RU2329038C1 - Method of angiopathy treatment technique selection associated with metabolic syndrome - Google Patents

Abstract

FIELD: medicine; cardiology.

SUBSTANCE: for this purpose vascular wall antiaggregatory activity, antithrombin III plasma level, euglobulin lysis time, nitrate plasma content are determined prior to and after venous occlusion for each characteristics. Based on measured values vascular wall antiaggregatory activity index, antithrombin III vascular synthesis index, vascular wall fibrinolytic activity index and nitrate index are calculated. Further arithmetic mean value of given indexes is resulted in calculated vascular antithrombotic index of vessels. Value of this index indicates necessity of individual low-calorie diet combined with graduated physical exercise, introduction of methphormin combined with low-calorie diet and physical exercises.

EFFECT: decreased risk of thrombotic complications.

2 tbl, 4 ex, 1 dwg

Description

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

The literature contains recommendations on the appointment of a low-calorie diet and physical training for metabolic correction in the metabolic syndrome (Almazov V.A., Blagosklonnaya Y. V., Shlyakhto E.V., Krasilnikova E.I. Metabolic cardiovascular syndrome. St. Petersburg. : Publishing House of St. Petersburg: State Medical University. 1999. - 208 pp.) And reducing the degree of abdominal obesity, which is its component with the help of recommendations more focused on the use of a low-calorie diet (Savelyeva L. Modern approaches to the treatment of obesity. // Doctor, 2000 , No. 12, - pp. 12-14; Kadyrova R. ., Salhanov BA Power in obesity Alma-Ata, Kazakhstan, 1990), or physical training (Moshkov VI Fitness obesity M .: Medicine, 1976. -.. 56)..

Metformin is used to correct metabolic disorders in patients with metabolic syndrome and abdominal obesity (Dedov I.I., Butrova S.A., Mishchenko B.P., Dzgoeva F.Kh. Use of metformin in patients with abdominal type of obesity. // Problems endocrinology. 2000. - T.46, No. 5. - C.25-29).

However, the method of differentiated administration of various therapeutic approaches for the treatment of vasopathy with metabolic syndrome has never been developed.

The aim of the invention is to increase the effectiveness of the treatment of vasopathy in patients with metabolic syndrome.

The essence of the proposed method lies in the fact that to select the necessary method of treatment of vasopathy in patients with metabolic syndrome, the following diagnostic complex of studies is carried out: the index of antiplatelet activity of the vessels, the activity of antithrombin III (AT III) and the time of euglobulin lysis before and after temporary venous occlusion are determined with the calculation the index of synthesis of AT III in the vessels and the index of fibrinolytic activity of the vascular wall, as well as the content of nitrates in the blood before and after temporary ischemia of the venous st ni, indicating the level of NO synthesis in the walls of blood vessels with the calculation of the nitrate index (NI). The results are processed statistically with the calculation of the antithrombotic vascular index (PTIS), the magnitude of which determines the need for each individual patient to be assigned an individually selected hypocaloric diet, its combination with dosed physical activity, metformin or its combination with a low-calorie diet and physical training.

The method allows you to timely prescribe the necessary treatment for vasopathy in each individual patient with hypertension and MS according to the reduction in PTIS in patients, which makes it possible to transfer their PTIS to a level close to that for healthy people. In the subsequent regular examination according to the claimed method, against the background of the prescribed treatment, it is possible to control the adequacy of therapy, which will significantly reduce the risk of thrombotic complications, reduce the number of cases of temporary disability, exit to disability, and reduce mortality among vascular patients.

The inventive method is as follows.

The anti-aggregation activity of the vascular wall was determined by the method (Baluda V.P., Lukyanova T.I., Baluda M.V. Method for determining the anti-aggregation activity of the wall of human blood vessels. // Labor. Delo, 1983. - No. 6. - p.17- twenty). The basis of this method is the calculation of the degree of inhibition of platelet aggregation in plasma obtained from blood after temporary venous occlusion.

A cuff of the sphygmomanometer is applied to the shoulder of the arm, from the blood vessels of which blood was not taken, and a pressure of 10 mm Hg is created. higher than systolic. After 3 minutes, 9 ml of blood was taken in 1 ml of a 3.8% sodium citrate solution. It was immediately centrifuged for 5 minutes at 1000 rpm to obtain platelet-rich plasma. The plasma was aspirated with a pipette and immediately placed in melting ice, where it was stored until research began. The sample was centrifuged again for 20 minutes at 3000 rpm to obtain platelet-free plasma. After counting the platelet count in platelet-rich plasma obtained before venous stasis (described in detail below), it was diluted with platelet-poor plasma (BeTP) taken before (1 test) and after (2 test) venous stasis to a concentration of 200,000 platelets / μl. The resulting mixture was shaken and incubated for 10 minutes at 20-22 ° C. Then platelets (AT) were aggregated with collagen (1: 2 dilution of the main suspension) on glass.

The AT assessment for this study is carried out in the following way (A. Shitikova, in the book: Hemostasis. Physiological mechanisms, principles for the diagnosis of the main forms of hemorrhagic diseases. Edited by N.N. Petrishchev, L.P. Papayan. St. Petersburg. 1999 S. 49-52).

Blood is taken with sodium citrate 3.8% in a 9: 1 ratio, centrifuged for 5 minutes at 1000 rpm to obtain platelet-rich plasma (BTP). Part of the plasma is taken away, and the remaining is centrifuged at 3000 rpm for 20 minutes to obtain platelet-poor plasma. BTP is standardized by the number of platelets by diluting the original BTP with an autologous BeTP sample (obtained before venous stasis - 1st test or after it - 2nd test) to 200 · 10 ⁹ / L. The concentration of blood platelets in the initial BTP is calculated in the Goryaev's chamber (in 50 large squares). The volumes of mixed BTP and BeTP are determined by the formula:

V _BeTP -V _BTP · [(N / 200000) -1],

V _BeTP - volume of platelet-poor plasma,

V _BTP - the volume of platelet-rich plasma,

N is the counted platelet concentration in the original BTP (cells / μl).

From a selected volume of standardized plasma, 0.02 ml of plasma is applied to a glass slide and 0.02 ml of a collagen inducer solution at a standard concentration with another pipette (1: 2 dilution of the main suspension). Plasma is mixed with inducers with a glass rod and the stopwatch is turned on. The mixture is stirred so that the liquid occupies a circle with a diameter of about 2 cm.

Shaking the glass in a circular motion in the transmitted light of the illuminator, on a black background they monitor the occurrence of aggregates through a magnifying glass. When distinct aggregates appear, the solution becomes clear and some of the aggregates adhere to the glass, the stopwatch is turned off, fixing the time of platelet aggregation.

The reaction is repeated 2-3 times, finding the arithmetic mean value.

The degree of inhibition of platelet aggregation after temporary venous stasis is used to judge the anti-aggregation activity of blood plasma due to the entry of prostacyclin into the bloodstream from the vascular wall. The index of antiaggregatory activity of the vascular wall (IAASC) in the study of AT on glass was calculated by the formula:

The normal values for collagen can be considered IAASC 1.50-1.60.

Determination of the anticoagulant properties of the vascular wall, depending on the release of antithrombin III from it, evaluating its basal level before and after temporary dosed ischemia of the vein wall is given below (Barkagan Z.S., Momot A.P. Basics of the diagnosis of hemostasis disorders. M. 1999 - 214 from.).

The principle of the method is based on the detection of a decrease in activity (in the absence of heparin) in antithrombin III plasma, which is determined by the ability of the studied plasma to inactivate thrombin, for which it is pre-treated with a heparin sorbent, then subjected to thermal defibrination and mixed with a standard amount of thrombin. After incubation of the mixture, the residual coagulation activity of thrombin is determined in it. The level of decrease in thrombin activity as a percentage of the norm assesses the activity of AT III in the studied plasma.

The following reagents are used. 1. Tris-HCl buffer 0.05 M, pH 7.4. 2. Thrombin solution in buffer: 0.2 ml of the solution should coagulate with 0.3 ml of 0.4% fibrinogen solution for 15-16 seconds. The thrombin working solution is prepared in a plastic or silicone tube, stored at room temperature and used in the test on the day of the study. 3. Heparin sorbent Hepasorb-1 (Technologiya-Standart company), 4. Freshly prepared solution of fibrinogen at a concentration of 3.5-4.0 g / l, which is used to test the residual thrombin activity. It is allowed to replace the fibrinogen solution with a normal platelet-poor citrate plasma diluted in buffer 2 times; 5. Fresh citrate platelet-poor plasma obtained from 6-8 healthy people, or proprietary lyophilized, with known activity AT III, which is used to build a calibration graph (figure 1).

The material for the study is a citrate platelet-poor plasma.

To prepare sorbed and defibrinated plasma in a test tube, 10 mg of heparin sorbent is mixed with 1.0 ml of the studied plasma. Constantly shaking the tube, mix its contents at room temperature for 8 minutes, excluding the formation of foam and sediment at its bottom. After that, the mixture is centrifuged for 2 minutes at 1000-1500 rpm. The plasma in the supernatant is transferred to a clean tube and defibrified in a water bath at + 56 ° C for 6 min, after which it is again centrifuged at 3000 rpm for 10 min, the supernatant is removed and examined for the first 2 hours.

The course of determination. 0.4 ml of a thrombin working solution is added to the test tube and heated in a water bath at + 37 ° C for 2 minutes. Then add 0.1 ml of the studied adsorbed and defibrified plasma, include a stopwatch. After 2 minutes (exactly!) 0.2 ml of the mixture was transferred to a test tube with 0.3 ml of fibrinogen solution (or diluted normal plasma), preheated to + 37 ° C. Immediately turn on the stopwatch and record the clotting time.

From the calibration curve, AT III activity is found in percent. The construction of the calibration curve is as follows. The plasma of healthy people is defibrated as described above. Then, dilutions are prepared from it for constructing a calibration curve in accordance with Table 1.

Table 1 Scheme for preparing plasma dilution for constructing a calibration curve in determining the activity of AT III Breeding number Plasma + buffer Activity AT III,% one Buffer free plasma one hundred 2 0.2 ml + 0.2 ml fifty 3 0.1 ml + 0.3 ml 25

With each of the dilutions, the clotting time is determined by the above procedure. All measurements are carried out three times, the average result is calculated. When constructing a calibration curve along the logarithmic axis of ordinates, the clotting time in seconds is plotted, along the abscissa, the activity of AT III in% in accordance with the above dilutions. An approximate calibration curve is shown in the drawing.

A calibration curve for one series of thrombin and buffer is built once. Only the activity of the thrombin working solution is periodically monitored.

Normally, without venous occlusion, AT III activity is 85-115%. When taking blood after temporary venous occlusion, as described in the method for assessing the antiplatelet activity of blood vessels and determining AT III in it, it is possible to indirectly assess the level of excretion of AT III from the vessel wall. Against the background of temporary venous occlusion, the activity of AT III increases and is within 120-143%. The index of AT III synthesis in blood vessels (ISAS) is calculated by dividing the value of AT III activity against venous occlusion by the value of AT III without it. Normally, it is 1.20-1.45.

The synthesis activity of tissue plasminogen activators by the time of lysis of the euglobulin clot before and after temporary venous occlusion was evaluated as follows (Barkagan Z.S., Momot A.P. Basics for the diagnosis of hemostasis disorders. M. 1999 - 214 p.).

The principle of the method is to precipitate the euglobulin fraction of plasma, while the main inhibitors of fibrinolysis, in particular α ₂ -antiplasmin, remain in the supernatant and are removed. Therefore, euglobulin lysis reflects the activity of fibrinolysis under conditions of exclusion of the inhibitory effect of antiplasmin. Its speed mainly reflects the amount of plasminogen in the plasma and the degree of its activation. The time of spontaneous lysis of the clot obtained from the euglobulin fraction of plasma is determined by adding a solution of calcium chloride to it.

The following reagents are used: 1. 1% solution of acetic acid. 2.2.277% solution of calcium chloride. 3. Michaelis buffer or Tris-HCl buffer, 0.05 M, pH 7.3-7.4.

The material for the study is a citrate platelet-poor plasma before and after temporary venous occlusion.

The course of determination. To obtain the euglobulin fraction, 0.15 ml of 1% acetic acid and 0.5 ml of the test plasma are added to 8.0 ml of distilled water. After 30 minutes of cooling the mixture in the refrigerator at + 2-8 ° C, the euglobulins are precipitated by centrifugation at 1500 rpm for 7 minutes. The supernatant is drained, the tube is dried by tipping over onto filter paper. The precipitate of euglobulins is diluted in 0.5 ml of buffer and placed in a water bath (+ 37 ° C). Then, without removing the tube from the bath, add 0.5 ml of calcium chloride solution, mix gently by shaking the tubes (without shaking!), Turn on the stopwatch and incubate in a water bath at + 37 ° C. Record the time from the moment of adding calcium chloride to the complete dissolution of the clot.

The result is expressed in minutes. Normally, the time of spontaneous lysis of the euglobulin clot is 180-240 minutes. After temporary venous occlusion, the lysis time decreases, being in the range of 126-170 minutes. When dividing the duration of spontaneous lysis of the euglobulin clot before occlusion by the value after, the index of fibrinolytic activity of the vascular wall (IFASS) was calculated, normally equal to 1.40-1.50.

Blood nitrates were determined by the method (Emchenko N.L., Tsyganenko O.I., Kovalevskaya T.V. A universal method for determining nitrates in the biological environment of an organism. // Clinical Laboratory Diagnostics. 1994. - No. 5. - p.19-20 )

The course of determination. 0.25-1.50 ml of a 50% zinc sulfate solution, 0.25-1.50 ml of a 17% iron ferricyanide solution, 1-5 ml of an analyzed sample are placed in 10 ml centrifuge tubes (a pipette for blood sampling is pre-moistened with a citrate solution sodium). Then add 0.5-2 ml of ammonium chloride buffer (pH 9.6 ± 0.05) and from 1 to 8 ml of distilled water for analysis of blood plasma.

The volumes of the analyzed sample and the reagents used for its deproteinization are presented in Table 2.

table 2 Volumes (in ml) of the analyzed samples and reagents added for their deproteinization Biosubstrate Try ZnSO ₄ K ₂ Fe (CN) ₆ Buffer Distilled water Blood 1.00 1.00 1.00 2.00 5.00

The total volume of the mixture should be 10 ml.

The resulting mixture was stirred and centrifuged for 20 minutes at 2500 rpm. In parallel, they conduct a blank experiment.

An aliquot of a 5 ml centrifugate was taken into a 50 ml flask, 2.5 ml of ammonia-chloride buffer, 2.5 ml of distilled water were added, stirred and a blank sample was passed through a sponge cadmium column, first a blank sample, then the test one. Before passing each of the samples, the column is washed sequentially with 5 ml of 1 N. HCl, 50 ml of distilled water and 25 ml of ammonium chloride buffer diluted in a ratio of 1: 9. The eluate is collected in the same volumetric flask, the column is washed with distilled water, not bringing the volume of solution in the flask to the mark of about 10 ml. Then, 5 ml of a 0.25% streptocide solution, 1 ml of HCl (1: 2) are added to the flask, and after 5 minutes, 1 ml of a 0.1% solution of N-naphthylethylenediamine dihydrochloride. The solution was adjusted to the mark with distilled water, stirred and left for 10 minutes. After this time, the samples are photometered on a photoelectric colorimeter at a wavelength of 540 nm (green filter), in a cuvette with an optical path length of 5 cm against a blank sample.

The concentration of nitrates is determined by the graded schedule, which is built in each laboratory separately and independently. To build it, 0.25, 0.5, 1, 2.5 and 5 ml of potassium nitrate solution with a concentration of nitrate ion equal to 10 μg / ml are added to volumetric flasks with a capacity of 50 ml, 10 ml of distilled water are added and 5 ml of ammonium chloride buffer and elute through a cadmium column. The color reaction and photometry is carried out as described above. The optical density is measured against a zero solution.

The nitrate content (X, mg / l) in the analyzed samples of biological media is calculated by the formula:

where, C ₁ is the concentration of nitrate ions in the photometric solution, found according to the calibration graph (in μg / ml); V ₁ - the total volume of protein-free extract (in ml); V ₂ - the total volume of photometric solution (in ml); V ₃ - the volume of the sample taken for analysis (in ml); V ₄ - the volume of protein-free extract taken for analysis (in ml). Normally, in healthy people, the concentration of nitrites in the blood is 1.20-2.2 mg / L. With temporary application of a tourniquet on the shoulder and the creation of temporary ischemia of the vessel wall according to the scheme described above, increased release of nitric oxide into the blood from the vessel with an increase in the nitrate content in the blood from 6.0 to 13.0 mg / L is noted. It is possible to calculate the nitrate index by the formula:

Normally, NI is in the range from 5.0 to 5.9.

PTIS is calculated by the formula:

Normal PTIS values are values not lower than 2.27. With PTIS within the limits of 2.26-2.10, there is a risk of developing vasopathy, and with a PTIS of 2.09 and lower, a clinical manifestation of vasopathy is noted, requiring immediate treatment with stable antihypertensive therapy. With a PTIS value of 2.09-2.00, for patients with MS, for the correction of vasopathy, the appointment of an individually selected hypocaloric diet is sufficient; with a PTIS value of 1.99-1.90, it is necessary for patients with MS to prescribe a combination of a low-calorie diet and dosed physical activity; at the PTIS level of 1.89-1.84, patients with MS require the administration of metformin to level vasopathy; with a decrease in PTIS of 1.83 and below, the treatment of vasopathy requires the appointment of a combination of a low-calorie diet, dosed physical activity and metformin for patients with MS.

An individually selected hypocaloric diet recommended by patients with MS to create a negative energy balance in their body is prescribed as follows.

The caloric content of the daily diet individually for each patient with MS is calculated in kcal according to the formula:

for women 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240,

31 years - 60 years (0.0342 × body weight, kg + 3.5377) × 240,

over 60 years old (0.0377 × body weight, kg + 2.7545) × 240,

for men 18-30 years old (0.0630 × body weight, kg + 2.8957) × 240,

31 years - 60 years (0.0484 × body weight, kg + 3.6534) × 240,

over 60 years old (0.0491 × body weight, kg + 2.4587) × 240.

The coefficient obtained remains unchanged with minimal physical activity, multiplied by 1.3 for moderate and 1.5 for high physical activity (as a rule, in patients with MS the level of physical activity is low).

3 main meals and 2 intermediate meals are recommended. With the regular skipping of one of the main meals, the frequency of obesity increases significantly, a positive correlation between obesity and skipping breakfast is also revealed. The following daily calorie distribution is recommended: breakfast - 25%, 2nd breakfast - 10%, lunch - 35%, afternoon tea - 10%, dinner - 20%.

To compile the patient’s menu, special tables are used with indications of the chemical composition and calorie content of the products, given that the main sources of energy are proteins (1 g contains 4 kcal), fats (9 kcal), carbohydrates (4 kcal) and alcohol (7 kcal).

The second component of the proposed method is feasible regular physical training.

In real life conditions, it is possible to carry out three forms of physical activity: 1) morning hygienic gymnastics (exercise); 2) therapeutic and preventive gymnastics; 3) fractional physical exercises throughout the day.

1. Morning hygienic gymnastics (exercise).

Morning exercises should be done after sleep before breakfast in a ventilated room. Under the influence of classes, the body is freed from the state of inhibition of physiological processes that occurs during sleep.

The sequence of exercises involves alternating the load on various muscle groups (arms, legs, body). Exercises are performed with a gradually increasing excursion of breathing, stretching, limited use of force conditions. The breathing during exercises should be free, rhythmic, without delay, mainly through the nose; the exhalation should be longer than the inhalation (inhalation 2-3 s, exhale 3-5 s).

With good health, the load can be strengthened by the number of repetitions, speeding up the pace, increasing the amplitude of movements and reducing pauses between exercises.

With fatigue, you should reduce the load, increase the duration of pauses between exercises, fill them with calm breathing.

After gymnastics, you need to go to a wipe or take a shower.

Morning exercises should cause a sense of vitality, increased activity, better health and performance.

If you feel unwell, develop shortness of breath or pain in the heart and behind the sternum, you should temporarily interrupt classes and consult a doctor.

During the day, patients with MS are recommended preventive gymnastics. Depending on the initial training, it is possible to use at the beginning of a lightened version of physical activity, and subsequently a strengthened version.

2. Complexes of therapeutic and preventive gymnastics for persons suffering from MS.

2.1. A lightweight version of therapeutic gymnastics.

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. During the exercise, a gradual deepening of breathing.

Exercise 2. Circular movements in the shoulder joints. When breeding - inhale, while mixing - exhale with a slight tilt of the body and retraction of the abdominal wall - 6-8 times. Fingers touch shoulders, elbows pressed to the body.

Exercise 3. Standing, hands on the belt. Alternately transferring the severity of the body from one leg to the other with slight bending of the legs in the knee joint, without taking the feet off the floor. Do the exercise 10-16 times with muscle tension in the legs.

Exercise 4. Standing, legs spaced shoulder width apart, hands on the belt. Torso forward, touch left sock with your right hand. 4-6 times alternately. When the position is straightened, inhale; when tilted, exhale. Looking forward.

Exercise 5. Standing, arms along the torso. At the same time, take straight arms and one leg to the sides with alternating leg abductions. 4-6 times in each direction alternately. A wave of arms and legs, breathing free, do not hold.

Exercise 6. Standing, legs to the sides, hands in front of the chest, palms down. With the turn of the body, spread your arms to the sides with the turn of the palms up - inhale. Return to the starting position with a slight tilt of the body forward - exhale. 3-5 times in each direction alternately. Coordinate breathing with the movement of the body and hands. By the end of the exhalation, retract the wall of the abdomen.

Exercise 7. Standing, hands free. Walking for free -1 min, then with high flexion of the hips - 10-20 movements, followed by a transition to a quiet walk - 1-2 minutes. Rhythmic breathing, medium depth.

Exercise 8. Sitting on the edge of the chair, hands on the waist. Bending back and bending forward of the body. Repeat 6-10 times. Do not hold your breath.

Exercise 9. Sitting on the edge of the chair, focus with tassels on the edge of the chair, and with your feet somewhat in front of the chair. Squats with an emphasis on the edge of the chair - 4-6 times. When squatting, exhale.

Exercise 10. Standing sideways to the back of the chair, hold on to it with one hand. Swing your free straight arm with your legs back. Return to starting position. Repeat 4-6 times with each hand and foot. Do not hold your breath.

Exercise 11. Standing, legs apart, arms at the waist. Turns the body to the right and left - 6-10 times alternately. Do not turn your head, look forward.

Exercise 12. Standing, legs together, arms down. To spread your arms to the sides - inhale, bend your leg at the knee and press your hands to your stomach - exhale. 3-5 times each leg in turn. Strive to maintain balance; as you exhale, draw in your stomach.

Exercise 13. Standing, legs together, hands down. Lateral slopes of the body with bending of the opposite arm ("pump"). Do not hold your breath, strive for a greater excursion of movement.

Exercise 14. Standing. Walking is calm with uniform breathing of medium depth. 1-2 minutes

Exercise 15. Lying on a rug with a pillow placed under the head. Go to the half-sitting position and hug the bent hips - exhale, return to the starting position - inhale. Do not hold your breath. Strive in a half-sitting position to maintain balance. Run 4-6 times.

Exercise 16. Lying, arms to the sides, legs apart. Semicircular movements with the right straight leg to the left with the turn of the pelvis - exhale - return to the starting position - inhale. 3-5 times in each direction. Alternately left and right with the greatest possible excursion of the leg movement, while maintaining the emphasis of the hands on the floor.

Exercise 17. Sitting on the floor; a) get on all fours; b) move to a kneeling position; c) raise your hands up - inhale, tilt the body, and take your hands back - exhale. When tilting, belly retract. Repeat 4-6 times; e) move to a standing position, and the son-in-law to a lying position; f) self-massage of the abdomen with small semicircular movements in a clockwise direction -1-2 min. Rest 2 min; g) calm breathing; h) exercise in protruding (calm) and retracting (active) the abdominal wall. Combine abdominal retraction with expiration through the mouth. Repeat 4-6 times.

Exercise 18. Standing, arms bent. Vigorous walking in place or in a room with high flexion of the hips and a wave of both arms - 20-30 steps. Do not hold your breath.

Exercise 19. Sitting on a chair, legs apart, hands on the waist or rest against the edge of the chair. Circular movements of the pelvis with retraction of the abdomen when the pelvis is brought back. 4-6 times in each direction.

Exercise 20. Standing. Calm walking with breathing of an average depth of 2-3 minutes.

With the initial sufficient training or exercise tolerance arising during classes, it is possible to use the following set of exercises.

2.2. A reinforced version of therapeutic gymnastics.

Exercise 1. Standing. Walking calm with rubbing the palms of the chest, abdomen, lower back. It takes 1-2 minutes.

Exercise 2. Standing, arms down. Simultaneous bending with tension and free “throwing” of arms forward, to the sides and up 12-16 times. When bending, exhale; when leveling, inhale. "

Exercise 3. Standing, arms at the waist, legs shoulder width apart. Lateral movements of the pelvis to the right and left, back and forth. It is performed 6-10 times alternately. Breathing is free.

Exercise 4. Standing, feet shoulder width apart, arms down. Circular movements of straight arms in the shoulder joints, 6-10 times with maximum excursion, do not hold your breath.

Exercise 5. Standing, arms in front of the chest, bent at the elbows. Walking with high flexion of the hips, with the touch of hands. 6-10 times each leg alternately. The movements are vigorous, while flexing the thigh - exhale through the mouth.

Exercise 6. Walking calm 1-2 minutes. Exercise 7. Sitting on the edge of the chair, hands on the waist. Bending and bending of the body. The exercise is performed 8-10 times. The movements are energetic. When straightening, inhale; when bent, exhale.

Exercise 8. Standing sideways to a chair, hold on to the back, the other hand at the waist. Alternating swings with a straight leg forward with the greatest possible excursion. Leg sweep combined with exhalation. It is carried out 4-6 times.

Exercise 9. Standing, legs apart, arms to the sides. Tilts the body forward with a touch of the right brush of the left toe of the foot, the other hand is pulled up. Return to starting position. Combine the slope with the exhale, while straightening, inhale 4-6 times.

Exercise 10. Walking calm with breathing of medium depth. 1-2 minutes

Exercise 11. Standing, hands in a fist and lowered: a) bending the arms at the elbows with force and unbending them with the back, with the greatest possible straightening and tension and a delay in tension for 2-3 seconds. Standing, hands on the waist; b) half-squats, followed by lifting on toes and straining the legs. The exercise is performed 4-6 times with the greatest possible rectification and tension, and a delay in the stress state for 2-3 seconds.

Exercise 12. Sitting on the edge of a chair. In the position of the leg raised and bent at the knee joint, alternately shake the tibia and thigh muscles with the hands. Reduce muscle tension. 1-2 minutes

Exercise 13. Sitting on the edge of the chair, straight legs divorced. Breeding and mixing straight arms and legs. When breeding, inhale, while mixing, exhale. It is carried out 4-8 times.

Exercise 14. Standing. Walking is calm with the transition to a rhythmic calm run (jogging) in place or with movement. If tired, go for a walk with moderate breathing. 2-5 minutes

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs as you exhale. 4-6 times. Arms and legs straightened, keep balance.

Exercise 16. Lying on the mat, emphasis with brushes on the floor. Cross movement with straight legs - “scissors”. 4-8 times. Do not hold your breath.

Exercise 17. With a quick straightening of the legs, move to a sitting position, then lie down. You can help with a wave, 4-6 times.

Exercise 18. Lying on your back, legs bent. Calm breath 4-6 times.

Exercise 19. Lying on your back, arms spread apart with the emphasis of the hands on the floor. With the turn of the pelvis to the left, bend the legs, turn the pelvis with the legs crossed to the right and stretch the legs. Repeat such circular movements with legs 3-6 times in each direction alternately. Do not tear your hands off the floor. Do not hold your breath.

Exercise 20. Lying on your back, arms and legs apart. Alternate turns of the body to the right and left with the laying of one hand on the other. Do not move your legs. With arms apart, inhale, while turning, exhale. It is carried out 3-6 times.

Exercise 21. Lying on your back, arms along the body: a) turn on your left side; b) turn on the right side; c) go to the supine position; d) get on your knees; e) move to a standing position; f) walking in a place with high hip flexion and arm movement - 20-30 steps; g) sit on the mat; h) lie on your back, calm breathing. Repeat the whole complex 3-4 times.

Exercise 22. Standing. Walking calm with breathing of medium depth - 1-2 minutes.

Exercise 23. Standing, legs spaced the width of the foot, hands on the waist. Circular motion of the pelvis, right and left 6-8 times. Do not hold your breath.

Exercise 24. Standing with legs wide apart, hands in front of the chest. Alternately bending the leg with the transfer of body weight to it with stretching the arms to the toe of the bent leg. 4-6 times in each direction. The other leg is straight. When straightening - inhale, while tilting - exhale.

Exercise 25. Standing, legs spaced shoulder width apart, arms at the waist. Circular head movements 4-10 times in each direction - Exercise 26, Standing, legs spaced shoulder width apart, arms at the waist. Tilt the body to the right, pulling the left hand up - inhale. Return to starting position - exhale. 4-6 times alternately.

Exercise 27. The same, arms to shoulders. Circular movements of the hands with a maximum excursion in the shoulder joints, when breeding - inhale, while reducing and retracting the walls of the abdomen - exhale. The breath is deep.

Exercise 28. Standing. Calm walking and breathing of medium depth. Reduced overall load. 1-2 minutes

3. Fractional exercise throughout the day.

A patient with MS is a patient with a number of concomitant disorders and, above all, the cardiovascular system. This circumstance limits the simultaneous use of great physical activity in the process of morning gymnastics, as well as in the main occupation of therapeutic and prophylactic gymnastics. That is why an increase in the physical activity of people suffering from MS should be carried out by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of patients with MS should be considered as a fractional load method.

Depending on the real life conditions of patients with MS suffering from various degrees of abdominal obesity, various exemplary fractions of various loads can be recommended to increase physical (motor) activity throughout the day.

Option 1.

Exercise 1. Sitting - spread your elbows to the sides - inhale, stretch your arms forward with tension - exhale, 4-6 times.

Exercise 2. Sitting - stand up with the deflection of the body and sit down - 8-10 times.

Exercise 3. Sitting - an imitation of the movements of a boxer with a possibly large rotation of the body -10-12 times.

Option 2

Exercise 1. Standing - walking with high flexion of the hips -16-30 times.

Exercise 2. Standing - circular movements of the head to the right and left - 3-8 times in each direction.

Exercise 3. Standing - legs spread apart - imitation of the movement of the pigtail - 10-12 times.

Exercise 4. Sitting - transition to a standing position - 10-12 times.

Option 3

Exercise 1. Walking is calm - 1 min.

Exercise 2. Walking accelerated - 1 min.

Exercise 3. Walking with a high flexion of the hips and alternate wave of hands 20-30 times.

Exercise 4. Walking calm with breathing - 1-2 minutes; the run is calm on the spot or with movement around the room - 2-5 minutes.

Option 4

Walking walk of various extent.

Option 5

Physical labor in various versions and of various durations depending on the conditions (cleaning the premises, home maintenance, work on cleaning the territory, garden works, etc.).

In addition to individually selected non-drug treatment, patients with MS on the background of stable antihypertensive therapy should be prescribed metformin at a dose of 500 mg 2 times a day after meals. The drug is able to weaken insulin resistance, improve the blood lipid spectrum, lipid peroxidation and platelet hemostasis. This is the basis for inhibition of atherosclerosis, effective prevention of vascular complications, improving the quality and prolonging the life of patients with MS.

The introduction of this method of choosing a method of treating vasopathy in patients with MS in the practice of medical institutions will solve a number of pressing socio-economic problems of our time. Early and necessary therapy for this patient will allow them to start treatment of vasopathy in a timely manner, which eliminates the risk of thrombosis, shortens the period of temporary disability in these patients, prevents strokes and heart attacks, reduces the number of disability exits and reduces mortality among this group of patients.

Example 1. Patient B., 44 years old, 79 kg, body mass index 30.0 kg / m ² , suffering from arterial hypertension with metabolic syndrome for 3 years, leading a healthy lifestyle, was examined during the physical examination for arterial hypertension. Blood was taken from the patient and examined according to the above scheme, with an assessment of the antiaggregatory activity of the vascular wall, antithrombin III content, euglobulin lysis time, nitrate levels before and after venous occlusion, and the calculation of IAASC, ISAS, IFASS, NR and antithrombotic vascular index.

The patient IAASC was 1.4, ISAS, IFASS, NI were 1.1, 1.3, and 4.5, respectively. PTIS amounted to 2.07. The patient was prescribed an individually selected hypocaloric diet (1974.9 kcal), it was recommended to continue to control blood pressure and lead a healthy lifestyle. A study after 12 weeks revealed a decrease in body weight (72 kg) and a body mass index (27.3 kg / m ² ) with normalization of the functions of the vascular wall, established by optimizing the PTIS value (2.29). The patient was recommended to continue to follow the recommendations given to her in order to maintain the achieved effect.

Example 2. Patient N., 49 years old, 83 kg, body mass index 29.6 kg / m ² , suffering from arterial hypertension with metabolic syndrome for 5 years, was examined during a physical examination for arterial hypertension. Blood was taken from the patient and examined according to the scheme described above with an assessment of the antiplatelet activity of the vascular wall, antithrombin III content, euglobulin lysis time, nitrate levels before and after venous occlusion, and the calculation of IAASC, ISAS, IFASS, NI and PTIS calculation.

IAASC was 1.32. ISAS, IFASS and NI amounted to 1.05, 1.21 and 4.2, respectively. PTIS amounted to 1.94. For the correction of PTIS, the patient was recommended a combination of a low-calorie diet (1526.4 kcal) and dosed physical activity with adequate control of blood pressure with a monthly examination. So, the examination after 12 weeks revealed a decrease in the patient’s body weight to 74 kg, body mass index to 26.4 kg / m ² with normalization of IAASC - 1.52, ISAS - 1.40, IFASS -1.42, NI - 5, one. PTIS at her level was normal - 2.36. To maintain the obtained positive effect of treatment, the patient was recommended to follow the recommendations given to her later.

Example 3. Patient U. 56 years old, 79 kg, body mass index 29.2 kg / m ² , suffering from arterial hypertension with metabolic syndrome for 11 years, was examined during a physical examination for arterial hypertension. Blood was taken from the patient and examined according to the scheme described above with an assessment of the antiplatelet activity of the vascular wall, antithrombin III content, euglobulin lysis time, nitrate levels before and after venous occlusion, and the calculation of IAASC, ISAS, IFASS, NI and PTIS calculation.

IAASC was 1.28. ISAS, IFASS and NI amounted to 1.06, 1.18 and 3.9, respectively. PTIS amounted to 1.85. The patient was prescribed metformin 500 mg 2 times a day. The examination was carried out monthly, after 3 months revealed a decrease in the patient’s body weight to 71 kg, body mass index to 26.3 kg / m ² while normalizing the PTIS value = 2.28. Further adherence to these patient recommendations made it possible to maintain the investigated parameters of antithrombotic activity of blood vessels at normal boundaries and to avoid the re-development of vasopathy.

Example 4. Patient K., 58 years old, 77 kg, body mass index 28.9 kg / m ² , suffering from arterial hypertension with metabolic syndrome for 14 years, was examined during a physical examination for arterial hypertension. Blood was taken from the patient and examined according to the scheme described above with an assessment of the antiplatelet activity of the vascular wall, antithrombin III content, euglobulin lysis time, nitrate levels before and after venous occlusion, and the calculation of IAASC, ISAS, IFASS, NI and PTIS calculation.

IAASC was 1.25. ISAS, IFASS and NI amounted to 1.05, 1.16 and 3.7, respectively. PTIS amounted to 1.79. The patient was prescribed a treatment complex from a hypocaloric diet (1921.9 kcal), dosed physical training and metformin 500 mg 2 times a day. The examination was carried out monthly, after 3 months revealed a decrease in the patient’s body weight to 68 kg, body mass index to 25.5 kg / m ² while normalizing the PTIS value = 2.32. Further adherence to these patient recommendations made it possible to maintain the investigated parameters of antithrombotic activity of blood vessels at normal boundaries and to avoid the re-development of vasopathy.

Claims (1)

A method for choosing a method for the treatment of vasopathy in patients with metabolic syndrome, including determining the antiplatelet activity of the vascular wall, the plasma level of antithrombin III, the time of euglobulin lysis, the plasma nitrate content before and after venous occlusion for each parameter, based on the obtained values of the antiplatelet activity index the vascular wall, the synthesis index of antithrombin III in the vessels, the fibrinolytic activity index of the vascular wall and the nitrate index, then the media are calculated Yu arithmetic value index data, which is the vascular antithrombotic index (PTIAs), and based on this index, the choice of treatment is carried out: at a value PTIAs 2.09-2.00 administered individually matched hypocaloric diet; with a value of PTIS 1.99-1.90 - a combination of a low-calorie diet and dosed physical activity; at a PTIS level of 1.89-1.84, metformin 500 mg is prescribed 2 times a day; with a decrease in PTIS of 1.83 and below - a combination of a low-calorie diet, dosed physical activity and metformin 500 mg 2 times a day.

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