Method to forecast development of cognitive defects in patients with combined atherosclerosis of coronary and cerebral arteries anoxic tank

FIELD: medicine.

SUBSTANCE: invention refers to the field of medicine, namely to neurology. Factors of risk are identified from anamnesis of life, as well as clinical-laboratory indices. Prognostic coefficients F 1 and F 2 are calculated using the following formulae: F 1=-1.06-0.56×X 1-0.51×X 2+0.44×X 3+0.3×X 4 and F 2=-1.02+0.54×X 1+0.5×X 2-0.39×X 3-0.29×X 4, where X 1…4 – gradations and numerical values of risk factors, besides, X 1 – sex: female – 1, male – 2; X 2 – arterial hypertension: available – 1, unavailable – 2; X 3 – fibrillation of auricles: available – 1, unavailable – 2; X 4 – chronic cardiac failure of 2 nd stage: available – 1; unavailable – 2.


If value of F 2 is higher than F 1, high risk is forecasted, and if F 1 is higher than F 2 – low risk of possible development of cognitive defects is forecasted.Anoxic tank

EFFECT: method expands arsenal of facilities to forecast development of cognitive defects in patients with combined atherosclerosis of coronary and cerebral arteries.

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The present invention relates to medicine, namely to neurology.

It is known that cognitive impairment in patients with cardiovascular diseases are one of the earliest and most sensitive indicator of vascular lesions of the brain and are the result of chronic cerebral ischemia and/or recurrent acute cerebrovascular disease (cerebral vascular accident).

A known method for predicting the development of dyscirculatory encephalopathy in patients with chronic obstructive pulmonary disease (COPD) and mild to moderate severity, did not have at the time of commencement of the clinical manifestations of chronic cerebral ischemia (nechayev, P.Anoxic tank early forms of chronic cerebral ischemia in men with mild-to-moderate chronic obstructive pulmonary disease // dis… Kida. The honey. Sciences. – irkutsk, 2008. – P.101-108). The known method includes the analysis of risk factors, clinical characteristics of COPD and paraclinical data of the survey. The risk factors shall include: age, overweight, smoking, hypertension, emotional tension, hypokinesia, closed craniocerebral injury (intracranial injury) in history, heredity, burdened by cardiovascular disease, duration of disease COPD.

The disadvantages of this method sleduyuschi,

That prediction is only possible for men and, at the same time, it is not considered a combination of lesions of atherosclerosis of the coronary and cerebral arteries, which is one of the important factors of severity of cognitive impairment.Anoxic tank

The closest in technical essence to the present invention is a method for predicting the development of ischemic disorders of cerebral circulation in men with asymptomatic for atherosclerotic occlusive lesions of the main arteries of the head. When carrying out the known method of life history and clinical and laboratory parameters determine the risk factors: age, obesity, psychological stress, hypokinesia, smoking, alcohol abuse, hypertension and its remoteness, myocardial infarction, atherosclerosis arcobaleno segment, closed craniocerebral injury, cervical osteochondrosis, diabetes, burdened by cardiovascular disease heredity, atherosclerosis of the carotid and vertebral arteries, stenosis of the common carotid artery syndrome subclavian victimize.Anoxic tank established risk factors assign grades that count prognostic factors F 1and F 2.. Comparing their numerical characteristics that predict a high or low risk of developing the disease (paten the no. 2068230 a method for predicting the development of ischemic disorders of cerebral circulation in men with asymptomatic for atherosclerotic occlusive lesions of the main arteries of the head,

Sprach V.V. Gusev, E.I., pushkina LI, negrey V.F., goryshin J.V., herakovich D.A., wild boars A.A. Irkutsk institute of improvement of doctors, IPC AV 5/00, AV 8/06, published 27.10.1996).

The disadvantages of this method, as similar, you should include the fact that a forecast can be made only for men. In addition, the known method does not refer to the risk factors for the presence of lesions of the coronary arteries, although it is known that cerebral blood flow may suffer not only with the defeat of the main arteries of the head, but also for violations of systemic hemodynamics, which is determined by the condition of the heart and extracranial vessels (skvortsova V.I.Anoxic tank and other chronic ischemia of the brain // www.Consilium-medicum.Com/media/bss/06_03/4 .Shtml).

The task of the invention is to develop a method for predicting the development of cognitive impairment in patients with concomitant coronary and cerebral arteries.

The technical result of the proposed method is to provide opportunities for individual development forecasting KN in patients with concomitant coronary and cerebral arteries, as well as to simplify the method. In skanirovaniya patients threatened by the development of cognitive deficits in timely detection and treatment of cognitive impairment.

The technical result of the proposed method of access is presumed to those

To determine the risk factors of the life history and clinical and laboratory parameters: arterial hypertension and coronary heart disease (CHD).Anoxic tank identified risk factors assign grades and determine the prognostic value of the coefficients of F 1and F 2that compare with each other.

The distinctive techniques of the proposed method is the fact that additionally take into account the sex of the patient and atrial fibrillation.

The difference lies in the fact that the established risk factors assign grades (X 1…4and numeric values, where:

X 1- gender: female – 1 male – 2;

X 2- arterial hypertension: is – 1; no – 2;

X 3atrial fibrillation: is – 1; no – 2;

X 4- chronic heart failure stage 2: is – 1; no – 2

The difference also lies in the fact that the prognostic factors F 1and F 2determined by the formula:

F 1=-1,06-of 0.56×X 1-0,51×X 2+0,44×X 3+0,3×X 4,

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F 2=-1,02+0,54×X 1+0,5×X 20.39 per×X 3-0,29×X 4,

And when the value of F 2more F 1predict a high risk, and when F 1more F 2low risk development opportunities KN.

The authors of the proposed method is established that when the absolute value of F 2more F 1predict high the cue risk

And when F 1more F 2low risk opportunities for the development of cognitive impairment in patients with concomitant coronary and cerebral arteries.

A comparative analysis was performed with the prototype showed that the proposed method differs from the known above-mentioned methods, and therefore meets the criterion of the invention of novelty.

The analysis of patent and literature the authors found that the proposed method has characteristics that distinguish it not only from the prototype, but also other technical solutions in this and related fields of medicine.Anoxic tank in the available literature there has been no method for predicting the development of cognitive impairment in patients with concomitant coronary and cerebral arteries on the above risk factors for men and women.

Clinical observations of the authors of the proposed method show that the use of the proposed solution makes it possible to predict the development of cognitive impairment for the next 3-year period in both sexes. The accuracy of the forecast of development of cognitive impairment amounted to 79%.

This allows to conclude that the technical solutions according to the criterion of inventive step.

A method for predicting the development of cognit the main disturbances in patients with concomitant coronary and cerebral arteries,

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Constituting the claimed invention is intended for use in health care. The implementation of its capabilities is confirmed as described in the application techniques and equipment. From the above it follows that the claimed invention meets the condition of patentability industrial applicability.

The proposed method is as follows.

The patient suffering from concomitant coronary and cerebral arteries, carry out physical examination. On the basis of anamnestic, clinical and laboratory data assign appropriate grades and numeric values of the established risk factors.

Then the formulas that determine the values of the prediction coefficients F 1and F 2compare their numerical characteristics, and assess the risk of KN in patients with concomitant coronary and cerebral arteries.Anoxic tank

If the absolute value of F 1more so F 2then the individual(oh) predict a low risk of developing cognitive impairment in patients with concomitant coronary and cerebral arteries. When the value of F 2more F 1predict a high risk of developing cognitive impairment, which allows reasonable to assign more intensive preventive measures.

The proposed method is prognozirovaniya development of cognitive impairment in patients with concomitant coronary and cerebral arteries is illustrated by examples of specific performance.

Example 1. Patient GWK, 52, the diagnosis of CHD. Stable angina of FC II, paroxysmal atrial fibrillation. Chronic heart failure (CHF) 1 tbsp. FC 0.

A clinical examination of the patient, risk factors, defined their grades and numeric values:

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1. Half – man, X 1=2;

2. Arterial hypertension – no, X 2=2;

3. Atrial fibrillation is, X 3=1;

4. HSN 2 tbsp. – no, X 4=2.

After identifying and establishing gradations of risk factors estimation value of prediction coefficients F 1and F 2in the above formulas:

F 1=-1,06-of 0.56×2-0,51×2+0,44×1+0,3×2,

F 2=-1,02+0,54×2+0,5×2-0,39×1-0,29×2.

When calculating the prediction coefficients obtained the value of prognostic factors: F 1=-2,16, F 2=0,09. Comparing their numerical characteristics, we find that F 2more than F 1therefore, the patient in danger of developing cognitive impairment.

Note: the forecast was carried out according to the caregiver for 2007. In 2009, the patient revealed cognitive impairment.Anoxic tank

Example 2. Patient STD, 63, the diagnosis of CHD. Stable angina of FC II. Arterial hypertension grade II-III stage, IV risk CHF 1 tbsp. FC 0.

Clinical examination of the patient, factors of R is ska,

Defined their grades and numeric values:

1. Half – woman, X 1=1;

2. Arterial hypertension is, X 2=1;

3. Atrial fibrillation – no, X 3=2;

4. HSN 2 tbsp. – no, X 4=2.

After identifying and establishing gradations of risk factors determined prognostic factors F 1and F 2in the above formulas:

F 1=-1,06-of 0.56×1-0,51×1+0,44×2+0,3×2.

F 2=-1,02+0,54×1+0,5×1-0,39×2-0,29×2.

When calculating the prediction coefficients obtained their values:

F 1=-0,64, F 2=-1,34.

Comparing their numerical characteristics, we find that F 1more than F 2therefore, the patient does not threaten the development of cognitive impairment.Anoxic tank

Note: the forecast was carried out according to the patient for 2007. In 2009, the patient was not identified cognitive deficits.

Clinical studies of the proposed method is carried out on the basis of the neurological department of HOKB from 2007 to the present.

To conduct discriminant analysis in the main group was included 143 patients with concomitant coronary and cerebral arteries. The control group consisted of 37 people combined coronary and cerebral arteries. The control group (n=37) consisted of patients with normal cognitive functioning and the main group (n=143) – PA is anti with cognitive impairment.

Were evaluated the following risk factors: gender, age (59 years and younger than 60 years and older), education (higher, secondary), myocardial infarction, chronic heart failure I and II stages, atrial fibrillation, arterial hypertension, taking nitrates, stable angina I and II functional class.Anoxic tank the most significant risk factors for KN in patients with concomitant coronary and cerebral arteries were male gender (p0,001), the absence of AG 1-2 degrees (p0.05), and age 60 years and older (p0.05), and the presence of CHF art. II (p0.05) and atrial fibrillation (p0,05), nitrate (p0,05).

The prediction accuracy was 79%.

Thus, the application of the proposed method for predicting the development of KN in patients with concomitant coronary and cerebral arteries, will improve the effectiveness of preventive and therapeutic measures in patients with risk and individualization of therapeutic and preventive measures.

A method for predicting the development of cognitive impairment (KN) in patients with concomitant coronary and cerebral arteries, including the identification of risk factors from the history of life and clinical and laboratory parameters: arterial hypertension, coronary heart disease, followed by calculation and comparison of prognostic coe is fficientow F

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1and F 2, characterized in that additionally take into account the sex of the patient, atrial fibrillation and chronic heart failure of the 2nd stage and prognostic factors F 1and F 2calculated by the formula F 1=-1,06-of 0.56×X 1-0,51×X 2+0,44×X 3+0,3×X 4; F 2=-1,02+0,54×X 1+0,5×X 20.39 per×X 3-0,29×X 4, where X 1…4- grades and numerical values of risk factors, and X 1- gender: female – 1 male – 2; X 2- arterial hypertension: is – 1; no – 2; X 3atrial fibrillation: is – 1; no – 2; X 4- chronic heart failure stage 2: is – 1; no – 2, and when the value of F 2more F 1predict a high risk, and when F 1more F 2- low risk opportunities for the development of cognitive impairment.

FIELD: medicine, operative gynecology.Anoxic tank

SUBSTANCE: at final stage of laparoscopic operation for 5-7 min one should introduce 16 U lidase in 1 ml 2%-lidocaine solution into uterine mesentery from both sides, and then, by not removing a needle – a half of single dose of antimicrobial preparation in 1 ml 2%-lidocaine solution, then in postoperational period – an antimicrobial preparation applied during laparoscopy lymphotropically under mucosa of lateral vaginal arch from both sides for 5-7 d once daily and one antimicrobial preparation – intravenously for 5-7 d, moreover, as antimicrobial preparations one should apply gentamicin, metrogyl and other preparations permitted for intravenous application. The present innovation stimulates lymphatic drainage in area of inflammation and activates interstitial humoral transport of antimicrobial preparations that, in its turn, favors complete sanitation of inflammation foci and prophylaxis of disease relapses.Anoxic tank

EFFECT: higher efficiency of therapy.

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