of life set: view recorded, the subject was traced, easy hypertonicity in the flexors of the hand, when the traction grouped, the head was restrained, R-Babkina (+), bearing on the foot, symmetrical neck tonic reflex (+), was rolled over from back to tummy, Galil actively. According to the people's Assembly identified the expansion of the interhemispheric fissure. On the basis of clinical data and the people's Assembly diagnosed perinatal Parag is the Central nervous system, violation of motor development. According to the proposed method, the child in the adjusted age 1 month electroencephalographic study measuring the number of Sigma spindles for 1 minutes and their duration, which amounted to 5 Sigma spindles and 3 sec, respectively, which corresponds to the claimed parameters favorable prognosis.
Conclusion: the child predicted the absence of the formation of cerebral palsy-year life.
When using the prototype method predicted the absence of the formation of cerebral palsy (EEG pattern I type).
At the age of 1 year of life with clinical and neurological examination of the child noted: normalization of muscle tone, timely generation of static skills - the child sat, crawled, stood up and stood by the bearing itself, made his first independent steps. According to the people's Assembly revealed no pathology.
Conclusion: the lack of formation of cerebral palsy. The forecast by the present method and the method prototype has confirmed.
Example 3. Child C., born in the period of 27 weeks weighing 990 g of 1 pregnancy, 1 independent childbirth rating on a scale of Apgar scores 5-7 points, were on treatment at the children's intensive care unit. The clinical-neurological obsledovanie the child in the adjusted age 1 month installed: increased muscle tone in the flexor tendons of the extremities, reliance on "tiptoe", when traction is not grouped, the head was held bad, the symptom Gref (+), pastanesi automation (asymmetric neck tonic reflex, tonic labyrinth reflex), p-Perez (+), p-Galante (+), p-Moro (+). According to neurosonography identified the expansion of the interhemispheric fissure, a slight enlargement of the lateral ventricles, subependymal hypoechoic cavity left up to 2 mm, the transparent cavity walls up to 3 mm On the basis of clinical data diagnosed with perinatal CNS damage, impaired motor development. According to the proposed method, the child in the adjusted age 1 month electroencephalographic study measuring the number of Sigma spindles for 1 minutes and their duration, which amounted to 2 Sigma-spindle and 1 sec, respectively, which corresponds to the claimed parameters of the formation of cerebral palsy.
When using the prototype method predicted the absence of the formation of cerebral palsy (EEG pattern type II).
At the age of one year of life in spite of repeat courses of rehabilitation treatment delayed the development of motor skills: sitting, began to stand on all fours, not crawling, hypertonicity along the pyramidal type in the legs, hypotension in the shoulder belt is, the beginning of the talk. According to neurosonography: mild enlargement of the lateral ventricles. Diagnosed with cerebral palsy.
Conclusion: the prognosis of the claimed method was confirmed.
The forecast for the prototype method was not confirmed.
Example 4. The child Was born in gestation 29 weeks, weighing 1420 g estimation on Apgar scale 2-2 score in a serious condition. Was in children's intensive care unit, was conducted IVL within 1 day 5 hours During examination of the child at the corrected age of 1 month revealed the following pathological symptoms: eyes were fixed badly, did not follow the subject, m Graefe (+), muscle tone was diffuse moderately increased in the flexors, adductor hips, traction grouped bad, never kept, labyrinth tonic reflex (+), asymmetric tonic reflex (+), p-Moro (+), p-C Babkina (+), support the weak, R-with Perez (+), gull little, revitalizing complex (+) estimated without reaction. According to neurosonography (people's Assembly) revealed a slight expansion of the ventricular system in the periventricular region on the left hypoechoic education 3×3 mm, the cavity of the transparent walls 4 mm On the basis of clinical data and an infringement of the people's Assembly and delayed motor development. According to the proposed method, the child in the corrected age of 1 m is month duration of the Sigma-rhythm was 1 sec, quantity for 1 min - 1, which corresponds to the claimed parameters of the formation of cerebral palsy.
Conclusion: the predicted formation of cerebral palsy-year life.
When using the prototype method predicted the absence of the formation of cerebral palsy (EEG pattern type II).
In clinical neurological examination of the child at the age of 1 year of life, there was an increase of muscle tone along the pyramidal type, delay reduction pastanesi attitudes, delay the formation of static skills - not sitting, not standing, not walked, the beginning of the talk. According to the people's Assembly revealed a slight expansion of the interhemispheric fissure. Diagnosis: cerebral palsy, spastic tetraparesis.
The forecast for the claimed method was confirmed.
The forecast for the prototype method was not confirmed.
The method proposed in the invention, examined 30 children, the results are shown in table 1.
|Index||The number of the examined|
|A true-negative result||23|
|A false-negative result||1|
The accuracy of the proposed method - 93,3%.
The sensitivity of the proposed method is 83,3%.
The specificity of the proposed method is 95.8%.
The method of the prototype examined 30 children, the results are shown in table 2.
|Index||The number of the examined|
|A true-negative result||24|
|A false-negative result||5|
The accuracy of the proposed method is 83,3%.
The sensitivity of the proposed method is 16.7%.
The specificity of the proposed method is 100%.
The advantages of this method:
1. H is Kai accuracy - of 93.3%, a sensitivity of 83.3%, specificity is 95.8%.
2. Used quantitative parameters obtained by electroencephalographic study that excludes subjective evaluation data.
3. Proposed to be used for forecasting specific EEG indicator reflecting the disruption of the formation of brain function.
4. Intended for use in children with extremely low and very low body weight at birth, which allows to take into consideration the peculiarities of the maturation of bioelectric activity of the brain.
5. Allows to carry out the correction of remedial measures.
1. Beresnev SCI, Burkova A.S. Organization neurological care in the perinatal period //Journal of neuropathology and psychiatry. - 1990. - C, No. 8. - P.3-5.
2. Samigina GA Hypoxidaceae CNS damage in newborn infants: clinic, diagnostics, treatment. // Pediatrics. - 1996. No. 5. - P.74-77.
3. Degtyarev MG, Stroganov T.V., Rogatkin S.O., Volodin N.N. Clinical and neurophysiological aspects of assessing the severity of post-hypoxic perinatal CNS lesions in newborns// Questions of gynecology, obstetrics and Perinatology. - 2005. - V.4, No. 1. - P.57-65.
4. Finger A.B., Shabalov, I.E. Hypoxic-ischemic encephalopathy in newborns. - SPb.: Peter, 2001. - 224 S.
5. Chugni H.T. Metabolic imaging - a window of brain development and plasticity // The neuroscientist. - 1999. - Vol.5. - P.29-40.
6. Logitharajah P., Rutherford M.A., F.M. Cowan Hypoxic-Ischemic Encephalopathy in Preterm Infants: Antecedent Factors, Brain Imaging, and Outcome // Pediatric Research. - 2009. - Vol.66, Issue 2. - P.222-229.
7. Laget, P., Salbreux R. Atlas d electroencephalographie infantile. - Paris: Masson&G, 1967. - 653 p.
A method for predicting the formation of cerebral palsy to a year of life by conducting EEG studies of the brain of children in the drug-free mode daytime sleep in the adjusted age of one month, wherein the slow-wave sleep to determine the number of Sigma-spindles for 1 minutes and their duration and the number of Sigma spindles equal to 2 or less and duration of 1 s or less predict the formation of cerebral palsy in infants with extremely low and very low body weight at birth.
SUBSTANCE: invention relates to medicine and can be used for automatic analysis of human electroencephalograms (EEG). The method comprises steps for recording an EEG; spectral analysis by continuous wavelet transform is carried out in two steps, at the first of which there is primary analysis of the recorded digital signal by the "common" wavelet, the basis function of which is a wavelet similar on its characteristics with the elementary area of the EEG; a matrix of recommendations on selection of the class of physiologically significant features of the recorded EEG is formed; physiologically significant parts of the analysed signal are selected; at the second step there is analysis of the physiologically significant parts of the analysed signal by the synthesised wavelets, the synthesis criterion of which is minimisation of the sum of squared deviations of the wavelet from the reference signal; a matrix of analysis results is formed; a video image of the moment of the patient is obtained, which is compared with the matrix of analysis results and, if the results match the corresponding information on moment, the patient has a physiologically significant feature and its type is determined, after which at least one trained artificial neural network is used to form a clinical conclusion matrix, based on which a clinical conclusion is formed in text form, which can be output for display and/or transmission to a remote reception unit; whether the patient has a disease is determined from the clinical conclusion.
EFFECT: automation of the process of analysing an EEG, high accuracy of analysis.
2 cl, 11 dwg
SUBSTANCE: individual is exposed to rhythmic coherent light, audio and vibrotactile signals. The session is preceded by rest and functional test electroencephalogram recording. The individual alpha activity values are determined: alpha peak frequency, alpha-band width, desynchronisation depth. The session is three-staged. At the first stage, a base frequency is specified as alpha peak frequency, while at the second stage the base frequency is maintained within the range of an individual flexibility resource described by the relations: Rmin=4.5-0.2*(F-10)-0.2*(ΔF-6) and Rmax=22+0.8*(F-10)+0.9*(ΔF-6) wherein F is an individual alpha peak frequency, ΔF is an individual alpha-band width. At the third stage, the base frequency is reduced to a value related to the required target functional state. Total time of the stimulation session is described by formula T=30+0.3*(D/10-10)2 wherein D is an individual desynchronisation frequency, %.
EFFECT: method provides higher effectiveness of correction that is ensured by regarding the individual characteristics of the patient.
1 dwg, 3 ex
SUBSTANCE: invention relates to field of medicine, namely to neurology, immunology and occupational pathology. Rheoencephalography with hypercapnic test are performed, visual evoked potentials (VEP), encephalography (EEG) are registered, level of antibodies to protein S100, level of immunoglobulin G in blood serum are determined. Canonical value is calculated by formula: Cv=3.18-0.38×a1-1.61×a2-0.71×a3+0.93×a4+1.19×a5-0.81×a6, where Cv is canonical value; -0.38; -1.61; -0.71; 0.93; 1.19; -0.81 are discriminant coefficients; 3.18 is constant; a1 is intensity of blood supply in frontomastoid pool during hypercapnic test in ohm; a2 is amplitude of peak N1 of VEP in right occipital lead in mcV; a3 is level of antibodies to protein S100 in conv. units; a4 is level of immunoglobulin G in g/l; a5 is presence or absence of nidus of pathological activity on EEG: 0 - no, 1 - present; a6 is degree of expression of diffuse changes by EEG; 0 - no, 1 - mild, 2 - moderate, 3 - expressed, 4 - severe. If Cv is lower than the constant, early manifestations of chronic mercury intoxication are diagnosed, if Cv is higher or equals the constant, chronic mercury intoxication of the first.
EFFECT: method extends arsenal of means for diagnostics of early manifestations of chronic mercury intoxication.
1 tbl, 3 ex
SUBSTANCE: invention relates to medicine, namely to neurology and psychiatry. Electroencephalogram (EEG) is registered at the background of hyperventilation on orthostatic table first in horizontal position, then, after turning the table on 60-70 degrees and bringing the examined person in orthostatic position. Registration of EEG is carried out in patient within 1 hour after sleepless night. Turning of orthostatic table is performed during 3-5 seconds. Examined person is brought into orthostatic position for 10 minutes and hyperventilation in orthostatic position is performed for 3 minutes. If signs of orthostatic blood circulation disorder are absent and epileptoform patterns are present, epileptoform activity is diagnosed.
EFFECT: method extends arsenal of means for detection of epileptiform activity.
SUBSTANCE: invention is applied in field of medicine, namely in neurology. Electric encephalogram is registered for patient of young age. If detected are: in occipital region alpha-rhythm with amplitude in range from 79 mcV to 98 mcV, reduction of alpha-rhythm index from 71% to 61%; in occipital, central parietal and central- frontal-anterior temporal regions of brain patterns of teta-activity with amplitude in range from 42 mcV to 48 mcV, teta-activity index from 11% to 40%, chonic ischemia of brain tissue is diagnosed.
EFFECT: method extends arsenal of means for diagnostics of chronic disorders of cerebral circulation, caused by arterial hypertension.
SUBSTANCE: invention relates to medicine and can be used for correction of person's functional state. Registration of electric encephalogram (EEG) is performed, EEG signals are transposed into sound range and patient is exposed to influence of sound signals. Spectral analysis of EEG is carried out, local extremums of obtained frequency spectrum of EEG are detected, frequencies of detected extremums of maximums and minimums are determined. From obtained values of frequencies of extremums selected are frequencies multiple to minimal one, with multiplication factor 2n where n is an integer number, and impact with sound signals with frequency which is multiple to, simultaneously multiple, frequencies of extremums of maximums and extremums of minimums of EEG frequency spectrum.
EFFECT: method extends arsenal of means for treatment of mental disorders.
3 dwg, 1 ex
SUBSTANCE: electroencephalography is performed; β2 - and δ - rhymes are recorded in F4 and P3 lead; a canonical variate is calculated by formula: Cv=1.6+1.6xa1-1.2xa2+0.7xa3-0.4xa4-) wherein Cv is the canonical value 1.6; -1.2; 0.7; -0.4 are discriminant coefficients; 1,6 is a constant; a1,2,3,4 are numerical values of research results of bioelectric cerebral activity: a1 is a percentage β2 of P3-lead rhythm, a2 is a percentage δ of P3-lead rhythm, a3 is a percentage δ of F4-lead rhythm, a4 is a percentage β2 of F4-lead rhythm. If the Cv value is more than 1.6, the absence of chronic action of mercury on the brain is stated; if the Cv is 1.6 or less, toxic encephalopathy is diagnosed in the animal.
EFFECT: method extends the range of the agents for diagnosing of toxic encephalopathy in small laboratory animals in chronic action of metallic mercury vapour.
1 tbl, 3 ex
SUBSTANCE: invention relates to medicine and can be used in neurology in diagnostics of frontal dysfunction. Registration of EEG is performed, spectral power of delta range with analysis of absolute values of power of the δ1-st rhythm and δ2-nd rhythm in frontopolar leads of both cerebral hemispheres is carried out. Absolute values of spectral power of the δ1-st rhythm and δ2-nd rhythm are determined. If obtained values of power of the δ1-st rhythm are from 182 mcV2 to 222 mcV2, the δ2-nd rhythm - from 42 mcV2 to 72 mcV2, dysfunction of frontal lobes is diagnosed.
EFFECT: method extends arsenal of means for diagnosing dysfunction of frontal lobes in patients with vibration disease.
7 dwg, 2 ex
SUBSTANCE: invention relates to medicine, namely to professional pathology. EEG registration is performed and analysis of spectral power of delta-range before and after treatment is carried out. Absolute values of power of δ1-st rhythm and δ2-nd rhythm in frontal leads of both cerebral hemispheres are analysed. If absolute values of power of δ1-st rhythm in right leads decrease more than by 37%, and in left leads - by more than 44% and of δ2-nd rhythm in left leads by more than 70% in comparison with said indices before treatment, performed therapy is assessed as efficient.
EFFECT: method increases reliability of assessment of efficiency of performed therapy of cognitive disorders in patients with vibration disease.
SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used as an anaesthesia care of surgical correction of severe spinal scoliosis with a high risk of developing neurological complications. For this purpose, 30 minutes prior to the operation, intramuscular pre-medication with Dormicum 0.1 mg/kg and Dimedrol 0.4 mg/kg is required. The anaesthesia is induced by Phentanyl 0.002 mg/kg, Propofol 2.5 mg/kg. The introduction of Nimbex 0.1 mg/kg is followed by the trachea intubation. After the trachea intubation and transition to artificial pulmonary ventilation, loading doses of Clopheline 0.004 mcg/kg and Ketamine 0.25 mg/kg are introduced. Sevorane in the concentration of 4 vol. % immediately follows the trachea intubation and transition to artificial pulmonary ventilation assisted by the air and oxygen flow rate of 4-5 l/min to reach the breath-out sevorane concentration min. 2.6 vol. % (1.04 minimum alveolar concentration). Then the air and oxygen flow rate is decreased to 1 l/min. Artificial pulmonary ventilation is enabled by an anaesthesia apparatus for sevorane delivery in forced pulmonary ventilation mode with the low fresh gas flow rate 1 l/min with minute tidal volume to ensure the breath-out concentration of carbon dioxide within 32-37 mm Hg, the concentration of oxygen in the mixture 40%. The mandatory safety monitoring involves blood pressure, heart rate, electrocardiogram, arterial blood oxygen saturation, mixture oxygen concentration, breath-out carbon dioxide concentration, air and oxygen sevorane concentration, breath-out sevorane concentration, breath-in air and oxygen carbon dioxide and bispectral electroencephalogram and electromyography index recordings. The anaesthesia is maintained by sevorane inhalations 3-1.5 vol. %. (1.2-0.6 minimum alveolar concentration), bolus introductions of Fentanyl 0.004±0.001 mg/kg/h, continuous infusion of Clopheline 0.004 mcg/kg/h, Ketamine 0.25 mg/kg/h and supporting Nimbex 0.05-0.03 mg/kg/h. 30 Minutes before the patient wakes up, sevorane dose is maintained at 1.0-0.8 vol. %, 20 minures before, the Nimbex introduction is completed, 15 minutes before, sevorane delivery is completed, 30 minutes before the waking up, the Fentanyl introduction is completed, while Clopheline and Ketamine are kept to be introduced. The spinal function monitoring is controlled by electroencephalogram activity and nervomuscular conduction as shown by electromyography. Patient contact is considered to be allowed if observing the bispectral electroencephalogram index min. 75-78% and the degree of residual neuromuscular blocks max. 20%. After obtaining the spinal function monitoring data, the bolus introduction of Fentanyl 0.002 mg/kg, Nimbex 0.1 mg/kg, while sevorane is started to be introduced in the concentration of 4 vol. %. Then concentration of Sevorane is reduced to 3-1.5 vol. % (1.2-0.6 minimum alveolar concentration), Clopheline and Ketamine are kept to be infused in the previous dosages.
EFFECT: method enables high control of the anaesthesia and an effective level of antinociceptive protection while the patient wakes up that is ensured by multidirectional action of the presented components of the anaesthesia.
FIELD: medicine, neurology, psychopathology, neurosurgery, neurophysiology, experimental neurobiology.
SUBSTANCE: one should simultaneously register electroencephalogram (EEG) to detect the level of constant potential (LCP). At LCP negativization and increased EEG power one should detect depolarizational activation of neurons and enhanced metabolism. At LCP negativization and decreased EEG power - depolarized inhibition of neurons and metabolism suppression. At LCP positivation and increased EEG power - either repolarized or hyperpolarized activation of neurons and enhanced metabolism. At LCP positivation and decreased EEG power - hyperpolarized suppression of neurons and decreased metabolism of nervous tissue. The method enables to correctly detect therapeutic tactics due to simultaneous LCP and EEG registration that enables to differentiate transition from one functional and metabolic state into another.
EFFECT: higher accuracy of diagnostics.
5 dwg, 1 ex, 1 tbl
FIELD: medicine, neurology.
SUBSTANCE: one should establish neurological status, bioelectric cerebral activity, availability of perinatal and ORL pathology in patients, establish their gradations and numerical values followed by calculation of prognostic coefficients F1 and F2 by the following formulas: F1=-31,42+1,49·a1-2,44·a2+0,2·а3+1,63·a4+0,62·а5+3,75·a6+1,8·а7-3,23·a8-0,8·а9-1,32·а10+3,26·а11+8,92·a12-2,0·a13+3,88·а14+1,79·a15+0,83·a16-2,78·a17; F2=-27,58+1,43·a1+3,31·а2+0,08·а3+3,05·а4-0,27·а5+2,69·а6+3,11·а7-6,47·a8-6,55·a9+1,99·а10+5,25·а11+7,07·a12-0,47·a13+0,13·a14+4,04·a15-1,0·a16-1,14·а17, correspondingly, where a1 - patient's age, a2 - studying either at the hospital or polyclinic, a3 - duration of stationary treatment (in days), a4 - unconscious period, a5 - terms of hospitalization since the moment of light close craniocerebral trauma, a6 - smoking, a7 - alcohol misuse, a8 - arterial hypertension, a9 - amnesia, a10 - close craniocerebral trauma in anamnesis, a11 - psychoemotional tension, a12 - meteolability, a13 - cervical osteochondrosis, a14 - ORL pathology, a15 - availability of perinatal trauma in anamnesis with pronounced hypertension-hydrocephalic syndrome, a16 - availability of paroxysmal activity, a17 - availability and manifestation value of dysfunction of diencephalic structures. At F1 ≥ F2 on should predict the development of remote aftereffects in young people due to evaluating premorbid background of a patients at the moment of trauma.
EFFECT: higher reliability of prediction.
2 ex, 1 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves doing multi-channel recording of electroencephalogram and carrying out functional tests. Recording and storing rheoencephalograms is carried out additionally with multi-channel recording of electroencephalogram synchronously and in real time mode in carotid and vertebral arteries. Electroencephalograms and rheoencephalograms are visualized in single window with single time axis. Functional brain state is evaluated from synchronous changes of electroencephalograms, rheoencephalograms and electrocardiograms in response to functional test. The device has electrode unit 1 for recording bioelectric brain activity signals, electrode unit 2 for recording electric cardiac activity signals, current and potential electrode unit 3 for recording rheosignals, leads commutator 4, current rheosignal oscillator 5, synchronous rheosignal detector 6, multi-channel bioelectric brain activity signals amplifier 7, electrophysiological signal amplifier 8, demultiplexer 9, multi-channel rheosignal amplifier 10, multi-channel analog-to-digital converter 11, micro-computer 12 having galvanically isolated input/output port and personal computer 13 of standard configuration.
EFFECT: enhanced effectiveness of differential diagnosis-making.
11 cl, 6 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.
EFFECT: wide range of functional applications.
15 cl, 10 dwg
FIELD: medicine, psychiatry.
SUBSTANCE: one should conduct EEG-testing to detect total value of the indices of spectral power or percentage spectral power of delta- and teta-rhythms due to spectrometric technique in frontal, parietal, central and temporal areas both before and during emotional-negative loading when visual emotionally negative stimuli are presented followed by their imaginary reproduction. In case of higher indices to visual stimuli being above 15% against the background one should diagnose epilepsy. The method enables to increase the number of diagnostic means, increase accuracy and objectivity in predicting epilepsy with polymorphic paroxysms at dissociation of clinical and EEG-values.
EFFECT: higher efficiency of diagnostics.
1 ex, 1 tbl
FIELD: medicine, neurophysiology.
SUBSTANCE: one should carry out EEG survey to detect spectrometrically the index of full range if alpha-rhythm both before and after therapy. Moreover, power index of full range of alpha-rhythm and the index of 9-10 Hz-strip's spectral power should be detected in occipital cerebral areas. One should calculate the value of the ratio of the index of 9-10 Hz-strip's spectral power to the index of full range of alpha-rhythm and at the increase of this value by 20% against the background it is possible to evaluate positive result of therapy. The method increases the number of diagnostic means applied in evaluating therapeutic efficiency in the field of neurophysiology.
EFFECT: higher efficiency of evaluation.
FIELD: medicine, neurology.
SUBSTANCE: method involves carrying out the standard vascular and nootropic therapy. Diazepam is administrated under EEG control with the infusion rate that is calculated by the following formula: y = 0.0015x - 0.025 wherein y is the rate of diazepam administration, mg/h; x is an average EEG amplitude, mcV. Method provides enhancing the effectiveness of treatment of patients. Invention can be used for treatment of patients in critical severe period of ischemic insult.
EFFECT: enhanced effectiveness of treatment.
2 tbl, 1 dwg, 1 ex
SUBSTANCE: method involves selecting signals showing patient consciousness level and following evoked auditory potentials as responses to repeating acoustic stimuli, applying autoregression model with exogenous input signal and calculating AAI index showing anesthesia depth next to it.
EFFECT: quick tracing of unconscious to conscious state and vice versa; high accuracy of measurements.
9 cl, 3 dwg
FIELD: medicine; experimental and medicinal physiology.
SUBSTANCE: device can be used for controlling changes in functional condition of central nervous system. Device has receiving electrodes, unit for reading electroencephalograms out, analog-to-digital converter and inductor. Low noise amplifier, narrow band filter linear array which can be program-tuned, sample and store unit, online memory, microcontroller provided with controlled permanent storage, liquid-crystal indicator provided with external control unit are introduced into device additionally. Receiving electrodes are fastened to top part of patient's head. Outputs of electrodes are connected with narrow band filters linear array through electroencephalograph. Output of linear array is connected with input of input unit which has output connected with input of analog-to-digital converter. First bus of analog-to-digital converter is connected with online storage. Recording/reading bus of microcontroller is connected with control input of input unit and its starting bus is connected with address input of online storage. Third control bus is connected with narrow band filters linear array. Second control bus is connected with liquid-crystal indicator. Output bus is connected with inductor. External control (keyboard) of first control bus is connected with microcontroller. Output of online storage is connected with data input of microcontroller through 12-digit second data bus. Efficiency of influence is improved due to getting specific directed influence being based onto general technological transparency of processing of human brain's signals and strictly specific influence based on the condition of better stimulation.
EFFECT: increased efficiency.
3 cl, 1 dwg, 1 tbl
FIELD: medicine, neurology, professional pathology.
SUBSTANCE: one should carry out either biochemical blood testing and electroencephalography or SMIL test, or ultrasound dopplerography of the main cranial arteries, rheoencephalography (REG) to detect the volume of cerebral circulation and hypercapnic loading and their digital values. Then it is necessary to calculate diagnostic coefficients F by the following formulas: Fb/e=6.3-0.16·a1+0.12·a2-1·a3+0.2·a4, or FSMIL=9.6+0.16·a5-0.11·a6-0.14·a7+0.07·a8, or Fhem=48.6-0.04·a9+0.15·a10+13.7·a11-0.02·a12+24.7·a13, where Fb/e -diagnostic coefficient for biochemical blood testings and EEG; FSMIL - diagnostic coefficient for SMIL test; Fhem - diagnostic coefficient for hemodynamic testing; 6.3; 9.6 and 48.6 - constants; a1 - the level of vitamin C in blood; a2 - δ-index by EEG; a3 - atherogenicity index; a4 - the level of α-proteides in blood; a5 - scale 3 value by SMIL; a6 - scale K value by SMIL; a7 - scale 5 value by SMIL; a8 - scale 7 value by SMIL; a9 - the level of volumetric cerebral circulation; a10 - the value of linear circulatory rate along total carotid artery, a11 - the value of resistive index along total carotid artery; a12 - the value for the tonicity of cerebral vessels at carrying out hypercapnic sampling by REG; a13 - the value for the intensity of cerebral circulation in frontal-mastoid deviation by REG. At F value being above the constant one should diagnose toxic encephalopathy, at F value being below the constant - discirculatory encephalopathy due to applying informative values.
EFFECT: higher accuracy of diagnostics.
6 ex, 1 tbl