Method for assessing pulmonary blood flow

IPC classes for russian patent Method for assessing pulmonary blood flow (RU 2539718):

G01N33/48 - Biological material, e.g. blood, urine (G01N0033020000-G01N0033140000, G01N0033260000, G01N0033440000, G01N0033460000 take precedence;determining the germinating capacity of seeds A01C0001020000); Haemocytometers (counting blood corpuscules distributed over a surface by scanning the surface G06M0011020000)

A61B5/145 - Measuring for diagnostic purposes (radiation diagnosis A61B0006000000; diagnosis by ultrasonic, sonic or infrasonic waves A61B0008000000); Identification of persons

A61B5/026 -

A61B5/02 - Measuring pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography; Heart catheters for measuring blood pressure

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FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to pulmonology, cardiology, gerontology and sports medicine, and can be used for assessing the pulmonary blood flow by assessing the capillary pulmonary blood flow and intrapulmonary venoarterial bypass. That is ensured by measuring heart rate a minute, haemoglobin concentration (Hb g/l), total oxygen consumption (CO_2(TOTAL) ml/min), arterial oxygen saturation (S_ART % or decimal portions 1) and mixed venous saturation in the greater circulation (GC) (Sv% or decimal portions 1). MBV (l/min) is calculated according to the measurements of Hb, CO₂, S_ART, S_V. Certain formulas are used to calculate the capillary pulmonary blood flow and intrapulmonary venoarterial bypass.

EFFECT: presented versions of the method enable the precise determination of ventilation-perfusion relations in lungs, as well as elimination of direct instrumental methods for measuring the capillary pulmonary blood flow.

2 cl, 2 tbl, 1 ex

The invention relates to medicine, namely to surgery, pulmonology, internal medicine and sports medicine.

It is known that after appearing in cardiac and pulmonary clinics accurate direct ways to assess and measure the parameters and functions of the circulatory and gas exchange in humans, it was necessary to control for all factors that affect the activity of the heart and lungs [j.G. Comroe, R. E. Forster, A. B. Dubois and others - Light. Clinical physiology and functional tests. M: Medgiz, 1961 196 C. See page 72 and page 171-172].

To assess the function of blood circulation before and after cardiac surgery creation of aorto-pulmonary anastomosis, it is necessary to measure the magnitude of the internal-lung bypass. Similar measurements should be performed and patients of advanced age [Whyte MK, Hughes JM, Jackson JE, Peters AM, Hempleman SC, Moore DP, Jones HA. The Cardiopulmonary response to exercise in patients with intrapulmonary vascular shunts // J Appl Physiol. 1993 Jul; 75(1):321-8.; Whyte MK, Peters AM, Hughes JM, Henderson BL, Bellingan GJ, Jackson JE, Chilvers ER. Quantification of right to left shunt at rest and during exercise in patients with pulmonary arteriovenous malformations. // Thorax. 1992 Oct; 47(10):790-796;. Taylor BJ, Johnson BD. The pulmonary circulation and exercise responses in the elderly. // Semin Respir Crit Care Med. 2010 Oct; 31(5):528-38. Epub 2010 Oct 12]. It was found that internal-lung shunt occurs when pulmonary hypertension complicated by hypoxemia [Jean-Frédéric Vodoz, Vincent Cottin, Jean-Charles Glérant, Geneviéve Derumeaux, Chahéra Khouatra, Anne-Sophie Blanchet, Bénédicte Mastroїanni, Jea-Yves Bayle, Jean-Francois Mornex and Jean-Francois Cordier - Right-to-left shunt with hypoxemia in pulmonary hypertension // BMC Cardiovascular Disorders 2009, 9:15 http://www.biomedcentral.com/1471-2261/9/15].

Mathematical analysis of the problem of the control of the gas exchange function of the lungs is given in the book [Dyachenko, A. I., Shabelnikov Century, The Mathematical model of the action of gravity on lung function. - M.: Nauka, 1985. - 279 S. Cm. pages 44-53]. However, their proposals are to use the graphs of the Dryer and Wound [Fenn, W. O., Rahn h, Otis A. C. And theoretical study of the composition of the alveolar air at altitude // Amer. J. Physiol. - 1946. - Vol.146. - PP.637-641] for analysis of alveolar gas exchange on the measured voltages gases in the alveolar volume. For a practical assessment of the magnitude of the internal-lung shunt is recommended to use values of oxygen saturation of blood in the capillaries of the lung, pulmonary artery (signesmarina venous blood of the great circle), in arterial blood [Guide clinical respiratory physiology / Ed. by L. L. Schick, N. N. Kanaeva. - L.: Medicine, 1980. - 376 S. (Cm. pages 180-181); Pods P. C., Vinnitsa Russian Assembly; Lukevics I. A. Introduction to functional diagnosis of external respiration. - M., 1996. - 72 S. Cm. pages 48-50]. According to them the value of internal-lung shunt is 5-6% of the minute volume of blood (IOC). Was developed nomogram for calculating internal-lung bypass the gases in the blood samples, which required a set is not always what is available and not exact because of the natural range of variation, due to the procedure of collection of samples of blood from the blood vessels of the patient [S. T. Chiang A nomogram for venous shunt (QS/QT) calculation // Thorax 1968; 23:563-565 doi:10.1136/thx.23.5.563]. In the above sources do not specify the amount of capillary blood flow in the lung, which assume equal IOC. Modern evaluation of the internal-lung shunt give it to the approximate size 1,4±0,8% (0,2-3,1%) [Stickland MK, Lovering AT, Eldridge MW. Exercise-induced intrapulmonary arteriovenous shunting in dogs // Am J Respir Crit Care Med. 2007 Aug 1; 176(3):300-305].

In a simplified way of estimating the value of internal-lung shunt (degree of saturation) there is no account of the concentration of hemoglobin in the blood [Ryabov, A. Hypoxia critical States. - M.: Medicine, 1988. - 288 S. (Cm. pages 163-166)]. From this it follows that the same percentage of internal-lung bypass will correspond to different volumes continuemos blood. Another disadvantage of this method is lack of communication with the amount of oxygen consumed.

At the present time to determine whether internal-lung shunt used contrast echocardiography [A. T. Lovering, Romer L. M., Haverkamp, H. C. et al. - Intrapulmonary shunting and pulmonary gas exchange during normoxic and hypoxic exercise in healthy humans // J. Appl. Physiol. 2008. - V. 104: pp.1418-1425], whereby it was shown that during exercise in healthy people the value of internal-lung shunt increases, but it is unknown exactly its value and it is unknown physiological role A. T. Lovering, Romer L. M., Haverkamp, H. C., J. Hokanson, S., Eldridge M. W. - Transpulmonary passage of^99mTc macroaggregated albumin in healthy humans at rest and during maximal exercise // J. Appl. Physiol. -2009. - V. 106: pp.1986-1992. (See the introduction of this article)].

Pulmonary circulation is the main place of resistance in the pulmonary circulation. Despite the dysfunction of this link for a number of pulmonary vascular diseases there are no specific methods to assess pulmonary microvascular integrity in a particular person [Ilsar R, Chawantanpipat S, Chan KH, Dobbins TA, Waugh R, Hennessy A, Celermajer DS, Ng MK. Measurement of Pulmonary Flow Reserve and Pulmonary Index of Microcirculatory Resistance for Detection of Pulmonary Microvascular Obstruction // PLoS One. 2010 Mar 9; 5(3):e9601].

Closest to the present invention is the Method for determining capillary blood flow and value arteriovenous shunt" [Patent 2267983 Russia, IPC⁷AV 5/02 AV 5/145, Vlasov, Y. A., Smirnov, S. M., Okuneva, N.: Institute pathol. kavooras. THE PUBLIC HEALTH MINISTRY. No. 2004100454; Appl. 05.01.04; 20.01.2006. Bull. No. 02], according to which measure oxygen consumption, determine the concentration of hemoglobin in the blood, and measure or calculate minute volume of blood (IOC). The amount of capillary blood flow (Q_CAP) are calculated according to the formula Q_CAP=((₂)/1,355)/((Hb)/1000), where a₂-oxygen consumption in ml/min; Hb is the hemoglobin concentration in g/l, then calculate the value arteriovenous shunt (Q_W) by the formula Q_W=Is OK-Q _CAP; where IOC - minute volume of blood flow in ml/min; Q_CAP- the value of capillary blood flow in ml/min

Assessment of capillary blood flow in the lung, carried out at the specified method will be underestimated. According to principle A. Fika in the big circle of blood consumed in the lungs the oxygen all switches in the fabric of the capillaries, and its transfer is used only 10-20% of the minute volume of blood circulation [Vlasov, Y. A., Smirnov, S. M. General and shunt blood flow in the Central hemodynamics person// human Physiology. - 2009. - So 35. No. 5. - S. 116-126]. In fact, almost all mixed venous blood, except internal-lung bypass passes through the capillaries of the lung, and the output of the capillaries of the lung it may not compromised oksigenirovannym blood from internal-lung bypass. Because the gas exchange in the lung is between the capillaries of the alveoli and alveolar air, precise determination of the magnitude of the capillary flow in the lung is necessary to accurately determine ventilation-perfusion relationships.

The aim of the invention is the measurement of pulmonary blood flow, expressed in ml per minute for the entire body, based on the assessment of capillary blood flow in the Central hemodynamics and value of internal-lung arteriovenous shunts (from the pulmonary artery into the pulmonary vein bypass to the pillars of the alveoli), also expressed in ml per minute at all easy. 1. To do this:

measure the concentration of hemoglobin (Hb g/l) in the blood;

measure₂(ml/min);

measure (S_ART) saturation of arterial blood with oxygen; measure (S_V) saturation of mixed venous blood oxygen; calculate minute volume of blood A. Features IOC=₂/((HB×1,355)×(S_ART-S_V));

calculate Q_KP(ALWG)volume of blood flowing through the functioning alveoli, the formula given below [3].

2. Next, assess internal-lung grafts.

measure heart rate (HR) simultaneously with the measurement₂;

calculate the total shunt easy by equation [4];

calculate physiological venoarterial the shunt equation. [5];

calculate the anatomic pulmonary shunt according to equation [6];

calculate the volume of all capillaries in the lung by the equation [7].

This goal is achieved by the proposed method, according to which the examined person measure the concentration of hemoglobin (Hb g/l), measure the total oxygen consumption of the body (_2(TOTAL)ml/min), oxygen saturation of arterial blood (S_ARTpercent or decimal 1) and the saturation of mixed venous blood in the pulmonary circulation (Bq) (S_Vpercent or decimal 1), simultaneously with the measurement of the oxygen consumption recorded electrocardiogram to measure the heart rate per minute. For measured values Hb,₂, S_ART, S_Vcalculate the IOC (l/min):

1. Find the capillary flow in the lung as the sum of the following values:

Q_CAP(LAY)=Q_CAP(CG)+Q_SHUNT(CG),

[1]

where Q_CAP(CG)- the capillary flow in the Central hemodynamics (the big circle of blood circulation, which delivers oxygen to all the body;

Q_SHUNT(CG)=IOC-Q_CAP(CG)- shunt in Central hemodynamics, which in the mixed venous blood enters the capillary bed of the lung. Equation [1] is converted to another

Q_CAP(LAY)=(((_2(TOTAL)+((Q_SHUNT(CG)×Hb×1,355)×S_V))×S_ART)/1,355)/(Hb/1000),

[2]

where Q_CAP(LAY)- the capillary flow in the lung, ml/min;_2(TOTAL)the total oxygen consumption of the organism, ml/min; Q_SHUNT(CG)- shunt on arteriovenous anastomosis (shunt in Central hemodynamics), l/min; Hb is the hemoglobin concentration in the blood, g/l; 1,355 - coefficient of Huffner, the amount of oxygen in ml, which binds 1 g Hb; S_V- oxygen saturation of the mixed venous blood in the pulmonary circulation; ((Q_SHUNT(CG)×b×1,355)×S _V- the amount of oxygen, which was transferred shunt Central hemodynamics of the arterial bed of the big circle in his venous part; (_2(TOTAL)+((Q_SHUNT(CG)×Hb×1,355)×S_V)- the total amount of oxygen (ml/min), which will come in the vascular bed of the lung;

((_2(TOTAL)+((Q_SHUNT(CG)×Hb×1,355)×S_V))×S_ART- the amount of oxygen (ml/min), which will eventually come in pulmonary veins of the lung.

The full magnitude of the pulmonary capillary blood flow flowing through the functioning alveoli, is calculated by the equation

where_2(TOTAL)the total oxygen consumption of the organism, ml/min; Q_SHUNT(CG)- shunt in Central hemodynamics, l/min; Hb is the hemoglobin concentration in the blood, g/l; 1,355 - coefficient of Huffner, the amount of oxygen in ml, which binds 1 g Hb; S_V- oxygen saturation of the mixed venous blood in the pulmonary circulation. Through existing anatomic pulmonary shunt that bypasses the alveoli of the lung [Arkhangelsk A. C. Reconstruction of the arteries of the lungs in congenital defects of the heart and great vessels. M.: Medicine, 1971. - S. 207. (See p. 31); Dukov L., Pulmonary shunt and its regulation/Advances in physiological Sciences. - 1981. - So 12. No. 4. - C. 112-128. (see page 112)], venous blood enters the pulmonary veins the pulmonary circulation that is Estet the amount of capillary blood flow around the light, which is calculated by the equation [2].

2. Full shunt Krause calculated by the equation

where IOC - minute volume of blood flow, l/min; Q_CAP(LAY)- the capillary flow in the lung, ml/min

Alveolar internal-lung shunt - physiological venoarterial shunt [Dukov L., Pulmonary shunt and its regulation // Advances in physiological Sciences. - 1981. - So 12. No. 4. - C. 112-128. (see page 112)] is calculated by the equation

where IOC - minute volume of blood flow, l/min; Q_CAP(_ALUGfull size pulmonary capillary blood flow flowing through the functioning alveoli, ml/min

Anatomic pulmonary shunt, in which the blood from the bronchial veins into the pulmonary veins of the lung, is calculated by the equation

where Q_SHUNT(LAY)- full shunt Krause, ml/min; Q_SHUNT(ALV)- internal-lung alveolar shunt - physiological venous-arterial shunt, ml/min Through the old literary estimated volume of all capillaries in the lung, in the bloodstream of a small circle 75 ml [Roughton FJ, Forster RE. Relative importance of diffusion and chemical reaction rates in determining rate of exchange of gases in the human lung, with special reference to true diffusing capacity of pulmonary membrane and volume of blood in the lung capillaries. // J Appl Physiol. 1957 Sep; 11(2):290-302]. According to other data, this value is >200 ml and corresponds to the surface and coolaroo endothelial 130 m ²[Gehr P, Bachofen M, Weibel ER. The normal human lung: ultrastructure and morphometric estimation of diffusion capacity. Respir Physiol. 1978 Feb;32(2):121-140.]. According to principle A. Fika is the number of fully saturated blood during each cardiac cycle enters into the left cavity of the heart, in the systemic circulation. From this it follows that the volume of the capillary bed of the lung is equal to the stroke volume of the heart. The above assessments of this volume are consistent with those that obtain in other ways, measuring stroke volume of the heart.

Hence, if the capillary blood flow of a small circle divided by the heart rate, thereby estimate the amount of all capillaries in the lung, and hence the stroke volume of the heart

V_∑CAP(L)=(Q_CAP(LAY))/HR,

[7]

where V_∑CAP(L)the sum volume of all of the capillaries of the lung, ml; Q_CAP(LAY)- the capillary flow in the lung, ml/min; HR - heart rate per minute. To blood oxygenated in the capillary bed of the alveoli, tainted mixed venous blood flowing through the anatomical shunt lung. Its amount to be added to the volume of all the capillaries of the lung for heartbeat, find the equation

V_∑Ø(EN)=(Q_SHUNT(ANAT)/HR,

[8]

where V_∑Ø(EN)- part mixed venous blood from the pulmonary anatomic shunt, connected to the main volume all the blood capillaries of the lung during one cardiac contraction; Q_SHUNT(ANAT)anatomic shunt lung ml/min; HR - heart rate per minute. Calculate the adjusted volume of capillary blood in the lung

V_∑(CAP+W)=V_∑CAP(L)+V_∑Ø(EN),

[9]

where V_∑CAP(L)the sum volume of all of the capillaries of the lung, ml; V_∑Ø(EN)- added share of mixed venous blood from the anatomic pulmonary shunt for heartbeat, Jr. This United blood enters the pulmonary veins and then into the left atrium and the left ventricle.

Multiply the obtained corrected value of the capillary volume of light on the heart rate and calculate the initial value of minute volume of blood (IOC₀)

Mokn=(V_∑(CAP+W))×HR,

[10]

where Mocn - initial value of the IOC, ml/min, which is associated with a measured by A. Features of the IOC_Andlinear equation. In the situation of the Institute without load value Mokn calculated by the equation

for men

Mokn=0,977×(IOC_And)-16,222; R²=0,9998;

[11]

for women

Mokn=0,979×(IOC_And)-17,835; R²=0,9996,

[12]

where Mocn - initial value of minute volume of blood, formed a small circle of blood, ml/min; IOC_And- the measured value of the IOC A. "Fika", ml/min During physical load IOC_0(H)calculated by the equation

for healthy men

IOC_N=1,0415×(IOC_And(N))-117,79; R²=0,9999;

[13]

for healthy women

IOC_N=1,0255×(IOC_And)+128,86; R²=0,9993,

[14]

where dimension values are the same as in equations [11] and [12].

Calculate the sum volume of all of the capillaries of the lung without a share, which makes anatomic shunt, by the equation

V_∑CAP(L)=(IOC_N-Q_SHUNT(ANAT)×1000/HR,

[15]

where V_∑CAP(L)SHUNT(ANAT)anatomic shunt lung l/min; HR - heart rate per minute.

Examples of the method

In healthy males from year to 49 years old female from one year to 50 years measured from the values of body mass (m, kg), haemoglobin concentration (Hb g/l), total oxygen consumption by the body (_2(TOTAL)ml/min), oxygen saturation of arterial blood (S_ART) and mixed venous blood (S_V), which is expressed in decimal 1, measured simultaneously with_2(TOTAL)heart rate (HR) on the electrocardiogram calculated for healthy men and women data on capillary blood flow in the lungs are shown in table 1.

The first nine count in the table 1 - measured source data in healthy persons In the remaining columns shows the estimated parameters of pulmonary capillary blood flow of the internal-lung venoarterial shunts.

1. Method of assessment of pulmonary blood flow, characterized in that, for the study of capillary blood flow of light to measure the concentration of hemoglobin (Hb g/l), measure the total consumption of oxygen is and the body ( _2(TOTAL)ml/min) to measure the oxygen saturation of arterial blood (S_ARTpercent or decimal 1) and the saturation of mixed venous blood in the pulmonary circulation (Bq) (S_Vpercent or decimal 1), the measured values of Hb,₂, S_ART, S_Vcalculate the IOC (l/min) A. Features; calculate the capillary flow in the lung

Q_CAP(LAY)=Q_CAP(CG)+Q_SHUNT(CG),

[1]

where Q_CAP(CG)- the capillary flow in the Central hemodynamics (the big circle of blood circulation, which delivers oxygen to all the body; Q_SHUNT(CG)=IOC-Q_CAP(CG)- shunt in Central hemodynamics, which in the mixed venous blood enters the capillary bed of the lung; equation [1] is converted into another

Q_CAP(LAY)=(((_2(TOTAL)+((Q_SHUNT(CG)×Hb×1,355)×S_V))×S_ART)/1,355)/(Hb/1000),

[2]

where Q_CAP(LAY)- the capillary flow in the lung, ml/min;_2(TOTAL)the total oxygen consumption of the organism, ml/min; Q_SHUNT(CG)- shunt in Central hemodynamics, l/min; Hb is the hemoglobin concentration in the blood, g/l; 1,355 - coefficient of Huffner, the amount of oxygen in the l, which binds 1 g Hb; S_V- oxygen saturation of the mixed venous blood in the pulmonary circulation; ((Q_SHUNT(CG)×Hb×1,355)×S_V- the amount of oxygen, which was transferred shunt Central hemodynamics of the arterial bed of the big circle in his venous part; (_2(TOTAL)+((Q_SHUNT(CG)×Hb×1,355)×S_V)- the total amount of oxygen (ml/min), which will come in the vascular bed of the lung;
((_2(TOTAL)+((Q_SHUNT(CG)×Hb×1,355)×S_V))×S_ART- the amount of oxygen (ml/min), which will eventually come in pulmonary veins light;
calculate the total value of pulmonary capillary blood flow flowing through the functioning alveoli, in ml/min by the equation

Q_CAP(ALWG)=((_2(TOTAL)+(Q_SHUNT(CG)×Hb×1,355)×S_V)/1,355)/(Hb/1000),

[3]

2. Method of assessment of pulmonary blood flow, characterized in that, for the study vnutrineironalnah shunts first calculate the total shunt lead by the equation

Q_SHUNT(LAY)=(IOC×1000)-Q_CAP(LAY),

[4]

where IOC - minute volume of blood flow, l/min; Q_CAP(LAY)- the capillary flow in the lung, ml/min;
calculate the alveolar physiological venoarterial shunt by the equation

Q_SHUNT(ALV)=(IOC×1000)-Q_CAP(ALWG),

[5]

where IOC - minute volume of blood flow, l/min or a; Q_CAP(ALWG)- full size pulmonary capillary blood flow flowing through the functioning alveoli, l/min;
calculate the anatomic pulmonary shunt, in which the blood from the bronchial veins going in the pulmonary veins of the lung, according to the equation

Q_SHUNT(ANAT)=Q_SHUNT(LAY)-Q_SHUNT(ALV),

[6]

where Q_SHUNT(LAY)- full shunt Krause, ml/min; Q_SHUNT(ALV)- alveolar physiological venoarterial shunt ml/min;
calculate the volume of all capillaries in the lung, and hence the stroke volume of the heart

V_∑CAP(L)=(Q_CAP(LAY))/HR,

[7]

br/> where V_∑CAP(L)the sum volume of all of the capillaries of the lung, ml; Q_CAP(LAY)- the capillary flow in the lung, ml/min; HR - heart rate per minute;
calculate the number primitively mixed venous blood received by the anatomical shunt, and add to the volume of all the capillaries of the lung for a heartbeat, by the equation

V_∑Ø(EN)=(Q_SHUNT(AHAT))/HR,

[8]

where V_∑Ø(EN)- part mixed venous blood from the pulmonary anatomic shunt, connected to the main volume all the blood capillaries of the lung during one cardiac contraction, ml; Q_SHUNT(ANAT)anatomic shunt lung ml/min; HR - heart rate per minute;
calculate the combined adjusted lung capillary blood

V_∑(CAP+W)=V_∑CAP(L)+V_∑Ø(EN),

[9]

where V_∑CAP(L)the sum volume of all of the capillaries of the lung, ml; V_∑Ø(EN)- added share of mixed venous blood from the anatomic pulmonary shunt for heartbeat, ml;
calculate the initial value of minute volume of blood (Mocn), multiplying polucen the Yu-adjusted value of the capillary volume of light on heart rate

Mokn=(V_∑(CAP+W))×HR,

[10]

where Mocn - initial value of the IOC, ml/min, which is associated with a measured by A. Features of the IOC_Andlinear equation
calculate the state at no load the value of the IOC₀
for men

Mokn=0,977×(IOC_And)-16,222; R²=0,9998;

[11]

for women

Mokn=0,979×(IOC_And)-17,835; R²=0,9996;

[12]

where Mocn - initial value of minute volume of blood, formed a small circle of blood, ml/min; IOC_And- the measured value of the IOC A. "Fika", ml/min;
calculate when performing physical activity Mocn by the equation
for healthy men

IOC_N=1,0415×(IOC_And)-117,79; R²=0,9999;

[13]

for healthy women

IOC_N=1,0255×(IOC_And)+128,86; R²=0,9993,

[14]

where notations are the same as in equations [11] and [12];
calculate the sums of the volume of all capillaries of the lung without a share, which brings anatomic shunt, by the equation

V_∑CAP(L)=(Macn-Q_SHUNT(ANAT))×1000/HR,

[15]

where V_∑CAP(L)- the sum of all the capillaries of the lung, ml; Macn - initial value of the IOC, ml/min; Q_SHUNT(ANAT)anatomic shunt lung ml/min; HR - heart rate per minute.