RU2128494C1 - Method of secondary prophylaxis of patients suffered from heart ischemia, stress stenocardia of functional classes i-iii - Google Patents

Abstract

FIELD: medicine; cardiology; physiotherapy. SUBSTANCE: method includes training on veloergometer. General baths with solution of pantohematogen are taken daily. Duration of the first two procedures is 10-12 min, and duration of subsequent procedures is 13-15 min. Course of treatment consists of 10-12 procedures. EFFECT: reduced necessity of medicaments. 2 ex

Description

 The invention relates to medicine, namely to cardiology and physiotherapy.

 Known methods of treatment and secondary prevention of patients with coronary heart disease (CHD), including comprehensive spa treatment, a component of which are therapeutic mineral baths, for example, carbon dioxide [1]. The disadvantage of this method is the need to add potassium bicarbonate to the bath, since without its presence the treatment efficiency is significantly reduced, as well as the inability to carry out treatment with carbon dioxide baths in out-of-resort conditions (in polyclinics, physiotherapy departments of hospitals, etc.).

 Closest to the technical nature of the claimed is a method of treating patients with coronary heart disease using radon baths prescribed daily or every other day [2]. The disadvantage of this method is the inability to treat patients with coronary artery disease, angina pectoris (HF) III functional class (FC), with cardiac arrhythmias, circulatory failure (NK) I-IIA Art. Difficulties in the preparation of artificial radon also sharply limit the use of radon baths in physiotherapy departments of clinics, dispensaries, sanatoriums, and sanatoriums.

 Common signs of the proposed method and prototype are the appointment of baths and training on a bicycle ergometer for exposure through centers of nervous and endocrine regulation, which have a normalizing effect on the work of the heart.

 Distinctive features of the proposed method is the holding in 12-13 hours of common baths of 0.9-1.0% solution of a dry preparation from the blood of deer - pantohematogen in the amount of 500 ml per procedure, with a duration of the first two procedures of 10-12 minutes and subsequent - 13- 15 minutes each, for a course of 10-12 procedures.

The essence of the proposed method is as follows: patients with coronary heart disease, angina pectoris I-III functional class, with rhythm disturbances (I-III gradations according to B.Lown, M.Wolf) with circulatory failure I-III A (postinfarction cardiosclerosis is possible, not earlier than 12 months after acute myocardial infarction), with various concomitant diseases (hypertension, chronic bronchitis, diabetes mellitus, osteochondrosis of various parts of the spine, diseases of the gastrointestinal tract) in the first the first half of the day conduct physical training on a bicycle ergometer, at 12-13 hours appoint general baths with 0.9-1.0% pantohematogen solution, temperature 36-37 ^o C, the duration of the first two baths 10-12 minutes and 13-15 minutes subsequent procedures, daily, for a course of treatment of 10-12 procedures. In addition, in the morning, patients are engaged in hygienic gymnastics and physical training on a bicycle ergometer with a power load of 70% of the threshold, with a training heart rate (HR) of 70% of the threshold, lasting 15-20 minutes, the number of workouts is 10.

The inclusion in the inventive method as a therapeutic agent of a new drug of natural origin "pantohematogen dry" (hereinafter "pantohematogen") can increase mental and physical performance, normalize the functionality of the cardiovascular system. The drug is obtained by vacuum drying at a temperature of 37-39 ^o C from the blood of deer taken during the rut. A 0.9-1.0% pantohematogen solution is prepared from a dry preparation according to the following scheme. Dry pantohematogen is diluted in distilled water at a dry matter concentration of 10% and left for 2 hours to dissolve, then the resulting solution is diluted to a concentration of 0.9-1.0% in an isotonic NaCl solution and filtered; the resulting solution has one absorption maximum in the region of 390-410 nm, and its spectral curve is close to that of native blood. With a shorter duration of the soaking of the dry preparation in distilled water, the spectral curves differ from the native blood curve more significantly. To assess the biological effect and toxicity of the drug, a study of intracoronary administration of increasing concentrations of pantohematogen on the contractile function of isolated hearts of 11 outbred white rats perfused with Langendorf Krebs-Henselight solution was carried out. After a 15-minute period of adaptation of the isolated hearts of intact rats, a solution of pentohematogen in increasing concentrations was introduced into the perfusion solution. The force-velocity parameters of heart contraction (contraction amplitude, contraction speed, relaxation rate, spontaneous rhythm), coronary duct size, and electrogram were recorded. The perfusion exposure of each pantohematogen concentration is 5 minutes. For comparison, we used the results of a study of the contractile function of the coronary duct of isolated hearts without effects. It turned out that the intracoronary administration of pantohematogen in the claimed concentration did not lead to a change in the force-velocity parameters of the heart, coronary duct, spontaneous rhythm and electrical activity of the heart. This indicates the absence of a direct effect of the drug on the electrical, contractile function of an isolated heart and the absence of cardiotoxic effects. In clinical studies, it was revealed that under the influence of pantogematogen baths, the clinical condition of patients with coronary heart disease rapidly normalizes, the electrical and pumping functions of the heart improve, the antioxidant status of the body, and the quality of life of patients is improved. The procedures in the inventive method are prescribed daily, since the use of bathtubs with 0.9% - 1.0% pantohematogen solution does not overload the adaptive systems of the body. This arrangement of procedures can accelerate the development of a therapeutic effect.

 Increasing the effect of the therapeutic effect of common baths using pantohematogen is realized due to the complex effect of a solution of a drug of natural origin on the body. Patients have a pronounced sedative effect associated with action on the higher centers of nervous and endocrine regulation, resulting in a decrease in irritability, increased mental and physical performance, antiarrhythmic effect. Normalization of the regulation of higher centers of nervous activity is also clinically manifested in a decrease in attacks of angina pectoris, cardialgia. Increased efficiency is associated with the normalization of the parameters of the cardiovascular system, increased exercise tolerance in patients by 35-47%. The bathing time (12-13 hours) was chosen by us on the basis of long-term observations of patients with coronary artery disease, when prescribing common mineral baths, as a result of the reaction of the sympathoadrenal system in patients with coronary artery disease, bathing at 12-13 hours does not cause overload of the cardiovascular system Heart rate, increase blood pressure), which allows you to take these baths daily. The number of procedures (10-12) and their arrangement in the present method are selected taking into account biorhythms, the nature, severity of the pathological process and the response of the body to treatment [3]. So, if after the first procedure without any clinical improvement there were 34.5% of patients, then by the 9-10th procedure there were 4-5% of them. Obviously, after the 7th-9th procedure, the maximum therapeutic effect develops, and for its fixation, 3-5 more procedures are added (but no more than 5 so as not to shift the achieved equilibrium in the negative direction).

The method is as follows. Every day, at eight o’clock in the morning, patients are prescribed physiotherapy exercises taking into account individual exercise tolerance, determined by bicycle ergometry. The pulse rate is brought to 70-75% of the threshold. After one and a half hours, bicycle training is carried out on a bicycle ergometer, the duration of a physical training on a bicycle ergometer is 25-30 minutes. The training method is interval. The power of the training load is 50% of the threshold with the training heart rate of 70% of the threshold. The total number of training sessions is 10. At 12-13 hours, general baths are prescribed with 0.9-1.0% pantohematogen solution, temperature 36-37 ^o С, duration of the first two baths 10-12 minutes with good tolerance, subsequent procedures 13-15 minutes daily, for a course of treatment - 10-12 procedures.

 Example 1. Patient U., 45 years old, was in the cardiology department of the Tomsk Scientific Research Institute of Balneology and Physiotherapy with a diagnosis of Coronary Heart Disease, angina pectoris II FC, post-infarction cardiosclerosis (1992), NI I art. in combination with hypertension I tbsp. From the anamnesis: considers himself ill since 1992, when, against the background of his health, an anginal attack sharply developed. The hospital was diagnosed with acute myocardial infarction in the anterior-septal region of the left ventricle. The real deterioration is about a month, I received outpatient treatment with prolonged action nitrates (Sustak) and Ca antagonists (Corinfar), there was a slight improvement, directed to treatment at TNIIKiF. Upon receipt, I complained of compressive pains in the heart area lasting up to 5 minutes, appearing when fast walking, stopping independently at rest or after taking 1 tablet (takes 1-2 tablets per week). Heart palpitations, headaches, poor sleep.

 An objective examination before treatment: blood pressure (BP) 140/90 mm RT. Art. ECG - sinus rhythm, with a heart rate (HCC) of 98 beats / min. The electrical axis of the heart is not deflected. Cicatricial changes in the anterior-septal region of the left ventricle. Violation of the processes of repolarization in the same area. Tolerance to physical activity: threshold power (PM) 80 W, total work 3300 kg / m, double product (DP) 292.6 srvc. units The criterion for the termination of the load is an increase in blood pressure to 220/120 mm RT. Art., heart rate 133 bpm.

The treatment is prescribed in accordance with the claimed method: daily morning physical therapy was carried out taking into account individual tolerance to physical activity. After 1 hour, cycling was performed on a bicycle ergometer lasting 25 minutes. The training method is interval. With a training load of 40 W with a training heart rate of 93 beats / min. The total number of trainings is 10. At 12 o’clock the patient took a common bath with a 0.9% pantohematogen solution, 36 ^o C, the duration of the first two baths was 12 minutes, then 15 minutes daily, 10 treatments per course of treatment. The reaction of the cardiovascular system to taking the first, fifth and tenth baths was studied according to the ECG and the index of the heart. A decrease in the index of cardiac performance after taking the first bath with 123 conv. units up to 113 srvc units and a significant decrease after the fifth to 106 srvc. units and after the tenth bath to 102 srvc. units, which indicates an adequately prescribed treatment. According to the electrocardiogram, there was an improvement in the processes of repolarization in the anterior-septal region of the left ventricle after the fifth procedure and preserved to the tenth bath. By the end of treatment, the patient's condition improved: the attacks of angina pectoris, headaches disappeared, sleep improved. The blood pressure was stable stabilized to 130/80 mm / Hg. According to the electrocardiogram, the processes of repolarization in the anterior-septal region of the left ventricle have improved. The threshold power was 110 W, the total work of 4500 kgm, DP-213.4 srvc. units The patient was discharged with improvement.

 Example 2. Patient S. was treated in the cardiology department of the Tomsk Scientific Research Institute of Balneology and Physiotherapy with a diagnosis of Coronary Heart Disease, angina pectoris III functional class, post-infarction cardiosclerosis (1985), ventricular extrasystole II gradation according to B. Lown, M. Wolf. Concomitant diagnosis: neurological manifestations of lumbar osteochondrosis in art. fading remission. From the anamnesis: considers himself sick since 1985, when he suffered an acute large-focal myocardial infarction in the region of the posterior wall of the left ventricle, annually an exacerbation of the underlying disease occurs in winter, undergoes outpatient or inpatient treatment. The real deterioration is about two months, the treatment with ambulatory nitrates of prolonged action (nitrong), Ca antagonists (verapamil), without improvement, is aimed at treatment at TNIIKiF.

 Upon admission, he complained of pressing pains in the heart area lasting 3-5 minutes that appear when walking after 5-10 minutes, stop at rest or after taking 1 tablet of nitroglycerin (takes 1-2 tablets daily), a feeling of interruption in the heart, aching pain in the lumbosacral spine, irritability, poor sleep. Objective data before treatment: blood pressure 130/80 mm Hg ECG: sinus rhythm with a heart rate of 64 beats / min. Cicatricial changes in the posterior wall of the left ventricle. Tolerance to physical activity: PM was 62 W, total work 2022 kgm, DP - 140.0, criterion for termination of the sample - lowering blood pressure. Daily cardiac monitoring data: recording within 19 hours. Sinus rhythm with a heart rate of 62 to 78 beats / min. Throughout the recording, ventricular extrasystoles 635 per hour are recorded. No ST segment changes noted.

The treatment was prescribed in accordance with the claimed method: daily physical therapy was carried out in the morning, taking into account individual tolerance to physical activity. After one hour, cycling was performed on a bicycle ergometer lasting 30 minutes. The training method is interval, the training load power is 30 W with a training heart rate of 103 beats / min, the total number of workouts is 10. At 13 hours the patient took a common bath with 1.0% pantohematogen solution, temperature 37 ^o С, 12 treatments per treatment course, the duration of the first two baths is 10 minutes, and then subsequent procedures for 13 minutes daily. In the afternoon, the patient received manual massage on the lumbar spine, daily, only 10 procedures. The reaction of the cardiovascular system to the first, fifth, and tenth baths was studied according to the ECG and heart function index. An increase in the index of heart function was noted two hours after the first bath from 98 to 123 conv. units and then its significant decrease after the fifth bath from 104 to 96 conv. units and after the tenth bath, the IRS was 81 srvc. units, which indicates an adequately prescribed treatment for patient Sh. According to the electrocardiogram, improvement of repolarization processes in the posterior wall of the left ventricle after the fifth procedure and preserved to the tenth bath was noted.

 By the end of treatment, the patient's condition improved: angina attacks and tension disappeared, sleep improved, heart failure stopped. According to the electrocardiogram, the processes of repolarization in the region of the posterior wall of the left ventricle improved. According to the daily cardiac monitoring: sinus rhythm, with a heart rate of 68 beats / min, rare gastric extrasystoles are recorded from 8 hours to 18 hours - 10-18 extrasystoles per hour. Depression of the ST segment is not registered. The threshold power was 90 watts, the total work of 3922 kgm. Patient S. was discharged with significant improvement; according to bicycle ergometry, he was transferred to the group of patients of the II functional class.

 Clinical studies were conducted at the Tomsk Scientific Research Institute of Balneology and Physiotherapy.

 The proposed method was tested on 57 patients with IVS with angina pectoris I-III FC, with rhythm disturbances (I-III gradations according to B. Lown, M.Wolf), NI I-II A art., With post-infarction cardiosclerosis, with concomitant diseases: hypertension disease, chronic bronchitis, diabetes mellitus, osteochondrosis of various parts of the spine, diseases of the gastrointestinal tract, etc. Of these, 27 patients (group 1) were assigned general baths of 0.9-1.0% pantohematogen solution against the background of an active motor regime, and 20 patients (group 2 - prototype) - general radon (arts en) baths of 3 kBq / l. Prescription ischemic heart disease 1 - 10 years. All patients were men, the average return was 44.4 years, of which 55% suffered myocardial infarction. Hypertension has a history of 45% of patients, chronic bronchitis - 56%, osteochondrosis of various parts of the spine - 63%. In all examined patients, by the end of the treatment by the claimed method, compared with the prototype, there was a more pronounced positive dynamics of clinical indicators - a decrease in the frequency and intensity of attacks of angina pectoris (Table 1), cardialgia, and a decrease in complaints of interruptions in the heart region.

 The dynamics of electrocardiograms taken in 12 standard leads and three leads across the sky, taken during treatment, indicated an improvement in the processes of repolarization in the myocardium of the left ventricle. Starting from the fifth procedure (two hours after the procedure), all observed patients showed a significant improvement in electrophysiological processes in the myocardium. The positive dynamics of the ECG parameters consisted in a decrease in the negative phase of the T wave, or from the negative it became positive in 68% of cases in patients of the 1st group and in 43% of cases in the 2nd group. Monitoring changes in hemodynamics in response to the proposed treatment was carried out according to the dynamics of the index of the heart (IRS), presented in table. 2.

 The dynamics of the IRS serves as a criterion for the adequacy of the treatment and indicates the adequately prescribed treatment in patients who received baths from pantohematogen [4].

 In assessing the immediate results of treatment, the data of bicycle ergometric studies are of decisive importance (Table 3).

 From the table. 3 shows that, despite the lower initial values of the studied parameters, in patients treated by the claimed method, by the end of treatment, the increase in average values of threshold power, overall work was higher than the groups of patients treated with radon baths. The threshold power increased in the main group by 44%, and in the prototype group - by 24%.

 The claimed method of treatment can improve the parameters of central hemodynamics both at rest and during physical exertion. Patients of the first group with hypokinetic type of blood circulation showed an increase in the cardiac index by 30% (P <0.01), in the second group by 15% (P> 0.05), mainly due to an increase in UI and a decrease in OSS.

 Thus, the claimed method of secondary prevention can reduce pain in the heart, normalize heart rhythm and blood pressure, improve contractile and pumping functions of the heart, increase endurance to physical activity, improve the quality of life of patients, increase the effectiveness of treatment, which amounted to 88 patients of the first group %, the second - 79%. The persistence of the therapeutic effect was also higher in patients treated by the claimed method, and amounted to 10.9 months in patients of the first group and 6.8 months in patients of the second group. The method can be used both in sanatorium institutions, and in clinics, dispensaries.

Sources of information
1.A.S. N 1708337 A1 (SU) A 61 H 33/04. A method for the treatment of coronary heart disease. / V.E. Ruzhenkov, P.A. Leshchinsky et al. - Publ. 01/30/92. Bull. N 4.

 2. Guide to balneology and physiotherapy / Ed. V.M. Bogolyubova. In 2 volumes. - M.: Medicine, 1985, 560 p. (prototype).

 3. Sorokina E. I. Physical treatment methods in cardiology. - M.: Medicine, 1989, 383 p.

 4. Fedotchenko A.A. Adrenergic reactivity of the heart and blood vessels in the mechanisms of development of hypertension and the effect of spa therapy on it // Irkutsk, 1992.

Claims (1)

 A method for the secondary prevention of patients with coronary heart disease, angina pectoris of functional classes I to III, including bathing and training on a bicycle ergometer, characterized in that patients are given daily baths with a 0.9 - 1.0% solution at 12 to 13 hours pantogematogen in the amount of 500 ml per procedure, lasting 10 to 12 minutes in the first two procedures and 13 to 15 minutes in subsequent procedures, for a course of 10 to 12 procedures.

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