RU2709469C1 - Method of determining degree of individual resistance of divers to toxic effect of nitrogen on indicators of renal functions - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine and can be used to determine degree of individual resistance of divers to toxic effect of nitrogen (TEN) by evaluating data obtained in determining renal function. That is ensured by determining the renal functional activity index (RFAI), renal volume-regulating activity index (RVAI) and renal potassium-uretic activity index (RPAI) after carrying out of corresponding loading tests during stay in the hyperbaric chamber and breathing air at the depth equal to 70 meters of water column. That is followed by calculating the diver's resistance to the toxic effect of nitrogen (TEN) on the renal function by the formula: resistance to TEN=0.21xRFAI+0.3xRVAI+0.23xRPAI; at stability value up to 1.5, a diver is referred to a group of unstable TEN, from 1.51 to 2.5 – to a group of medium-stable, and from 2.51 and more – to a group of high-resistant to TEN.EFFECT: method enables high-accuracy assessment of the degree of individual resistance of divers to toxic effect of nitrogen on the renal function by taking into account several parameters characterizing the excretory system, without using complex diagnostic medical equipment.1 cl, 3 ex

Description

The invention relates to medicine, in particular to the field of marine medicine, can be used in the practice of diving medicine to determine the degree of individual resistance of divers to the toxic effect of nitrogen (TDA), by evaluating the data obtained when determining kidney functions.

Determination of resistance to TDA is one of the important measures to ensure the safety of a person’s professional activities when working under water. The significance of determining resistance to TDA is due to the fact that the toxic (narcotic) effect of nitrogen can occur in divers breathing air already when diving to depths of more than 30 meters.

There is a method of determining the degree of individual resistance of divers to the toxic effect of nitrogen by conducting test studies in which they carry out a corrective test with Landolt rings and the arithmetic count “Addition in the mind”. (Patent 2688788 C1 Russian Federation, IPC А61В 3/00; А61В 5/16; A61G 10/00. Method for determining the degree of individual resistance of divers to the toxic effect of nitrogen / D.P. Zverev, Yu.M. Bobrov, A.N. Polikarpochkin, A.Yu. Shitov; Federal State Budgetary Educational Institution of Higher Military Education Military Medical Academy named after S.M. Kirov - No. 2018120976; claimed 06.06.2018; published on 05.22.2019 // Inventions. Utility models: official bulletin - M .: FIPS, 2019 .-- No. 15). In addition, there is a method of determining the individual resistance of divers to decompression sickness by indicators of renal function. This method is based on the determination of indicators of functional activity of the kidneys. (Patent 2680376 C1 Russian Federation, IPC G01N 33/50, А61В 5/20. A method for determining the degree of individual resistance of divers to decompression sickness by indicators of renal function / A.Yu. Shitov; No. 2018119592; claimed 28.05.2018; publ. 20.02 .2019 // Inventions. Utility models: official bulletin - M .: FIPS, 2019. - No. 5.). However, these patents do not evaluate the functions of the human excretory system in TDA conditions. Although the activity of the human excretory system is important from the point of view of excretion of dissolved indifferent gases, including nitrogen, from the body.

A disadvantage of the known methods is that their implementation requires complex diagnostic medical equipment.

At the same time, a method is known for assessing renal function under conditions of increased pressure of a gaseous medium, in which, after an oral pressure load, during isopression in a pressure chamber at a dose of 20 ml / kg body weight, the index of functional activity of the kidneys (IFAP) is calculated. (Patent 2423703 C1 Russian Federation, IPC А61В 1/00; G01N 33/493. Method for assessing renal function under conditions of increased pressure of the gaseous medium / A.A. Myasnikov, A.Yu. Shitov; No.2010101343 / 15; application. 18.01 .2010; publ. 07/10/2011 // Inventions. Utility models: official bulletin - M .: FIPS, 2011. - No. 19.).

A known method for evaluating the volume-regulating functions of the kidneys under conditions of increased pressure of the gaseous medium, in which the volume-regulating activity index of the kidneys (IVAP) is calculated after an oral salt load of 0.5% sodium chloride solution during isopression in a pressure chamber at a dose of 0.5% of body weight. (Patent 2499557 C1 Russian Federation, IPC А61В 5/20. Method for assessing volume-regulating kidney functions under conditions of increased pressure of the gaseous medium / A.Yu. Shitov, B. L. Makeev; No. 2012142910/14; claimed 08.10.2012; publ. 08.10.2012; publ. 11.27.2013 // Inventions. Utility models: official bulletin - M .: FIPS, 2013. - No. 33).

There is a method of evaluating the potassium urethral activity of the kidneys under conditions of increased pressure of the gaseous medium, in which, after an oral load of 10% potassium chloride solution at a dose of 0.55 ml / kg, the potassium urethral activity index of the kidneys (ICAP) is calculated (Patent 2499993 C1 Russian Federation, IPC G01N 33 / 493. A method for evaluating the potassium-urinary function of the kidneys under conditions of increased pressure of the gaseous medium / A.Yu. Shitov, BL Makeev; No. 2012118725/15; claimed 04.05.2012; publ. 11/27/2013 // Inventions. Useful models : official bulletin - M .: FIPS, 2013. - No. 33).

The disadvantage of all these methods is that they evaluate only certain functions of the excretory system of the body, were not used comprehensively under the toxic effects of nitrogen and, therefore, do not allow one to judge the body's resistance to this underwater diving factor.

The basis of the invention is the creation of a method for determining the degree of individual resistance of divers to the toxic effect of nitrogen by indicators of kidney function.

The aim of the invention is to determine the degree of individual resistance of divers to the toxic effect of oxygen according to indicators of renal function.

The goal is achieved in that a method is used to determine the degree of individual resistance of divers to the toxic effect of nitrogen by indicators of kidney function, characterized in that they determine:

- index of functional activity of the kidneys, IFAP after an oral water load in a dose of 20 ml / kg body weight according to the formula:

IFAP = 0.1 × N ₁ + 0.4 × D ₁ + 0.2 × D ₂ + 0.1 × N ₂ - 0.1 × K + 0.1 × X _l

where: H ₁ - the amount of sodium excreted by the kidneys at the 60th minute after exercise, mmol / hour; D ₁ - the amount of urine excreted in the 60th minute after the load, ml / min; D ₂ - the amount of urine released in the 90th minute after the load, ml / min; N ₂ - the amount of sodium excreted by the kidneys at the 90th minute after the load, mmol / hour; K is the amount of potassium excreted by the kidneys at the 90th minute after the load, mmol / hour; X _l - the amount of chlorine released at the 90th minute after the load, mmol / hour;

- an index of volume-regulating activity of the kidneys, IVAP after an oral salt load of 0.5% sodium chloride solution at a dose of 0.5% of body weight according to the formula:

IVAP = -3.32 + 0.18 × N ₂ - 0.36 × K ₂ + 0.14 × D ₁ + 0.3 × X ₁ + 0.14 × N ₂ + 0.11 × X _l

where: N ₂ - the amount of sodium excreted by the kidneys at the 40th minute after the load, mmol / hour; K ₂ - the amount of potassium excreted in the 60th minute after exercise, ml / min; D is the amount of urine excreted in the 60th minute after the load, ml / min; X ₁ - the amount of chlorine excreted by the kidneys at the 60th minute after exercise, mmol / hour; N ₂ - the amount of sodium excreted by the kidneys at 90 minutes after exercise, mmol / hour; X _l - the amount of chlorine released at 90 minutes after loading, mmol / hour;

kidney potassium activity index, ICAP after an oral load of 10% potassium chloride solution at a dose of 0.55 ml / kg body weight according to the formula:

ICAP = 0.2 × K ₁ - 0.1 × H ₁ - 0.2 × D ₂ - 0.2 × K ₂ + 0.2 × K ₃ + 0.1 × X

where: K ₁ - the amount of potassium excreted by the kidneys at the 40th minute after exercise, mmol / hour; H ₁ - the amount of sodium released at the 60th minute after the load, ml / min; D ₂ - the amount of urine excreted in the 60th minute after the load, ml / min; To ₂ - the amount of potassium excreted by the kidneys at the 60th minute after exercise, mmol / hour; K ₃ - the amount of potassium excreted by the kidneys in the 90th minute after exercise, mmol / hour; X is the amount of chlorine released at the 90th minute after the load, mmol / hour.

Moreover, all these indices are determined after the corresponding load tests while in the pressure chamber and breathing air at a depth of 70 meters of water.

After that, an additional formula is calculated to determine the resistance of divers to the toxic effect of nitrogen (TDA) by indicators of kidney function:

Resistance to TDA = 0.21 × IFAP + 0.3 × IVAP + 0.23 × ICAP

with a resistance value of up to 1.5, the diver is assigned to the group of nitrogen resistant to the toxic effect, from 1.51 to 2.5 to the group of medium resistant and from 2.51 or more to the group of highly resistant to the toxic effect of nitrogen.

The proposed solution is new, since it takes into account the largest number of parameters characterizing the activity of the human excretory system and determining resistance to the toxic effect of nitrogen, which ensures greater accuracy of the assessment.

For example, it is necessary to determine the degree of individual resistance to TDA in three divers: “A”, “B” and “C”. For this, divers are placed in a pressure chamber to increase air pressure to a depth of 70 meters of water. In the process of being in the pressure chamber, appropriate stress tests are performed and the index of renal functional activity (IFAP), the volume-regulating activity index of the kidneys (IVAP) and the potassium-uric activity index of the kidneys (ICAP) are evaluated.

So, after diver “A”, after carrying out stress tests, the following results were obtained:

IFAP - 3.1

IVAP - -1.2

ICAP - 3.2

Using the formula we obtain the value of resistance to the toxic effect of oxygen:

1.027 = 0.21 × 3.1 + 0.3 × -1.2 + 0.23 × 3.2

Therefore, the diver "A" is recognized as unstable to the toxic effect of nitrogen.

So, the diver "B" after conducting stress tests obtained the following results:

IFAP - 4.4

IVAP - -0.6

ICAP - 3.5

Using the formula we obtain the value of resistance to the toxic effect of oxygen:

1.549 = 0.21 × 4.4 + 0.3 × -0.6 + 0.23 × 3.5

Therefore, the diver "B" is recognized as medium resistant to the toxic effect of nitrogen.

So, the diver "C" after conducting stress tests obtained the following results:

IFAP - 6.4

IVAP - 0.7

ICAP - 4.5

Using the formula we obtain the value of resistance to the toxic effect of nitrogen:

2.589 = 0.21 × 6.4 + 0.3 × 0.7 + 0.23 × 4.5

Therefore, the diver "C" is recognized as highly resistant to the toxic effect of nitrogen.

Thus, using the proposed method, it is possible to determine the individual resistance of divers to the toxic effect of nitrogen according to indicators of renal function.

Claims (14)

A method for determining the degree of individual resistance of divers to the toxic effect of nitrogen by indicators of kidney function, characterized in that they determine: - index of functional activity of the kidneys, IFAP after an oral water load in a dose of 20 ml / kg body weight according to the formula: IFAP = 0.1 × N ₁ + 0.4 × D ₁ + 0.2 × D ₂ + 0.1 × N ₂ - 0.1 × K + 0.1 × X _l , where H ₁ is the amount of sodium excreted by the kidneys at the 60th minute after the load, mmol / hour; D ₁ - the amount of urine excreted in the 60th minute after the load, ml / min; D ₂ - the amount of urine released in the 90th minute after the load, ml / min; N ₂ - the amount of sodium excreted by the kidneys at the 90th minute after the load, mmol / hour; K is the amount of potassium excreted by the kidneys at the 90th minute after the load, mmol / hour; X _l - the amount of chlorine released at the 90th minute after the load, mmol / hour; - an index of volume-regulating activity of the kidneys, IVAP after an oral salt load of 0.5% sodium chloride solution at a dose of 0.5% of body weight according to the formula: IVAP = -3.32 + 0.18 × H ₂ - 0.36 × K ₂ + 0.14 × D ₁ + 0.3 × X ₁ + 0.14 × H ₂ + 0.11 × X _l , where N ₂ is the amount of sodium excreted by the kidneys at the 40th minute after the load, mmol / hour; K ₂ - the amount of potassium excreted in the 60th minute after exercise, ml / min; D is the amount of urine excreted in the 60th minute after the load, ml / min; X ₁ - the amount of chlorine excreted by the kidneys at the 60th minute after exercise, mmol / hour; N ₂ - the amount of sodium excreted by the kidneys at the 90th minute after the load, mmol / hour; X _l - the amount of chlorine released at the 90th minute after the load, mmol / hour; - kidney potassium activity index, ICAP after an oral load of 10% potassium chloride solution at a dose of 0.55 ml / kg body weight according to the formula: ICAP = 0.2 × K ₁ - 0.1 × H ₁ - 0.2 × D ₂ - 0.2 × K ₂ + 0.2 × K ₃ + 0.1 × X, where K ₁ - the amount of potassium excreted by the kidneys at the 40th minute after exercise, mmol / hour; H ₁ - the amount of sodium released at the 60th minute after the load, ml / min; D ₂ - the amount of urine excreted in the 60th minute after the load, ml / min; To ₂ - the amount of potassium excreted by the kidneys at the 60th minute after exercise, mmol / hour; K ₃ - the amount of potassium excreted by the kidneys in the 90th minute after exercise, mmol / hour; X is the amount of chlorine released at the 90th minute after the load, mmol / hour; at the same time, all these indices are determined after carrying out the corresponding stress tests while in the pressure chamber and breathing air at a depth of 70 meters of water; after that, an additional formula is calculated to determine the resistance of divers to the toxic effect of nitrogen - TDA, according to indicators of kidney function: resistance to TDA = 0.21 × IFAP + 0.3 × IVAP + 0.23 × ICAP; with a TDA resistance value of up to 1.5, a diver is assigned to the group of nitrogen unstable to the toxic effect, from 1.51 to 2.5 to the group of medium-resistant and from 2.51 and more to the group of highly resistant to the toxic effect of nitrogen.