RU2195324C2 - Method for treating ischemic cardiac disease, tension stenocardia of i-ii functional classes - Google Patents

Abstract

FIELD: medicine, cardiology. SUBSTANCE: one should carry out procedures of normobaric hypoxically hypercapnic trainings in a cyclic mode. It should be conducted 3-5 cycles according to ascending increase of impact terms and total time of hypoxic impact ranged within 9-25 min. Total time is 15-40 min. Since the fourth day hydrosulfuric baths are supplemented. Therapy course consists of 10 physio- and 8 balneoprocedures. EFFECT: increased adaptive body reserves. 1 dwg, 2 ex, 6 tbl

Description

 The invention relates to medicine, namely cardiology and can be used in spa practice and practical healthcare in the treatment of coronary heart disease (CHD).

 There is a method of treating coronary heart disease by means of common hydrogen sulfide baths dispensed at a concentration of hydrogen sulfide 25-50-100-150 mg / l 12 per treatment course (Shikhova N.M., Shikhov M.M., Batrak A.I. Sulfide balneotherapy of ischemic heart diseases. In the collection of scientific papers "Physical factors in the complex therapy and prevention of cardiovascular diseases." - Sochi. - 1978. - P.5-7). However, this method is less effective and requires some costs when vacationing water procedures.

 The objective of the invention is to increase the adaptive capabilities of the body, physical performance, normalization of lipid metabolism, lipid peroxidation and antioxidants, as well as immune defense, which leads to an increase in therapeutic effectiveness up to 96%, reduction of treatment time to 15 days instead of 16-20, lengthening remission .

 The problem is solved by carrying out during the period of adaptation from the 1st day of stay in the clinic the procedures of normobaric hypoxic-hypercapnic training, carried out while breathing with a gas hypoxic mixture with a constantly maintained oxygen concentration of 15% and atmospheric air in a cyclic mode: the number of cycles from 3 to 5 on the upward increase in exposure time and cycles. The total time of hypoxic exposure is from 9 to 25 minutes, the total is from 15 to 40 minutes. A course of 10 procedures daily From the 4th day of treatment, hydrogen sulfide baths are released for I functional class with a concentration of 50-100-150 mg / l of hydrogen sulfide, the first two every other day, the next 2 days in a row, with a break day, and with II functional class - at a concentration of 50-100 mg / l of hydrogen sulfide, the first three every other day, the next two days in a row with a break day, for a course of 8 baths.

 The advantage of the proposed combined method over the known ones is that it provides correction of the body's adaptive systems in a shorter time — by the 4th day of stay in the clinic and is achieved by training the hypoxic-hypercapnic mixture used for the first time in IHD and general intensive course hydrogen sulfide baths, the mode of which is determined differentially depending on the functional class of angina pectoris of ischemic heart disease.

 For the first time in the recommended treatment complex for patients with coronary heart disease, the method of normobaric hypoxic-hypercapnic training is used to achieve a high therapeutic and medico-economic effect due to the activation of adaptive systems of the body and increase physical performance.

 Adaptation is, first of all, internal balance and coordinated stability of body functions. Hypoxic-hypercapnic training is used to increase the body's resistance to physical overload, psycho-emotional stress and stress, and to prevent diseases of the circulatory system. Workouts with hypoxia increase the resistance of the heart to the action of extreme factors, significantly improve the condition of the contractile function of the heart and level the negative effect on the body of hypokinesia, and lead to stable and prolonged normalization of blood pressure. The increase in health occurs due to improved oxygen delivery to tissues and increased ability to work in conditions of oxygen deficiency. At the same time, metabolic processes are activated in the organs and systems that are also responsible for the adaptation of the body, an increase in coronary blood flow by 2–3 times, and a decrease in resistance in a large circle of blood circulation.

 In the process of training hypoxia, an emergency, clinical adaptation is initially formed, which gradually turns into a long-term (biochemical) adaptation. At all stages of the development of adaptation with an inadequate mode of its training, a violation of the vital activity of the body as a whole, and its individual functions, may occur due to increased sensitivity to hypoxia.

 The choice of a method for increasing physical performance, endurance to loads, increasing resistance to the action of negative environmental factors, in particular, stresses, through the termination of normobaric hypoxic-hypercapnic effects is pathogenetically determined during multifactorial prophylaxis and treatment of IHD. One of the significant risk factors for coronary heart disease - insufficient motor activity (hypokinesia) promotes detraining and weakening of the heart muscle and aggravates other risk factors for developing coronary heart disease: changes in the energy balance of the body lead to an increase in body weight, impaired lipoprotein metabolism, and a hemostatic system, which ultimately leads to the development of atherosclerosis. A decrease in the reserve capacity of the body leads to the appearance of asthenoneurotic conditions, psychoemotional stress, and an increase in blood pressure. Therefore, the use of the normobaric training method as a prophylaxis of hypokinesia as a risk factor for coronary heart disease is justified.

 It should be noted that the stimulating adaptive systems of the body and the therapeutic effects caused by them enhance and potentiate the effect of hydrogen sulfide baths in coronary heart disease, which reduces their number to 8 instead of the generally accepted 10, as well as the general course of treatment up to 15 days.

 Thus, the complex method is physiological, harmless, does not give complications, has sufficient therapeutic, medical and economic efficiency.

 The technique is performed using a commercially available membrane installation for the production of hypoxic gas mixtures "Hypoxicator Everest-1", TU-MPFK.941 Pharma Klimbi LLP, Moscow (organization-developer), 94 / 271-55 of the state register of medical devices, M.-1996. Procedures are released in a separate room equipped with 2 seats. Reception of procedures is carried out in a sitting position, in a comfortable chair, in a comfortable position. The respiratory facial mask is removable and during regular regime pauses is placed on a nearby table or held in hand. For each patient, the mask is selected individually and assigned to him for the entire course of treatment. The compressor included in the unit is installed in an adjacent separate room. The air is taken from the outside, fed through the air duct to the module of the device located in the office. Two patients can take the procedure at the same time, because the device is equipped in two places.

 The therapeutic effect of the method is based on the development in the body of hypoxia dosed by depth and time during breathing by a gas hypoxic mixture with an oxygen concentration of 15% and atmospheric air in a cyclic mode. The number of cycles from 3 to 5 in ascending increase in exposure and rest time. The total time of hypoxic exposure is from 9 to 25 minutes, the total is from 15 to 40 minutes. Course - 10 daily procedures from the 1st day of stay in the clinic. During the procedure, the rhythm, frequency and depth of breathing are normal, correspond to the conditions when measuring the main metabolism, excluding forced and intermittent breathing, which can cause hyperventilation and undesirable orthostatic reactions or provoke a disturbance in the heart rhythm.

From the 4th day of stay in the clinic, hydrogen sulfide baths are prescribed at a water temperature of 36 ^o C with a differentiated purpose of hydrogen sulfide concentration and bath duration depending on the functional class of angina pectoris: with I functional class - 50-100-150 mg / l from 10 to 15 minutes , the first two baths every other day, the next two days in a row with the day of the break; at II - 50-100 mg / l lasting 6-15 minutes, the first three baths every other day, the next two days in a row with a break day.

 A preparatory four-day course of normobaric hypoxic-hypercapnic training creates the prerequisites for developing clinical adaptation of the body to stress and for the subsequent effective use of hydrogen sulfide baths in multifactorial prophylaxis and treatment of coronary heart disease (Scheme 1).

 With poor tolerance, the “time” of the previous day is assigned without increasing the number of cycles. On days of "unfavorable" weather with poor tolerance or pronounced meteotropic reactions, the procedure is also carried out according to the "time" of the previous day without increasing the number of cycles.

Example 1. Patient K., 58 years old, lives in Vladikavkaz. I was treated in a cardiology clinic from 12/13/99 to 12/29/99 with a diagnosis of IHD. Angina pectoris, FC II, H _0-I . Vertebrogenic Lumbalgia
Upon admission, she complained of short-term pressing pains in the region of the heart, arising from physical and emotional stress, radiating to the left hand, stopping with validol, nitroglycerin, shortness of breath when climbing to the 3rd floor, increased irritability, fatigue, sleep disturbance.

 Data from an objective study at the time of admission: proper physique, moderate nutrition. The borders of the heart are extended to the left by 0.5 cm, the heart sounds are rhythmic, muffled, the emphasis is II tone above the aorta, the pulse is 76 beats. in minutes, rhythmic, satisfactory qualities. HELL = 110/70 mm Hg (D = S). In the lungs, vesicular breathing. The abdomen is soft, painless, the liver is not enlarged. Pasternatsky’s symptom is negative on both sides. Emotionally labile. Tremor of the eyelids, in the Romberg position is stable, coordination tests are performed correctly.

Additional study data: General blood test: Hb -141 g / l, er. - 4.1 • 10 ¹² / l, L. - 6.4 • 10 ⁹ / l, ESR - 6 mm / h, p - 2%, s - 52%, e - 4%, m - 9%, l - 36%. Adaptation reaction = 0.65 (according to Garkavi L.Kh.) - training reaction.

 ECG - sinus rhythm, 62 beats / min, impaired intraventricular conduction, left ventricular myocardial hypertrophy.

 VEM - exercise tolerance is sharply reduced, achieved power is 58 watts, clinical signs of coronary heart disease, normotonic type of reaction of the cardiovascular system to physical activity are recorded.

 Biochemical analysis of blood: the patient has slight disturbances in lipoprotein metabolism - total lipids - 4.41 g / l, triglycerides - 1.68 mmol / l, total cholesterol - 5.82 mmol / l, cholesterol-alpha lipoproteins - 1.0 mmol / l, atherogenic index - 4.82, beta-lipoproteins - 7.80 g / l, diene lipid conjugates - 4.69 units, malonic dialdehyde of red blood cells - 52.6 nmol / ml er. mass, malondialdehyde of lipids - 11.93 nmol / mg of lipids, serum catalase - 31.6 μkat / l, ceruloplasmin - 0.319 g / l.

The adaptation period was calm. From the first day of her stay in the clinic, the patient received normobaric hypoxic-hypercapnic training daily, for a course of 10 procedures. From the fourth day of their stay in the clinic, hydrogen sulfide baths were connected at t ^o 36 ^o , lasting 6-8-10-12-15 minutes, with a concentration of 50-100 mg / l, the first 3 every other day, the next two days in a row with a break day, only 8 bathtubs. The medical complex also included diet food, therapeutic exercises, climatic procedures (walks by the sea, dosed walking). By the fifth day of the hospital stay, the pain in the heart stopped, headache decreased, sleep improved. By the end of the second week of treatment, shortness of breath decreased, neurotic complaints, headache disappeared, sleep normalized.

 As a result of the treatment, by the end of the second week the patient’s condition improved significantly: the pain in the heart disappeared, the headache ceased, sleep normalized, and exercise tolerance increased.

During the control examination, the following data were obtained:
Complete blood count: Hb - 135.8 g / l, er. - 4.0 • 10 ¹² / l, L.- 5.05 • 10 ⁹ / l, ESR - 13 mm / h, p - 2%, s - 46%, e - 2%, m - 8%, l - 42%. The adaptation reaction according to Garkavi is 0.9 (reaction of increased activation).

 ECG - sinus rhythm, 70 beats / min, improvement of myocardial repolarization processes.

 VEM - increased exercise tolerance, achieved power - 83 W, which is 43% more compared to the original data. The clinical signs of coronary heart disease are recorded.

 Biochemical analysis of blood: total lipids - 6.17 g / l, triglycerides - 0.97 mmol / l, total cholesterol - 6.27 mmol / l, cholesterol-alpha lipoproteins - 1.34 mmol / l, atherogenicity index - 3 , 68, beta-lipoproteins - 6.40 g / l, diene conjugates of lipids - 1.27 units, malonic dialdehyde of red blood cells - 42.8 nmol / ml er. masses, malondialdehyde of lipids - 6.94 nmol / mg of lipids, serum catalase -29.2 μkat / l, ceruloplasmin - 0.319 g / l.

 Thus, the use of the recommended methodology showed an increase in physical performance, psycho-emotional stability (improved sleep, decreased irritability), a clear analgesic effect: relieving pain in the heart, headaches; activation adaptation reactions; Improving the processes of lipoprotein metabolism - reducing the most atherogenic fractions of lipid metabolism (triglycerides - by 42.2%, beta-lipoproteins - by 18%), lipid peroxidation indicators (diene conjugates of lipids - by 73%, malonic dialdehyde of erythrocytes and lipids - by 8 % and 42%, respectively), an increase in alpha-lipoprotein cholesterol by 34%; activation of the antioxidant defense system. Discharged with significant improvement.

Example 2. Patient T., 62 years old, lives in Orenburg. He was treated in the cardiology clinic of the Center from 11/20/99 to 12/13/99 with a diagnosis of IHD. Angina pectoris, FC I, N ₀ . Hypertension II Art. Vertebrogenic cervicalgia, lumbalgia.

 Upon admission, he complained of short-term compressive pain in the region of the heart, arising against the background of emotional stress, radiating to the left subscapular region, stopping with nitroglycerin; increased blood pressure, periodic headache, sleep disturbance, increased irritability, pain in the cervical and lumbar spine.

 Data from an objective study at the time of admission: proper physique, moderate nutrition. The borders of the heart are within normal limits, the pulse is 72 beats / min, rhythmic, of satisfactory qualities, heart sounds are rhythmic, muffled, the emphasis is II tone above the aorta. HELL = 170/110 mm Hg (S) and 175/115 mm Hg. ct (d). In the lungs, vesicular breathing, no wheezing. The abdomen is soft, painless, the liver is not enlarged. Pasternatsky’s symptom is negative on both sides. In the Romberg position is stable, tremor of the eyelids, fingers, coordination tests performs correctly. Palpation of paravertebral points in the cervical and lumbar spine - pain.

Additional study data:
General blood test: Нb - 153.9 g / l, er. - 4.6 • 10 ¹² / l, L - 8.45 • 10 ⁹ / l, ESR - 6 mm / h, p - 2%, s - 53%, e - 2%, m - 5%, l - 34% The Garkavi adaptation reaction is a training reaction.

 ECG - sinus rhythm, 66 beats / min, left ventricular myocardial hypertrophy, diffuse-dystrophic myocardial changes in the anterior lateral wall of the left ventricle.

 VEM - exercise tolerance is slightly reduced, the achieved power is 83 watts. Hypertonic type of reaction to physical activity.

 Blood biochemical analysis: serum catalase - 60.3 μkat / l, ceruloplasmin - 0.306 g / l, total lipids - 5.71 g / l, triglycerides - 1.37 mmol / l, total cholesterol - 6.46 mmol / l, alpha-lipoprotein cholesterol - 1.84 mmol / l, atherogenicity index - 2.51, beta-lipoproteins - 5.6 g / l, lipid diene conjugates - 2.67 units, erythrocyte malondialdehyde - 59.1 nmol / ml er. mass, malondialdehyde lipids - 10.4 nmol / mg lipids.

The adaptation period was calm. From the first day of his stay in the clinic, the patient received a course of normobaric hypoxia daily 10 in the regime of hypoxic-hypercapnic training. From the fourth day of their stay in the clinic, hydrogen sulfide baths were connected to a course of 8 procedures (the first two every other day, the next 6 - two days in a row with a break day), with a concentration of 50-100-150 mg / l at a temperature of 36 ^o C. The treatment complex also included diet food (table 10), climatic procedures, physiotherapy exercises, collar massage, dosed walking. By the fifth day of the hospital stay, blood pressure decreased to 130/80 mm Hg, headache, complaints of a neurotic nature decreased, sleep improved. By the middle of the course of treatment, the frequency of angina attacks decreased, sleep normalized, headache disappeared, and became calmer. All complaints disappeared by the 15th day: pains in the heart area stopped, headache disappeared, sleep normalized, exercise tolerance increased (by 30.1%), blood pressure returned to normal and stabilized at 120/80 mm Hg, trophism improved myocardium (according to ECG), indicators of lipoprotein metabolism improved: total cholesterol decreased by 26.8% (6.46 before treatment and 4.73 after), beta-lipoproteins by 26.8% (5.6 before treatment and 4.1 after treatment), lipid peroxidation, a change in the adaptation reaction towards its activation. The treatment ended with significant improvement.

 The second example also confirms the high efficiency of the proposed treatment method: developing adaptability to the middle of the course of treatment, which created the conditions for a favorable effect in changes in cardiohemodynamics, physical performance, lipid metabolism, lipid peroxidation systems and antioxidant protection by the 20th day of treatment.

 In total, I group — 40 patients, received treatment according to the proposed method — patients with coronary heart disease, exertional angina of 1–11 functional classes, without rhythm disturbance, with circulatory failure not higher than I st. , with risk factors - arterial hypertension, hypercholesterolemia, psychoemotional stress, impaired adaptation reactions. Group II - 30 patients with coronary artery disease, angina pectoris of functional classes 1–11, without rhythm disturbance, with circulatory failure not higher than stage I, with risk factors — arterial hypertension, hypercholesterolemia, psychoemotional stress, impaired adaptation reactions — received treatment with common hydrogen sulfide baths ( prototype).

 The most frequent subjective manifestations of the disease in both groups were compressive or aching heart pains with irradiation to the left arm, under the shoulder blade, arising from physical or psycho-emotional stress, palpitations, shortness of breath when climbing uphill or stairs. In addition, almost all patients had sleep disturbances expressed to varying degrees, irritability, fatigue, unmotivated feelings of fear, anxiety.

 When analyzing subjective symptoms during treatment, an improvement was noted in all groups of observed patients. With the unidirectional dynamics of the subjective state, a noticeable analgesic effect was noted in the first group: relieving pain in the heart, palpitations, headaches by the middle of treatment; a clear tranquilizing effect is also observed - irritability, fatigue, sleep disturbance disappeared, in group II, a positive effect was noted only at the end of treatment.

 According to table 1, there is a fairly high treatment efficiency in group I of patients who took treatment according to the proposed method compared to the prototype: there is a more significant reduction in complaints, the percentage of significant improvement and improvement prevails, there are no cases of the patient's condition - no change.

 One of the objectives of this work was to study the adaptive reactions of patients with coronary artery disease during treatment using various treatment complexes. Adaptation reactions were studied according to Garkavi L.Kh. (the ratio of the number of lymphocytes to segmental neutrophils) and was estimated by the value of this indicator (table 2).

 According to table 2, a marked adaptogenic effect under the influence of the proposed treatment complex is noted: a decrease in the number of patients with indifferent adaptive reactions of training with an increase in the number of patients with more favorable calm activation reactions and an increase in the number of patients with adaptive reactions of increased activation towards the end of the course of treatment . A positive adaptogenic effect is achieved gradually by the end of treatment, without sharp fluctuations, which favorably affects the well-being of patients.

 When unidirectional changes in the adaptability of the body under the influence of medical complexes, the effect is significantly higher when using the proposed complex than the prototype (table 2).

 A comparative assessment of indicators of a bicycle ergometric test for patients with coronary heart disease under the influence of complex treatment reveals high efficiency in all groups of patients (table 3).

 But more significant - in group I: the volume of work performed in this group is significantly higher than in group II patients, which reflects a significant increase in tolerance to physical stress (the volume of work performed in group I increased by 21.5% of the original, and in group II group - by 1.7%). At the same time, the heart rate at the level of achieving the maximum tolerated load practically did not change in both groups, as did the diastolic blood pressure in group II. The dynamics of the double product, systolic and diastolic pressures are most pronounced in group I, who accepted the proposed method, and less significant in group II, which allows us to consider the use of only hydrogen sulfide baths less favorable for physical performance.

 Under the influence of the treatment with the use of various treatment complexes, positive dynamics of lipid metabolism was observed in patients, which was manifested in a decrease in cholesterol, triglycerides, beta-lipoproteins and an increase in 1-cholesterol and, accordingly, a decrease in the atherogenic index. At the same time, significant changes in these indicators were noted in the group of patients taking the 1st treatment complex, which included hydrogen sulfide baths and normobaric hypoxic-hypercapnic training. When using the II treatment complex (hydrogen sulfide baths), the directionality indicators studied had similar dynamics of lipid metabolism, however, in most cases, it statistically had only a high tendency to reliability (tables 4, 5).

 From tables 4; Figure 5 shows that the most effective is the complex using hydrogen sulfide baths and normobaric hypoxic-hypercapnic training.

 Thus, in the course of the studies, it was found that the proposed treatment complex causes more favorable adaptive shifts and distinct positive changes in blood biochemical parameters, reducing the most atherogenic fractions of lipoprotein metabolism, lipid peroxidation and increasing blood antioxidant protection. At the same time, an increase in physical performance by 21.5%, an improvement in adaptation processes in patients with a transition to the most favorable reactions of "increased activation" (according to Garkavi L.Kh.) by the end of the treatment period, which provides a significant increase in physical performance, is noted.

 A comparative assessment of the use of two treatment complexes in the treatment of coronary artery disease, according to clinical and physiological reactions, the dynamics of physical performance, indicators of lipoprotein metabolism, the hemostatic system and immune defense, showed a sufficiently high efficiency of the proposed treatment method, due to its differentiated choice of multifactorial prophylaxis and treatment of this contingent (table 6).

 When evaluating effectiveness, the timing of its onset should also be taken into account. As a rule, improvement of subjective symptoms, adaptation reactions and psycho-emotional stability is noted by the 5-7th day of stay in the clinic in patients of group I, by the end of treatment - in group II. Improvement of objective data in group I is noted by the 15-20th day of treatment, in group II - by 21-24 days.

 With a general therapeutic efficacy of up to almost 100% in a shorter time period (15-20 days), a significant economic effect is also noted due to the shortening of the course of shared baths (8).

 The effect lasts 8-12 months after treatment in patients of group I, with a decrease in the number of exacerbations by 8 times.

Claims (1)

A method for the treatment of coronary heart disease, angina pectoris I-II functional classes by common hydrogen sulfide baths dispensed at a water temperature of 36 ^o C, lasting 6-15 minutes, characterized in that during the adaptation period from the first day they carry out normobaric hypoxic-hypercapnic training procedures with constantly maintained oxygen concentration of 15% and atmospheric air in a cyclic mode from 3 to 5 cycles in ascending increase in exposure time and total time of hypoxic exposure from 9 to 25 minutes (total - from 15 to 40 minutes) daily; moreover, from the 4th day of treatment, a vacation of common hydrogen sulfide baths is added: for functional class I with a concentration of 50-100-150 mg / l of hydrogen sulfide, the first two - every other day, the following - 2 days in a row, with a break day, and with II functional class - at a concentration of 50-100 mg / l of hydrogen sulfide, the first three - every other day, the next - two days in a row with a break day, for a course of 10 physiotherapy and 8 balneotherapy.

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