A method for the treatment of patients with severe chronic heart failure

 

(57) Abstract:

The invention relates to medicine, cardiology. Provide medication and stimulation. While conducting direct electrical stimulation of the abdominal muscles, the extensors of the back and posterior hip muscles symmetrically left and right. Use pulses with amplitude up (10015) mA, a frequency of (2110) to (12010) Hz. Sessions are conducted daily. The method improves the efficiency of the treatment. 1 Il.

The invention relates to medicine, namely to cardiology.

Congestive heart failure is a major cause of morbidity and mortality in patients with cardiovascular diseases. Chronic circulatory failure is the end point of development and the outcome of several diseases of the cardiovascular system (CVS), which determines the necessity of finding effective treatments for this condition (Achilov A. A. Cardiology 1994; 1: 43-46). This syndrome is characterized by a decrease in the pumping function of the heart, the activation of the various components of vasoconstrictor systems resulting in spasm of peripheral arterioles and venules. (Muharlyamov N. M the Early stages of circulatory failure and compensatory mechanisms.it just is a compensatory mechanism, then in the later stages of circulatory failure, it leads to a significant reduction of blood flow in the periphery. This is accompanied by the restructuring of peripheral vessels, historicimages changes in skeletal muscle and contributes to the closure of the various parts of the main vicious circle of chronic circulatory failure (Mareev C. Y. Cardiology. 1991; 12: 5-11). In addition, there is evidence that the progression of heart failure to III - IV according to NYHA FC accompanied by a decrease dependence aerobic capacity of patients from the States of Central hemodynamics and increase the role of peripheral circulatory disorders in the determination of the physical status of patients (Florea C.,, Mareev C. Y., Belenkov Y. N. Cardiology 1995; 5: 37-42).

Reduced tolerance to stress in these patients largely depends on the improvement of regional vascular resistance and venous tone, than the fall in cardiac output.

In numerous publications and guides for cardiology it was believed that the presence of chronic heart failure IIA and above the stage is a contraindication to the conduct of exercises and physical training. In recent years, mercy (Sullivan M. J., Cobb F. R. Circulation, 1990; 81:2:II-47 II-58). Because of the above studies included patients with relatively stable, the question remains about the possibility of using dosed exercise in complex therapy of patients with decompensated heart failure. Due to the severity of the condition of such patients previously developed methodological approaches and modes of training obviously unsuitable. However, in recent years, increasingly (including in different areas of medicine) has been applied method electromyostimulation, as an alternative to conventional physical training.

There is a method of electrical stimulation of muscles using packets of pulses, providing long-lasting impact on the function and structure of muscle tissue and neurological diseases (EPO, N 3. 85301736.6 from 13.03.85,, publ. 25.09.85., M CL A 61 N 1/00).

However, the magnitude of the impact and its settings do not allow this method to be used for electrical muscle stimulation in patients with severe chronic heart failure.

There is a method of treatment of patients with severe heart failure, selected as a prototype, comprising the use of cardiac glycosides, diuretics, prolonged nitrate (as peripheral vasodilators, angiotensin-converting enzyme inhibitors, b-blockers (in small doses), infusion of dopamine. (International guidelines on heart failure. Hoechst AG 1994: 51-56).

The disadvantage of this method of treatment is that patients with severe chronic heart failure have to be in constant physical inactivity, against which muscles develop secondary degenerative changes of the circulatory system eliminates muscle component, and drugs do not have a significant impact in dystrophic changes in muscle.

The objective of the invention is to increase the efficiency of treatment of patients with decompensated heart failure, shorter period of rehabilitation of patients.

The task is achieved by the fact that additionally carry out simultaneously the direct electrical stimulation of the abdominal muscles, the extensors of the back, gluteal and posterior thigh muscles symmetrically to the left and right series of pulses with amplitude from 0 to (10015) mA and a frequency of (2110) to (12010) Hz trapezoidal law changes the envelope of the amplitude of the pulses, while provode series 16 with pausing 5 sec.

These muscle groups are selected based on the fact that they occupy a significant amount of and significantly suffer if forced inactivity of patients. In addition, electrical stimulation of these muscle groups allows you to "include" in the circulatory system peripheral muscle component.

The amplitude of the electrical action is selected on the basis of a good muscle contraction (visually and by palpation), but without pain, for each channel individually, at each session of electrical stimulation.

This mode of stimulation was well tolerated and significantly less pronounced effect of habituation to electric effect.

Rhythmic muscle contractions caused by pulse currents with optimal parameters (amplitude, duration, frequency, and others) are active means of improving the trophic tissue, improve motor function, reduction of autonomic disorders and pain. In the process of electrical stimulation increases blood flow to twitch muscles, which helps to improve metabolism. Systematic electrical stimulation during the entire course of treatment is 15 - 20 days increases the contractility of the muscular substance, increase illaroo apparatus of muscle fibers, and by increasing the "psychological" border arbitrary maximum effort due to the release of the nerve centers under the influence of additional afferention. Under the influence of electrical stimulation increases muscle tone, improves circulation, increases the activity of several enzyme systems in the muscles and other tissues. All this helps to improve motor function, the health of the neuromuscular system, has a beneficial effect on regenerative processes in tissues. These effects are achieved only in the case of a combination of electrical stimulation of muscles with adequate drug therapy.

The invention is illustrated in the drawing, which shows a diagram of electrostimulation of muscles.

The method consists in the following

Patients with severe chronic heart failure electrical stimulation of muscle groups is carried out directly in the chamber in any patient position. The first session held under observation for individual portability, control of peripheral hemodynamics (blood pressure, heart rate) clinical state and Central hemodynamics using echocardiography.

For electrical stimulation may be ulator, designed for multi-channel electrical effects of low frequency pulsed currents on the organs and tissues of man.

Each channel is a pair of electrodes connected thereto conductors. Adjusting the amplitude of the output signal is performed independently in each channel.

The electrode is a metal plate size 20 x 15 mm, enclosed in cotton sleeve with tab of the conductive fabric.

The electrodes before using sterilized by boiling for 30 minutes using 4 channel stimulation:

direct abdominal muscles,

the extensors of the back,

- glutes and hamstring symmetrically to the left and to the right.

On the body of the patient, the electrodes are placed in the middle of the selected muscles with elastic cuffs (see drawing). Good contact of the electrodes with the skin by wetting them in warm water.

Electrostimulation is carried out by a series of impulses with a group (sequential operation of the two groups of channels: 1,2 and 3,4) order channels.

Throughout a series of pulses are phase modulated in amplitude from 0 to (10015) mA and frequency from (2110) to (12010) Hz with the keystone is by Uta in time, the repetition period of the series is set to: 16, followed by a pause of 5 C. This mode of stimulation was well tolerated and significantly less pronounced effect of habituation to electric effect.

The amplitude of the electrical action is selected on the basis of a good muscle contraction (visually and by palpation), but without pain, for each channel individually. Daily 1 session of electrical stimulation of muscles duration 1 h

Example No. 1. Patient Kuznetsov A. F., age 38, was in the cardiology Department 31.05.96 on 20.06.96 with a diagnosis of Dilated cardiomyopathy NC 2B. (IV according to NYHA)

At admission the patient complained of:

Shortness of breath at rest, sharply increasing in the supine position. Swelling to the lumbar region, standing. The increase in the abdomen, pain in the right hypochondrium, weakness, fatigue.

History: according to the patient within six months shortness of breath. In January, lying in the card. the Department with a Diagnosis of Dilated cardiomyopathy NC 2B. Issued in a compensated state. However, in the last two weeks stopped the medication, the condition progressively worsened, today has caused SMEs and delivered to the receiving Department. Data dynamic anaprilin, DIGOXIN, GIPOTIAZID, VEROSPIRON, LASIX, polarizing mixture.

With the second day of stay in the ward the patient was carried out daily electrostimulation major muscle groups by using the apparatus of BIORITM-040".

Muscle stimulation was carried out on 4 channels:

direct abdominal muscles,

the extensors of the back,

- glutes and hamstring symmetrically to the left and to the right.

Electrical stimulation was carried out by a series of impulses with a group (sequential operation of the two groups of channels: 1,2 and 3,4) order channels. Throughout a series of pulses are phase modulated in amplitude from 0 to (10015) mA and frequency from (2110) to (12010) Hz trapezoidal law changes the envelope of the amplitude of the pulses of the series, with group operation pulses are shifted in time, the repetition period of the series is set to: 16 followed by pauses 5 sec.

The amplitude of the electric action were selected on the basis of a good muscle contraction (visually and by palpation), but without pain, for example, for the patient Kuznetsova first stimulation session was held with the amplitude of 56 mA, and subsequent 50-65 mA for each channel individually. Daily did 1 session of electrical stimulation of muscles prodali min, HELL 115/80 mm RT.article The ejection fraction of the left ventricle (mode.) 32%.

During the first session of electrical stimulation of the muscles of the heart rate did not change and amounted to 75 minutes of AD increased slightly to 130/90 mm RT.article By echocardiography increased PV from 32% to 36%.

After the course, stimulatory effects of PE of the left ventricle increased further, amounted to 40% and has not changed in the background stimulation. Performance variation and AD has not been significantly changed.

Subjectively the patient, despite the heavy overall, a well-tolerated procedure electrical stimulation of muscles, shortness of breath did not arise.

Before discharge the patient without limitation travelled around the office, free rose on the 2nd floor by stairs. The patient was discharged to outpatient treatment in a satisfactory condition with the recommendation of the monthly repetition rate of the stimulation effects on outpatient basis.

Example N 2 Suslov B. C. 65 years.

The diagnosis of CHD. Postinfarction cardiosclerosis (1982, 1990, 1996). Aneurysm of the anterior wall of LV. NC-III (IV according to NYHA). Bilateral hydrothorax.

At admission the patient complained of pronounced shortness of breath at rest, sharply increasing PR, suffered a myocardial infarction posterior wall of the left ventricle. Subsequently remained angina of FC-II. In may of this year moved next to/on anterior myocardial infarction complicated clinical death. In subsequent increased signs of heart failure (dyspnea, edema of the lower extremities), ECG remained lifting ST in the anterior wall of the left ventricle (V1-V4).

According to the surveys revealed the following deviations: Echocardiography: aneurysm of the anterior wall of LV, the critical reduction of global contractility, PV 12%; U.S.: bilateral hydrothorax.

Conducted treatment: prolonged nitrates, ACE inhibitors, diuretics, drugs K, cardiac glycosides (in small doses), b-blockers, were conducted infusion of dopamine.

With the second day of stay in the ward the patient was conducted multichannel electrical stimulation of the major muscle groups.

Used 4 channel stimulation:

direct abdominal muscles,

the extensors of the back,

- glutes and hamstring symmetrically to the left and to the right.

Electrical stimulation was carried out by a series of impulses with group order channels. Throughout a series of pulses are phase modulated, p is water pulse series, for group operation pulses are shifted in time, the repetition period of the series is set to: 16 followed by pauses 5 sec.

The amplitude of the electric action were selected on the basis of a good muscle contraction (visually and by palpation), but without pain, for each channel individually, during the first session she was 45 mA, and subsequently fluctuated between 45-55 mA. Daily did 1 session of electrical stimulation of muscles duration 1 h

Baseline hemodynamics heart rate 80 / min, BP 75/50 mm RT.article The ejection fraction of the left ventricle 12%.

During the first session of electrical stimulation of heart rate and HELL has not changed, the ejection fraction of the left ventricle remained at the same level.

After the course, stimulatory effects of blood pressure and heart rate remained virtually unchanged, PV increased slightly and amounted to 16%.

The patient is well tolerated procedure for the stimulation of the muscles, shortness of breath did not arise. During the treatment the patient's health has improved significantly, significantly decreased shortness of breath. Patient without limitation moves through the compartment rises on the 2nd floor, was discharged for outpatient monitoring in a satisfactory, redlagaemyi method has the following advantages:

1. This method allows you to conduct physical training in the form of electrical muscle stimulation in the most severe patients with chronic heart failure, without causing deterioration of parameters of Central hemodynamics.

2. Improves peripheral circulation in patients with severe heart failure.

3. Helps to reduce the duration of treatment for patients with severe chronic heart failure.

A method for the treatment of patients with severe chronic heart failure, involving the use of drugs, characterized in that it further carry out simultaneously the direct electrical stimulation of the abdominal muscles, the extensors of the back and posterior hip muscles symmetrically to the left and right series of pulses with amplitude from 0 to (10015)mA and a frequency of (2110) to (12010)Hz trapezoidal law changes the envelope of the amplitude of the pulses, while they conduct daily, throughout the course of treatment, one session of electrical stimulation for 1 h, with periodic episodes of 16 with a pause of 5 C.

 

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FIELD: medicine.

SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

EFFECT: complete destruction of neoplasm; excluded tumor recurrence; reduced risk of tumor cells dissemination.

3 cl, 3 dwg

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