RU2440785C1 - Method of estimating state of vegetative nervous system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to functional diagnostics. Cardiorhythmographic examination with analysis of heart rhythm is carried out. Vegetative reactivity is determined from the fifth minute of staying in orthoposition, coefficient of adaptation reserve (CAR) is calculated by formula: CAR=TI₃/TI₂, where TI₃ is tension index, calculated by Baevskiy, starting from the fifth minute of staying on orthoposition; TI₂ is tension index, calculated by Baevskiy, immediately after transition into orthostasis. By specific values of tension index and CAR and their combination level of vegetative reactivity and state of vegetative adaptation reserve are estimated.

EFFECT: method makes it possible to reduce examination time preserving high result accuracy.

6 tbl, 3 ex

Description

The invention relates to medicine, namely to functional diagnostics, and can be used to determine the reserve of adaptation of the autonomic nervous system in patients and healthy people.

To assess the state of the autonomic nervous system, instrumental techniques determine the initial autonomic tone and autonomic reactivity. Using the method of cardiorhythmography (KRG), the initial autonomic tone (IWT) and autonomic reactivity (VR) are evaluated. The KRG method involves recording a short segment of the sinus rhythm with subsequent mathematical analysis of the variability of the RR interval and calculating indicators characterizing its changes when moving to ortho, as indicators of the restructuring of the regulatory effects of the autonomic nervous system (autonomic reactivity), including the calculation of the stress index (IN) , which informs about the state of IWT and BP, the level of functioning of the central contour of heart rhythm regulation.

Table 1. Evaluation of IWT and BP by the index IN ₂ / IN ₁ for CPC (Belokon N. A., Kuberger M. B. Diseases of the heart and blood vessels in children. Moscow, 448 p., 1987). ID ₁ at rest, conventional units (IWT) Vegetative Reactivity normal hypersympathicotonic asymptaticotonic less than 30 (vagotonia) 1-3 > 3 <1 30-60 (aytonia) 1-2,5 > 2.5 <1 61-90 (sympathicotonia) 0.9-1.8 > 1.8 <0.9 91 and more (sympathicotonia) 1.5-0.7 > 1.5 <0.7

The disadvantages of the method are the complexity and duration of the study.

Effect: simplification with high accuracy, reducing the time spent on research.

The essence of the method is the use of a three-stage cardiorhythmic study with a standard analysis of rhythm variability and the subsequent calculation of a special coefficient characterizing the state of the reserve of the autonomic nervous system.

The method is as follows.

The patient undergoes a cardiac rhythmographic study on the Valenta hardware-software complex (St. Petersburg, NPO Neo Russia), which is intended for visual observation and graphical recording of heart biopotentials, measuring the time parameters of the cardiocycle duration. The electrodes are applied to the patient’s limbs according to the standard method: red electrode - the right hand, yellow - the left hand, green - the left leg, black - the right leg. The II standard ECG lead of 200 RR intervals in the V-position is recorded, then immediately after the transition to orthosis and starting with the fifth minute of being in the orthosis, a constant visual control of the presence of the correct steady sinus rhythm is carried out. Calculate the index of the stress index (IN) P.M. Baevsky (P.M. Baevsky, GG Ivanov. Ultrasonic and functional diagnostics. - 2001. - No. 3. - S.108-127):

IN = AMo (%) / 2Mo × ΔX (s),

Where

Mo - mode - the duration of the most common value of the cardio interval in seconds; Amo — mode amplitude — frequency of occurrence of the cardio interval, equal in value of Mo, expressed as a percentage; ΔX is the spread of the cardio intervals RR in seconds; average cardio intervals (M) in seconds.

IN are calculated separately for each of the fragments: IN ₁ - clinoposition; IN ₂ - orthoposition of the first episode; IN ₃ - Ortho-position of the second episode Then, the coefficients characterizing vegetative reactivity from the 1st minute of being in the orthogonal position (IN ₂ / IN ₁ ), vegetative reactivity from the 5th minute of being in the orthopedic position (IN ₃ / IN ₁ ) and adaptation reserve coefficient (IN ₃ / IN ₂ ) are calculated ) When the IN ₁ value is less than 30 units and the ratio of IN ₃ to IN _{1 is} from 1.0 to 3.0, vegetative reactivity from the 5th minute of being in the ortho position is assessed as normal, when the value of IN ₃ / IN ₁ <1.0 BP is asymptaticotonic, with a value of IN ₃ / IN ₁ > 3.0 - as hypersympathicotonic, with a value of KPA from 0.33 to 3 - the reserve of vegetative adaptation is considered normal, with a KPA value <0.33 - insufficient, with KPA> 3 - excessive, if the value of IN _{1 is} from 30 to 60 units and the ratio of IN ₃ to IN _{1 is} from 1.0 to 2, the vegetative reactivity from the 5th minute of being in the ortho position is estimated they are normal, with an IN ₃ / IN ₁ <1.0 - asymptaticotonic, with an IN ₃ / IN ₁ > 2.5 - hypersympathicotonic, with a KPA value of 0.25 to 2.5, the reserve of vegetative adaptation is considered normal , with a KRA index <0.25 - insufficient, with a KRA> 2.5 - excessive, with a value of IN ₁ from 61 to 90 units and a ratio of IN ₃ to IN ₁ from 0.9 to 1.9 vegetative reactivity from the 5th minutes of being in the ortho position are considered normal, with an IN ₃ / IN ₁ <0.9 - asymptotic, with an IN ₃ / IN ₁ > 1.8 - hypersympathicotonic, with KPA from 0.5 to 2, the reserve of vegetative adaptation is determined normal, with KPA values <0.5 - insufficient, with KPA> 2 - excessive, if IN ₁ is more than 91 units and the ratio of IN ₃ to IN _{1 is} from 0.7 up to 1.5, vegetative reactivity from the 5th minute of being in the ortho position is defined as normal, with an IN ₃ / IN ₁ <0.7 - as asymptatic, with an IN ₃ / IN ₁ > 1.5 - as hypersympathicotonic, with KRA from 0.47 to 2.14, the reserve of vegetative adaptation is assessed as normal, with indicators of KRA <0.47 - insufficient, with KRA> 2.14 - zbytochnym.

Examples of specific performance.

Example 1. Patient Gulin Roman, 12 years old. Diagnosis: autonomic dystonia syndrome according to the vagotonic type, permanent course, exacerbation period.

IN ₁ ID ₂ ID ₃ IN ₂ / IN ₁ IN ₃ / IN ₁ IN ₃ / IN ₂ (KRA) 12 81 76 6.75 6.33 0.94

Conclusion The initial vegetative tone (IVT) is vagotonia; vegetative reactivity from the 1st minute of being in the orthosis hypersympathicotonic; vegetative reactivity from the 5th minute of being in orthosis - hypersympathicotonic; reserve of vegetative adaptation (KRA) is normal.

Example 2. Patient Baharov Daniil, 14 years old. Diagnosis: autonomic dystonia syndrome according to the vagotonic type, permanent course, remission period.

IN ₁ ID ₂ ID ₃ IN ₂ / IN ₁ IN ₃ / IN ₁ IN ₃ / IN ₂ (KRA) 25 61 19 2.44 0.76 0.31

Conclusion IVT - vagotonia; BP from the 1st minute of being in orthopedic position is normal; BP from the 5th minute of being in orthosis - asymptatic; KRA - insufficient.

Example 3. Kuznetsov Nikita, 8 years old. Diagnosis: healthy.

IN ₁ ID ₂ ID ₃ IN ₂ / IN ₁ IN ₃ / IN ₁ IN ₃ / IN ₂ (KRA) 40 63 172 1,58 4.3 2.73

Conclusion IVT - eitonia; BP from the 1st minute of being in orthosis - normal; BP from the 5th minute of being in orthosis - hypersympathicotonic; KRA - excess.

A total of 49 people were examined.

Claims (1)

A method for assessing the state of the autonomic nervous system using a cardiorhythmic study with a standard analysis of rhythm variability by determining the initial autonomic tone, autonomic reactivity, characterized in that it additionally determines autonomic reactivity from the 5th minute in the ortho position and additionally assess the adaptation reserve coefficient (RRA) by formula: KRA = IN ₃ / IN ₂ , where IN ₃ is the stress index calculated according to Baevsky, starting from the fifth minute in the ortho position; IN ₂ is the stress index calculated according to Baevsky immediately after the transition to orthostasis, and, when the value of the stress index calculated according to Bayevsky, in the clinically position (IN ₁ ) is less than 30 units and the ratio of IN ₃ to IN _{1 is} from 1.0 to 3, 0 vegetative reactivity from the 5th minute of being in the orthogonal position is assessed as normal, with an IN ₃ / IN ₁ <1.0 BP - as asymptotic, with an IN ₃ / IN ₁ > 3.0 - as hypersympathicotonic, with a KP of 0.33 to 3 - the reserve of vegetative adaptation is considered normal, with an index of KRA <0.33 - insufficient, with KR > 3 - excessive, if the value ID ₁ from 30 to 60 units and a ratio of ₃ to IN IN ₁ from 1.0 to 2.5 autonomic reactivity with 5-minute residence at the ortho position is evaluated as normal, the exponent ₃ IN / IN ₁ <1.0 - as asympticotonic, with a value of IN ₃ / IN ₁ > 2.5 - as hypersympathicotonic, with a value of KPA from 0.25 to 2.5 - the reserve of vegetative adaptation is considered normal, with a KPA value <0.25 - insufficient , with KRA> 2.5 - excessive, with a value of IN ₁ from 61 to 90 units and a ratio of IN ₃ to IN ₁ from 0.9 to 1.95 - vegetative reactivity from the 5th minute of stay in ortho position is considered normal, with an IN ₃ / IN ₁ <0.9 - asymptaticotonic, with an IN ₃ / IN ₁ > 1.8 - as hypersympathicotonic, with a KPA value of 0.5 to 2 - the vegetative adaptation reserve is determined normal , with KPA values <0.5 - insufficient, with KPA> 2 - excessive, if IN ₁ is more than 91 units and the ratio of IN ₃ to IN _{1 is} from 0.7 to 1.5 vegetative reactivity from the 5th minute of stay in ortho determined as normal, a value of IN ₃ / MI ₁ <0.7 - asimpatikotonicheskuyu like, a value of IN ₃ / MI _1> 1.5 - both g persimpatikotonicheskuyu, at a value of CRA from 0.47 to 2.14 - autonomic adaptation reserve estimate normal, at rates CRA <0.47 - inadequate, with the CRA> 2.14 - redundant.