RU2316257C2 - Method for diagnosing cerebrovascular reserves and predicting vascular optic nerve abnormalities in gerontological patients suffering from dyscirculatory encephalopathy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves recording final diastolic blood circulation speed (EDV) in common carotid artery. Lifting legs to 90° for 2 min is used as functional load. Carotid index IC is calculated before and after loading from formula IC = EDV_ica/EDV_cca, then, absolute carotid index increment Δ_ic is calculated from formula Δ_ic = IC _{before loading} - IC a_{fter loading}. The value being equal to or less than -0.18, cerebrovascular reserves reduction and possible blood circulation disorder in orbital artery system is diagnosed.

EFFECT: wide range of functional applications in clinical diagnosis field.

4 dwg, 3 tbl

Description

The invention relates to medicine, namely to ophthalmology and neurology, to methods for diagnosing vascular pathology of the carotid pool, as well as determining cerebrovascular reserves.

The purpose of the invention is to propose a method for the diagnosis of cerebrovascular reserves and the prediction of vascular pathology of the optic nerve with discirculatory encephalopathy in gerontological patients. Considering the age of patients (55 years and older), the presence of many concomitant diseases, it is advisable to conduct the study as quickly as possible, easier, with affordable physical activity for the patient, without the use of additional devices and medications, so as not to cause the patient to worsen with his research.

The invention consists in dopplerographic registration of blood flow parameters: final diastolic velocity (EDV cm / s), calculation of the carotid index IC in the norm 1-1.5 and increases with an increase in the stenotic process in the distal parts of the internal carotid artery, determination of the absolute increment of the IC carotid index. The common carotid artery (CCA), the internal carotid artery (ICA) are examined before and after the functional load of a physical nature in the horizontal position of the patient;

Formula number 1

IC (preload) = EDV (ICA) (preload) / EDV (OCA) (preload)

Formula number 2

IC (after loading) = EDV (ICA) (after loading) / EDV (OCA) (after loading)

The concept of Δ _IC is introduced - the absolute increment of the IC index, which determines changes in the state of the vascular wall of 2 vessels of the OCA and ICA with simultaneous examination, that is, the reactivity of these vessels to physical activity, as well as the functional reserve of these vessels, which makes it possible to judge cerebrovascular reserves and the possibility of damage orbital artery, calculated by the formula No. 3;

Formula number 3

Δ _IC = IC (after load) -IC (before load)

1. A known method for the diagnosis of blood supply to the brain with coronary heart disease and arterial hypertension. Test with hypercapnic hypoxia by breathing through additional dead space. Changes in the gas composition of the blood were achieved by breathing for 3 minutes through an additional dead space, the role of which was played by a horizontally located elastic tube (3.0 cm in diameter, 145 cm long, 1.0 l in volume) equipped with a mouthpiece; in the horizontal position of the patient in the initial state and at the peak of the sample, a linear blood flow velocity is measured in the cerebral artery system using the method of ultrasound transcranial dopplerography. To exclude nasal breathing, a clip was applied to the wings of the nose. To study the dynamics of the gas composition of blood in the initial state and at the peak of the test in arterial capillary blood, the oxygen and carbon dioxide contents were estimated using the Astrup micrometer method on a BMS-3 microanalyzer from Radiometr (Denmark) (Astanina I.A. Complex radiation morphofunctional study of blood supply of the brain in patients with coronary heart disease and arterial hypertension with asymptomatic atherosclerotic lesions of the carotid arteries: Abstract of thesis, Candidate of Medical Sciences, Tomsk, 2001. - 29 p.)

2. The closest solution in terms of anatomical and physiological nature, selected as a prototype, is a method for determining the assessment of the reserves of blood circulation of the heart and brain in patients with coronary and carotid atherosclerosis using a modified antiorthonload test (AONP), with the lower limbs on a stand, under angle of 60 degrees to the horizontal surface. Registration of hemodynamic parameters is carried out at rest and at the 5-10th minute of the load. When using AONP, the functional response of the circulatory system depends on its reactivity, which determines its functional reserve, the quantitative assessment of which is the reactivity index (IR), as the ratio of the blood flow index against the background of the functional test to the initial value.

The authors predict the hemodynamic efficacy of coronary artery bypass surgery by examining the increase in the ejection fraction of the left ventricle in AONP, as well as dopplerography of the internal carotid artery (Vorozhtsova I.N. Reserves of the blood circulation of the heart and brain in patients with coronary carotid atherosclerosis: Author's abstract. Diss. Dr. med. Science. - Tomsk, 2000 .-- 53 p.).

Considering the age of our patients (55 years and older), the presence of many concomitant diseases, it is advisable to conduct the study as quickly as possible, easier, with affordable physical activity for the patient, without the use of additional devices and drugs, so as not to cause the patient to worsen with his research .

The proposed technique is carried out using an ultrasonic AB scanner “Toschiba-270” with a convex sensor - 4.5 Mhz, for surface structures, the scanning depth is up to 6 cm.

In the horizontal position of the patient, the common carotid artery (OCA) and the internal carotid artery (ICA) were examined.

The measurement was carried out in the position of the patient lying on his back, before the study for at least 6 hours the patient did not receive vasoactive drugs and physiotherapeutic procedures. The sensor is located in the cranial direction at an angle of about 60 degrees to the bloodstream in the vessel, with a transverse examination of the vessel and parallel to the vessel 90 degrees, with a longitudinal examination of the vessel (Agadzhanova L.P. Ultrasound diagnosis of diseases of the aortic arch and peripheral vessels: Atlas. - M .: Vidar, 2000 .-- 176 p.).

When examining the carotid arteries, the patient’s chin is slightly raised and the face is turned away from the studied artery.

The common carotid artery is located at the bifurcation site, the site of carotid bifurcation is determined at the intersection of the medial surface of the edge of the sternocleidomastoid muscle and vocal cords, this location point is informative regarding stenosis of the common carotid artery at this level, as well as the pathology of the internal carotid artery.

The internal carotid artery is located under the edge of the lower jaw (Zenkov L.R., Ronkin M.A. Functional Diagnosis of Nervous Diseases (Manual for Doctors). - 2nd ed., Revised, and add. - M .: Medicine. - 1991 . - 640 s. - ISBN 5-225-01170-5).

The load test consists in raising the patient upwards bent at the knees of the legs to 90 degrees, while the hemodynamic parameters are recorded at rest and at the 2nd minute of the load test.

A group of patients was investigated - 51 people (72 eyes) with ischemic opticopathy. In the first group with the phenomena of posterior ischemic opticopathy (ZIOP) - 39 patients (56 eyes). The average age composition in this group is 72 years. The second group with the phenomena of anterior ischemic opticopathy (PIOP) - 12 people (16 eyes). The average age composition in this group is 73 years.

The control group consisted of 25 people (50 eyes). The average age composition of this group is 77 years.

Background disease "Discirculatory encephalopathy of the I-II-III degree" was confirmed by a neurologist in the study and control group.

Table 1
Blood flow indicators before and after a stress test. Control group ZIOP PIOP PSV cm / s EDV cm / s PSV cm / s EDV cm / s PSV cm / s EDV cm / s ICA 0.33 ± 0.06 0.10 ± 0.02 0.23 + 0.06 0.09 ± 0.02 0.25 ± 0.06 0,07 ± 0,02 before after 0.34 ± 0.07 0.12 ± 0.02 0.24 + 0.06 0.08 ± 0.02 0.23 ± 0.07 0.06 ± 0.02 WASP 0.27 ± 0.06 0,07 ± 0,02 0.26 ± 0.05 0.06 ± 0.02 0.21 ± 0.04 0.05 ± 0.01 before after 0.33 ± 0.06 0.09 ± 0.03 0.27 ± 0.08 0,07 ± 0,02 0.22 ± 0.06 0.05 ± 0.01 Significance of differences in results P <0.05 table 2
IC indicators Control group ZIOP PIOP IC to load 1.42 ± 0.02 1,50 ± 0,02 1.40 ± 0.02 IC field load 1.33 ± 0.02 1.14 ± 0.02 1.20 ± 0.02 Significance of differences in results P <0.05 Table 3
Δ _IC Control group ZIOP PIOP Δ _IC -0.09 ± 0.02 -0.36 ± 0.02 -0.2 ± 0.02 Significance of differences in results P <0.05

A decrease in the absolute increment of the carotid index Δ _IC against the background of a functional load of a physical nature in the horizontal position of the patient from - minus 0.18 or less, indicates a decrease in cerebrovascular reserves and the possibility of impaired regional blood flow in the orbital artery system.

Clinical case study:

Vetlugin Anatoly Yakovlevich, 75 years old. Outpatient card No. 479/95.

On January 25, 01, when contacting an optometrist, it was registered:

Vis = 1.0 / 1.0 intraocular pressure 17/17 mmHg The field of view was determined by the Ferster perimeter, a white object of 0.5 cm is the norm.

Objectively: Both eyes (OU) - Anterior segment without features. Biomicroscopic: Both eyes are focal opacities in the lens. Fundus: Disks of the optic nerve (optic nerve disc) are pale pink, the borders are clear, the arteries are narrowed, convoluted. The veins are dilated.

Diagnosis: OU - Initial age-related cataract. Retinal vascular angiosclerosis.

Ultrasonic duplex scanning: Right side Left-hand side To load after loading before load after load OCA - 0.33-0.09 0.39-0.11 0.30-0.05 0.31-0.05 ICA - 0.36-0.10 0.42-0.12 0.27-0.06 0.25-0.05 After the study, we calculate the indices: IC to load 1,1 1,2 IC after loading 1.09 1,0 Δ _IC -0.01 -0.2 August 9, 01, Complaints of a sharp decrease in vision in the left eye.

Objectively: OU-1,0 / arm movement. Front segment without feature. Biomicroscopic: Both eyes are focal changes in the lens. Fundus: Right eye (OD) - DZN-pale pink, clear borders. The left eye (OS) -DZN-pale, fuzzy borders, retinal edema in the posterior pole.

Diagnosis: Ischemic opticopathy OS.

The patient is examined by a neurologist - Diagnosis: Atherosclerotic discirculatory Encepholopathy II - stage, amniostatic syndrome.

On the example of this patient, good cerebrovascular reserves from the right OSA and ICA are clearly visible, the absolute increment of the carotid index Δ _IC is minus 0.01. This reaction of the vascular bed is observed during the patient’s circulation and in dynamic observation during the year, high functional visual indicators of the right eyeball are preserved. On the left side, a decrease in cerebrovascular reserves of OCA and ICA, the absolute increment of the carotid index Δ _IC - minus 0.2. The appearance of ischemic opticopathy of the left eye was noted.

Stashkov Valentin Stepanovich, 79 years old. Outpatient card number 006179. 01/19/00 years when contacting an ophthalmologist registered:

Vis - 0.4-1.0 Diopters (D) = 0.5 / 0.1-2.0 D = 0.5 IOP-16 mm Hg / 27 mm Hg

The field of view of the OD is the norm, the OS on top is 10 degrees, on the bow is 10 degrees, below is 10 degrees, on the temporal side is 70 degrees.

Objectively: OU-thinning pigment rim. Biomicroscopic: nuclear-cortical opacities in the lens. The fundus of the eye: OD - optic nerve discs are pale pink, the borders are clear, the arteries are sclerotic, veins full-blooded. OS - the optic nerves are pale, monotonous, the borders are clear, the arteries are sclerosed, veins are full-blooded.

Diagnosis: OU - Initial age-related cataract, retinal vascular sclerosis. OS-Subatrophy of vascular genesis of optic disc disease, suspected open-angle glaucoma. The patient was examined by a neurologist. - Diagnosis: Atherosclerotic atherosclerotic encepholopathy of the II-III stage, micro-focal symptoms. Arterial hypertension.

Ultrasonic duplex scanning: Right side Left-hand side To load after loading to load after loading OCA - 0.31-0.08 0.32-0.10 0.23-0.07 0.25-0.09 ICA - 0.30-0.10 0.30-0.10 0.17-0.09 0.17-0.09 After the study, we calculate the indices: IC to load 1.25 1.29 IC after loading 1,0 1,0 Δ _IC -0.25 -0.29

01/15/01, Complaints of a gradual decrease in vision during the year in both eyes. Objectively: Vis - 0.1 does not correct (n / a) / 0.1 n / k IOP - 18 mm Hg / 18 mm Hg The field of view of the OS OS is 15 degrees above, 15 degrees from the nose, 15 degrees below, 25 degrees from the temporal side, 5 degrees from the top, 5 degrees from the nose, and 5 degrees from below. sides - 25 degrees. OU-thinning pigment rim. Biomicroscopic: nuclear-cortical opacities in the lens. The fundus of the eye: OD - optic nerve discs are pale pink, monotonous, the borders are clear, the arteries are sclerotic, the veins are full-blooded. OS - DZN pale, monotonous, clear boundaries, arteries sclerotic, veins full-blooded.

Diagnosis: OU - Initial age-related cataract, retinal vascular sclerosis. OU - Subatrophy D.Z.N. vascular origin. OS - Open-angle stage II glaucoma compensated.

On the example of this patient, a decrease in cerebrovascular reserves on the right and left sides of the OCA and ICA, the absolute increment of the carotid index Δ _IC is minus 0.25 on the right and minus 0.29 on the left. This reaction of the vascular bed is observed during the patient’s circulation and in dynamic observation during the year, a sharp decrease in the visual functions of the eye, subatrophy of the optic nerve discs of both eyes of the vascular origin.

Kurochkin Pavel Leonidovich, 75 years old. Outpatient card number 73/85.

02/18/00 years when contacting an ophthalmologist registered:

Vis - 0.5 + 1.0 Diopters (D) = 0.7 / 0.5 + 1, OD = 0.7 IOP - 18 mm Hg / 18 mm Hg No complaints at the time of inspection.

The OD field of view from above is 50 degrees, from the fore side - 50 degrees, from below - 55 degrees, from the temporal side - 80 degrees.

OS on top - 50 degrees, on the bow side - 50 degrees, bottom - 55 degrees, on the temporal side - 80 degrees.

Objectively: OU - anterior camara of medium depth, dystrophic changes in the stroma of the iris. Biomicroscopic: nuclear-cortical opacities in the lens. Fundus: OU - optic nerve discs are pale pink, the borders are clear, the arteries are sclerotic, the veins are full-blooded, in the macular zone of the drusus.

Diagnosis: OU - Initial age-related cataract, retinal vascular sclerosis. Central involutional dystrophy of the retina. The patient was examined by a neurologist. - Diagnosis: Discirculatory Atherosclerotic Encepholopathy of the II stage.

Ultrasonic duplex scanning: To load after loading to load after loading OCA - 0.29-0.12 0.33-0.13 0.27-0.10 0.33-0.12 ICA 0.34-0.17 0.42-0.18 0.26-0.12 0.32-0.14 After the study, we calculate the indices: IC to load 1.42 1,2 IC after loading 1.38 1.16 Δ _IC -0.04 -0.04

06/19/01, when contacting an optometrist, it was registered:

Vis - 0.4 + 1.0 Diopters (D) = 0.7 / 0.7 + 1.0 D = 0.9 IOP-19 mm Hg / 19 mm Hg

No complaints at the time of inspection.

The OD field of view from above is 50 degrees, from the fore side - 50 degrees, from below - 55 degrees, from the temporal side - 70 degrees.

OS on top - 50 degrees, on the bow - 50 degrees, below - 55 degrees, on the temporal side - 70 degrees.

Objectively: OU - anterior camara of medium depth, dystrophic changes in the stroma of the iris. Biomicroscopic: nuclear-cortical opacities in the lens. The fundus of the eye: OU - optic nerve discs are pale pink, the borders are clear, the arteries are sclerotic, the veins are full-blooded, in the macular zone of the drusus

Diagnosis: OU - Initial age-related cataract, retinal vascular sclerosis. Central involutional retinal dystrophy

On the example of this patient, good cerebrovascular reserves on the right and left sides of the OSA and ICA are clearly visible, the absolute increment of the carotid index Δ _IC is minus 0.04. This reaction of the vascular bed is observed during the patient’s circulation and in dynamic observation during the year, high functional visual indicators of both eyes are preserved.

BRIEF DESCRIPTION OF THE DRAWINGS

Figure 1 shows an ultrasonogram of the internal carotid artery in the medium - 3, to load; 1 - peak systolic velocity (PSV cm / s), 2 - final diastolic velocity (EDV cm / s).

Figure 2 shows an ultrasonogram of the internal carotid artery in section - 3, after loading; 1 - peak systolic velocity (PSV cm / s), 2 - final diastolic velocity (EDV cm / s).

Figure 3 shows the ultrasonogram of the common carotid artery in the slice - 3, to load; 1 - peak systolic velocity (PSV cm / s), 2 - final diastolic velocity (EDV cm / s).

Figure 4 shows an ultrasonogram of the common carotid artery in section - 3, after loading; 1 - peak systolic velocity (PSV cm / s), 2 - final diastolic velocity (EDV cm / s).

The proposed method for the diagnosis of cerebrovascular reserves and vascular pathology of the optic nerve with discirculatory encephalopathy in gerontological patients is carried out quickly, simply, with affordable physical activity for the patient, without the use of additional devices and drugs, so as not to cause the patient to worsen with his research. In the proposed method, an absolute increment index of the carotid index Δ _{IC is used} , which makes it possible to judge the state of cerebrovascular reserves and predict vascular pathology of the optic nerve, which allows us to conclude that the claimed diagnostic solution meets the criterion of "novelty".

Literature

1. Astanina I.A. Complex radiation morphofunctional study of cerebral blood supply in patients with coronary heart disease and arterial hypertension with asymptomatic atherosclerotic lesions of the carotid arteries: Abstract. Dis ... cand. honey. sciences. - Tomsk, 2001 .-- 29 p.

2. Vorozhtsova I.N. Blood circulation reserves of the heart and brain in patients with coronary carotid atherosclerosis: Abstract. Dis ... d-pa honey. sciences. - Tomsk, 2000 .-- 53 p.

3. Agadzhanova L.P. Ultrasound diagnosis of diseases of the aortic arch and peripheral vessels: Atlas. - M .: Vidar, 2000 - 176 p.

4. 3enkov L.R., Ronkin M.A. Functional Diagnosis of Nervous Diseases (A Guide for Physicians). - 2nd ed., Revised, and ext. - M.: Medicine. - 1991 .-- 640 p.: Ill. - ISBN 5-225-01170-5.

Claims (1)

A method for diagnosing cerebrovascular reserves and predicting vascular pathology of the optic nerve with discirculatory encephalopathy in gerontological patients, including dopplerographic registration in the region of the internal carotid artery (ICA) of the final diastolic blood flow velocity (EDV cm / s) at rest and after a functional load, characterized in that the study includes the registration of EDV of the common carotid artery (OBS), and as a functional load, raising the legs by 90 ° for two minutes calculate the carotid index (IC) before and after the load according to the formula IC = EDV _VSA / EDV _oca , then determine the absolute increment of the carotid index (Δ _ic ) according to the formula Δ _ic = IC _{after the load} -IC _{to the load} and at values Δ _ic from minus 0 , 18 and below diagnose a decrease in cerebrovascular reserves and the possibility of impaired blood flow in the orbital artery system.

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