RU1811374C - Method for determination of minute volume of heart - Google Patents

Abstract

The invention relates to medicine. The aim of the invention is to increase the information content. In a method for determining cardiac output, including the administration of a marker into the bloodstream and measuring the dynamics of its blood levels, a mixture of glucose with insulin is used as a marker. 1 tab.

Description

The invention relates to medicine, in particular to the determination of cardiac output and cardiac output.

A known method for determining the minute -volume of the heart is to determine the rate of consumption of the marker per unit time and the arteriovenous difference in the content of the marker in the blood: the ratio of the first value to the second gives the value of the value of the minute heart volume.

The main disadvantage of this method is its low information content, which is associated either with nonphysiological or simplicity of metabolism of the markers used.

The method is as follows

The patient under study is given an intravenous mixture of glucose with insulin at the rate of 1 unit. the effects of insulin on 4 g of glucose administered. The start time of marker administration is recorded. At the 7th and 16th minutes, the dynamics of blood glucose were determined.

Then, the amount of glucose introduced into the bloodstream in millimoles is determined, which is determined by the formula

GPst

- (Mouth) (% Cr) .10

MWfc

where VCT is the volume of glucose solution introduced into the bloodstream, cm;

% CT - concentration of glucose solution introduced into the bloodstream,%;

Mmst — 180.2 g / mol — relative molecular weight of the glucose substance;

10 is a coefficient for converting the concentration of glucose solution from percent to ppm (%);

 K - specific client extracellular fluid

K ln (Ci / C2) / (t2-ti)

where Ci is the concentration of glucose in the blood at time ti, i.e., at the end of the period of time from the moment the glucose solution was introduced into the bloodstream until the first blood sampling, mmol / dm;

C2 is the concentration of glucose in the blood at time t2, i.e., at the end of the period of time from the moment the glucose solution is introduced into the bloodstream until the second blood sampling, mmol / dm.

Dimension K - dimension operator00

with

2

with

ra

-dvaf-avat

Then, the conditional concentration of glucose Co in the blood is determined at the time of the start of the introduction of the glucose solution into the bloodstream, provided that the injected dose of the glucose substance is received and uniformly distributed evenly in the extracellular fluid at time t0:

Co c2iK (t2-to) Based on the obtained data, the glucose distribution space PRst is determined, which corresponds to the volume of extracellular fluid:

PRst tf / (Co - One Hundred),

One hundred homeostatic fasting blood glucose concentrations, for laboratory determination of which a blood sample is taken directly by intravenous glucose solution, mm / dm,

Then determine the cardiac output

MOS PRst2 K

and, if necessary, stroke volume of the heart, dm3 / systole (UO):

UO MOS / HR,

where heart rate is the number of heartbeats per minute ...

Example. A 60-year-old patient was undergoing treatment for a tumor of the large duodenal papilla and obstructive jaundice. The patient underwent surgery-pancreato-duodenal resection. The postoperative course was complicated by pneumonia and the formation of an abscess of the abdominal cavity, which was opened and drained. Postoperative complications were stopped and in satisfactory condition the patient was discharged for outpatient follow-up for postoperative asthenia.

A study of MOS and MA, glucose kinetics and PRSt indicators in a patient was performed according to the readings 16 times: one study on the eve of surgery, 14 studies in the postoperative period and one study before discharge.

On the eve of surgery, the following anthropometric indicators were determined in a patient: height - 168 cm, body weight - 82 kg, body surface - 1.92 m2. Immediately before the intravenous administration of a mixture of glucose with insulin, the following were determined: fasting blood glucose (Hundred) - 5.7 mmol / dm3, heart rate - 66 per minute. Then, a 38 cm-40% glucose solution was injected intravenously into a mixture with insulin, and the time of the start of glucose solution administration was recorded by the hour. At the 7th (ti) and 16th (ta) minutes, the dynamics of glucose content was determined

in the blood: Ci 9.4 and C. 6.6 mmol / dm3, respectively.

The calculation of indicators was carried out according to the formulas:

(Us). (° / oSt) .1P 38-40 MMz 180.2

MG

10

 84.350721 mmol;

TO

 CST / Cg) (9.4 / 6.6),

T.2-11

0.0392933 1 / dm3, min;

16 -7

5

0

5

0

5

0

5

0

5

Co C2 lK (t2 t1) 6.6.0.0393-16 T2.376042 mmol / dm3;

PRST TS & -351

Co - One Hundred 12.38 - 5.7 12.634839 dm3,

MOS PRST K 12.6352 - 0.0393 6.2727505 dm3 / min;

UO MOS / HR 6.273 / 66 0.0950 dm3 / systole 95 cm3 / systole.

Assessment of indicators before surgery and in dynamics,

Before surgery: PRST corresponds to the volume of extracellular fluid and normally makes up 12-19% of body weight; in this patient, this indicator was 15% of body weight. Minute and stroke volume of the heart is within normal limits.

The table shows the dynamics of indicators of the number of heart contractions, body weight, glucose distribution spaces in absolute figures and in% with respect to body weight, cardiac output and cardiac output. From the dynamics of the indicators PRst, MOS, MA, HR, it is obvious that the information received is of great practical importance, since it allows you to purposefully and reasonably correct the current detoxification and cardiovascular therapy, to correct the exchange of water and electrolytes, i.e. conduct quantitative control of the effectiveness of conservative treatment and sanitization operations on the 12th day after the main operation.

A critical drop in cardiovascular activity was noted on the 2nd and 3rd day after the operation, the relief of which was facilitated by the timely diagnosis of the state of the cardiovascular system using the claimed research method.

With the formation of an abscess of the abdominal cavity and the addition of purulent intoxication, the development of hyperkinetic heart syndrome was noted.

In connection with postoperative aldosteronism, there was a pronounced tendency to delay large amounts of water in the tissues of the body.

As the postoperative complications stopped and by the time the patient was discharged from the hospital, normalization of the hemodynamic indices and hydro exchange was noted.

The method allows to increase the information content of the study by simultaneously determining the entire gamut of marker metabolism, hydroexchange and hemodynamics, and, if necessary, calculating derivatives of them, using a physiological, affordable and cheap marker, which is a glucose substance.

0

Claims (1)

SUMMARY OF THE INVENTION A method for determining the minute heart volume, including the introduction of a marker into the bloodstream and measuring the dynamics of its blood levels, characterized in that, in order to simplify and increase the information content of the method, a mixture of glucose with insulin is administered to the test person, the amount of glucose determined by the amount of ml of a 40% solution equal to half the weight of the patient, and insulin by the number of units equal to the initial glycemia in mmol / L. x - On this day, the patient had spontaneous (non-stimulus Knd) popiuri xx - After the study, urine-onm was prescribed ..; xxx - Date of opening and drainage of the abscess Oryuoshoi stripes i