RU2363372C2 - Method of predicting outcome of ischemic stroke in sugar diabetes patients - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patients are assigned the following prognostic features: sex, age, work capacity, seasonality, previous acute cerebrovascular accident, developmental variation of acute cerebrovascular accident, duration of pre-hospital period, stroke severity level, conscious state, duration of comatose period, duration of sugar diabetes, severity level of sugar diabetes, compensation state of sugar diabetes, extracerebral complications of sugar diabetes, pulmonary complications, primary hypertension/secondary hypertension, ischemic heart disease, hermorheology, magnitude of brain infarcation, opening of intracranial arteries, complicated forms of atherosclerosis. Prognostic features are evaluated in points on an "Appraisal by points of features in ischemic stroke patients on the background of sugar diabetes" table, given in the description. The obtained points are added and a total of 47 points and more indicate high probability of fatal ischemic stroke.

EFFECT: objective evaluation of the severity of the state of a patient, easier selection of optimum therapeutic tactic.

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Description

The invention relates to medicine, namely to neurology and pathological anatomy.

According to the patent information search, no quantitative methods were found for assessing the severity of the condition of patients with advanced cerebral infarction in the presence of diabetes mellitus.

DM is regarded as the second most important (after arterial hypertension) risk factor for the development of a brain disaster (Balabolkin MI Diabetology. - M .: Medicine, 2000. - 672 p.). This point of view is supported by the observations of Vorlow, Ch. P., Dennis M.S., van Gein, J., Hanky, G.Zh., Sunderkock, P.A.G., Bamford, J.M., and Wardlau, J., who noted 25% of stroke patients had a history of diabetes mellitus (Stroke: a practical guide for managing patients. - St. Petersburg: Polytechnic, 1998. - 632 p.).

Among all types of stroke, ischemic brain lesions predominate. According to international multicenter studies, the ratio of ischemic and hemorrhagic strokes averages 80-85% and 15-20% (Gusev E.I., Skvortsova V.I. Brain ischemia. - M .: Medicine, 2001. - 346 p. .).

The relevance of predicting the outcome of ischemic stroke as the most common form of acute cerebrovascular accident (stroke) is associated with an assessment of its severity and the need to choose the optimal therapeutic tactic.

The closest analogue of the claimed method is the abstract of the thesis of Demidov V.I. "Clinical and morphological characteristics of outcomes of acute cerebrovascular accident in patients with diabetes" for the study. Art. Ph.D. Ivanovo, 2003.

The technical result of the proposed method lies in the fact that the severity of the condition of a patient with a cerebral infarction (GM), developed against the background of diabetes, is calculated by summing up the scores according to the evaluation table of clinical and morphological signs, with a total of 47 points and above, a high probability of a fatal outcome is predicted.

Based on the developed system for predicting the outcome of ischemic stroke, the first stage included a quantitative assessment of the 21 most significant anamnestic, clinical, and paraclinical signs presented in the patient examination scheme. The first group included a set of 7 anamnestic signs that took into account the age of the deceased, their ability to work and the seasonality of the development of ischemic stroke. The second group was based on 11 clinical signs reflecting the patient’s state of consciousness, especially the course of diabetes, the presence of visceral complications and background pathology. The third group - 3 signs formed on the results of pathological studies of GM and is characterized by the localization, the vastness of the heart attack of GM, the severity of atherosclerotic (At) lesions of intracranial arteries (ICA). The use of morphological signs in predicting the outcome of ischemic stroke is reliable in computed tomography and Doppler studies of patients with stroke in the acute period of the development of the disease.

At the second stage, attributes were scored on a 4-point scale, where the absence of a sign was evaluated at 1 point, a light degree of a sign - at 2 points, moderate - at 3 points, severe - 4 points.

The essence of the proposed method lies in the fact that patients are examined according to the presented scheme and scoring according to the table.

Using the scoring table based on a logical-probabilistic algorithm, an analysis of the outcomes of ischemic stroke against the background of diabetes in 379 patients (of which 93 cases of fatal outcome from GM infarction) was performed, in which the total score varied from 32 to 65. The frequency distribution revealed a significant the level of the threshold amount of points at which the probability of a fatal outcome in an ischemic stroke against diabetes in the acute period of a stroke was 47 points (p <0.001).

The scheme of examination of patients is as follows:

1 - assessment of anemnestic data taking into account gender, age, working ability, seasonality, duration of the prehospital period preceding ONMK;

2 - examination of the patient with an assessment:

a) the severity of the stroke (on the scale of the severity of the stroke of the American Institute of Neurological Disorders and Stroke);

b) impaired consciousness (on the Glasgow scale);

3 - computed (magnetic resonance) imaging of the head;

4 - assessment of extra-intracranial blood flow using the apparatus of ultrasonic dopplerography ("Duplex");

5 - assessment of the state of the respiratory system - chest x-ray, lung auscultation;

6 - determination of glycemic profile (daily monitoring) - blood sugar; sugar, urine acetone;

7 - optometrist consultation, assessment of renal symptoms of diabetic glomerulopathy;

8 - determination of the functional state of cardiac activity:

a) electrocardiography;

b) echocardiography;

c) measurement of blood pressure;

9 - assessment of the rheological properties of blood - coagulogram.

Clinical examples.

Example 1. Patient K., 64 years old. He became acutely ill on August 5, 1997. Against a background of increased blood pressure, a convulsive seizure developed with loss of consciousness. In the anamnesis: a condition after suffering a stroke (treatment with a complete restoration of central nervous system functions), myocardial infarction, and diabetes mellitus, a disabled person of group II, has suffered from more than 5 years.

Objectively: the duration of the prehospital period is up to 6 hours; in neurological status - the absence of corneal and conjunctival reflexes, spontaneous vertical and horizontal nystagmus, deviation of the tongue to the left, lack of movement in all limbs, muscle hypotension is more pronounced on the left, rigidity of the muscles of the neck, involuntary urination, loss of consciousness like coma II; blood sugar level from 9.3 mmol / l to 11.6 mmol / l; auscultation - bilateral wet rales. X-ray computed tomography revealed an extensive right hemisphere heart attack of GM; according to Doppler ultrasonography, critical stenosis of the right internal carotid artery (ICA). The coagulogram revealed indirect signs of DIC. The patient received vascular, decongestant, symptomatic (including insulin) therapy.

Objective: to assess the likelihood of death. To calculate the severity of the condition, we use the data in the table, where gender is 3 b, age is 3 b, seasonality is 1 b, disability is 4 b, the previous ONMK is 3 b, the acute onset is 3 b, the length of the prehospital period is 1 b, severe stroke - 4 b, coma - 4 b, coma period longer than 1 day - 4 b, extensive heart attack - 4 b, obliterating atherosclerosis of the ICA - 4 b, duration of diabetes - 3 b, medium-heavy diabetes - 3 b, subcompensation of diabetes - 3 b, stage II arterial hypertension - 3 b, post-infarction cardiosclerosis - 3 b, hypostatic pneumonia - 2 b, DIC-syndrome - 4 b. When summing, we get 59 points. High probability of death. Patient K., 64 years old, died on the 3rd day, without regaining consciousness, in conditions of increasing edema and dislocation of the GM trunk.

Example 2. Patient N., 55 years old, during the week of June 1996, after alcohol abuse amid a moderate increase in blood pressure, noted weakness, nausea, dizziness, and swallowing disorders. In connection with the development of convulsive syndrome, he was delivered by the ambulance team to the neurological department for patients with stroke. In the anamnesis: the presence of diabetes is denied, works as a locksmith, was not observed regarding diseases of the cardiovascular system. On admission: moderate state, clear consciousness, flaccid tetraparesis, alternating hemihyposthesia, the forming pseudobulbar syndrome, coordinative dysfunctions; moderate hyperglycemia in the blood (up to 9.2 mmol / L), amenable to correction with sugar-lowering drugs, mild hypercoagulation is noted by the coagulogram. X-ray computed tomography revealed small symmetrical foci of reduced density in the area of the Varoliev bridge; according to Doppler ultrasonography, moderate stenosis of the basilar artery (BA).

Objective: to assess the likelihood of death. To calculate the severity of the condition, we use the data of the table, where gender is 3 b, age is 2 b, seasonality is 3 b, subacute onset is 1 b, the duration of the prehospital period is 4 b, mild stroke is 2 b, conscious - 1 b, small heart attacks GM - 1 b, stenosing atherosclerosis BA - 2 b, newly diagnosed diabetes - 1 b, moderate diabetes - 3 b, subcompensation of diabetes - 3 b, stage II arterial hypertension - 3 b, hypostatic pneumonia - 2 b , mild degree of hypercoagulation - 2 b. When summing up, we get 34 points. The probability of death is very low. The patient was discharged in satisfactory condition after 3 weeks of vascular, decongestant and symptomatic therapy.

The table of a point assessment of the signs of ischemic stroke in the presence of diabetes mellitus, based on the use of available examination methods, makes it possible to more objectively assess the severity of the patient's condition, based on an analysis of most aspects of the pathological process, which will facilitate the selection of optimal therapeutic tactics.

Table. Scoring of symptoms in patients with ischemic stroke with diabetes mellitus. No. p / p Feature Groups Prognostic signs Score score in points one 2 3 four one Floor female - male - 2 Age 21-44 45-59 60-74 75-89 3 Disability unemployed retiree working disabled four I Seasonality summer winter autumn Spring 5 Previous ONMK - - constantly - 6 ONMK development option subacute - sharp - 7 Duration will be hired. period up to 6 hours up to 12 hours up to 1 day over 1 day 8 Severity of stroke - light average heavy 9 State of consciousness in the mind stun sopor coma 10 Comatose period - up to 1 day - over 1 day eleven Duration of diabetes forward revealed up to 2 years up to 5 years over 10 years 12 The severity of diabetes - light average heavy 13 II LED Compensation Status - compensation subcompensation decompensation fourteen Out-silver. complications of diabetes - retinopathy glomerulopathy - fifteen Pulmonary complications - gip.pneumonia - Tela 16 Hypertension / AH - Stage 1 2 stage 3 stage 17 Coronary heart disease - walls. the crown. art. p / inf. scar about. inf. myocardium eighteen Blood rheology coagul. without special. easy. hypercoagul. vyr. hypercoagulum. DIC 19 The extent of heart attack GM small average big extensive twenty III IKA lumen condition - stenosis - obliteration 21 Complicated forms of At - - aneurysm thrombosis

Claims (1)

A method for predicting the outcome of ischemic stroke in patients with diabetes mellitus, including the allocation of clinical and morphological signs and their four-point assessment, characterized in that the patient distinguishes the following prognostic signs: gender, age, ability to work, seasonality, previous acute cerebrovascular accident (stroke), option the development of stroke, the duration of the prehospital period, the severity of the stroke, the state of consciousness, the duration of the coma, the duration of diabetes mellitus (DM), the degree severity of diabetes, compensation status of diabetes, cerebral complications of diabetes, pulmonary complications, hypertension / symptomatic arterial hypertension, coronary heart disease, blood rheology, extensiveness of cerebral infarction, intracranial artery lumen condition, complicated forms of atherosclerosis, prognostic signs are estimated in points according to the table “points A scoring of symptoms in patients with ischemic stroke with diabetes mellitus "contained in the description, the scores are summarized and with a score of 47 points fishing and above predict a high probability of death of ischemic stroke.