RU2241430C2 - Method for treating the cases of cardiac ischemia disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering general iodine-bromide baths taken every other day 10-15 min long at 36°C. Normobaric and hypoxic-hypercapnic trainings are administered beginning from the first adaptation period day. Gas mixture for breathing has some constantly supported 15% amount of oxygen and atmospheric air in hypoxia-rest mode in 3-7 cycles with growing exposure time and total exposure to hypoxia treatment from 9 to 35 min and to general treatment from 8 to 70 min daily. General iodine-bromide baths are administered beginning from the fourth treatment day. The first two baths are administered every other day and the rest baths daily. The total treatment course is 10 physio- and 8 balneoprocedures long.

EFFECT: enhanced effectiveness of treatment; strengthened adaptation capacity of organism.

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Description

The invention relates to medicine, namely cardiology, and can be used in the treatment of coronary heart disease.

A known method of treating coronary heart disease by using common iodine-bromine baths at a water temperature of 36 ° C, lasting from 6 to 15 minutes, every other day, on a course of 8 to 12 baths (1).

However, this method is ineffective.

The technical result of the invention is to increase the adaptive capabilities of the body, physical performance, normalize lipid metabolism, lipid peroxidation and antioxidant systems, increase therapeutic efficacy, reduce treatment time, and extend remission.

The problem is solved in that during the adaptation period from the first day they carry out procedures of normobaric hypoxic-hypercapnic training with breathing gas mixture with a constantly maintained oxygen concentration of 15% and atmospheric air in hypoxia-rest mode, from 3 to 7 cycles with an upward increase in exposure time and the total the time of hypoxic exposure is from 9 to 35 minutes, total - from 18 to 70 minutes, daily, and from the 4th day of treatment a vacation of common iodine-bromine baths is added, the first two every other day, the next hedgehog daily, for a course of 10 physiotherapy and 8 balneotherapy.

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, increasing physical performance by the 14th day, which is achieved by training hypoxic-hypercapnic mixture and general iodine-bromine baths for a course of 10 physical - and 8 balneological procedures. 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 a factor of 2-3, and a decrease in resistance in a large circle of blood circulation. In the process of training with 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 disruption 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 effects of negative environmental factors, in particular stresses, by training with normobaric hypoxic-hypercapnic effects is pathogenetically determined during multifactorial prophylaxis and treatment of coronary artery disease. One of the significant risk factors for coronary heart disease - insufficient motor activity (lack of exercise) promotes detraining and weakening of the heart muscle and aggravates other risk factors for the development of 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 prevention of physical inactivity as a risk factor for coronary heart disease is justified. In addition, the stimulating adaptive systems of the body and the therapeutic effects caused by them enhance and potentiate the effect of iodine-bromine baths in coronary heart disease, which reduces their number to 8 instead of the generally accepted 10-12, as well as the general course of treatment up to 14 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 installation for the production of hypoxic gas mixtures "Hypoxicator Everest-1". Procedures are released in a separate room equipped with 2 seats. Acceptance of procedures is carried out in a sitting position, in a comfortable chair, in a comfortable position. The respiratory facial mask is removable. For each patient, the mask is selected individually and assigned to him for the entire course of treatment. Two patients can take the procedure at the same time.

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 the “hypoxia-rest” mode. The number of hypoxia-rest procedures is from 3 to 7 in ascending increase in exposure and rest time. The total time of hypoxic exposure is from 9 to 35 minutes, the total is from 18 to 70 minutes, with the first two procedures consisting of three cycles of “hypoxia-rest” for 3 minutes, the third procedure of four cycles of 3 minutes, the fourth of four cycles 4 minutes each. The following procedures are carried out for 5 minutes with an increase in the number of cycles: the fifth and sixth - four cycles, the seventh and eighth - five cycles, the ninth - six cycles, the tenth - seven cycles (Table 1).

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, iodine-bromine baths are prescribed at a water temperature of 36 ° C, the first two every other day, the next daily. The duration of the first three baths is 10 minutes, the subsequent 15 minutes. The course has 8 baths.

To develop clinical adaptation of the body to stress and for the subsequent effective use of iodine-bromine baths in multifactorial prophylaxis and treatment of coronary artery disease, a three-day preparatory course of normobaric hypoxic-hypercapnic training is carried out (Table 1).

Example 1:

Patient K., 48 years old, lives in Moscow. I was treated in a cardiology clinic from 10.06.01 to 23.07.01, with a diagnosis of IHD. Angina pectoris, functional class I, chronic heart failure functional class I (NYHA). Obesity 2 degrees.

Upon admission, she complained of short-term pressing pains in the heart area, arising from significant physical and emotional stress, radiating to the left hand, accompanied by a feeling of lack of air, with the effect of nitroglycerin with validol, shortness of breath when climbing to the 3rd floor, increased irritability, fatigue, sleep disturbance, dizziness episodes, and frequent headaches.

Objective research data at the time of admission: of proper physique, increased nutrition, body weight of 76 kg with an increase of 158 cm. The borders of the heart are extended to the left by 1 cm, heart sounds are rhythmic, muffled, the emphasis is II tone above the aorta, pulse is 96 beats. in minutes, rhythmic, satisfactory quality. HELL = 130/80 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. In the Romberg position is stable, coordination tests are performed correctly.

Additional research data: General blood test: Нb -118 g / l, er. - 4.8 · 10 ¹² / l, L. - 6.665 · 10 ⁹ / l, ESR - 8 mm / h, p - 1%, s - 50%, e - 2%, m - 7%, l - 40 % The adaptation reaction is calm activation (according to Garkavi L.Kh.). ECG - sinus rhythm, 90 beats / min, horizontal position of the electrical axis of the heart, left ventricular myocardial hypertrophy. VEM - exercise tolerance is low, achieved power of 75 W (due to 133 W), 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 - 7.1 g / l (normal 3.5-8.0 g / l), triglycerides - 0.96 mmol / l (normal 0.59-1 , 77 mmol / L), total cholesterol - 6.5 mmol / L (normal 3.9-6.37 mmol / L), HDL cholesterol - 1.7 mmol / L (normal 1.01-1.9 mmol / l), atherogenic index - 2.8 (norm 2.6-2.9), LDL cholesterol - 6.0 g / l (norm 2.94-5.42 g / l), diene lipid conjugates - 2.4 units (norm 1.06-2.06 units), erythrocyte malondialdehyde - 55.5 mmol / ml er. mass (norm 35.6-43.4 mmol / ml er. mass), malondialdehyde lipids - 7.8 nmol / mg lipids (norm 8.05-8.65 nmol / mg lipids), serum catalase - 38.5 mkkat / l (norm 10.6-23.0 mkkat / l), ceruloplasmin - 0.363 g / l (norm 0.300-0.380 g / l), fibrinogen - 4.22 g / l (norm 2.0-4.0 g / l), coalin time - 50 s (norm 50-70 s), plasma tolerance to heparin - 10 minutes (norm 10-16 min), fibrinolytic activity of plasma - 210 minutes (norm 183-263 min).

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, iodine-bromine baths were connected at t ° 36 ° C, lasting 10-15 minutes, the first two every other day, the next daily, a total of 8 baths (Table 1). By the fourth day of the patient’s stay in the clinic, the pain in the heart stopped, the headache stopped and sleep improved. By the end of the second week of treatment, shortness of breath decreased, neurotic complaints, headache, dizziness disappeared, sleep normalized, and body weight decreased by 1.8 kg. During the control examination, the following data were obtained: General blood test: Нb - 110.2 g / l, er. - 4.2 · 10 ¹² / l, L. - 6.7 · 10 ⁹ / l, ESR - 6 mm / h, p - 1%, s - 53%, e - 1%, m - 5%, l - 40%. The adaptation reaction is the reaction of calm activation (according to L.Kh. Garkavi). ECG - sinus rhythm, 80 beats / min, improvement of left ventricular myocardial repolarization processes. VEM - increased exercise tolerance, achieved power - 83 W (due to 133 W), which is 11% more than the original data. Clinical signs of coronary heart disease are not recorded, the normotonic type of reaction of the cardiovascular system to the load. Blood biochemical analysis: total lipids - 4.6 g / l, triglycerides - 0.91 mmol / l, total cholesterol - 6.1 mmol / l, HDL cholesterol - 1.8 mmol / l, atherogenic index - 2.4, LDL cholesterol - 4.0 g / l, diene lipid conjugates - 1.62 units, erythrocyte malondialdehyde - 53.1 nmol / ml er. masses, malondialdehyde of lipids - 6.7 nmol / mg of lipids, serum catalase - 35 μkat / l, ceruloplasmin - 0.341 g / l, fibrinogen - 3.77 g / l, coalin time - 70 s, plasma tolerance to heparin - 11 minutes, fibrinolytic activity of plasma - 150 minutes.

Thus, the proposed method allowed to increase physical performance by 11%, psycho-emotional stability (improved sleep, reduce irritability), provide a clear analgesic effect: relieve pain in the heart, headaches; a decrease in blood pressure of 120/70 mm Hg; stabilization of adaptation reactions; improvement of lipoprotein metabolism processes - reduction of the most atherogenic fractions of lipid metabolism (triglycerides - by 5.2%, LDL cholesterol - by 33%), lipid peroxidation indices (diene lipid conjugates - by 32.5%, erythrocyte and lipid malondialdehyde - by 4.3% and 14.1%, respectively) against the background of high activity of antioxidant enzymes, a decrease in fibrinogen level by 10.7%, an increase in HDL cholesterol by 5.9%. Discharged with significant improvement.

Example 2: Patient S., 61 years old, lives in Sochi. He was treated in the cardiology clinic of the Center from 04/16/01 to 05/09/01 with a diagnosis of IHD. Angina pectoris, functional class II, post-infarction cardiosclerosis (myocardial infarction in 1984), chronic heart failure of functional class II (NYHA).

Upon admission, he complained of short-term compressive pains in the heart region, arising against the background of emotional stress, during normal physical exertion, radiating to the left subscapular region, stopping with nitroglycerin; periodic headache, sleep disturbance, increased irritability, fatigue, pain in the cervical and thoracic spine, dizziness, memory loss for current events.

Objective research data at the time of admission: proper physique, moderate nutrition, body weight 70 kg with a height of 168 cm. Heart borders within normal limits, heart rate - 76 beats / min, rhythmic, satisfactory qualities. Heart sounds are rhythmic, loud. HELL = 135/80 mm Hg (D = S). In the lungs, hard breathing, rales are rare. The abdomen is soft, painless, the liver is not enlarged. The symptom of striking is negative on both sides. In the Romberg position is stable, tremor of the fingers, coordination tests performs correctly. On palpation of the paravertebral points in the cervical and thoracic spine - pain.

Additional research data: General blood test: Hb -150.4 g / l, er. - 5.4 · 10 ¹² / l, L - 6.35 · 10 ⁹ / l, ESR - 7 mm / h, p - 2%, s - 46%, e - 3%, m - 7%, l - 42% Adaptation reaction - training reaction (according to L.Kh. Garkavi). ECG - sinus rhythm, 78 beats / min, horizontal position of the electrical axis of the heart, cicatricial changes in the myocardium of the posterior wall of the left ventricle, left ventricular myocardium hypertrophy, diffuse-dystrophic changes in the myocardium of the anterolateral wall of the left ventricle. VEM - exercise tolerance is slightly reduced, the achieved power is 83 W (due to TFN - 118 W). ECGs are recorded - signs of coronary heart disease (positive test). Normotonic type of reaction of the cardiovascular system to physical activity. Biochemical analysis of blood: total lipids - 5.8 g / l (norm 3.5-8.0 g / l), triglycerides - 1.2 mmol / l (norm 0.59-1.77 mmol / l), total cholesterol - 6.5 mmol / l (norm 3.9-6.37 mmol / l), HDL cholesterol - 1.2 mmol / l (norm 1.01-1.9 mmol / l), atherogenic index - 4, 4 (norm 2.6-2.9), LDL cholesterol - 5.0 g / l (norm 2.94-5.42 g / l), diene lipid conjugates - 2.93 units. (norm 1.06-2.06 units), erythrocyte malondialdehyde - 50.5 nmol / ml er. mass (norm 35.6-43.4 mmol / ml er. mass), malondialdehyde lipids - 8.71 nmol / mg lipids (norm 8.05-8.65 nmol / mg lipids), serum catalase - 41.2 mkkat / l (norm 10.6-23.0 mkkat / l), ceruloplasmin - 0.293 g / l (norm 0.300-0.380 g / l), fibrinogen - 4.55 g / l (norm 2.0-4.0 g / l), coalin time - 55 s (norm 50-70 s), plasma heparin tolerance - 12 minutes (norm 10-16 min), plasma fibrinolytic activity - 210 minutes (norm 183-263 min).

The adaptation period was calm. From the first day of his stay in the clinic, the patient received a course of normobaric hypoxia daily No. 10 in the regime of intensive hypoxic-hypercapnic training. From the 4th day of treatment the day the patient was in the clinic, a course of iodine-bromine baths was prescribed: the first two every other day, the following daily, a total of 8 baths (Table 1).

By the fifth day of the hospital stay, the headache, dizziness, 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, became calmer, more active. All complaints disappeared by day 10, body weight decreased by 2 kg, blood pressure remained at the level of 130/80 mm Hg, physical exercise tolerance increased (by 20.5%), myocardial trophism in the anterolateral wall of the left ventricle improved (by ECG data), lipoprotein metabolism indicators improved: the level of total cholesterol decreased slightly by 9.8% (6.5 before treatment and 6.4 after), LDL cholesterol without dynamics (5.0-5.2 g / l to and after treatment, respectively), the level of HDL cholesterol increased by 40%, there was a decrease in the processes of peroxidation of diene lipids conjugates by 55%, malondialdehyde of erythrocytes by 16%, malondialdehyde of lipids by 5.9%) on the background of activation of the antioxidant defense system, a decrease in fibrinogen level by 34.1% (4.55-3.0 g / l before and after treatment, respectively) a change in the reaction of adaptation towards calm activation. The patient was discharged with significant improvement.

Thus, the proposed method of treatment has achieved high efficiency.

A total of 70 patients in two groups were examined and received treatment.

Group 1 - 38 patients, received treatment according to the proposed method - patients with coronary heart disease (angina pectoris I-II functional classes, without rhythm disturbance, with chronic heart failure not higher than FC II (NYHA), with risk factors - arterial hypertension, dyslipoproteinemia, psycho-emotional stress, overweight, impaired adaptation reactions).

Group II - 32 patients with coronary heart disease, received treatment with common iodine-bromine baths at a water temperature of 36 ° C, lasting from 6 to 15 minutes, every other day, for a course of 8 to 12 baths.

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 psychoemotional 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 and clinically significant concomitant pathology of internal organs.

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

According to the table. 2, there is a fairly high treatment efficiency in group I of patients taking treatment according to the proposed method compared to the prototype: there is a more significant reduction in complaints when analyzing coronary pains, palpitations, sleep disorders, the percentage of improvement is slightly predominant.

Adaptation reactions were studied according to L.Kh. Garkavi (the ratio of the number of lymphocytes to segmental neutrophils) and the value of this indicator was estimated (Table 3).

According to the table. 3, a more pronounced adaptogenic effect under the influence of the proposed treatment complex is noted: by the middle of the complex treatment, the number of patients with increased activation reactions and indifferent training reactions decreased with an increase in the number of patients with more favorable calm activation reactions. In group II, this dynamics is less pronounced: a decrease in the number of patients with adaptive reactions of increased activation with the prevalence of favorable reactions of calm activation is noted towards the end of the course of treatment. A positive adaptogenic effect in group I is achieved gradually towards the end of treatment without sharp fluctuations, which favorably affects patients' well-being.

Thus, with unidirectional changes in adaptation reactions under the influence of medical complexes, the effect is significantly higher when using the proposed complex than in the prototype (table. 3).

A comparative assessment of bicycle ergometric test parameters of patients with coronary artery disease under the influence of complex treatment reveals high efficiency in all groups of patients (Table 4), but more significant in group I: there is a significant increase in exercise tolerance (the amount of work performed in group I significantly increased by 23 , 0% of the original, and in group II - by 2.8%).

Moreover, 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 systolic and diastolic pressures is also most pronounced in group I, which was treated according to the proposed methodology, and less significant in group II, which makes it possible to consider the use of iodine-bromine baths only less favorable for increasing 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 manifested itself in a decrease in the level of the most atherogenic indicators: total cholesterol, triglycerides, LDL cholesterol and an increase in HDL cholesterol with a corresponding decrease in atherogenicity index. At the same time, significant changes in these indicators were noted in the group of patients taking the 1st treatment complex, which included iodine-bromine baths and normobaric hypoxic-hypercapnic training. When using the II treatment complex (iodine-bromine baths), the directionality indicators studied had similar dynamics of lipid metabolism, however, it statistically had only a tendency to improve (Tables 5, 6).

From the table. 5, 6 and 7 it is seen that the most effective is the complex using iodine-bromine baths and normobaric hypoxic-hypercapnic training. Thus, in the course of the studies, it was found that the proposed method of treatment causes more favorable adaptive shifts and distinct positive changes in the biochemical parameters of blood, 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 23.0%, an improvement in adaptation processes in patients with a transition to the most favorable “calm activation” reactions (according to L.Kh. Garkavi) by the end of the treatment period, which provides a significant increase in physical performance, are noted. Overweight was in patients of group I and decreased by 2.3 kg, in patients of group II - without changes.

In 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, hemostasis system, a rather high overall effectiveness of the proposed treatment method was noted compared to the prototype (Table 8).

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 14-20th day of treatment, in group II - by 21-24 days. With a total therapeutic efficacy of 92.5% in a shorter time period (14-20 days), a significant economic effect is also noted due to the shortening of the course of shared baths (No. 8) instead of 12. The effect persists for 8-12 months after treatment in patients of group I with a decrease exacerbation numbers 4.8 times.

Literature

1. Shvyrov MB, Shadrin V.E. The results of the treatment of coronary heart disease with iodine-bromine baths of Kudepst source, Sat. scientific works of the All-Russian Scientific Research Institute of Scientific and Practical Technologies "Physical factors in complex therapy and prevention of cardiovascular diseases", Sochi, 1978, pp. 51-53

Claims (1)

A method of treating coronary heart disease by means of common iodine-bromine baths dispensed every other day at a water temperature of 36 ° C, duration 10-15 minutes, characterized in that during the adaptation period from the first day they carry out procedures of normobaric hypoxic-hypercapnic training breathing with a gas mixture with a constantly maintained concentration oxygen 15% and atmospheric air in the hypoxia-rest mode, from 3 to 7 cycles with an upward increase in exposure time and a total time of hypoxic exposure of 9 - 35 minutes, a total of 18 - 70 minutes, daily, and from the 4th day of treatment they add a vacation of common iodine-bromine baths, the first two every other day, the next daily, on a course of 10 physiotherapy and 8 balneotherapy.