The method of physical rehabilitation of patients with complicated myocardial infarction

 

The invention relates to medicine and is intended for physical rehabilitation of patients with complicated myocardial infarction. Conduct drug therapy and electrical stimulation of low-frequency pulsed currents in skeletal muscle after relieving pain and stabilization of hemodynamics, two daily sessions for 1 h electrical Stimulation starting from the second day till the stabilization of the clinical condition, a series of pulses at 16 with a pause of 5 s with a frequency of 21±10 to 120±10 Hz with keystone law changes the envelope of the amplitude of the pulses. Stimulate direct abdominal muscles, the extensors of the back, glutes and hamstring, front thigh muscles, calf muscles symmetrically left and right. During the first session of stimulation spend any four channels, during the second session the other four channels. The method allows to increase the effectiveness of physical rehabilitation of patients with complicated myocardial infarction. 1 C.p. f-crystals, 1 tab., 1 Il.

The method relates to medicine, namely to cardiology.

Well-known and widely used physical exercise in patients with previous myocardial Mikey during the physical rehabilitation of patients after myocardial infarction, held on 3-5-week program with the goal to restore the ability of the patient to self-service, to prevent deterioration of the cardiovascular system, skeletal muscles and other organs and systems to physical inactivity and physically and psychologically prepare the patient for further expansion of physical training (Syrkin, A. L. myocardial infarction. - M.: Medicine, 1991). In addition, physical exercise has a positive effect on the rheological properties of the blood, reducing the risk of thromboembolic complications.

Along with the numerous positive aspects this rehabilitation program has some disadvantages, one of which is that a substantial proportion of patients, especially over the age of 60 years and with severe circulatory failure, unacceptable in full even five-week program. In this category of patients physical exercise, even in a minimal volume can cause significant hemodynamic changes and the risk of threatened complications in the form of severe rhythm disorders, the formation of aneurism of the heart and breaks infarction, especially in the first days after myocardial infarction. In addition, there are species who have undertaken adequate physiotherapy exercises causes considerable difficulties. But therapeutic gymnastics in these patients is necessary, as even short-term lack of exercise leads to significant changes of blood flow in the periphery, the development of degenerative changes in the muscles and high risk of thrombotic and thromboembolic complications.

The known method of using rhythmic pneumocompressive lower extremities in patients with acute myocardial infarction (Lysov C. A., Dalacin C. E. and other Cardiology, 1996; 9: S. 34-37). This method proved to be effective in the acute period of myocardial infarction. When it is used in patients there is a decrease and stabilization of blood pressure, decreases blood viscosity by increasing erythrocyte deformability. The procedure has no significant effect on values of Central venous pressure and heart rate. (Lysov C. A., Dalacin C. E. and other Cardiology, 1996; 9: 34-37).

Along with the above advantages, this method has some disadvantages - the need to use complex specialized equipment, the inability to use the large category of patients with impaired patency of the deep veins of the lower extremities, the need for a preliminary assessment of swertia is not having a significant impact on the tone and strength of muscles and are not applicable for the rehabilitation of patients.

There is a method of training of patients with acute myocardial infarction, consisting in carrying out a specially designed system of physical exercises, differentiated according to the severity of the condition and dates from the beginning of acute myocardial infarction. (Nikolaeva, L. F., D. Aronov, M. Rehabilitation of patients with ischemic heart disease. - M.: Medicine, 1988). Along with the indisputable advantages of this method has some significant drawbacks. Active exercise is contraindicated in patients with persistent phenomena of left ventricular failure in patients with severe neurological and orthopedic disorders, and patients in the older age group.

There is a method of electrical stimulation of skeletal muscles, selected as a prototype, as an auxiliary method of blood flow in acute myocardial infarction. When it patients with acute myocardial infarction are electromyostimulation abdominal muscles, lower back, hips and legs in the “top-down” cycle of excitation and relaxation 4 C. the duration of the session is 15 minutes, and the course duration is 10 days. This method of electrical stimulation allows to optimize the main parameters of emodin is in these patients. In addition, this effect reduces the number of complications in patients with acute myocardial infarction and reduces the treatment time. But this way of electromyostimulation, is designed to impact on the indices of Central hemodynamics and conduct of such modes electromyostimulation, namely a short period of exposure (15-minute sessions 1 time per day) cannot be used for physical rehabilitation in patients with complicated myocardial infarction, because in this period it is impossible to achieve an adequate training effect.

The objective of the invention is to increase the effectiveness of treatment and rehabilitation of patients with severe myocardial infarction complicated by heart failure, rough orthopedic and neurological disorders at the early stationary phase by passive holding of medical physical culture in the form of multi-channel electrical stimulation of large skeletal muscle and maintain muscle tone.

The task is achieved by the fact that after relieving pain and stabilize the hemodynamics of patients in addition to primary medical therapy provide direct electrical stimulation of the abdominal muscles, the extensors of the back, gluteus is mulsow 16 with a pause of 5 s, amplitude from 0 to (100±15) mA and a frequency of (21±10) to (120±10) Hz trapezoidal law changes the envelope of the amplitude of the pulses. Thus, electrical stimulation is carried out daily for 2 h sessions for 1 h starting 2 days prior to stabilization of the clinical condition. Use 8 channels, stimulating direct abdominal muscles, the extensors of the back, glutes and hamstring, front thigh muscles, calf muscles symmetrically left and right without following the sequence of stimulation channels, any 4 channel stimulate the morning, and the other 4 channels in the evening, starting from the 2nd day usually within 10-12 days, to improve the clinical condition of patients and the emergence of opportunities for conventional rehabilitation measures. When saving bed mode electrical myostimulation is ongoing.

These muscle groups are selected based on the fact that they occupy a significant amount of and significantly suffer if forced inactivity of patients. At the same time it is proved that the arterioles and precapillaries are resistive element microcirculation and are the main contributors to the formation of total peripheral resistance and, accordingly, posterski. For electrical stimulation of the major skeletal muscles of PRSA lower posterski and the increase in cardiac output. Stimulation of the abdominal muscles can effectively deal with constipation and paralysis of the bowel, frequent prolonged bed rest.

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 of muscles.

This mode of stimulation was well tolerated and significantly less pronounced effect of habituation to electric effects. The optimum time to conduct electrical simulation of muscles in patients with complicated myocardial infarction is stimulation for 10-12 days until the stabilization of the General condition and appearance of the possibility of carrying out the conventional active rehabilitation measures.

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. Our proposed regime, namely the increase in the duration of the stimulating pulse to 16 with time and training up to 2 hours each day effectively increases the tone we helps to improve motor function, the health of the neuromuscular system, has a beneficial effect on regenerative processes in tissues. According to experimental studies, local electrical stimulation leads to favorable effects is to increase muscle blood flow by 76%, persisting for at least 1 h after cessation of stimulation (Tukavin A. I., Kozlov A. C. Issues of physiotherapy, balneology and therapeutic physical culture, 1995; 3: 20-22).

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

The method consists in the following.

Patients with myocardial infarction complicated by cardiac failure, severe concomitant diseases and other complications, not allowing it to start active exercise therapy, electrical stimulation of the muscle groups is carried out directly in the chamber in any patient position. The first session is held on the second day from the beginning of myocardial infarction, after relieving pain and stabilization of hemodynamics under observation for individual portability, control of peripheral hemodynamics (blood pressure, heart rate), clinical status.

For electrical stimulation may be used, for example, the unit "m & e is channel electrical effects of low frequency pulsed currents on the organs and tissues of the person.

Used 8 channels of stimulation:

straight muscle of the abdomen;

the extensors of the back;

- glutes and hamstring symmetrically left and right;

- the front muscles of the thigh;

- calf.

On the body of the patient, the electrodes are placed in the middle of the selected muscles with elastic cuffs (drawing).

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

Throughout a series of pulses are phase modulated in amplitude from 0 to (100±15) mA and frequency from (21±10) to (120±10) Hz trapezoidal law changes the envelope of the amplitude of the pulse series. The pulses are shifted 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 effects. 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. The second session will stimulate the other two groups of channels, such as 5, 6, and 7, and 8, with the same electrical parameters. Daily is about 2 days. When saving the rest for a longer time electric stimulation to continue.

Data on changes in strength and endurance of skeletal muscles of 45 patients with complicated myocardial infarction after the course of electrical stimulation of the muscles on the presented methodology is presented in the table.

Thus, electrical myostimulation is well tolerated by patients with severe myocardial infarction, contributes to a significant increase in strength and endurance stimulated muscles without causing ischemic ECG changes, arrhythmias and significant changes in hemodynamic parameters.

Example 1. Patient T., 67., was treated in the cardiology Department with 09.12.00 on 10.01.01 diagnosed with:

Ischemic heart disease. Primary transmural anterior-apical myocardial infarction from 09.12.00 complicated emerging apical aneurysm region, MK IIA.

The patient was admitted to our Department with complaints of intense squeezing pain in the chest caused 4 hours ago, severe weakness, shortness of breath.

Treatment: Nitrosorbid, Inderal, Injections of heparin under the skin of the abdomen, Furosemide.

After diagnosis and stabilization of hemodynamics on 2nd su is yscy belly, extensors of the back, gluteal muscles and the back muscles of the thigh symmetrically left and right of the front of the thigh muscles, calf muscles. On the body of the patient, the electrodes were located in the middle of the selected muscles with elastic cuffs. 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. Daily did 2 sessions of electrical stimulation of muscles by the time 1 o'clock in the Morning stimulated straight abdominal muscles, the extensors of the back, gluteal muscles and the back muscles of the thigh symmetrically left and right, and in the evening the front thigh muscles and calf muscles symmetrically left and right. Just held 14 sessions of stimulation within 7 days.

Baseline hemodynamics before stimulation influences the patient was HELL 120/70 mm RT.article HR 72 beats./min On the background of electrostimulation of the muscles being patient remained satisfactory, ECG-monitor cardiac rhythm and conductivity was not observed, there has been some reduction in HELL before 95/65 mm RT.art., maximum heart rate was 106 beats/min

Sessions of electrical stimulation of the major muscle groups continued in subsequent daily the s rehabilitation.

Clinical example 2.

Patient K., 75, years enrolled in the cardiology Department with complaints: severe constricting pain in the chest, with irradiation in both hands, emerged alone, not removable, nitroglycerin, accompanied by severe weakness, sweating; shortness of breath when talking. From the anamnesis: such pain appeared first 8 hours ago for no apparent reason, took nitroglycerin, pain wore undulating character with the constant increase, have shortness of breath. After what was called the ambulance, doctor brigade revealed reduction of HELL amid pain syndrome to 85/60 mm RT.article After introduction of the solution of morphine 2%-1,0/solution mezatona 1%and 0.5 ml s/C the patient was transported by stretcher to the hospital.

When inspecting the condition of the patient due to acute severe period of transmural anterior-lateral myocardial infarction. Clear consciousness. Pale skin, wet, warm. The visible mucous pink color. Subcutaneous fat is moderately expressed, no edema. Breathing with difficulty inhaling. BH 28 minutes on percussion of the chest is determined pulmonary sound. Auscultation heard vesicular respiration, in the lower sections of traiterous wheezing. Pulse 88 / min is; top - 3 intercostal space to the left of the sternum; the right one at the right edge of the sternum. Heart sounds muffled, rhythmic. I tone at the top is weakened, II tone is not changed. HELL 130/80 mm RT.article Abdomen normal configuration, participates in the act of breathing, palpation of soft, painless. The liver is not enlarged. No edema.

ECG at admission: sinus Rhythm, heart rate of 91 per minute Signs of transmural lesions in the anterior wall of the left ventricle, the rise of ST in the left chest leads.

Diagnosis at admission: coronary artery disease: Primary transmural anterior-lateral myocardial infarction, acute, complicated reflex shock, aneurysm formation of the apical region, MK IIA.

Laboratory data in dynamics reported a considerable increase in the level of cardiospecific enzymes (CPK to 3229 u/l, LDH until 1615 u/l, LDH-1 to 956 u/l, ACT to 178 u/1), ECG - natural dynamics, according to ECHOCARDIOGRAPHY - critical reduction of global contractility (PV-22%), dyskinesia tops (aneurysmal bulging top in the systole 5.5 cm, parietal thrombus in the aneurysm cavity). When x-ray examination of the lungs showed signs of venous congestion. The patient received treatment: nitrosorbid, inderal, acetylsalicylic acid, Enap, injections of heparin under the x, reflecting the gravity of the patient, the size of myocardial infarction, presence of complications in the acute period: reflex shock, emerging apical aneurysm region with the presence of a blood clot in it, symptoms of heart failure IIA degree, as well as old age, patient referred to the III-IV classes of gravity and, therefore, needed in the individual program of physical rehabilitation. So after relieving pain and complications of the acute period, stabilization of hemodynamics on the 2nd day the patient was prescribed course of electrical stimulation of large muscle groups while maintaining bed rest. Before electromyostimulation HELL, the patient was 120/70 mm RT.art., Heart rate 76 beats/min, the ejection fraction of the left ventricle 22%, PP 15,7 ml. Daily conducted in two sessions electromyostimulation duration by 1 o'clock in the Morning stimulated the front thigh muscles and calf muscles symmetrically left and right, and in the evening straight abdominal muscles, the extensors of the back, glutes and hamstring symmetrically left and right. On the body of the patient, the electrodes were located in the middle of the selected muscles with elastic cuffs. The amplitude of the electric action were selected on the basis of horoshem is Ogadenia the first session of electrical stimulation of the muscles being patient remained stable, ECG-monitor cardiac rhythm and conductivity was not observed, there has been some reduction of blood pressure to 105/65 mm RT.article, maximum heart rate was 92 beats/min, PV increased to 26%, UO - to 21 ml for subsequent sessions worsening of the clinical status, hemodynamics have changed slightly. Just spent 20 sessions EMS within 10 days. The increase in movement mode, the patient was started on 11 days from receipt in the office and was conducted according to the standard scheme. At 21 days the patient has mastered walking around the room and along the corridor up to 300 m per day and discharged from hospital for further outpatient treatment. By echocardiography before discharge showed increase in stroke volume to 29.3 ml and ejection fraction of the left ventricle to 28%.

Thus, the proposed method has the following advantages:

1) this method allows the passive exercise therapy in the form of electrical muscle stimulation in patients with severe complicated by myocardial infarction;

2) improves the effectiveness of treatment and rehabilitation of severe complicated myocardial infarction, reducing the length of inpatient;

3) improves strength and endurance stimulated muscles;

4) considerable the persons physical rehabilitation is used in the emergency Department of cardiology State research and clinical center for health of miners in the treatment of patients with complicated myocardial infarction.

Claims

1. The method of physical rehabilitation of patients with complicated myocardial infarction, including drug therapy and electrical stimulation of low-frequency pulsed currents in skeletal muscle, which is carried out after relieving pain and stabilization of hemodynamics, two daily sessions of 1 h, wherein the electrical stimulation starting from the second day till the stabilization of the clinical condition of the series of pulses at 16 with a pause of 5 s with a frequency of 21±10 to (120±10) Hz trapezoidal law changes the envelope of the amplitude of the impulses and stimulate direct abdominal muscles, the extensors of the back, glutes and hamstring, the front thigh muscles calf muscles symmetrically left and right.

2. The method according to p. 1, characterized in that during the first session of stimulation spend any four channels, during the second session the other four channels.



 

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