RU1805402C - Method for diagnosing course of myocardial infarction - Google Patents

Abstract

The purpose of the invention is the simplification, acceleration and non-invasiveness of the method. The invention consists in a non-invasive measurement of the concentration of oxyhemoglobin in the capillary bed (at the fingertips) in the first 72 hours from the development of myocardial infarction by applying a clip of a US Oxygen monitor saturation pulse oximeter. With a saturation index below 84%, a high likelihood of developing complications is predicted. The invention can be used in cardiac resuscitation and cardiology departments of hospitals. 1 tab.

Description

The invention relates to medicine, namely to prognostic methods based on a study of peripheral blood. It can be used in clinical practice to predict the course of myocardial infarction. Timely prediction of a possible complication of myocardial infarction allows us to choose the optimal management strategy for patients with myocardial infarction.

The purpose of the invention is to accelerate, simplify and eliminate the invasiveness of the method for predicting the course of myocardial infarction.

This is achieved by determining the concentration of oxyhemoglobin in the first 72 hours from. the onset of the disease by a non-invasive examination of capillary blood and at a score below 84%, a high probability of complications is predicted.,.

Example 1. B. As an example of a patient with low oxyhemoglobin concentrations and an unfavorable prognosis of the course of the disease, we provide a brief extract from the medical history.

Sick Magdich M.M., 71 years old, medical history N ° 5256. Admitted to the clinic 16 / 111-1989 g, with complaints of intense pain behind the sternum, weakness. For 7 years, the patient had angina attacks, 16/111 at 10.00 the patient suddenly developed intense pain behind the sternum and, with suspicion of acute myocardial infarction, the patient was admitted to the intensive care unit. On admission, the patient’s state of moderate severity, conscious consciousness, pale skin, cyanosis of the lips, body temperature of 37 ° C, heart rate - 80 / min, heart rhythm disturbances. Blood pressure 120/80-mm RT. Art. In the lungs in the lower parts, a small amount of congestive small-bubbling rales is heard, respiratory rate is 20 / minute. On the ECG, fresh focal changes in the lower wall of the left ventricle.

In the first day of the disease, the patient's oxySO concentration was determined

WITH

00

about

SL

Оь О Yu

hemoglobin. To do this, the patient attached a sensor in the form of a peg of an Oxygen monitor saturation pulse oximeter / USA / to the terminal phalanx of the finger of the hand, the oxyhemoglobin concentration indicator / in percent / and the pulse were displayed on a light table. pulse oximeter.

The oxyhemoglobin concentration in the patient on the first day of the disease was 83%, which did not exceed 84% and predicted an unfavorable course of myocardial infarction.

Against the background of treatment with nitrates, anticoagulants, antiplatelet agents for 15 days, the patient retained a pain syndrome associated with physical exertion, stopping non-narcotic analgesics. On the 15th day of the disease, the patient again developed an intense anginal attack, accompanied by ventricular extrasystole. Based on ECG data, increases

. and / the activity of cardiospecific enzymes in Krosi, the patient was diagnosed with recurrence of myocardial infarction.

Subsequently, over the entire hospital observation period, the patient recorded a single ventricular extrasystole, moderate congestive effects in a small circle of blood circulation. The patient was discharged on day 43 of the disease with a diagnosis of:

Ischemic heart disease. Acute large-focal myocardial infarction, lower localization from 16 / 111-1989 g, recurrent course / relapse from 1989 /, ventricular extrasystole. Atherosclerosis of the aorta and coronary vessels. NKpA.

. In this case, early prediction of the unfavorable course of myocardial infarction made it possible to determine longer periods of stay of the patient under intensive medical supervision and to prevent a possible fatal outcome. PRI me R 2. As a patient with

 high indicators of oxyhemoglobin concentration and favorable course of the disease, we provide a brief extract from the patient history A.A. Zaitseva, 79 years old, from the medical history 14162, received on 28 / IX-1989 with complaints of severe pain in the heart, weakness, sweating. In the last 5 years, angina attacks and arterial hypertension have been disturbing. On the day of admission, an intense anginal attack occurred, stopped by repeated injections of narcotic analgesics. Upon receipt, a state of moderate severity, in the lungs, single congestive moist rales are heard, A / D - 140/80 mm Hg. Art., C.S.S. - 83 / min, rhythmic pulse,

0

0

BH - 18 / min. On the ECG - signs of acute anterior transmural myocardial infarction. When determining the concentration of oxyhemoglobin, it was 91%, which allowed us to determine the prognosis as favorable. A pain attack was repeated once on the first day, requiring the administration of non-narcotic analgesics, however, subsequently, throughout the entire hospital period, the pain did not recur, heart rhythm disturbances were not detected, and there were no manifestations of circulatory failure. The patient was discharged on the 30th day of treatment for Levani with a diagnosis of coronary heart disease. Acute myocardial infarction, transmural, anterior localization, atherosclerosis of the aorta and coronary vessels. Arterial hypertension.

Example 3. As another example of a patient with low oxyhemoglobin concentrations and an unfavorable prognosis of myocardial infarction, we give a brief extract from the patient’s medical history EM Mishunina,

5 43 years old, medical history No. 5016, admitted to the clinic on 11/3-89, with complaints of non-intense pain in the left half of the chest, weakness. 11 / 3-89 g at 10.00 h; for the first time in life, an intense anginal attack behind the sternum developed, accompanied by a feeling of fear of death, weakness, the ambulance crew, the pain was relieved by the administration of narcotic and non-narcotic analgesics. With suspicion of acute myocardial infarction, the patient was delivered to BIT.

Upon receipt, a state of moderate severity. Sleeping consciousness, skin of normal color and humidity, heart rate 0 76 / min, A / D - 120/80 mm Hg. Art. Vesicular breathing in the lungs, no wheezing, BH - 16 / min. Heart sounds are clear, the rhythm is correct. On the ECG, there are signs of acute lower diaphragmatic myocardial infarction:

On the first day of the disease, the patient's oxyhemoglobin concentration was determined, which was 82%, which did not exceed 84% and predicted an adverse course of the disease.

On the 4th day of myocardial infarction, the patient developed aching pains in the heart area, aggravated by deep breathing, coughing, and pressure on the chest. On E KG, a decrease in the voltage of the teeth was noted. On the 6th day, ventricular extrasystoles joined the pain syndrome, and signs of circulatory failure appeared. Against the background of ongoing therapy with analeptics, non-steroidal pro0

5

5

0

5

With anti-inflammatory drugs, the patient completely disappeared pain, however, throughout the entire hospital period, a rare ventricular extracostomy and mild circulatory failure persisted.

The patient was discharged on the 37th day of the disease with a diagnosis of CHD. Acute, large-focal myocardial infarction of lower diaphragmatic localization, from 11/3-89, complicated by pericarditis, ventricular extrasystole and circulatory failure 11e.

Thus, even in the early period of myocardial infarction, it is possible to predict an unfavorable course of myocardial infarction with the development of complications, which should pay attention to the attending physicians and help in choosing treatment tactics and patient management, possibly prolonging the patient's stay in the intensive care unit and cardiology department, the activation of such a patient in a delayed manner.

Thus, a significant difference of the proposed method is that, with widespread possible changes in the oxyhemoglobin concentration index, specific values were selected that determine the possibility of developing complications of myocardial infarction, which is a creative, non-standard solution.

When examining groups of patients in the acute period of myocardial infarction with a certain level of oxyhemoglobin concentration, it was noted that in all patients with a poor prognosis of myocardial infarction, i.e. with the development of cardiac arrhythmias, circulatory failure, recurrent disease in the first 72 hours of the disease, the hemoglobin concentration was below 84% (table).

The level of oxyhemoglobin concentration in patients with various course of acute myocardial infarction.

The table shows that the difference in the concentration of oxyhemoglobin is statistically significant (Ryt. 0.05). This means that the reliability of the prognosis regarding the adverse course of myocardial infarction with a decrease in the index below 84% exceeds 95%.

. The proposed method allows predicting the nature of the course of myocardial infarction in the early period, regardless of the electrocardiographic picture, localization of the lesion, and does not require a lot of time. The proposed method is simple to perform, is performed on standard serial equipment and can be carried out by nursing staff or a laboratory assistant.

Claims (1)

The claims A method for predicting the course of myocardial infarction, including a blood test, characterized in that, in order to simplify, speed up and atraumatic the method, the concentration of ocean hemoglobin is determined in the capillary blood in the first 72 hours from the onset of the disease using a non-invasive method and with a value lower than 84 % predict an unfavorable course of the disease with the development of complications. The level of oxyhemoglobin concentration in patients with various course of acute myocardial infarction. Patient groups Number of patients Group I Patients with a complicated course of the disease Group I Patients with uncomplicated disease The concentration level of oxy-hemoglobin in% eleven 78.2 ± 2.8 fifteen 91.3 ± 3.3