RU2433812C2 - Method of reducing spontaneous erythrocyte aggregation in case of arterial hypertension with abdominal obesity and disturbance of tolerance to glucose - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to hematology and cardiology, and can be used for reduction of spontaneous aggregation of erythrocytes in case of arterial hypertension with abdominal obesity and disturbance of tolerance to glucose. For this purpose at the background of hypocalory diet, dosed static and dynamic physical exercise and daily swimming for not less than 30 minutes per day in the middle of the day introduced are lisinopril and metformin. Physical exercise includes morning hygienic gymnastics, therapeutic-preventive gymnastics, fractional physical exercise throughout the day. Lisinipril is introduced in dose 10 mg 1 time per day in the morning. Metformin is introduced in dose 500 mg 2 times per day. Treatment is carried out for 2 months.

EFFECT: method makes it possible to normalise spontaneous aggregation of erythrocytes during 2 months, bringing it to the level close to the level of healthy people, thus contributing to prevention of vascular complications in patients with arterial hypertension with abdominal obesity and with disturbance of tolerance to glucose.

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Description

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

Analogues of the proposed method to reduce spontaneous aggregation of red blood cells (SAE) in patients with arterial hypertension (AH) with abdominal obesity (AO) and impaired glucose tolerance (NTG) do not exist.

For the correction of arterial hypertension, ACE inhibitors are often prescribed, including lisinopril, for the correction of NTG metformin, in the correction scheme of patients with hypertension, AO and NTG in different combinations, a hypocaloric diet, physical training and swimming are often included.

In preparing this application, the task was set - to develop an effective and affordable way to reduce red blood cell aggregation in patients with hypertension with AO and NTG, which would solve the problem of correcting hypertension, AO and NTG with the simultaneous normalization of SAE and thereby prevention in a wide range of patients with hypertension with AO and NTG development of myocardial infarction, cerebral strokes and thrombosis of various localization.

Moreover, never before a treatment complex consisting of a hypocaloric diet, individually selected physical training, swimming and lisinopril and metformin preparations was not used in patients with hypertension with AO and NTG to normalize SAE.

The aim of the invention is to increase the efficiency of correction of SAE disorders in patients with hypertension with AO and NTG.

The essence of the proposed method lies in the fact that for the correction of SAE, patients with hypertension with AO and NTG are prescribed a complex of a hypocaloric diet, dosed physical exercises, daily swimming for at least 30 minutes a day in the middle of the day and lysinopril in a dose of 10 mg once a day in the morning and metformin 500 mg 2 times a day.

The method allows you to adjust the SAE in patients with hypertension with AO and NTG for 2 months, translating it to a level close to that for healthy people. Subject to the subsequent recommendations of the proposed method, it is possible to maintain the SAE, and therefore the blood rheology in optimal condition, which will significantly reduce the risk of thrombotic complications, reduce the number of cases of temporary disability, speed up and improve the quality of inpatient care, reduce disability, and also extend life and reduce mortality of patients with hypertension with AO and NTG from heart attack, stroke and thrombosis of various localization.

The inventive method is as follows. A sample of 9 ml of blood is taken in the morning after a 14-hour fast from a vein through a thick needle by gravity into a test tube with sodium citrate in a ratio of 9: 1 to evaluate red blood cell aggregation.

Red blood cell aggregation is assessed by the degree of ability of red blood cells to spontaneously aggregate (Pakhrova O.A., Grineva MR, Ivanov K.S. Methodology and clinical significance of the study of rheological properties of blood // Bulletin of the Ivanovo Medical Academy. - 2008. - T.13, No. 1-2. - S.89-98).

To assess the aggregation of red blood cells, blood from a vein is taken into sodium citrate at a ratio of 9: 1 and centrifuged for 10 min at 3000 rpm. In a 96-well plate, 2 wells of 0.2 ml of plasma of the subject are filled. All plasma and the white blood cell layer are removed from the tube. The red blood cells are resuspended in standard 1: 4 phosphate buffer, followed by centrifugation for 10 min at 3000 rpm, which allows them to be washed from plasma residues while removing the supernatant. After that, 0.02 ml of red blood cells is taken and resuspended in the first autologous plasma-filled well of a 96-well plate, which allows to obtain 10% hematocrit. Then, 0.02 ml of contents are taken from this well with a clean dry pipette and placed in a second filled well, which allows to obtain 1% hematocrit. After that, 1 grid in the Goryaev’s chamber is filled with the obtained erythrocyte suspension, kept for 3 min for the occurrence of spontaneous aggregation, and free erythrocytes (including 2 red blood cells together) and aggregates are counted, starting with 3 erythrocytes connected in the form of “coin columns”) in 2 large squares of the camera (lens × 40, eyepiece × 10). The number of “coin columns” and the number of red blood cells involved in them are considered.

Based on the data obtained, the following indicators are calculated that evaluate the SAE:

1) Average unit size (CPA):

CPA = SEA / CA

SEA - the sum of all red blood cells in the aggregates; KA - the number of units

2) Aggregation Index (PA):

PA = (CPA · KA + KSE) / (KA + KSE) KSE - the number of free red blood cells

3) Percentage of non-aggregated red blood cells (PNA):

PNA = KSE · 100 / (CPA · KA + KSE)

The standard values for CPA are 4-5, for PA 1.05-1.30, for PNA 80.0-92.0%. An increase in CPA is above 5, and PA above 1.30 and a decrease in PNA below 80.0% indicates an increase in SAE. In case of violation of at least one of these three indicators, patients with hypertension with AO and NTG need to be treated 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 calorie content of the daily diet for each patient individually 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 resulting coefficient remains unchanged with minimal physical activity, multiplied by 1.3 for moderate and 1.5 for high physical activity (as a rule, the level of physical activity in patients 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, 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 with AO and NTG are 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 for persons suffering from hypertension with AO and NTG.

2.1. A 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 freely - 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 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 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 then to a prone position; e) 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 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 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 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 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 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. Reduced overall load. 1-2 minutes

3. Fractional exercise throughout the day.

Depending on the real life conditions of patients with hypertension with AO and NTG, 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.).

The third component of the claimed method is daily swimming in the sea, river or pool for at least 30 minutes a day in the middle of the day.

The fourth component of the method for leveling increased SAE in patients with hypertension with AO and NTG is the appointment of lisinopril at a dose of 10 mg once a day in the morning and metformin 500 mg 2 times a day.

Example 1. Patient R. 47 years old, suffering from hypertension, AO and NTG for 8 years, was examined during a physical examination for arterial hypertension. Blood was taken from a patient in a plastic test tube followed by a study of the aggregation activity of red blood cells (CPA-5.4, PA = 1.62, PNA = 66.7%), indicating an increase in SAE.

The patient was recommended a hypocaloric diet, dosed physical activity, swimming in the pool for at least 30 minutes a day in the middle of the day, taking lisinopril 10 mg in the morning and metformin 500 mg 2 times a day.

After 1.5 months. it was found that the patient with SAE (CPA = 4.5, PA = 1.21, PNA = 86.0%) returned to normal.

Example 2. Patient E. 58 years old, suffering from hypertension, AO and NTG for 14 years, was examined during a physical examination for arterial hypertension. Blood was taken from a patient in a plastic tube followed by a study of the aggregation activity of red blood cells (CPA = 6.1, PA = 1.92, PNA = 42.7%), which indicated a sharp increase in SAE and the risk of thrombosis.

The patient was recommended a hypocaloric diet, dosed static and dynamic physical activity, daily swimming for at least 30 minutes a day in the middle of the day, lisinopril 10 mg in the morning and metformin 500 mg 2 times a day.

2 months later erythrocyte aggregation parameters (CPA = 4.4, PA = 1.28, PNA = 89.3%) returned to normal treatment, indicating a normalization of SAE in the patient.

Using the proposed method for the correction of SAE in hematology and cardiology will help to avoid many vascular complications in patients with hypertension with AO and NTG, reduce the number of cases of temporary disability, reduce the duration of hospitalization, reduce disability and mortality.

Claims (1)

A method of reducing the spontaneous aggregation of red blood cells in arterial hypertension with abdominal obesity and impaired glucose tolerance, including the use of a hypocaloric diet, dosed static and dynamic physical activity, including morning hygienic gymnastics, therapeutic and preventive gymnastics, fractional physical exercises throughout the day, daily swimming for at least 30 minutes a day in the middle of the day, taking lisinopril at a dose of 10 mg once a day in the morning and metformin 500 mg 2 times a day in t chenie 2 months.