RU2140306C1 - Method of diagnosis and prophylactic treatment of insult - Google Patents

Abstract

FIELD: cardiology. SUBSTANCE: method includes clinical and biochemical examinations to determine the stage of disease. Determined additionally is insult risk coefficient by formula: Kr=Er.f.+Ka, where Er.f. is sum of weight coefficient of risk factors Kn where n=1-15; sex, are, use of alcohol, smoking, pressure of accompanying diseases, stage of ischemic disease of heart, heredity, presence of cerebral vascular episodes in anamnesis, systolic and diastolic arterial pressure, meterolability, presence of cardiac arrhythmia, nature of arterial hypertension, blood sugar, stress index, with arbitrary set of insult risk factors (from 5 to 15); Ka is coefficient of adaptation of cardiovascular system according to data on cardiointervalometry. At 0.29 < Kr < 0.29, low risk of insult development is diagnosed. In this case, transcutaneous radiation of cubital vein in infrared band is administered. Pulse power is 4.7 W, frequency of 80 Hz. Radiation is carried out for 15 min daily up to total dose of 0.19-0.24 J for course of 8-10 days. If Kr exceeds 0.3, high risk of insult development is diagnosed. In this case, transcutaneous radiation in infrared band of cubital vein is administered, with frequency of 600 Hz pulse power of 1.7 W. Radiation is carried out for 10 min daily up to total dose of 0.21-0.26 J, for course of 5-6 days. EFFECT: higher quality of diagnosis and efficiency of insult prevention due to fuller consideration of degree of adaptation of cerebrovascular system and more intensive physiological treatment by factors of low intensity.

Description

 The invention relates to medicine, in particular to neurology, and is intended for the diagnosis, prevention and treatment of stroke after determining the risk of its development mainly during mass examinations of the population.

 Separate methods for predicting stroke and certain methods for preventing stroke are known. The pathogenesis of the disease has been sufficiently studied, it is known that arterial hypertension, as well as cerebral atherosclerosis, plays a significant role.

 A known method for predicting the risk of stroke by the presence or absence of risk factors for stroke. The method consists in a tabular assessment of existing risk factors, such as indicators of blood pressure, signs of atherosclerosis, bad habits, working conditions, etc., after which the points for and against the development of a stroke are calculated using the formula and the prevailing amount of points is the conclusion (Misyuk N.S. Prediction and prevention of acute cerebrovascular accident. Minsk, 1987, p. 84-92).

 This method has significant drawbacks, it is based on a simple arithmetic sum of the risk factors present for the subject, and the mutual influence of individual factors is not taken into account, that is, their "weight", both increasing and decreasing the risk of stroke (for example, the simultaneous presence of cerebral arteriosclerosis and diabetes does not summarize, but greatly increases the risk of stroke). The method does not take into account the adaptive state of the cardiovascular system, while the same hemodynamic parameters may indicate a different level of body health depending on the degree of adaptation. Thus, an increase in blood pressure and heart rate, often to very high numbers, in an athlete during the competition is an adequate reaction and cannot be considered a risk factor, while in an elderly patient with hypertension, the same indicators indicate the development of a hypertensive crisis, t .e. at a high risk of stroke.

 Known methods of drug prevention of stroke using antiplatelet drugs (trental, ticlide), cerebral vasodilators (cavinton, nimotope), metabolics (nootropil, glycine), lipid-lowering agents (lipanor, mevacor) (Neretin V.Ya., Kotov S.V. Prevention cerebrovascular diseases. 1997, p. 110-126).

 This method differs in duration (for example, when taking tantalum, ticlide, lipanor, etc., it is carried out throughout the patient’s life), the absence of a selective approach — preventive treatment is carried out for all patients with risk factors regardless of their severity, low efficiency in case of spontaneous cancellation - a sharp increase in the number of strokes after discontinuation of the drug, at a high price per year per patient.

 A known method for the diagnosis and prophylactic treatment of stroke, including clinical and biochemical studies to determine the degree of the disease, transcutaneous exposure to blood with monochromatic radiation (Problems of laser medicine. Materials of the 4th International Congress dedicated to the 10th anniversary of the Moscow Regional Center for Laser Surgery. Moscow-Vidnoe. 1997 p. 182-183).

 The disadvantages of this method are the lack of assessment of the adaptive abilities of the cerebrovascular system, the severity of risk factors for stroke is not taken into account, the effectiveness of the diagnosis and treatment of stroke is reduced.

 The task set by the authors is to eliminate these shortcomings by improving the quality of diagnosis and the effectiveness of stroke prevention due to a more complete account of the degree of adaptation of the cerebrovascular system and a more physiological effect of low-intensity physical factors.

To this end, in a method for the diagnosis and prophylactic treatment of stroke, including clinical and biochemical studies with the determination of the stage of the disease and transcutaneous exposure to blood with monochromatic radiation, it is proposed to additionally determine the risk factor for stroke by the formula
K _p = E _f.r. + K _a ,
where E _f.r. - the sum of the weighting factors of risk factors K _n = 1 - 15, with an arbitrary set of risk factors for stroke from 5 to 15;
K _a is the coefficient of adaptation of the cardiovascular system according to cardiointervalometry.

At the same time, at -0.29 <K _p <0.29, they diagnose a low risk of developing a stroke and prescribe irradiation of the cubital vein cutaneous in the infrared for 15 minutes daily to a total dose of 0.19 - 0.24 J per course of 8 - 10 days , at K _p > 0.3, they diagnose a high risk of developing a stroke and prescribe irradiation of the cubital vein cutaneously in the infrared for 10 minutes daily to a total dose of 0.21 - 0.26 J per course of 5 - 6 days.

A significant difference of the proposed method from the prototype is that an arbitrary set of stroke risk factors (from 5 to 15) is selected, cardiointervalometry and, in particular, its integrative indicator, the stress index, are used to create a decision rule to assess the state of adaptation of the cardiovascular system the mechanism of linear discriminant analysis was used, preventive measures for patients are carried out differentially, depending on the severity of the risk of stroke (K _p value).

 Cardiointervalometry is a simple and affordable method of ECG analysis. The essence of the method is to measure changes in the duration of the distance between heart contractions.

 As a result of the study, a number of stroke risk factors were obtained: gender, age, alcohol consumption, the presence of concomitant diseases, the stage of coronary heart disease, a history of cerebral vascular episodes, heredity, systolic blood pressure, diastolic blood pressure, meteorolability, the presence of cardiac arrhythmia, the nature hypertension, blood sugar, voltage index value.

 The proposed method is as follows.

 Assess the presence of qualitative risk factors in points. The patient's gender is evaluated: male - 1 point, female - 2 points; age - up to 45 years - 1 point, 45-59 - 2 points, 60-74 - 3 points, over 74 years old - 4 points. Alcohol use: 1 point - do not or occasionally, 2 points - do, but no addiction (household drunkenness), 3 points - abuse (alcoholism). The presence of concomitant diseases: 1 point - no, 2 points - there is one compensated, 3 points there is one decompensated, 4 points - there are several, of which one is decompensated. The presence of cerebral vascular episodes in the anamnesis: 1 point - was not, 2 points - were in the vertebro-basilar pool, 3 points - were in the carotid pool. Heredity: 1 point - not burdened, 2 points - early atherosclerosis, diabetes, obesity, myocardial infarction in blood relatives, 3 points - hypertension, 4 points - stroke. Meteolability: 1 point - when the weather changes, health does not change, 2 points - changes slightly, 3 points - changes significantly. The presence of cardiac arrhythmia: 1 point - no, 2 points - sinus, 3 points - extrasystole, 4 points - atrial fibrillation. The nature of arterial hypertension: 1 point - no, 2 points - transient, 3 points - persistent without fluctuations in blood pressure, 4 points - persistent with fluctuations in blood pressure. Stage of coronary heart disease: 1 point - no, 2 points - angina pectoris, 3 points - myocardial infarction, 4 points - diffuse cardiosclerosis.

 The subject is measured systolic and diastolic blood pressure in millimeters of mercury.

Measure the blood sugar level in millimoles per liter. An electrocardiographic study is performed with the fixation of at least 100 QRS complexes. After that, make a graph of the distribution of cardio intervals by duration. Determine the mode (the most common duration of cardio intervals) in seconds, the amplitude of the mode as a percentage, the variation in the duration of cardio intervals in seconds and determine the value of the stress index by the formula
IN = AMo / (2 • dX • M ₀ ),
where IN is the voltage index, AMo is the amplitude of the mode, dX is the spread of the duration of the cardio intervals (delta X), M _o is the mode.

 The stress index is an integral indicator of the ratio of the state of the sympathetic and parasympathetic systems of the body. This indicator is normally equal to 119.6 + 5.7 conventional units. With an increase in the activity of the parasympathetic link, the value of this indicator decreases, with an increase in the activity of the sympathetic Even, it increases. A significant increase in the value of the voltage index to 250 srvc. units and more indicates disadaptation of the cardiovascular system, which is a risk factor in terms of the development of stroke. Using a system for variational pulsometry, this study is significantly accelerated.

Then, the risk of stroke development is calculated using the formula we developed
K _p = E _f.r. + K _a ,
K ₁ Gender (points) • 0.19
+ K ₂ Age (points) • 0.61
+ K ₃ Alcohol use (points) • 0.39
+ K ₄ Smoking (points) • 0.01
+ K ₅ Presence of concomitant diseases • (-0.21)
+ K ₆ Stage coronary heart disease (points) • 0.03
+ K ₇ Heredity (points) • 0.19
+ K ₈ History of concomitant episodes (points) • 0.53
+ K ₉ Systolic blood pressure (mmHg) • 0.01
+ K ₁₀ Diastolic blood pressure (mmHg) • 0.02
+ K ₁₁ Meteolability (points) • (-0.46)
+ K ₁₂ The presence of cardiac arrhythmia (points) • 0.16
+ K ₁₃ Nature of arterial hypertension (points) • 0.11
+ K ₁₄ Blood sugar (mmol / l) • 0.06
+ K ₁₅ (-7.29 - constant).

+ K _a Index of voltage IN (conventional units) • 0.01
The optimal set of risk factors is given. Diagnosis can be carried out with an arbitrary set of factors, but not less than 5 and not more than 15, because a decrease or increase in the number of factors taken into account leads to a decrease in diagnostic accuracy.

Having received a specific value of the sum of these indicators - the risk factor for stroke, assess the degree of risk of stroke in this subject. If the value of K _p does not exceed -03, then the absence of a risk of stroke is diagnosed (group 1), if the value of K _p is in the range -0.29 <K _p <0.29, then a low risk of stroke is diagnosed (group 2 ), if the value of K _p is 0.3 or more, they diagnose a high risk of stroke (group 3). The surveyed group 1 preventive measures are not taken, the surveyed group 2 conduct a course of transcutaneous laser therapy, prescribe irradiation of the cubital vein cutaneous in the infrared with a wavelength of 0.89 + 0.02 μm, a frequency of 80 Hz, a pulse power of 4.7 W for 15 minutes daily to a total dose of 0.19 - 0.24 J per course of 8 to 10 days. After a year, this group is recommended to re-evaluate K _p . The proposed course of treatment is carried out in this group of patients twice a year. The examined 3 groups are prescribed irradiation of the cubital vein cutaneous in the infrared with the same wavelength at a frequency of 600 Hz and a pulse power of 1.7 W for 10 minutes daily to a total dose of 0.21 - 0.26 J per course of 5 - 6 days . This group of patients is recommended to carry out this course of treatment twice a year.

 Examples of specific performance.

 Example 1. Patient D. (medical history N 349, 1998), 59 years old, was in the neurological department.

 Diagnosis: cerebral arteriosclerosis. Dyscirculatory encephalopathy of the III Art. in the stage of decompensation. Parkinsonism, trembling form.

 Upon receipt of a complaint of headaches, dizziness, trembling head. Headaches have been bothering the patient for several years; since January 1997, head trembling has appeared.

Objectively:
Pulse - 92 beats. per minute. HELL - 190/110 mm Hg. Art. Cranial nerves - slightly does not bring the eyeballs to the external adhesions, the right nasolabial fold is smoothed. Irregular dizziness. Reflex-motor sphere - tendon reflexes are high, with an emphasis on the right. There are no clear pathological symptoms. "+" Jacobson-Lask symptom on both sides. There are no paresis. Clear sensitive disorders were not identified. Coordination tests are performed uncertainly, with a mismatch. In the Romberg position is unstable.

Survey Results:
In general, biochemical blood tests, general urine tests, indicators are within normal limits. Blood sugar - 6.5 mmol / L. Coagulogram - a tendency to hypercoagulation. ECG - normal position of the electrical axis, sinus arrhythmia, heart rate - 74 beats per minute. Changes in the myocardium of the left ventricle of a diffuse nature. Spondylogram of the cervical spine - scoliosis, arthrosis of the unco-vertebral joints, spondylarthrosis. Optometrist Consultation - Retinal Angiosclerosis.

 A computer study of the brain is a small focal lesion of the brain of a vascular nature.

Based on the results of the examination, the risk factor for the development of stroke was calculated according to the formula K _p = E _f.r. + K _a :
K ₁ - 0.19 • 2 = 0.38 +
K ₂ - 0.61 • 2 = 1.22 +
K ₃ - 0.39 • 1 = 0.39 +
K ₄ - 0.01 • 1 = 0.01 +
K ₅ - (-0.21) • 2 = -0.42 +
K ₆ - 0.03 • 2 = 0.06 +
K ₇ - 0.19 • 3 = 0.57 +
K ₈ - 0.53 • 3 = 1.59 +
K ₉ - 0.01 • 190 = 1.9 +
K ₁₀ - 0.02 • 110 = 2.2 +
K ₁₁ - (-0.46) • 2 = -0.92 +
K ₁₂ - 0.16 • 2 = 0.32 +
K ₁₃ - 0.11 • 3 = 0.33 +
K ₁₄ - 0.06 • 6.5 = 0.39 +
K ₁₅ - (-7.29)
E _f.r. = 0.73
K _a = 0.01 • 247 = 2.47
K _p = 0.73 + 2.47 = 3.2.

 Thus, patient D. has a high risk of developing a stroke. The patient was prescribed transcutaneous irradiation of the cubital vein in the infrared with a wavelength of 0.89 + 0.02 μm at a frequency of 600 Hz and a pulse power of 1.7 W for 10 minutes daily to a total dose of 0.25 J for 5 days.

 After a course of therapy, the patient noted a significant decrease in the frequency and severity of headaches, dizziness of a non-systemic nature almost ceased to disturb, and trembling of the head decreased.

 Objectively: the severity of head tremor decreased, tendon reflexes decreased, and anisoreflexia decreased. The patient became more confident in performing coordinating tests. A tendency toward normalization of blood coagulation processes was noted: the level of fibrinogen decreased, the prothrombin index and the time of fibrinolytic activity decreased. Observation for 6 months did not reveal signs of an increase in cerebrovascular insufficiency.

 Example 2. Patient S. (medical history N 627, 1998), born 1955, a driver by profession.

 Diagnosis: dyscirculatory encephalopathy II tbsp. with frequent cerebral vascular crises. Upon receipt of a complaint of frequent headaches, bouts of hot flashes to the head, upper chest, accompanied by palpitations, a sense of fear, a rise in blood pressure to 140-150 / 80-90. Considers himself ill for about 10 years.

 Objectively: Pulse - 80 beats. in minutes HELL - 150/90 mm RT. Art. FMN - without focal pathology. Tendon reflexes are lively, without a clear difference of sides. There are no pathological stop signs. Coordination tests are performed confidently. In the Romberg pose sways. Clear sensitive disorders were not identified.

 Examination results: general and biochemical blood tests - no pathology was detected. Blood sugar - 4.6 mmol / L.

 Urine analysis for catecholamines: adrenaline - 66.6 nmol / day (normal - 11.0 - 44.0), norepinephrine - 331 nmol / day (normal - up to 236.0) EEG - unsharp cerebral disturbances in the form of irregular alpha rhythm . Diffuse sharp waves are diffusely isolated.

 EEG changes are regulatory and indicate dysfunction of brain stem formations. Craniogram - porosity of the back of the Turkish saddle was revealed.

 Spondylogram of the cervical spine - straightening of the cervical lordosis, arthrosis of the unco-vertebral joints, spondylo-arthrosis. ECG - pacemaker migration in the atria, heart rate - 56 - 59 per minute. Optometrist - Macular Dystrophy OD.

Based on the results of the examination, the risk factor for the development of stroke was calculated according to the formula K _p = E _f.r. + K _a :
K ₁ - 0.19 • 1 = 0.19 +
K ₂ - 0.61 • 1 = 0.61 +
K ₃ - 0.39 • 2 = 0.78 +
K ₄ - 0.01 • 2 = 0.02 +
K ₅ - (-0.21) • 3 = -0.63 +
K ₆ - 0.03 • 1 = 0.03 +
K ₇ - 0.19 • 1 = 0.19 +
K ₈ - 0.53 • 2 = 1.06 +
K ₉ - 0.01 • 150 = 1.5 +
K ₁₀ - 0.02 • 90 = 1.8 +
K ₁₁ - (-0.46) • 2 = -0.92 +
K ₁₂ - 0.16 • 2 = 0.32 +
K ₁₃ - 0.11 • 2 = 0.22 +
K ₁₄ - 0.06 • 4.6 = 0.276 +
K ₁₅ - (-7.29)
E _f.r. = -2.156
K _a - 0.01 • 211 = 2.11
K _p = 0.266.

 Thus, patient S. has a low risk of developing a stroke. The patient was prescribed transcutaneous irradiation of the cubital vein in the infrared with a wavelength of 0.89 + 0.02 μm at a frequency of 80 Hz, a pulse power of 4.7 W for 15 minutes daily up to a total dose of 0.24 J. The treatment performed is a course of transcutaneous blood irradiation (8 sessions).

 As a result of the therapy, the patient's seizures almost completely disappeared, his mood returned to normal, and the frequency and severity of headaches significantly decreased. Further observation did not reveal a deterioration.

 The proposed method allows to reduce the patient’s time in hospital, to reduce the number of people affected by stroke. The periods of temporary disability and the number of persons with disabilities are reduced.

Claims (1)

A method for the diagnosis and prophylactic treatment of stroke, including clinical and biochemical studies with the definition of the stage of the disease, transcutaneous exposure to blood by laser radiation, characterized in that it further determines the risk factor for stroke by the formula
K _p = E _f.p + K _a ,
where E _fr.r is the sum of the weight coefficients of risk factors K _n (n = 1 - 15): gender, age, alcohol consumption, smoking, the presence of concomitant diseases, the stage of coronary heart disease, heredity, a history of cerebral vascular episodes, systolic arterial pressure, diastolic blood pressure, meteorolability, the presence of cardiac arrhythmia, the nature of arterial hypertension, blood sugar, stress index with an arbitrary set of risk factors for stroke (from 5 to 15);
K _a - adaptation coefficient of the cardiovascular system according to cardiointervalometry,
at -0.29 <K _p <0.29, a low risk of stroke is diagnosed and irradiation of the cubital vein is prescribed transcutaneously in the infrared range with a pulse power of 4.7 W and a frequency of 80 Hz for 15 min daily to a total dose of 0.19 - 0.24 J, for a course of 8 to 10 days, at K _p > 0.3, a high risk of stroke is diagnosed and irradiation of the cubital vein is prescribed transcutaneously in the infrared range at a frequency of 600 Hz and a pulse power of 1.7 W for 10 min daily up to a total dose of 0.21 - 0.26 J, for a course of 5 - 6 days.