RU2430715C1 - Method for optimising vascular wall activity in patients with degree i-ii hypertension associating metabolic syndrome suffered eye vessel thrombosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology and angiologia, and can be used for optimising vascular wall activity in patients with degree I-II arterial hypertension (AH) associating metabolic syndrome (MS) suffered eye vessel thrombosis. That is ensured by introduction of the preparations pioglitazone and amlodipine with underlying an individually prescribed hypocaloric diet and graduated physical exercises. The hypocaloric diet is calculated in kcal by formula: for women of 18-30 years old - (0.0621 × body weight, kg + 2.0357) × 240, of 31-60 years old - (0.342 × body weight, kg + 3.5377) × 240, over 60 years old - (0.0377 × body weight, kg + 2.7545) × 240, for men of 18-30 years old - (0.0630 × body weight, kg + 2.8957) × 240, of 31-60 years old - (0.0484 × body weight, kg + 3.6534) × 240; over 60 years old - (0.0491 × body weight, kg + 2.4587) × 240. The graduated physical exercises represent morning hygienic gymnastics, therapeutic exercises and graduated physical exercises throughout a day. The preparations pioglitazone 30 mg and amlodipine 10 mg are introduced once a day in the same time. The therapy is performed for 4 months.

EFFECT: method provides correction of reduced vascular wall function in the patients with degree I-II AH associating MS suffered eye vessel thrombosis for 4 months and allows avoiding vascular complications in such patients.

1 dwg, 1 tbl, 2 ex

Description

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

Analogues of the proposed method for optimizing the activity of the vascular wall in patients with arterial hypertension (AH) of the I-II degree with metabolic syndrome (MS) who underwent eye vascular thrombosis do not exist.

There is evidence of the use of a low-calorie diet (Savelyeva L. Modern approaches to the treatment of obesity. // Doctor, 2000, No. 12, p. 12-14; Kadyrova R.Kh., Salkhanov B.A. Nutrition for obesity. Alma-Ata , Kazakhstan, 1990) or physical training (Moshkov V.N. Physical education for obesity. M., Medicine, 1976. - 56 pp.) In patients with various components of MS.

In patients with hypertension with MS, valsartan is often prescribed to lower blood pressure. Pioglitazone is prescribed for the correction of insulin resistance in patients with stage I-II hypertension in MS. However, never before has a treatment complex consisting of a low-calorie diet, dosed physical exertion, pioglitazone and amlodipine preparations been used in patients with AH of the II-II degree in MS who underwent eye vascular thrombosis in order to correct their vasopathy.

The aim of the invention is the correction of the weakening of the functions of the vascular wall in patients with AH of the I-II degree in MS who underwent thrombosis of the vessels of the eye.

The essence of the proposed method lies in the fact that to correct the weakening of the functions of the vascular wall, patients with hypertension of the I-II degree in MS who have undergone thrombosis of the vessels of the eye for 4 months are prescribed a low-calorie diet, dosed static and dynamic physical activity, the drug pioglitazone at a dose of 30 mg 1 time per day and amlodipine 10 mg 1 time per day.

The method allows to correct the weakening of the functions of the vascular wall in patients with AH of the I-II degree in MS who underwent thrombosis of the vessels of the eye for 4 months. Subject to the subsequent recommendations of the proposed method, it is possible to maintain the state of the functions of the vascular wall at a normal level, which will significantly improve the quality of life of patients with hypertension of the I-II degree in MS who have experienced eye thrombosis, reduce their pathological burden, reduce the number of cases of temporary disability, accelerate and to improve the quality of inpatient treatment, eliminate disability, as well as prolong life and reduce mortality in patients with AH of the I-II degree in MS who underwent eye vascular thrombosis from nfarkta and stroke, eliminating re-thrombosis eyes.

The inventive method is as follows.

To diagnose the weakening of the functions of the vascular wall of patients with hypertension of the I-II degree in MS who underwent thrombosis of the eye vessels, the following examination is carried out.

The antiaggregatory activity of the vascular wall is determined by the method (Baluda V.P., Lukyanova T.I., Baluda M.V. Method for determining the antiaggregatory 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 vessels of which blood sampling has not yet been performed, and a pressure of 10 mm is created. Hg 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 min 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 min 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, and the remaining is centrifuged at 3000 rpm for 20 min, obtaining platelet-poor plasma (BeTP). BTP is standardized according to the number of platelets by diluting the original BTP with an autologous sample of BTP (obtained before venous stasis - the 1st test or after it - the 2nd test) to 200 · 10 ⁹ / L. The concentration of blood platelets in the initial BTP is calculated in the Goryaev chamber (in 50 large squares). The volumes of mixed BTP and BeTP are determined by the formula:

V _BeTP = V _BTP · [(N / 200000) -1],

where V _BeTP is the volume of platelet-poor plasma,

where V _BTP is 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 in the 1st and 2nd samples, finding for each of them the arithmetic mean value.

The degree of inhibition of platelet aggregation after 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.

The determination of the antithrombogenic properties of the vascular wall, depending on the production of antithrombin III activating substances, 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 p.).

The principle of the method is based on the detection of a decrease in activity (in the absence of heparin) in antithrombin III (AT 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 (company "Technology-Standard"). 4. Freshly prepared solution of fibrinogen at a concentration of 3.5-4.0 g / l, which is used to test the residual activity of thrombin. It is allowed to replace the fibrinogen solution with a normal platelet-poor citrate plasma diluted in buffer 2 times. 5. Fresh platelet-poor plasma obtained from 6-8 healthy people, or proprietary lyophilized, with known AT III activity, which is used to construct a calibration graph.

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 was transferred to a clean tube and defibrinated in a water bath at + 56 ° C for 6 min, after which it was again centrifuged at 3000 rpm for 10 min, the supernatant was removed and examined for the first 2 hours.

The course of determination. 0.4 ml of 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 dilutions 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 type and 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 synthesis of tissue activators of AT III in the vessel wall. Against the background of temporary venous occlusion, the activity of AT III increases and is in the range of 120-143%. The vessel synthesis index of AT III activators (ISAAS) 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 activity of the synthesis of tissue plasminogen activators by the time of lysis of the euglobulin clot before and after temporary venous occlusion was evaluated as follows.

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% acetic acid solution. 2.2.277% solution of calcium chloride. 3. Michaelis buffer or Tris-HC buffer, 0.05M, 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.

For each laboratory, a survey of a group of healthy people is necessary to find the average standard values with the calculation of S ² according to all three methods for subsequent calculations.

For each technique, for each patient, for greater diagnostic accuracy, a test is performed 3-4 times with the calculation of arithmetic mean values, which are used in subsequent calculations and the calculation of S ² .

To determine the severity of the individual studied parameters in vascular patients and calculate their total antithrombotic potential of blood vessels, a systematic multivariate analysis was used to translate multidimensional quantitative characteristics of the process under study with incomparable absolute values into comparable relative values (Application of morphometry and statistical analysis methods in morphological studies. Comp. M.V. Uglova, B.A. Uglov, V.V. Arkhipov et al., Kuibyshev, 1982.-47 p.). The calculation was made according to the formulas:

X _j is the investigated parameter, X ₀ is the normative parameter, X _j is the relative difference.

Pi is the weight coefficient (coefficient of influence), a is a constant factor (in our studies, a = 0.1), σ _j is the standard deviation of the value of X _j in relative units:

S _i ² is the variance of the investigated parameter X _i , n _i is the number of observations in determining X _i , S ₀ ² is the variance of the normative parameter X ₀ , n ₀ is the number of observations in determining X ₀ .

X _{Bi OAPS} - a value that integrally characterizes the studied process at a given time (in relative units), is the common antithrombotic potential of blood vessels (OAPS).

The combined use of the described methods with subsequent processing of the obtained values of IAASC, ISAAS and IFASS systemic multivariate analysis with the determination of the total antithrombotic potential of blood vessels (X _{Bi OAPS} ) rate of 0.201 and higher. The risk of developing a weakening of antithrombotic activity of blood vessels is noted with X _{Bi OAPS} from - 0.200 to 0.070. When the value of X _{Bi OAPS} from _0,069 and below, it is necessary to immediately treat patients according to the claimed method.

To create a negative energy balance in the body of patients, they are recommended an individually selected hypocaloric diet.

The caloric content of the daily diet is calculated in kcal individually for each patient with AH of the I-II degree in MS who underwent thrombosis of the eye vessels, 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 obtained value remains unchanged with minimal physical activity, multiplied by a coefficient of 1.3 for moderate and 1.5 for high physical activity (as a rule, in patients with I-II degree AH in MS who underwent eye vascular thrombosis, the level of physical activity low).

3 main meals and 2 intermediate meals are recommended. 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 that indicate 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, exhalation 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 hypertension of the I-II degree in MS who have undergone thrombosis of the vessels of the eye, is recommended therapeutic and prophylactic 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

2.1. Lightweight version of therapeutic gymnastics

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. When performing 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 hip flexion - 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, arms down. Lateral tilts 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 an average depth of 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 its original position - inhalation. 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 for 1-2 minutes. 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 on the spot or in a room with high flexion of the hips and waved 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 the classes, the following set of exercises can be used.

2.2. 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 upwards 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 in turn. 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 average 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 for 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 quiet walk with breathing medium depth of 2-5 minutes.

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs on the 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 a turn of the pelvis to the left, bend the legs, turn the pelvis with crossed legs 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 the 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. Reducing the total load 1-2 minutes

3. Fractional exercise throughout the day

A patient with hypertension of the I-II degree in MS who underwent thrombosis of the vessels of the eye 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 the increase in physical activity of persons suffering from AH of the I-II degree in MS after thrombosis of the vessels of the eye should be carried out by distributing physical activity in small doses throughout the day. This method of increasing physical activity in these patients should be considered as a fractional load method.

Depending on the real life conditions of patients with AH of the I-II degree in MS who have undergone thrombosis of blood vessels of the eye, suffering from various degrees of abdominal obesity, various approximate variants of fractional 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 hip flexion - 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 work in various versions and of various durations depending on the conditions (cleaning the premises, home maintenance, work on cleaning the territory, garden works, etc.).

The third component of the proposed method is the appointment of pioglitazone 30 mg 1 time per day, the fourth - amlodipine 10 m 1 time per day at the same time of day.

The introduction of this method of correcting the functions of the vascular wall in patients with AH of the I-II degree in MS who have undergone thrombosis of the vessels of the eye into the practice of medical institutions will solve a number of pressing socio-economic problems of our time. Effective correction in these patients will reduce the time of temporary disability in these patients, prevent strokes, heart attacks and repeated thrombosis of the vessels of the eye, reduce the number of disability exits and reduce mortality among this group of patients.

Example 1. Patient S., 56 years old, 72 kg, body mass index 29.8 kg / m ² , suffering from grade I arterial hypertension with metabolic syndrome for 7 years, having undergone eye vascular thrombosis 2 weeks ago, systematically not being treated, examined while in an ophthalmic hospital for eye vascular thrombosis. Blood was taken from the patient and examined according to the above scheme with the assessment of IAASC, ISAAS and IFAS and calculation of the total antithrombotic potential of blood vessels.

The patient showed pronounced signs of inhibition of the antithrombotic function of the vascular wall. IAASC was 1.06, ISAAS 1.07 and IFAS 1.09. The total antithrombotic potential of the vessels was X _{Bi OAPS} = 0.054. The patient was prescribed a treatment complex from a hypocaloric diet (1872.0 kcal.), Dosed physical exertion, pioglitazone 30 mg 1 time per day and amlodipine 10 mg 1 time per day. The study of the functions of the vascular wall was carried out monthly. After 4 months, body weight was 67 kg, body mass index 27.8 kg / m ² , IAASC was 0.54, ISAAS 1.41 and IFAS 1.51, normalization of the total antithrombotic potential of blood vessels was noted (X _{Bi OAPS} = 0.208) . Further, sometimes lax observance of the patient’s recommendations regarding diet and physical training made it possible to subsequently support the investigated parameters of the antithrombotic activity of blood vessels at normal boundaries.

Example 2. Patient M., 50 years old, 82 kg, body mass index 31.2 kg / m ² , suffering from arterial hypertension of the II degree with metabolic syndrome for 6 years, having undergone eye vascular thrombosis 2 weeks ago, systematically not being treated, examined while in an ophthalmic hospital for vascular thrombosis. Blood was taken from the patient and examined according to the above scheme with the assessment of IAASC, ISAAS and IFAS and calculation of the total antithrombotic potential of blood vessels.

The patient showed pronounced signs of inhibition of the antithrombotic function of the vascular wall. IAASC was 1.08, ISAAS 1.10 and IFAS 1.15. The total antithrombotic potential of the vessels was X _{Bi OAPS} = 0.063. The patient was prescribed a treatment complex from a hypocaloric diet (1978.7 kcal), dosed physical activity, pioglitazone 30 mg 1 time per day, and amlodipine 10 mg 1 time per day. The study of the functions of the vascular wall was carried out monthly. After 4 months, body weight was 74 kg, body mass index 28.1 kg / m ² , IAASC was 1.58, ISAAS 1.40 and IFAS 1.52, normalization of the total antithrombotic potential of blood vessels was noted (X _{Bi OAPS} = 0.211) . Further, sometimes lax observance of the patient’s recommendations regarding diet and physical training made it possible to subsequently support the investigated parameters of the antithrombotic activity of blood vessels at normal boundaries.

Using the proposed method for correcting the weakening of the functions of the vascular wall in hematology, cardiology and endocrinology will help to avoid many vascular complications in patients with grade I-II arterial hypertension with metabolic syndrome who have experienced eye vascular thrombosis, reduce the number of cases of temporary disability, reduce the duration of hospitalization, and reduce disability and mortality, eliminating repeated thrombosis of the vessels of the eye.

Claims (1)

A method for optimizing vascular wall activity in patients with grade I-II arterial hypertension with metabolic syndrome who have undergone eye vessel thrombosis, including the use of an individually selected hypocaloric diet calculated (kcal) according to the formula:
for women 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240,
31-60 years (0.342 × 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,
31-60 years (0.0484 × body weight, kg + 3.6534) × 240,
over 60 years old (0.0491 × body weight, kg + 2.4587) × 240,
dosed physical activities, including morning hygienic gymnastics, therapeutic and preventive gymnastics and fractional physical exercises throughout the day, the introduction of pioglitazone 30 mg 1 time per day and amlodipine 10 mg 1 time per day at the same time for 4 months.

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