RU2349297C1 - Method of coronary disease treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly cardiology, and can be applied in coronary disease treatment, exertional angina of I-II functional class. Magnet laser therapy is performed starting from 4^th adaptation day. Infrared laser radiation is applied with wavelength of 0.89 mcm in impulse mode of intensity of 7 W, pulse frequency of 80 Hz and constant magnetic field with induction of 50 mTl. Each of 4-5 symmetrical bioactive points is affected for 1 minute. Total impact time is 8-10 minutes. Full-body hydrosulfide baths are added starting from 5^th day of treatment with hydrosulfide concentration of 50-150 mg/l for exertional angina of I functional class and with hydrosulfide concentration of 50-100 mg/l for exertional angina of II functional class. Water temperature is 36°C, duration comprises 6-15 minutes. Baths are performed on days free from magnet laser therapy. A course includes 8 physiological procedures and 8 balneological procedures.

EFFECT: enhanced physical efficiency, stimulated activity of involuntary nervous system, improved indicator values of lipid exchange, peroxide lipid oxidation, antioxidant and coagulation systems, reduced risk of coronary disease complications.

2 ex, 14 tbl, 3 dwg

Description

The invention relates to medicine, namely cardiology, and can be used in the treatment of coronary heart disease, angina pectoris I-II functional classes.

There is a method of treating coronary heart disease by prescribing common hydrogen sulfide baths from the fourth day in the clinic with angina pectoris of I FC at a concentration of 50-100-150 mg / l of hydrogen sulfide, II FC - 50 mg / l of hydrogen sulfide at a water temperature of 36 ° C, duration 6-15 minutes, the first two baths every other day, the next two days in a row with a break day, for a course of 8 baths (Konovalova M.P. Interval normobaric hypoxia in combination with hydrogen sulfide balneotherapy in the sanatorium rehabilitation of patients with coronary artery disease rdtsa: Author's abstract ... Candidate of Medical Sciences. - Sochi, 2002. - 23 p.).

However, this method is ineffective in the prevention and treatment of coronary heart disease.

The technical result of the invention is to increase the adaptive capabilities of the body, physical performance; antianginal, cardiotrophic actions; improving lipid metabolism, lipid peroxidation (products of primary lipid peroxidation) and antioxidant defense, stimulating the anticoagulant phase of coagulation and reducing the activity of the coagulation system, increasing therapeutic efficacy, stabilizing the course and reducing the risk of complications of coronary heart disease and hypertension.

The technical result is achieved by the fact that from the 4th day of the adaptation period, magnetic laser therapy from the Mustang-2000 apparatus with the LO2-2000 emitter and the magnetic nozzle MH 30 of the generating laser infrared radiation with a wavelength of 0.89 microns in pulsed mode is carried out every other day. with a power of 7 W, a repetition rate of 80 Hz and a constant magnetic field of 50 mT, irradiating 1 of 4-5 symmetrical biologically active points for 1 minute with a total exposure time of 8-10 minutes, adding from the 5th day of treatment the release of total hydrogen sulfide n on days free from magnetic laser therapy with a concentration of 50-150 mg / l of hydrogen sulfide for angina pectoris I functional class or with a concentration of 50-100 mg / l of hydrogen sulfide for angina pectoris II functional class, lasting 6-15 minutes per course - 8 physical - and balneotherapy.

The method is as follows.

Magneto-laser therapy is released in the position of the patient lying on his stomach or back. The emitter of the apparatus is set in contact on the site of the skin at the following biologically active points (BAP) (table 1, figures 1-3);

Figure 1 shows the projection of acupuncture points on the muscles and skeleton of the body;

figure 2 is a projection of acupuncture points on the muscles of the arms and legs;

figure 3 is a projection of acupuncture points on the muscles of the foot.

Magnetic laser therapy procedures are performed by a Mustang-2000 apparatus with an LO2-2000 emitter and a MN 30 magnetic nozzle generating laser infrared radiation with a wavelength of 0.89 μm in a pulsed radiation mode, with a radiation power of 7 W, a repetition rate of 80 Hz, and magnetic nozzle with a constant magnetic field of 50 mT. 4-5 symmetrical biologically active points (BAPs) are irradiated, in total for a procedure - 8-10 BATs, the duration of exposure to one BAT zone is 1 minute, the total procedure time is 8-10 minutes. On the course - 8 procedures every other day on days without baths (Table 2).

Hydrogen sulfide balneotherapy is prescribed from the 5th day of the patient’s stay in the clinic at a water temperature of 36 ° C every other day (on days free of physiotherapy), lasting from 6 to 15 minutes, 8 baths per course.

The treatment complex, including magnetic laser therapy procedures and hydrogen sulfide baths, is presented in Table 2.

The use of magnetic laser therapy as an adaptive-training therapy is an effective rehabilitation tool in the complex of spa treatment of chronic diseases. Coronary heart disease is accompanied by a violation of the cellular metabolism of cardiomyocytes. Deviations in the processes of energy production, electrolyte imbalance, violations of redox, enzymatic and other reactions are often crucial for the prognosis of the disease. Intracellular physiological changes are caused by damage to biological membranes, and correction of their structural organization can have a positive effect on the functional status of cells. Magnetolaser radiation causes, due to the photobiological process, the expansion of microcirculation vessels, increased cerebrospinal fluid drainage and tissue metabolism, and by acting on biologically active points (BAPs), it stimulates the autonomic, endocrine and immune systems, activates the opioid receptor system (enkephalins), and restores energy-information reserves in the body, both according to the type of viscero-visceral, viscerosomatic, viscerosensory reflexes, and the general reaction, directed th at increasing of adaptive reactions. Magnetic laser therapy is used as an anesthetic, antioxidant, immunomodulatory, vasodilator, anti-inflammatory, regenerative agent, however, the assessment of changes in various indicators under the influence of magnetic laser radiation is difficult due to the use of different methods, power and intensity and dose, duration, number, sequence and compatibility of procedures.

Hydrogen sulfide mineral water has a specific effect on the body of IHD patients, has an effect on redox reactions in the body, increases the activity of high molecular weight proteins, enzymes, improves the functional state of the myocardium, corrects the rheological properties of blood, normalizes lipid metabolism, and, having natural antioxidant properties, reduces negative effect of lipid peroxidation products on vascular endothelium. These effects determine the therapeutic value of hydrogen sulfide baths, however, the variety and variability of the clinical forms of coronary heart disease dictates the need to affect the reflex-segmental zones of the autonomic innervation of the heart, which can significantly affect the clinical picture, severity and outcomes of coronary heart disease. The advantage of the proposed combined method over the known one is that the integrating effect of physical factors is capable of correcting prognostically significant risk factors for coronary heart disease - arterial hypertension, physical inactivity, overweight, impaired lipid metabolism, and blood coagulation. Thus, the complex method is physiological, harmless, does not give complications, has sufficient therapeutic, medical and economic efficiency.

Example 1: Patient B., 50 years old, was treated in a cardiology clinic from 03/10/2007 to 04/02/2007 with a diagnosis of CHD. Angina pectoris I functional class, chronic heart failure I functional class (NYHA). Hypertension stage III, 2 degree, risk 4 (very high). Dyslipidemia II b (WHO). Overweight. Osteochondrosis of the lumbar spine.

Upon admission, he complained of burning pressing pains in the sternum, arising from significant physical exertion and stress, radiating to the left shoulder, stopping with nitroglycerin after 2-3 minutes; shortness of breath and palpitations with a rapid rise of more than 3 floors of the stairs, episodes of interruptions in the work of the heart, headaches, dizziness associated with an increase in blood pressure over 170/100 mm Hg, pain in the lumbar spine with irradiation on the outer surface of the left hips.

The first pain behind the sternum appeared 6 months ago. Arterial hypertension manifests itself 3-4 years. Examination and treatment in the therapeutic department of the central hospital in February 2007. The patient takes drugs b-blockers, ACE inhibitors, antiplatelet agents, nitrates "on demand".

Objective research data at the time of admission: the physique is correct, of increased nutrition, body weight 84 kg with a height of 171 cm (body mass index - 28.8). The left border of the heart is shifted to the left - 1 cm outward from the left midclavicular line. Pulse - 70 beats / min, rhythmic, satisfactory quality. Rhythmic heart sounds - 70 beats / min, muffled. Emphasis II tone on the aorta. HELL 160/100 mm Hg (D = S). In the lungs, vesicular breathing, no wheezing. 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, coordination tests are performed correctly. On palpation of the paravertebral points in the lumbar spine, pain was noted.

Additional study data:

Complete blood count: Hb - 147 g / l, er. - 5.2 × 10 ¹² / l, L - 5.7 × 10%, ESR - 2 mm / h, p - 2%, s - 49%, e - 2%, m - 11%, l - 36% . The adaptation reaction is a reaction of increased activation (according to L.Kh. Garkavi). Blood sugar - 4.1 m / mol.

ECG - sinus rhythm, 89 beats / min, normal position of the electrical axis of the heart, signs of left ventricular myocardial hypertrophy.

VEM - exercise tolerance is reduced, the achieved power is 100 W (due to TFN - 133 W). The test is negative, but with features (increase in blood pressure 250/120 mm Hg, headache and dizziness). Hypertensive type of reaction of the cardiovascular system to physical activity.

Cardiac rhythmogram - Wave characteristics: Power HF (BV) - 27, Power LF (MB2) - 16, Power VLF (MB1) - 160. Combined characteristics: Mode amplitude - 81, Voltage index - 130, MV2 / BV ratio - 0.592, Ratio MV1 / BV - 5.925, The ratio (MV1 + MV2) / BV - 6.518, pRR50% - 0. The normal heart rate. Heart rate = 76 bpm Dominant slow waves of a large period of 7> 30 s against the background of attenuation of waves generated by the ANS. Perhaps a significant vagosympathetic imbalance. A significant increase in parasympathetic influence on the regulation of SR.

Biochemical analysis of blood: total cholesterol - 7.4 mmol / L (normal 3.9-6.5 mmol / L), HDL cholesterol - 2.7 mmol / L (normal 0.9-1.9 mmol / L), atherogenicity index - 2.7 (norm 2.6-2.9), LDL cholesterol - 15.8 g / l (norm 3.3-5.5 g / l), diene lipid conjugates - 5.55 units. (norm 1.06-2.06 units), erythrocyte malondialdehyde - 57.8 nmol / ml er. mass (normal 0.8-3.6 nmol / ml er), malondialdehyde lipid - 7.2 nmol / mg lipids (normal 8.8-19.2 nmol / mg lipids), serum catalase - 28.7 μkat / l (norm 10.6-23.0 μkat / l), ceruloplasmin 0.230 g / l (norm 0.300-0.580 g / l), fibrinogen 3.3 g / l (norm 2.0-4.0 g / l), koalin time - 65 sec (norm 50-70 sec), plasma tolerance to heparin - 12 min (norm 10-16 min), plasma fibrinolytic activity - 200 min (norm 183-263 min).

The adaptation period passed with the preservation of blood pressure figures of the 2nd degree of arterial hypertension (blood pressure> 150-90 mm Hg), dose adjustment of drugs was carried out. From the fourth day of being in the clinic, the patient was prescribed a course of treatment according to the proposed method - magnetic laser therapy procedures, every other day, a course of 8 procedures. From the fifth day - hydrogen sulfide baths with a concentration of hydrogen sulfide 50-100-150 mg / l, at a water temperature of 36 ° C, lasting 6-8-10-15 minutes, every other day, on a course of 8 baths (Table 2). By the middle of the patient’s stay in the clinic, angina attacks did not occur during exercise, blood pressure numbers returned to normal (130/80 mm Hg), headaches and pains in the lumbar spine decreased and decreased in intensity. By the end of the treatment, there were no coronary pains, shortness of breath decreased, sensations of interruptions in the work of the heart, increased physical activity, a controlled normal level of blood pressure remained, without headaches and dizziness, body weight decreased by 0.5 kg.

During the control examination, the following data were obtained:

Complete blood count: Hb - 147 g / l, er. - 4.5 × 10 ¹² / l, L - 6.9 × 10%, ESR - 3 mm / h, PO - 2%, e / I - 52%, e - 3%, m - 8%, l - 35%. The adaptation reaction is the reaction of calm activation (according to L.Kh. Garkavi).

ECG - sinus rhythm, 75 beats / min, normal position of the electrical axis of the heart, left ventricular myocardial hypertrophy. Without dynamics.

VEM - increased exercise tolerance, achieved power - 108 W (due to 133 W), which is 7.4% more compared to the original data. The test is negative, but with features (increased blood pressure 230/120 mm Hg, a single ventricular extrasystole, headache and dizziness). Hypertensive type of reaction of the cardiovascular system to the load.

Cardiac rhythmogram - Wave characteristics: Power HF (BV) - 1497, Power LF (MB1) - 373, Power VLF (MB2) - 287. Combined characteristics: Mode amplitude - 53, Voltage index - 28, MV2 / BV ratio - 0.249, Relationship MV1 / BV - 0.191, The ratio (MV1 + MV2) / BV - 0.44, pRR50% - 1. Conclusion: normal heart rate Heart rate = 76 beats / min. Powerful fast waves with a period of 2 to 10 s. Preservation of vagosympathetic balance (normotonic nature of the regulation of SR).

Biochemical analysis of blood: total cholesterol - 4.84 mmol / L (normal 3.9-6.5 mmol / L), HDL cholesterol - 1.8 mmol / L (normal 0.9-1.9 mmol / L), atherogenic index - 1.6 (norm 2.6-2.9), LDL cholesterol - 13.8 g / l (norm 3.3-5.5 g / l), diene lipid conjugates - 3.11 units. (norm 1.06-2.06 units), erythrocyte malondialdehyde - 44.7 nmol / ml er. mass (norm 0.8-3.6 nmol / ml er), malondialdehyde of lipids - 7.0 nmol / mg lipids (norm 8.8-19.2 nmol / mg lipids), serum catalase - 65.1 μkat / l (norm 10.6-23.0 μkat / l), ceruloplasmin - 0.324 g / l (norm 0.300-0.580 g / l), fibrinogen - 3.3 g / l (norm 2.0-4.0 g / l), koalin time - 65 sec (norm 50-70 sec), plasma tolerance to heparin - 14 min (norm 10-16 min), fibrinolytic activity of plasma - 210 min (norm 183-263 min).

Thus, the proposed method contributed to: the cessation of angina pectoris, shortness of breath, sensations of interruptions in the work of the heart, normalization of the controlled level of arterial hypertension, relief of headaches, dizziness, pain in the lumbar spine, weight loss by 0.5 kg; the transition of increased adaptation reactions to a calm, increased physical performance by 7.4%; stable dynamics of the ECG; preservation of the vagosympathetic balance (normotonic nature of the regulation of the sinus rhythm of the heart) of the autonomic nervous system. The effect on the plasma lipid spectrum was noted: a decrease in atherogenic fractions of lipids - total cholesterol content by 35.1%, LDL cholesterol by 12.7%, without changes in the atherogenic index; the anti-atherogenic potential of the plasma normalized - the content of HDL cholesterol. Dynamics of lipid peroxidation indicators: products of primary lipid degradation - erythrocyte malondialdehyde decreased by 22.7% and lipid malondialdehyde decreased by 2.8%, the content of secondary degradation products - lipid diene conjugates decreased by 43.9%, against the background of an increase the activity of the antioxidant protection enzyme - catalase by 55.9%, and with an increase in the level of ceruloplasmin - by 29.0%. From the side of blood coagulation activity, the indicators practically did not change with a slight increase in plasma fibrinolytic activity by 4.8%. Discharged with improvement.

Example 2: Patient K., 56 years old. He was treated in a cardiology clinic from 03/01/2007 to 03/24/2007 with a diagnosis of IHD. Angina pectoris II functional class, chronic heart failure I functional class (NYHA). Hypertension stage III, 2 degree, risk 4 (very high). Dyslipidemia IIb (WHO). Overweight. Osteochondrosis of the cervical, thoracic, lumbar spine. Gonarthrosis bilateral I Art., Federal Tax Service 0.

Upon admission, he complained of pressing pains behind the sternum during normal physical exertion, unrest, going out on frosty or windy weather with the effect of taking nitrates for 5 years, shortness of breath when climbing to the 2nd floor. Arterial hypertension for 5 years, occasional administration of antihypertensive drugs without blood pressure control. Frequent headaches, sensations of interruptions in the work of the heart, dizziness, fatigue, morning weakness and pain in all parts of the spine, knee joints, decreasing after taking non-steroidal anti-inflammatory drugs.

Objective research data at the time of admission: proper physique, increased nutrition, body weight 77 kg with an increase of 165 cm (body mass index 28.3). The borders of the heart are extended to the left by 1 cm, heart sounds are rhythmic, muffled, systolic murmur in the projection of the apex of the heart, accent II tone above the aorta, pulse - 74 beats. in minutes, rhythmic, satisfactory quality. HELL 140/80 mm Hg (D = S). In the lungs - vesicular breathing, wheezing is not heard. The abdomen is soft, painless, the liver is not enlarged. The symptom of striking is negative on both sides. Emotionally labile. In the Romberg position is stable, coordination tests are performed correctly.

Additional study data:

Complete blood count: Hb - 159 g / l, er. - 4.7 × 10 ¹² / l, L - 5.5 × 10%, ESR - 4 mm / hour, PO - 2%, s / I - 61%, e - 2%, m - 5%, l - 30%. The adaptation reaction is the reaction of training (according to Garkavi L.Kh.).

ECG - sinus rhythm, 84 beats / min, the electrical axis of the heart is sharply deflected to the left, blockade of the anteroposterior branch of the left leg of p. Gisa, myocardial hypertrophy of the left atrium and left ventricle, exchange-electrolyte (trophic) changes in the myocardium of the anterior-septal and anterior apical areas of the left ventricle.

VEM - average exercise tolerance, achieved power - 83 W (proper - 122 W), the test result is negative (achieving submaximal heart rate, severe shortness of breath and weakness), hypertonic type of reaction of the cardiovascular system to physical activity.

Cardiac rhythmogram - Wave characteristics: Power HF (BV) - 46, Power LF (MB2) - 93, Power VLF (MB1) - 161. Combined characteristics: Mode amplitude - 63, Voltage index - 100, MV2 / BV ratio - 2.021, Ratio MV1 / BV - 3.5, The ratio (MV1 + MV2) / BV - 5.521, pRR50% - 0. Conclusion: normal heart rate Heart rate = 76 beats / min. Dominant slow waves of a large period. A significant increase in parasympathetic influence on the regulation of sinus rhythm.

Blood biochemical analysis: total cholesterol - 6.37 mmol / L (normal 3.9-6.5 mmol / L), HDL cholesterol - 0.98 mmol / L (normal 0.9-1.9 mmol / L), atherogenicity index - 5.5 (norm 2.6-2.9), LDL cholesterol - 10.8 g / l (norm 3.3-5.5 g / l), diene lipid conjugates - 7.1 units. (norm 1.06-2.06 units), erythrocyte malondialdehyde - 39.4 nmol / ml er. mass (normal 0.8-3.6 nmol / ml er), malondialdehyde lipid - 5.4 nmol / mg lipids (normal 8.8-19.2 nmol / mg lipids), serum catalase - 49.6 μkat / l (norm 10.6-23.0 μkat / l), ceruloplasmin - 0.324 g / l (norm 0.300-0.580 g / l), fibrinogen - 3.1 g / l (norm 2.0-4.0 g / l), koalin time - 80 sec (norm 50-70 sec), plasma tolerance to heparin - 16 minutes (norm 10-16 min), fibrinolytic activity of plasma - 240 minutes (norm 183-263 min).

The results of the study show: atherogenic dyslipidemia, activation of lipid peroxidation processes, antioxidant defense system tension and a tendency to hypocoagulation.

The adaptation period was calm, blood pressure level 120/80 mm Hg From the fourth day of stay in the clinic, the patient was prescribed a course of treatment according to the proposed method - magnetic laser therapy every other day, a course of 8 procedures. From the fifth day - hydrogen sulfide baths with a concentration of hydrogen sulfide 50-100-150 mg / l, at a water temperature of 36 ° C, lasting 6-8-10-15 minutes, every other day, on a course of 8 baths (Table 2). By the seventh day of the hospital stay, the patient did not have angina attacks, the level of blood pressure remained normal (at 120/80 mmHg), headaches, sensations of interruptions in the work of the heart, dizziness, increased fatigue, morning weakness decreased significantly . By the end of treatment, there were no coronary pains, shortness of breath decreased, controlled blood pressure remained, headache, neurotic manifestations disappeared, pains in the spine and knee joints were not disturbed.

During the control examination, the following data were obtained:

Complete blood count: Hb - 157.9 g / l, er. - 5.0 × 10 ¹² / l, L - 8.6 × 10%, ESR - 5 mm / h, PO - 1%, s / I - 51%, e - 2%, m - 10%, l - 36%. The adaptation reaction is a reaction of increased activation (according to L.Kh. Garkavi).

ECG - sinus rhythm, 67 beats / min, improvement of exchange-electrolyte changes (trophic) of the myocardium of the anterior-septal and antero-apical regions of the left ventricle.

VEM - increased exercise tolerance, achieved power - 90 W (due to 122 W) - is reduced, which is 7.8% more compared to the original data. The result of the test is negative (achievement of submaximal heart rate, severe shortness of breath and weakness), hypertonic type of reaction of the cardiovascular system to physical activity.

Cardiac rhythmogram - Wave characteristics: Power HF (BV) - 31, Power LF (MB2) - 30, Power VLF (MB1) - 165. Combined characteristics: Mode amplitude - 59, Voltage index - 94, MV2 / BV ratio - 0.967, Ratio MV1 / BV - 5.322, Relationship (MV1 + MV2) / BV - 6.29, pRR50% - 0. Conclusion: normal heart rate heart rate = 81 beats / min. Dominant slow waves of a large period. A significant increase in the sympathetic effect on the regulation of sinus rhythm.

Biochemical analysis of blood: total cholesterol - 7.2 mmol / L (normal 3.9-6.5 mmol / L), HDL cholesterol - 1.7 mmol / L (normal 0.9-1.9 mmol / L), atherogenicity index - 3.2 (norm 2.6-2.9), LDL cholesterol - 8.6 g / l (norm 3.3-5.5 g / l), diene lipid conjugates - 2.22 units. (norm 1.06-2.06 units), erythrocyte malondialdehyde - 42.1 nmol / ml er. mass (norm 0.8-3.6 nmol / ml er), malondialdehyde of lipids - 7.8 nmol / mg lipids (norm 8.8-19.2 nmol / mg lipids), serum catalase - 34.2 μkat / l (norm 10.6-23.0 mkkat / l), ceruloplasmin 0.288 g / l (norm 0.300-0.580 g / l), fibrinogen 3.3 g / l (norm 2.0-4.0 g / l), coalin time - 50 sec (norm 50-70 sec), plasma tolerance to heparin - 10 min (norm 10-16 min), plasma fibrinolytic activity - 210 min (norm 183-263 min).

Thus, the proposed method allowed: to increase physical performance by 7.8%, contributed to the regression of angina pectoris, shortness of breath, normalization of blood pressure and electrocardiography, activation of adaptation reactions, relief of neurotic complaints. There was an effect on lipid metabolism: the atherogenic spectrum of the plasma decreased - by 71.8% the atherogenic index by 25.6% LDL cholesterol with an increase in the content of antiatherogenic properties of blood by 42.4% for HDL cholesterol. The dynamics of lipid peroxidation showed a lack of dynamics of the products of primary lipid degradation - malondialdehyde of erythrocytes and malondialdehyde of lipids, with a significant decrease in the content of products of secondary lipid degradation - diene conjugates of lipids by 3.2 times, with a decrease in the activity of antioxidant protection enzymes (consumption enzyme) catalase by 45% and ceruloplasmin by 12.5%. From the side of blood coagulation - normocoagulation. Discharged with significant improvement.

The study included 96 patients with an established diagnosis of coronary heart disease, exertional angina of functional class I-II without rhythm disturbances, chronic heart failure I-II FC (NYHA), and risk factors - essential arterial hypertension (I10.0, ICD-X ), mixed hyperlipidemia (E78.2, ICD-X), changes in the blood coagulation system, obesity (E66, ICD-X), smoking, psychoemotional stress, impaired adaptation reactions. Patients of the two groups were comparable in age, number of men and women, body mass index, state of lipid metabolism, lipid peroxidation, coagulation parameters, and level of arterial hypertension.

Group I - 54 patients received treatment according to the proposed method - magnetic laser therapy in combination with hydrogen sulfide baths.

Group II (prototype) - 42 patients received treatment with hydrogen sulfide baths.

When comparing the dynamics of the clinical manifestations of coronary heart disease in groups, differences in the nature of all controlled clinical indicators were revealed. Higher efficacy in the positive effect on the clinical course of angina pectoris and manifestations of chronic heart failure was noted in patients in group I of the study (Table 3). The severity of the antianginal effect in group I was higher by 11.1%, and the manifestations of chronic heart failure decreased by 24.4%, compared with the data in group II. A significant decrease in complaints of a neurasthenic nature: irritability, fatigue after exertion, tension headache and palpitations was noted in all groups of patients, however, the largest regression of these complaints was in group I, which was associated with potentiation of the therapeutic effects of magnetic laser therapy and hydrogen sulfide baths.

According to table 3, there was a predominance of percent improvement in clinical symptoms in group I of patients taking treatment by the proposed method, compared with the dynamics of clinical indicators in patients of group II.

Table 3
Dynamics of complaints according to the subjective symptoms of patients with coronary heart disease under the influence of complex treatment (%) Groups Angina pain Dyspnea Irritability Headache Heartbeats Fatigability before before before before before before after Δ after Δ after Δ after Δ after Δ after Δ I 96.3 -61.1 75.9 -33.2 42.6 -21.1 83.3 -66.6 50,0 -27.4 55.6 -41.2 35,2 42,2 21.5 16.7 22.6 14,4 II (prototype) 61.9 -50.0 57.1 -8.8 57.1 -38.0 90.5 -66.7 38.1 -21.4 38.8 -36.4 11.9 42.9 19.1 23.8 16.7 2,4

When analyzing the dynamics of arterial hypertension, normalization of the level of arterial pressure (BP) by 49.2% was observed in group I due to a decrease in numbers by 20.8% of the level of the first degree and by 28.4% of the second degree of arterial hypertension. In group II, a normalization of blood pressure by 13.6% was noted mainly due to a decrease in numbers in patients with a second degree of hypertension.

When assessing the dynamics of body weight (according to the recommendations of the European Society for Atherosclerosis and the European Society for Hypertension, 1994), a decrease in the body mass index in patients with the use of all treatment complexes was noted. However, the greatest positive effect on the regression of obesity was observed in group II (Table 4).

Table 4
The dynamics of body mass index in patients with coronary heart disease Groups Treatment periods Body mass index Δ% R I Before treatment

-3.2 > 0.05 After treatment II (prototype Before treatment

-13.4 <0.01 After treatment

Dynamic changes in adaptive reactions (according to L.Kh. Garkavi) in patients in group I were reflected in the redistribution of adaptive adaptation reactions towards increased activation, while in group II only an increase in calm activation reactions (Table 5). In this regard, the use of the proposed treatment complex indicates a significant strength of the irritating effect of physical factors and stimulation of the adaptogenic effect in the treatment process.

Table 5
Dynamics of adaptive reactions in patients with coronary artery disease during treatment (%) Adaptation reactions I group II group (prototype) Before treatment After treatment Δ Before treatment After treatment Δ Stress 0 0 0 0 0 0 Increased activation reaction 35,2 46.7 +11.5 78.1 66.7 -11.4 Calm activation reaction 48.1 44,4 -3.7 21.9 33.3 +11.4 Workout reaction 16.7 8.9 -7.8 0 0 0 Note. Δ - change in indicators during treatment

The data of instrumental research methods in assessing the processes of repolarization by electrocardiography showed a decrease in ischemic (ST interval) by 10.0% and nonspecific changes (T wave) by 8.1% in group I, while in group II there was a greater percentage of regression of ischemic manifestations and an increase in nonspecific changes in the final part of the ventricular complex by 7.8% (Table 6).

Table 6
Dynamics of changes in repolarization processes according to ECG in patients with coronary artery disease Groups Repolarization change in% no non-specific ischemic before after Δ before after Δ before after Δ I 52.8 62.8 +10.0 45.3 37,2 -8.1 1.9 0 -1.9 II (prototype) 40.5 37.8 -2.7 38.1 45.9 +7.8 21,4 16.3 -5.1

When assessing the QT interval of corrected (Q-Tc) by ECG, a tendency to lengthen this interval by 0.9% was observed in patients of group I, and in group II there was a statistically insignificant dynamics by 4.5%, however, the values of Q-Tc did not reach their prognostic significant value (more than 0.440 s ^1/2 ). These changes in the final part of the ventricular complex may reflect the effects of the autonomic nervous system and electrolyte disturbances when physical factors are affected by the myocardium (Table 7).

Table 7
The dynamics of the QT interval corrected (Q-Tc) during treatment Groups Treatment periods Q-Tc Δ% R I Before treatment

+0.9 > 0.05 After treatment II (prototype Before treatment

+4.5 <0.01 After treatment

The data of a bicycle ergometric test with a qualitative assessment showed a decrease in the hypertonic type of reactions of the cardiovascular system to the load after treatment by the proposed method by 22.0%, which is 17.7% more compared to the treatment according to the prototype (Table 8).

Table 8
The response of the cardiovascular system to dosed physical activity (%) Groups Normotonic type Hypertonic type Before treatment Δ Before treatment Δ After treatment After treatment I 31.8 +22.0 68,2 -22.0 53.8 46.2 II (prototype) 24.3 +4.3 75.7 -4.3 28.6 71,4

A quantitative assessment of bicycle ergometric test results showed a positive change after treatment in group I: in men, the increase in threshold load power was 10.6% (p> 0.05), in women, a significant increase of 8.7% (p <0.001). In group II, the increase in the power of the threshold load in men was less pronounced and amounted to 7.9% (p> 0.05), while in women the exercise tolerance was 8.8% higher compared to group I.

A similar trend was determined by the level of maximum oxygen consumption (IPC). The increase in physical performance is adequate to the increase in IPC. The greatest increase in the level of fitness occurred in men with the combined use of physical factors (Table 9). However, in men of group I, upon reaching threshold loads, there was a significant increase in the performance of a double product by 10.0%, which reflected an increase in the influence of the sympathetic nervous system on the heart during exercise. Women in both groups showed the same trend in terms of double product indicators as an indirect indicator of increased myocardial oxygen consumption (Table 9).

Thus, analyzing the obtained data, we can say about the good effectiveness of magnetic laser therapy and hydrogen sulfide balneotherapy as training factors in increasing physical performance in patients with coronary artery disease and reducing inadequate hemodynamic reactions to physical activity.

In recent years, the features of the functioning of the autonomic nervous system have been actively studied by its effect on the activity of the sinus node using cardiorhythmography. Studying the state of the autonomic nervous system of the myocardium opens up prospects for the selection of treatment methods for leveling its disorders in patients with cardiovascular diseases, which can affect the prognosis and course of the disease.

We conducted a study of the vegetative status in group I before and after treatment using 10-minute (500 R-R intervals) records of the cardiointervalogram in the patient’s lying position after 15 minutes of rest. Spectral analysis showed a tendency to decrease the power of the high-frequency component of the spectrum - HF by 7.9% (as a decrease in the influence of the parasympathetic part of the autonomic nervous system) and the power of the low-frequency component of the spectrum - LF by 19.6% (as the state of the sympathetic part of the autonomic nervous system, particular system of regulation of vascular tone). Vegetative balance (LF / HF ratio) significantly increased by 0.9% towards the predominance of the sympathetic nervous system. The spectrum of very low-frequency rhythm fluctuations (VLF) is a marker for controlling metabolic processes and well reflects energy-deficient states. This indicator had a significant decrease of 54% (p <0.01), which reflected post-load energy deficiency and a decrease in autonomous (segmental) levels of regulation of cardiac circulation with suprasegmental during the functional effects of magnetic laser therapy and hydrogen sulfide baths. The voltage index of regulatory systems (SI) showed a significant increase of 31.2%, which characterizes the increased activity of the mechanisms of sympathetic regulation as a state of the central circuit of regulation. Activation of the central contour was observed, an increase in the mode amplitude (AMo) by 13.9% (p <0.05) was similarly manifested as an increase in sympathetic regulation against the background of physical factors, a decrease in the variation in the duration of cardio intervals, and an increase in the number of intervals of the same type (table 10) ) In a quantitative analysis of the dynamics of supraventricular ectrasystole, a favorable trend was noted in the reduction of rhythm disturbances by 8.0%.

The data showed that the treatment complex of group I decreased the power of all components of the heart rhythm spectrum, with a predominance of the influence of the sympathetic department of the autonomic nervous system, a slight decrease in the amount of supraventricular extrasystole, which indicated a hyperactive (stressful) reaction of the autonomic nervous system to these components of the treatment complex.

Table 10
Dynamics of cardiac rhythmogram indicators in group I Indicator I group N M ± m p /% Hf 25 115.04 15.70 0.65 25 106.60 16.81 -7.9 Lf 25 134.68 21.22 0.31 25 112.60 15.60 -19.6 Vlf 25 555.32 82.26 0.01 25 360.52 53.39 -54.0 AMo (%) 25 54.36 2.73 0.008 25 63.16 2.78 + 13.9 SI 25 86.16 11.43 0.04 25 125.16 16.01 +31.2 LF / HF 25 56.18 10.81 0,0005 25 56.68 10.92 +0.9 VLF / HF 25 59.75 10.12 0.41 25 58.69 10.71 -1.8 IC 25 60.29 10.01 0.18 25 58.69 10.50 -2.7 pNN50 (%) 25 1.96 , 41 0.36 25 1.40 , 43 -40

Correction of dyslipidemia is the main task of the secondary prevention and treatment of coronary heart disease. Initially, before complex treatment in patients in all groups, lipid metabolism disorders were revealed in the form of hypercholesterolemia, hyperlipoproteinemia, and low cholesterol of high density lipoproteins (Table 11). A high atherogenic spectrum of lipid metabolism is an extremely unfavorable factor in the progression of atherosclerosis in this group of patients.

Under the influence of the treatment in patients in two groups, an improvement in the lipid profile of plasma was noted. A decrease in atherogenic lipids was observed in group I: the level of total cholesterol (OXC) decreased by 7.6% (p> 0.05), the atherogenic index - by 14.1% (p <0.05) (Table 11). In this group, the most favorable trend was observed for a decrease in low-density lipoprotein cholesterol (LDL cholesterol) - 10.7% and an increase in antiatherogenic high-density lipoprotein cholesterol (HDL cholesterol) by 14.7% (p <0.05). Positive changes in the atherogenic profile, in our opinion, are due to the influence of magnetic laser therapy. In group II, there was a tendency to lower total cholesterol by 4.3%, LDL cholesterol by 0.6%, and atherogenic index by 9.6%. The increase in antiatherogenic cholesterol of high density lipoproteins (HDL cholesterol) by 20.5% is due to the non-specific effect of hydrogen sulfide balneotherapy.

Thus, the lipid-correcting effect is due to the action of the applied physical factors, but is largely associated with the use of magnetolaser therapy and general hydrogen sulfide baths.

Table 11
The dynamics of lipid metabolism in patients with coronary heart disease Groups Stat. indicator Total cholesterol, mmol / l HDL cholesterol, mmol / l Atherogenic index, units LDL cholesterol, g / l I M ± m

Δ% -7.6 +14.7 -14.1 -10.7 R > 0.05 <0.05 <0.05 > 0.05 II (prototype) M ± m

Δ% -4.3 +20.5 -9.6 -0.6 R > 0.05 <0.05 <0.05 > 0.05 Healthy M ± m 5.20 ± 0.21 1.46 ± 0.08 2.75 ± 0.13 4.16 ± 0.22 Note: in the numerator indicators before treatment, in the denominator - after treatment

Pathological changes in lipid metabolism during the atherosclerotic process are also manifested by an increase in the content of lipoperoxides in the blood plasma due to the activation of free radical peroxidation with the formation of active primary (malondialdehyde) and secondary (diene conjugates) oxidation products that irreversibly damage cell structures and enhance platelet aggregation and provocation and complications of atherosclerosis. In all observed patients, when assessing the system of lipid peroxidation (LP) by the number of formed diene conjugates (DC) and malondialdehyde (MDA), an increase was observed in comparison with the group of healthy ones. The increased content of DC - the initial phase of LPO processes indicated a reduced resistance of lipoproteins to oxidation and their readiness to oxidize. At the same time, the atioxidant defense system in the atherosclerotic process is depleted, which is considered as one of the reasons for the intensification of LP. Enzymatic plasma antioxidants - catalase and ceruloplasmin are involved in the protection of LDL cholesterol from atherogenic oxidative modification.

The antioxidant defense system was evaluated in patients according to catalase activity and ceruloplasmin content. The initial increased level of catalase in all groups was associated with the intensification of the LPO system with increased production of hydrogen peroxide, and the level of ceruloplasmin was reduced as a result of irreversible interaction with hydroperoxides and the accumulation of unoxidized free radicals upon depletion of this enzyme.

The use of medical complexes contributed to a positive change in the indicators of LP and AOP. The most pronounced changes were observed in patients of group I: in the system of lipid peroxidation and antioxidant protection, the level of decrease in lipid peroxidation products was DC by 15.1% (p> 0.05), red blood cell MDA was 15.6% (p <0.01 ), MDA of lipids 29.9% (p <0.01) against the background of an increase in ceruloplasmin content by 7.2% (p> 0.05) (Table 12). This positive biochemical effect could be due to the inhibitory effect of magnetic laser therapy on the LPO system. There was no effect on catalase levels.

In the II group of patients under the influence of treatment with hydrogen sulfide baths, no significant shifts were observed in the studied LPO and AOD indicators (Table 12).

Table 12
Indicators of lipid peroxidation and antioxidant protection Groups Stat. indicator Lipid peroxidation rates Antioxidant Performance Diene conjugates MDA, mmol / ml er. masses MDA, n / mol / mg lip. Catalase, mkkat / l Ceruloplasmin, g / l I M ± m

Δ% -15.1 -15.6 -29.9 +2.2 +7.2 p > 0.05 <0.01 <0.01 > 0.05 > 0.05 II (prototype) M ± m

Δ% -3.7 -15.2 -11.2 -10.7 +3.9 R > 0.05 > 0.05 > 0.05 > 0.05 > 0.05 Healthy M ± m 1.56 ± 0.14 39.5 ± 0.92 8.35 ± 0.08 16.8 ± 1.59 0.340 ± 0.009 Note: in the numerator indicators before treatment, in the denominator - after treatment

Thus, the analysis of lipid metabolism revealed the corrective effect of the complex, including magnetic laser therapy and hydrogen sulfide balneotherapy. The use of this treatment complex contributes to the balanced operation of peroxidation systems (the primary effect on the products of primary lipid peroxidation) and antioxidant protection. Obviously, the effect of magnetic laser therapy, potentiated by hydrogen sulfide baths, contributes to the retention of the processes of atherogenesis and the restoration of the equilibrium of lipid oxidation. The inclusion of hydrogen sulfide baths in the treatment complex is not enough to correct lipid metabolism disorders.

Biochemical changes in the coagulating and fibrinolytic properties of blood during the atherosclerotic process lead to increased thrombosis, determine their significance as factors in the progression of coronary heart disease and the need for correction.

Treatment of patients with coronary heart disease according to the proposed method (group I) contributed to an improvement in the blood coagulation system: a decrease in fibrinogen by 36.8% (p <0.01), lengthening of the coalin time by 28.0% (p <0.01), a significant increase fibrinolytic activity of plasma by 27.7% (p <0.05) - anticoagulant potential of blood (table 13).

In the II group of patients, changes in the coagulation and anticoagulation properties of blood are also reliably expressed, but to a lesser extent, which determines the therapeutic value of hydrogen sulfide mineral water (Table 13).

Table 13
Coagulation indicators in patients with coronary heart disease Groups Stat. indicator Fibrinogen, g / l Koalin time, sec Plasma tolerance to heparin, min Fibrinolytic activity, min I M ± m

Δ% -36.8 +28.0 -1.9 +27.7 p <0.01 <0.01 > 0.05 <0.05 II (prototype) M ± m

Δ% -12.3 +5.1 +47.9 +9.6 p <0.02 > 0.05 <0.02 <0.05 Healthy Vibration range 2.0-4.0 50-70 10-16 183-263

When evaluating the results of treatment, the greatest therapeutic efficacy was observed in group I - 4.19 ± 0.07 points, with a higher percentage of “significant improvement” - 22.2 and “improvement” - 71.4 with low values of “slight improvement” "- 3.7 in comparison with the II group of the prototype. The use of hydrogen sulfide balneotherapy showed a less pronounced (by 0.38) effectiveness in points (3.81 ± 0.11) with a high percentage of "minor improvements" - 21.4% (Table 14).

Table 14
The overall effectiveness of the comprehensive spa treatment of patients with coronary heart disease (%) Groups Treatment results significant improvement improvement slight improvement no change worsening Performance Score (M ± m) I 22.2 74.1 3,7 0 0 4.19 ± 0.07 II (prototype) 11.9 64.3 21,4 2,4 0 3.81 ± 0.11

Thus, high therapeutic efficacy was observed when using magnetic laser therapy and hydrogen sulfide balneotherapy.

When analyzing the long-term results of spa treatment in 11 patients with coronary heart disease receiving a developed treatment complex, including magnetic laser therapy and hydrogen sulfide baths, it was noted: remission (stable course) of coronary heart disease within 8.16 ± 0.23 months, with the number of attacks angina pectoris per week decreased by 34% (p <0.05); control indicators (maintaining normal numbers, the absence of hypertensive crises, greater resistance to weather factors), blood pressure levels in patients were observed for 6.3 ± 0.51 months. The number of days of temporary disability for the underlying disease decreased 2.9 times.

A comprehensive analysis of the problem related to the secondary prevention and treatment of coronary heart disease patients using hydrogen sulfide balneotherapy and magnetic laser therapy showed that the integrating effect of physical factors can correct prognostically significant risk factors and thereby stabilize the course of the atherosclerotic process in coronary heart disease and reduce the risk of complications.

Sanatorium-resort treatment, having a multifactorial effect, to some extent, can be an alternative to pharmacological treatment in the secondary prevention of coronary heart disease.

Claims (1)

A method for the treatment of coronary heart disease by means of common hydrogen sulfide baths with a concentration of hydrogen sulfide of 50-150 mg / l, released with angina pectoris voltage I functional class and 50-100 mg / l, released with angina pectoris voltage II functional class, at a water temperature of 36 ° C, duration 6-15 minutes and exposure to a physical factor, characterized in that, from the 4th day of the adaptation period, magnetic laser therapy from the Mustang-2000 apparatus is carried out every other day, with a LO2-2000 emitter and a magnetic nozzle MN 30, ge emitting laser infrared radiation with a wavelength of 0.89 μm in a pulsed mode with a power of 7 W, a repetition rate of 80 Hz and a constant magnetic field of 50 mT, irradiating each of 4-5 symmetrical biologically active points for 1 minute, with a total exposure time of 8 10 min, adding from the 5th day of treatment a vacation of common hydrogen sulfide baths on days free from laser therapy, for a course of 8 physiotherapy and balneotherapy.

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