RU2306156C2 - Method for treating patients with hypertonic disease - Google Patents

Abstract

FIELD: medicine, physiotherapy.

SUBSTANCE: at treating a patients during the period of April-October a curative complex consists of balneo- and EHF-therapy prescribed in the following sequence during a day: from 11 a.m. till 3 p.m. - the procedures of EHF-therapy, from 2 p.m. till 4 p.m. - balneotherapy. At treating during the period of November-March the above-mentioned complex should be additionally supplemented with peloidotherapy prescribed from 9.00 till 11.00 a.m. The innovation enables to improve endurance of complex therapy.

EFFECT: higher efficiency of therapy.

3 cl, 2 ex, 3 tbl

Description

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

There is a method of treating patients with hypertension with radon baths, in which radon baths are prescribed against the background of the constant intake of medications every other day [1]. The disadvantage of this method is the lack of differentiated appointment of radon baths depending on the time of day and season, excluding periods of maximum and minimum levels of blood pressure, which can, in some cases, lead to an excessive decrease in blood pressure, and in other cases, to an insufficiently expressed hypotensive action.

A known method of treating patients with hypertension with electromagnetic radiation of the millimeter range (EHF-therapy) from the device "Yav" on the background of drug treatment [2]. The disadvantage of this method is the lack of temporary differentiation of prescribed procedures during the day and year.

A known method of treating patients with hypertension using applications of silt sulfide mud according to a segmental-reflex technique by applying mud to the collar area, appointed every other day, while the treatment complex includes cycling and therapeutic swimming in the pool [3]. The disadvantages of the method include the need for the presence in the medical institution of the pool and simulators, which leads to an increase in the cost of treatment in general. In addition, applications of sulfide mud enhance the activity of the hypothalamic-pituitary-adrenal system, excitation processes in the central nervous system, which, without proper correction, can lead to “failure of adaptation” and autonomic regulation, leading to an increase in blood pressure in cardiac patients.

The task of the invention is to increase the efficiency and improve the tolerability of complex treatment.

The problem is solved by the complex appointment of balneotherapy and EHF-therapy, and radon baths with a concentration of 1.5-3 kBq / l, a temperature of 36-37 ° C, lasting 8-10 minutes, assigned every other day from 14.00 to 16.00 are used as balneotherapy. hours, for a course of 8-10 procedures, EHF-therapy is carried out by acting on corporate biologically active points with a frequency of 60.9-61.3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (paired ), VG-20, the duration of exposure to one biologically active point 3-5 minutes, the total procedure time Ura 20-30 minutes, from 11.00 to 15.00 hours, for a course of 10 procedures, the specified effect is carried out in the period from April to September, while treating the patient from November to March, peloid therapy is additionally included, which use peat mud applications with a temperature of 36- 38 ° C on the collar area, the duration of the procedure is 15-20 minutes, is prescribed every other day on days free of baths, from 9.00 to 12.00 hours, for a course of 8-10 procedures.

The use of radon baths in the claimed method is due to their pronounced inhibitory effect on the central and autonomic nervous system at all levels of its regulation, normalization of lipid metabolism, decreased activity of the sympathoadrenal system with a decrease in the clinical and hemodynamic signs of hypersympathicotonia in patients with a cardiological profile.

The inclusion of EHF radiation into the treatment complex is based on the known properties of this physical factor to increase the nonspecific resistance of the body to various factors of a chemical, physical and biological nature, normalize pathologically altered reactivity of the autonomic nervous system, activate the antiradical system of the body and reduce the intensity of lipid peroxidation in patients with hypertension.

The duration of the course of EHF-therapy in 8-10 procedures is determined by the effectiveness of treatment of patients. With a decrease in the duration of the course, the effectiveness of treatment decreased, and with its lengthening, it did not increase.

Peloid therapy in the claimed method is prescribed to correct lipid metabolism disorders, normalize lipid peroxidation and antioxidant protection, increase the general nonspecific reactivity and adaptive capabilities of the body. The use of peat mud in this method is due to the well-known properties of peat mud to inhibit the synthesis of catecholamines and glucocorticoids in the adrenal glands, in contrast to sulfide mud, which stimulate these processes [4]. The inclusion of peloid therapy in the treatment complex from November to March is due to the fact that the most pronounced lipid metabolism disturbance occurs in the autumn-winter season [5], and pelioiodotherapy helps to normalize the level of the atherogenic fraction of low density lipoproteins.

Traditionally, peloid and balneotherapy are prescribed every other day or two days in a row, followed by a rest day. The temperature and exposure of the mud applications and baths are selected in accordance with the range that is most preferred in physiotherapy.

The duration of the treatment course is determined taking into account the data that the improvement of clinical symptoms in balneotherapy is after 5-7 procedures. Therefore, the lower limit of the duration of treatment was 8 procedures. At 11-12 procedures, an increase in sympathoadrenal activity, an increase in the frequency of astheno-vegetative disorders, which determined the limitation of the course of treatment by 10 procedures, are noted.

The time of the peloid and balneotherapy procedures was selected taking into account the circadian daily biorhythms of the activity of the sympathoadrenal system in patients with a cardiological profile. Morning hours are the phase of the rise of the functions of homeostatic systems, the predominance of excitation processes. Peloid therapy is prescribed in the morning to stimulate metabolic processes aimed at correcting lipid metabolism and increasing the adaptive capacity of the body. In the afternoon hours there is an increase in inhibition processes in the central and autonomic nervous systems, the appointment of balneotherapy at this time helps to correct the increased activity of the hypothalamic-pituitary-adrenal system. The purpose of peloid therapy in the autumn-winter period of the year is due to an increase in the level of total cholesterol and low-density lipoprotein cholesterol and cholesterol-lipoproteins detected during biorhythmological studies in this period of the year, which is associated with the peculiarities of the nutrition and motor regimen of patients at this time of year [5].

Example 1. Patient M., 50 years old, medical history No. 1968, was admitted for treatment to the rehabilitation therapy department of the Tomsk Scientific Research Institute of Balneology and Physiotherapy 07/19/2004 with a diagnosis of Hypertension, stage I, degree of arterial hypertension 1, risk 2. Dyslipoproteinemia. Concomitant diseases: Varicose veins of the lower extremities, stage of compensation. Upon receipt, he complained of an increase in blood pressure to 150/90 mm Hg, pain in the heart stitching, not associated with physical exertion, not stopping nitroglycerin, arising after emotional exertion, palpitations, difficulty breathing during physical exertion, increased fatigue , weakness, irritability, headaches, dizziness.

From the anamnesis: the first increase in blood pressure and pain in the heart appeared about 2 years ago after a stressful situation in the family. Increased blood pressure periodically, the maximum level of hypertension is 150/90 mm Hg Objective status: increased nutrition, height 188, weight 97 kg. General condition is satisfactory. The skin and mucous membranes are clean, skin moisture is increased. Lymph nodes are not enlarged. Heart sounds are clean, rhythmic, emphasis II tone on the aorta, heart rate 59 per minute. HELL at admission 150/90 mm Hg The vesicular breathing, wheezing in the lungs are not heard. The abdomen is soft, painless on palpation.

Biochemical blood parameters before treatment: total lipids 6.9 g / l (normal up to 8 g / l), total cholesterol 5.46 mmol / l (normal up to 5.17 mmol / l), high density cholesterol lipoproteins 1 , 06 mmol / L (with a norm of 0.78-1.81 mmol / L), low density cholesterol lipoproteins of 3.74 mmol / L (with a norm of up to 2.2 mmol / L), an atherogenic index of 4.2 (with normal up to 3.0), catalase 17.3 μkat / l (with normal 16-30 μkat / l), ceruloplasmin 400 mg / l (normal up to 400 mg / l), malondialdehyde 2.9 mmol / l (with normal to 3.6 mmol / l). The adaptation reaction was evaluated as a reaction of reactivation of a low level of reactivity (the number of lymphocytes is 42%, with the norm being up to 40%). Tolerance to physical activity by the method of bicycle ergometry is high - 160 W, the economy index is 2.01 cu EF according to Echocardiography 64% (with a norm of 60% and above), DAC 3.6 (with a norm of up to 3.5 cm), CRC 5.7 (with a norm of up to 5.0 cm) - a violation of the diastolic function of the left ventricle.

The treatment was carried out in accordance with the claimed method. From the first day of their stay in the clinic, EHF therapy was prescribed for corporate biologically active points with a frequency of 60.9-61.3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (paired), VG-20, the duration of exposure to one biologically active point is 3-5 minutes, the total procedure time is 20-30 minutes, from 11.00 to 15.00 hours, a course of 10 procedures, total radon baths with a concentration of 1.5 kBq / l in the first 3 procedures, 3 kBq / l on the following days of treatment, at a temperature of 36 ° C, lasting 10 minutes, appointed every other day in the afternoon (14.00), for a course of 10 procedures. The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. No sharp fluctuations in the autonomic indices characterizing the autonomic tone and reactivity were found. After treatment according to the claimed method, the patient disappeared headaches, cardialgia, palpitations, significantly reduced emotional disturbances. Normalization of the level of ceruloplasmin to 357 mg / l was noted. After treatment, blood pressure decreased from 150/90 to 134/81 mm Hg. Tolerance to physical activity remained at a high level (160 W) with a decrease in myocardial oxygen demand (economy index 1.76 cu). Myocardial contractility increased, which is reflected in an increase in PV from 64 to 68%, a decrease in CSR to 3.5 cm, and a decrease in CRC to 5.6 cm. There was a tendency to normalize the blood lipid spectrum: total lipid concentration 6.5 g / l, total cholesterol 5.43 mmol / l, high-density cholesterol lipoproteins 1.09 mmol / l, low-density cholesterol lipoproteins 3.69 mmol / l, atherogenicity index 3.98 (normal to 3.0). Immediate treatment results are generally rated as improvement.

Example 2. Patient Sh., 56 years old, medical history No. 2467, was admitted for treatment to the rehabilitation therapy department of the Tomsk Scientific Research Institute of Balneology and Physiotherapy November 26, 2004 with a diagnosis of Hypertension, stage II, degree of arterial hypertension 2, risk 4. Upon receipt, presented complaints of an increase in blood pressure up to 150/90 mm Hg, pain in the heart stitching, not associated with physical exertion, not stopping nitroglycerin that occurs after emotional exertion, palpitations, difficulty breathing during exercise e povyshennnuyu fatigue, weakness, irritability, headaches, and dizziness.

From the anamnesis: the first increase in blood pressure and pain in the heart appeared about 2 years ago after a stressful situation in the family. Increased blood pressure periodically, the maximum level of hypertension is 150/90 mm Hg Objective status: increased nutrition, height 168, weight 87 kg. General condition is satisfactory. The skin and mucous membranes are clean, skin moisture is increased. Lymph nodes are not enlarged. Heart sounds are clean, rhythmic, emphasis II tone on the aorta, heart rate 86 per minute. HELL at admission 150/90 mm Hg The vesicular breathing, wheezing in the lungs are not heard. The abdomen is soft, painless on palpation.

Biochemical blood parameters before treatment: total lipids 3.4 g / l (normal up to 8 g / l), total cholesterol 5.42 mmol / l (normal up to 5.2 mmol / l), high density cholesterol lipoproteins 0 78 mmol / L (with a norm of 0.78-0.81 mmol / L), low density cholesterol-lipoproteins of 3.68 mmol / L (with a norm of up to 2.2 mmol / L), an atherogenic index of 3.48 (with normal up to 3.0), catalase 13.3 μkat / l (normal 16-30 μkat / l), ceruloplasmin 393 mg / l (normal up to 400 mg / l), malondialdehyde 3.7 mmol / l (at normal to 3.6 mmol / l). The adaptive reaction was evaluated as a calm activation reaction (the number of lymphocytes is 31%, with the norm being up to 40%) of a low level of reactivity. Tolerance to physical activity by the method of bicycle ergometry was 110 W, the economy index was 2.4 cu FV according to the data of EchoCG 63% (with a norm of 60% and above), KSR 3.7 (with a norm of up to 3.5 cm), KDR 5.6 (with a norm of up to 5.0 cm).

The treatment was carried out in accordance with the claimed method. From the first day in the clinic, EHF therapy was prescribed for corporative biologically active points with a frequency of 60.9-61.3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (paired), VG-20, the duration of exposure to one biologically active point is 3-5 minutes, the total procedure time is 20-30 minutes, from 11.00 to 15.00 hours, 10 courses per course, total radon baths with a concentration of 1.5 kBq / l in the first 3 procedures, 3 kBq / l on the following days of treatment, at a temperature of 36 ° C, lasting 10 minutes, appointed every other day in the afternoon (14.00), for a course of 8 procedures. From the second day of stay in the clinic, applications of peat mud to the collar area, temperature 36 ° C, lasting 15 minutes in the first 3 treatments, 20 minutes in the following days of treatment, appointed daily in the morning (10.00) on days free of baths, on a course of 8 procedures. The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. Sharp fluctuations in the autonomic indices characterizing the autonomic tone and reactivity were not detected. After treatment according to the claimed method, the patient disappeared headaches, cardialgia, palpitations, significantly reduced emotional disturbances. Normalization of the initially altered biochemical blood parameters was noted: total cholesterol 4.4 mmol / l, catalase 19.8 mkkat / l. The adaptive capabilities of the body have increased: the adaptation reaction after treatment is regarded as a reaction of calm activation of a high level of reactivity. After treatment, blood pressure decreased from 150/90 to 134/81 mm Hg. Exercise tolerance increased to 120 W while reducing myocardial oxygen demand (profitability index 2.29 cu). Myocardial contractility increased, which is reflected in an increase in EF from 63 to 66%, a decrease in CSR to 3 cm, a decrease in CRC to 4.6 cm. The immediate results of treatment are rated as a significant improvement.

For the first time, a method is proposed for the differential appointment of complex balneo-physical-peloid therapy for patients with hypertension, moreover, balneotherapy, physiotherapy and peloid procedures are prescribed in a strictly defined sequence depending on the time of day and season.

The proposed method treated 116 patients with hypertension, of which 68 patients were treated according to the proposed method from April to October, and 48 patients were treated from November to March. The obtained results convincingly prove that the differentiated purpose of complex treatment allows achieving more significant positive dynamics from the main clinical manifestations of hypertension and blood lipid fractions in patients with hypertension in the autumn-winter period of the year (Tables 1, 2, 3).

Information sources

1. Sorokina E.I. Physical methods of treatment in cardiology. / E.I. Sorokina. - M .: Medicine, 1989. - P.82-91.

2. Filippova T.V. Millimeter-wave electromagnetic radiation in the complex treatment of patients with arterial hypertension: Abstract. diss ... cand. honey. sciences. - Tomsk, 2001 .-- 24 p.

3. Barantsev F.G. Peloid therapy in the correction of lipid metabolism in patients with the initial stages of cardiovascular disease in the spa practice. / F.G. Barantsev // Physiotherapy, balneology and rehabilitation. - 2003. - No. 3. - S. 19-21.

4. Andreeva I.N. Therapeutic use of mud. / I.N. Andreeva, O.V. Stepanova, L.A. Pospeeva, S.A. Timoshin. - Physiotherapy, balneology and rehabilitation. - 2004. - No. 5. - S. 46-52.

5. Borodin Yu.I. Fundamentals of chronobiology and chronomedicine. / Yu.I. Borodin, V.A. Trufakin, A.V. Shurlygin. - Novosibirsk, 2000. - P. 61-64.

Table 1 The dynamics of the frequency of detection of clinical symptoms of hypertension during treatment in the autumn-winter period of the year (in%) Symptoms Groups EHF balneotherapy (n = 68) Balneo-EHF-peloid therapy (n = 48) d / l s / l d / l s / l Cardialgia 81.3 29.3 ** 78.6 5.7 * ^ Heartbeat 62.5 16.3 * 51.1 4.1 * ^ Asthenovegetative manifestations 87.5 25.0 ** 93.3 12.5 * ^ Headache 93.8 16.3 ** 93.3 12.5 * ^ Note: * - significance of differences in the group p <0.05; ** - significance of differences in the group p <0.01; ^ - significance of differences between groups. table 2 The dynamics of blood lipid profile during treatment in the autumn-winter period of the year Indicators EHF balneotherapy (n = 68) Balneo-EHF-peloid therapy (n = 48) Before treatment After treatment Before treatment After treatment Total cholesterol, mmol / l 5.81 ± 0.13 5.51 ± 0.11 * 5.68 ± 0.14 5.01 ± 0.10 * ^ HS-HDL, mmol / l 1.28 ± 0.17 1.44 ± 0.15 1,02 ± 0,06 1.34 ± 0.08 * ^ CS-LDL, mmol / l 3.4 ± 0.56 3.12 ± 0.38 3.38 ± 0.07 3.07 ± 0.09 * ^ Atherogenic index, cu 3.11 ± 0.15 2.54 ± 0.23 * 3.38 ± 0.16 2.38 ± 0.19 * ^ Note: * - significance of differences in the group; ^ - significance of differences between groups.

Table 3 Distribution of patients by types of adaptive reactions and the level of reactivity before and after treatment in the autumn-winter period of the year (in%) Type of adaptive reaction Groups EHF balneotherapy (n = 68) Balneo-EHF-peloid therapy (n = 48) d / l s / l d / l s / l Calm activation reaction 34.6 50.0 * 40,0 40 ^ Increased activation reaction 34.6 39.7 60.0 60.0 Reactivity Level: Tall 69.1 91.3 * 71,4 100 * ^ Low 30.9 8.7 * 28.6 0 * ^  Note: * - significance of differences within groups; ^ - significance of differences between groups.

Claims (4)

1. A method of treating patients with hypertension by the complex appointment of the effects of balneotherapy and EHF-therapy, characterized in that when treating a patient from April to October, balneotherapy and EHF-therapy are prescribed in the following sequence during the day: from 11.00 to 15.00 procedures EHF-therapy, from 14.00 to 16.00 balneotherapy; during treatment from November to March, additionally include peloid therapy, prescribed from 9.00 to 11.00 hours. 2. The method according to claim 1, characterized in that as balneotherapy using common radon baths with a concentration of 1.5-3 kBq / l, a temperature of 36-37 ° C, lasting 8-10 minutes, appointed every other day, from 14.00 to 16.00 h, for a course of 8-10 procedures. 3. The method according to claim 1, characterized in that they use the EHF effect on corporate biologically active points with electromagnetic radiation at a frequency of 60.9-61.3 GHz in the following sequence: VC-17, E-36 (paired), TR-5 (paired), VG-20, the duration of exposure to one biologically active point is 3-5 minutes, the total procedure time is 20-30 minutes, from 11.00 to 15.00 hours, for a course of 10 procedures. 4. The method according to claim 1, characterized in that, as peloid therapy, peat mud applications are used on the collar area at a temperature of 36-38 ° C, lasting 15-20 minutes, appointed every other day on days free from baths, from 9.00 to 11.00 h , on a course of 8-10 procedures.