RU2500346C1 - Method of estimating risk of development of post-stress cardiovascular disorders - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to physiology and rehabilitation science. Analysis of heart rhythm variability (HRV) before and after test, modelling load in case of fire is performed with identification of disadaptable indices, and rate of pulse wave spreading (RPWS) in vessels of muscular type is determined. If RPWS value remains higher or equal 12 m/s and disadaptive changes of HRV indices remain unchanged for 3 days after test, risk of development of post-stress disorders is identified.

EFFECT: method makes it possible to objectivise and optimise preparation of people having dangerous jobs, monitor efficiency of rehabilitative measures individually for a particular person, realize professional prediction for training and following service, dose intensity of impact of stressogenic factors during training.

3 ex, 3 tbl, 3 dwg

Description

The invention relates to medicine, namely to physiology and rehabilitation, to methods for assessing the risk of developing post-stress cardiovascular disorders.

Assessing the severity of the stressful effect and the completeness of recovery after it for a person of a “dangerous” profession is extremely relevant in industries in which risk is an unremovable element of the professional environment. According to the patent information search, a number of methods are known for assessing the professional suitability of personnel in the selection of personnel in industries that require maximum stress of the body, described, for example, in A.S. USSR No. 1607777 (operators - with an assessment of the dynamics of the nervous system for various motor reactions in response to various positive color stimuli), A.S. No. 1452515 (operators - with an assessment of the cost of resources to complete the task according to the values of the maximum heart rate), А.с. No. 2164776 (testing on the dynamics of changes in the indicators of a set of significant questions, the answers to which cause a deviation in the magnitude of the following recorded indicators: skin-galvanic reaction, frequency of chest and diaphragmatic respiration, heart rate, reactions of motor activity and voice in response to tests containing three groups questions of different importance). However, these well-known methods determine either the physiological abilities of the test subject (A.S. No. 1607777, A.S. No. 1452515), or his motivation for choosing this profession (A.S. No. 2164776), but not the psychophysiological state with an assessment of the real consequences the effects of "occupational stress" for the cardiovascular system.

There is a known method for determining emotional stress and a device for its implementation (RF patent No. 2073484, IPC АВВ 5/02, АВВ 5/04, 02/20/1997), based on the registration of vegetative indicators of a person (heart rate, respiratory rate and galvanic resistance ) with the subsequent calculation of cross-correlation coefficients reflecting the degree of stress development, and a method for determining the level of stress (RF patent No. 2147831, IPC АВВ 5/02, 04/27/2000) with the calculation of the "stress indicator" by body weight, heart rate and pulse ar erialnogo pressure. The main disadvantages of these methods is its inapplicability to persons of “dangerous” professions, because It does not take into account population norms and does not imply an initial assessment of the body's stability in the dynamics of extreme loads, stress under which is an unremovable element of the professional environment.

There is a method of assessing the risk of development of prenosological, premorbid and pathological conditions in a long space flight (RF patent No. 2448644, IPC АВВ 5/02, September 15, 2010) by referring the patient to a certain type of autonomic regulation and calculating posterior probabilities. The main disadvantage of this method is its probabilistic nature and inapplicability in the dynamics of extreme loads.

A known method for determining the timing of the development of arterial hypertension in the long term in individuals exposed to radiation (patent No. 2438567, IPC A61B 5/0402, A61B 5/02, 01/10/2012), based on daily monitoring of ECG with rhythmogram analysis and keeping a diary by a patient with subsequent detection of night hypersympathicotonia syndrome according to the proposed formula. This method is not applicable in the practice of conducting emergency services, requires special conditions, is long and time-consuming.

Significant relationships were found between heart rate variability and the speed of pulse wave propagation through the vessels of the elastic type in patients with systemic diseases of the connective tissue (Petrova E.V. The value of assessing the elastic properties of the vascular wall and autonomic regulation of the heart rhythm in the diagnosis of cardiovascular disorders in rheumatoid arthritis: abstract . ... Candidate of Medical Sciences, Ivanovo, 2010. 24 c), but the criteria applicable in the dynamics of stress exposure in healthy individuals with initially high rates sihofiziologicheskogo health has not been established. It was noted that changes in the vessels of the muscular type in patients are more rare.

A known method for the early diagnosis of arterial remodeling in the formation of arterial hypertension (RF patent No. 2414849, IPC AB 5/02, 03/27/2011), including determining the propagation velocity of the pulse wave in the section of the vascular bed between the carotid and femoral arteries, and with values greater than 12 m / c, an additional functional test is performed with a peripheral vasodilator, and if after the test the pulse wave propagation velocity has not changed or increased, vascular remodeling is diagnosed. The main disadvantage of this method is its inapplicability in healthy individuals, as well as its focus on the remodeling mechanisms of elastic vessels that reflect organic rather than prenosological changes.

Closest to the proposed method is the author's "Method for assessing the professional adaptation of cadets of educational institutions of the Ministry of Emergencies of Russia" by application No. 2012103772/14 (005634) (priority 03.02.2012), including the study of heart rate variability before and after modeling extreme stress in a fire, and professional the adaptation is considered satisfactory if, as a result, the TP (background sample) is reduced by no more than 50%, the 30/15 indicator is no more than 20% of the initial values, and the LF / HF (active orthostatic robe) is increased by not more than 30% of the original.

The pathogenetic basis of the proposed method is the postulate on the relationship of autonomic support of the heart and cardiovascular changes at the prenosological level, which is one of the foundations for predicting cardiovascular disease. In this case, the manifestations of post-stress discirculatory disorders dictate a further “scenario” of the disease: with the hypertensive form of discirculation, the pathological process develops in the smaller branches of the vascular system, which are morphologically vessels of the muscle type, the tone of which is determined by neuro-humoral influences. Based on this methodological principle, our approach to the analysis of the vibrational structure and the search for possible ratios was based on a functional-dynamic study of autonomic reactivity, the state of cerebral hemodynamics and the propagation velocity of the pulse wave, an independent predictor of the development of cardiovascular diseases with a hypertensive type of response to stress. It is also based on the well-known fact of the influence of stress in the “triggering” of blood pressure destabilization mechanisms (more than half of respondents noted stress as the main maladaptation mechanism, and 10% noted a factor of significant physical activity, Bokarev I.N. Hypertensive crises // Clinical Medicine. - 2005 . - No. 8. - P.84-86). Numerous studies have found that an increase in the pulse wave propagation velocity is an independent predictor of coronary heart disease and strokes in healthy people (Gurfinkel Yu.I. et al. Study of the pulse wave velocity and endothelial function in healthy and patients with cardiovascular disease // Russian Journal of Cardiology. - 2009. - No. 2 / http://www.ckb-rzd.ru/php/content.php?=1636).

The studies were carried out in standard conditions of the research laboratory of FSBEI HPE IVI GPS EMERCOM of Russia "Catastrophe Medicine" in compliance with ethical and legal standards for a decreed group of patients. We used standard equipment and hardware and software of Neurosoft OJSC (VNS-Micro for studying heart rate variability, Reo-Spectrum for cerebral hemodynamics and Poly-Spectrum-SRPV for measuring the pulse wave propagation velocity-SRPV).

The study involved 92 male cadets of various years and forms of training, the average age was 22.1 ± 0.8 years. Surveys were carried out in the dynamics of the load (extreme simulating fire in the conditions of the Zagorodny training center of the institute and in the conditions of real combat use in extinguishing forest-peat fires). The load of the experiment is 6 km cross in full combat equipment (16-18 kg) with the passage of a heat and smoke chamber and a “fire” strip of psychological training. The data obtained were processed by the methods of variation and correlation statistics, the Wilcoxon test was used to compare successive measurements, and factor analysis in Latin square forms was used to identify the most informative indicators.

The technical result of the proposed method for assessing the risk of developing post-stress cardiovascular disorders consists in that, in addition to heart rate variability with isolation of maladaptive indicators before and after simulating extreme stress in a fire, the pulse wave propagation velocity through muscle vessels is determined and if the value is greater than or equal to 12 , 0 m / s, which does not recover to normal within 3 days, the risk of developing post-stress cardiovascular diseases is diagnosed roystv.

In the dynamics of the load study, it was found that according to the results of the change in PWV, 2 main groups are clearly distinguished: in the first, the velocity along the vessels of the muscle type either remained within the age norm or, when the recommended values were exceeded, returned to normal within 1-2 days; in the second, the increase in PWV was significant and did not return to the initial values within 3 days or more. It has been statistically proven that in 83% of cases, professional maladaptation under extreme loads in terms of heart rate variability (HRV) is accompanied by an increase in the propagation velocity of the pulse wave (PWV) through the vessels of the muscular type more than age norms and in 64% of cases above 12 m / s. The average direct force (r = 0.76, p <0.05) was determined as the correlative relationships between the intensification of sympathoadrenal effects on the heart rhythm according to HRV (indicators “LF / HF” and “30/15”, significant in the occurrence of hypertension and maladaptation) and deterioration of cerebral blood flow according to rheoencephalography according to hypertensive type with increased spasm of the bringing link of microcirculation (in both leads characterizing blood flow through the systems of internal and external carotid arteries). No significant strength of the correlation relationships between the duration of the professional route, age, and changes in PWV revealed for the method was established.

In the group of cadets and students who met the standards without increasing the PWV above 12 m / s, or who regained normal levels before 3 days passed, only 2 respondents “conditionally” demonstrated changes characteristic of professional maladaptation: out of 3 changes necessary for this characteristic, 2 - “TR” and “30/15” significantly decreased. In the dynamics of simulating the load during a fire, the indicators of the intensity of blood flow and blood supply to the cerebral vessels of the Republic of Ingushetia and the AFP were satisfactory both with the background test and with the head turning in both directions. The DIA elasticity index, which reflects the state of the outflow from arteries to veins, also did not reveal changes. Changes in blood flow when assessing the impact of stress modeling simulations concerned only the delivery link: a significant decrease in the tone of arterioles and blood vessels of the microvasculature was established, reflecting a hypotensive response to stress exposure (DIC) and a moderate increase in venous stasis (PVO), i.e. the target professionally “beneficial” is a hypotensive stress response. At the same time, a decrease in the tone of the bringing microcirculatory link was noted both with a background REG test and with head turns to the left and to the right. These changes were more pronounced on the right (Background DIC Oms = 46.64 ± 5.57; when turning the head to the left Oms 44.49 ± 5.56 and to the right Oms 50.03 ± 3.61). The correlation analysis made it possible to establish the presence of an average reverse directional force between the “LF / HF” and DIC indicators, both for assessing the state of the internal carotid artery and for the vessels of the vertebro-basilar basin (r = 0.61 and r = 0.59 , respectively, with p≤0.05). Thus, the state of hyperparasympathicotonia, which provides more stable functioning of the cardiovascular system of the body of people in dangerous professions under stressful effects (a measure of targeted professional selection), is professionally significant.

The study of the individual characteristics of the body's response to extreme factors of the professional environment in terms of the elasticity of the vascular wall will allow targeted rehabilitation measures at the early, prenosological stages of stress-dependent cardiovascular disorders. In the case of persistent unsatisfactory reactions to occupational stress, the method will allow to recommend occupational selection, which will extend occupational longevity and become the primary prevention of the development of occupational diseases. When identifying the risk of developing cardiovascular disorders, an in-depth medical examination is necessary in relation to the formation of cardiovascular pathology.

Example 1. Cadet Sh., 24 years. Survey results for the selected indicators: see table 1.

The dialog box program "Poly-Spectrum-SRPV" - figure 1.

Subjectively, the cadet noted increased excitability and excitement, to a BP load of 125/80 mm Hg. Art., after loading - 150/90 mm RT. Art. Before the load, the PWVSm were already above 9.3 m / s (standard for age), but the difference did not exceed the recommended one. After exercise, an increase in PWV has become clinically significant. When examining the dynamics of the recovery period after 3 days: PWV See remains elevated. After 7 days, it decreased to 10.9 m / s. Thus, the reaction of cadet Sh. To professional work is characterized by the presence of mechanisms for the formation of a sustainable risk of developing cardiovascular diseases due to the excessive activation of sympathoadrenal influences and their regidity. The recovery period is slow.

Despite the low overall cardiovascular risk according to the stratification criteria of the European Society of Cardiology (2007), the cadet is given recommendations on career guidance (it is not advisable to use a firefighting service with a daily work regime), labor and leisure planning, and examination in dynamics.

Example 2. Cadet V., 22 years old. Survey results: see table. 2. The dialog box program "Poly-Spectrum-SRPV" - figure 2.

Baseline indicators also do not go beyond the recommended ones. The increase in the Cm indicator in terms of the pulse wave propagation velocity in the load dynamics did not exceed the calculated one; in 3 days it completely returned to the age norm. According to HRV, no state of professional maladaptation was noted. Thus, in this case, the individual risk of post-stress cardiovascular disorders under the influence of occupationally significant loads has not been established, it is recommended to use a fire fighting service.

Example 3. Cadet P., 21 years old. Survey results for the most informative indicators identified: see table 3. The dialog box program "Poly-Spectrum-SRPV" - figure 3.

Baseline indicators also do not go beyond normal. At the same time, in the dynamics of extreme load, the Cm indicator in terms of the pulse wave propagation velocity exceeded the recommended one, after 3 days it retained the boundary value. The state of professional maladaptation was noted in three indicators after exercise and in two of them after 3 days of recovery. Maintaining homeostasis by activating the predominantly sympathetic part of the autonomic nervous system in most cases serves as a mechanism for a steady increase in blood pressure, which increases the risk of cerebral “catastrophes”. Thus, in this case, the risk of post-stress cardiovascular disorders after an extreme load is increased, it is necessary to consider the issue of re-profiling (for example, work as an inspector of supervisory activities). The cadet needs dynamic observation.

During a conversation with cadet P., it turned out that close relatives (mother and older brother) suffer from cerebrovascular diseases.

Claims (1)

A method for assessing the risk of developing post-stress cardiovascular disorders, including performing heart rate variability (BCP) before and after a test simulating fire load, with the identification of maladaptive indicators, characterized in that it additionally determines the propagation velocity of the pulse wave (PWV) through the vessels of the muscle type and while maintaining within 3 days after the test, the PWV value is greater than or equal to 12 m / s, and the maladaptive changes in HRV parameters are maintained, the risk of developing post-stress disorders is determined tv.

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