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;
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.
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.
SUBSTANCE: through puncture opening in proximal and distal directions one should perform osseous tunnels being coaxial to osseous log to connect, thus, the cavity of osseous cyst with medullary canal. Through the parts of healthy bone at the distance of 1-2 cm against cyst's edge in oblique direction one should implant rigid electrodes at the angle of 45 deg. against its center by applying beck's needles with dielectric covering. Subcutaneously one should implant elastic electrodes in projection of lesion focus and connect an electrostimulating unit to cutaneous ends of electrodes. Onto intraosseous electrodes one should supply impulse current of negative polarity, and onto elastic ones - of positive polarity at 10-20 mcA power and frequency of 0.5 Hz, of total duration and front of rectangular impulses cut being 200 mcsec, not more.. One should affect with impulse electric currents on the 24-h basis till complete covering the osseous defect observed.
EFFECT: higher efficiency of therapy.
FIELD: medicine; cosmetics.
SUBSTANCE: method involves preparing and applying electrically activated cosmetic therapy substance. Preparation process involves passing alternating electric current through electrolyte material. The alternating current is applied for at least 10 min with preferential time being 4-8 h long for changing physical properties of the substance. Then the current is switched off. The active substance is administered as inhalation in pulmonary tract or as injections into human or animal body. The substance properties are retained for some limited time.
EFFECT: enhanced effectiveness of treatment; excluded electric current passage through patient tissues; excluded drug concentration in the vicinity of electrodes.
50 cl, 13 dwg
SUBSTANCE: method involves concurrently acting with stimulating electric pulses and back pressure pulses upon the prostate from the large intestine side synchronized with the stimulating electric pulses under excessive rinsing solution pressure into posterior urethra region. Device has pneumatic massage unit as elastic shell enveloping hollow cylindrical casing having a row of radial holes for supplying compressed air into the shell and periodic pulsating pressure source having at least one unit for producing electric pulses and pneumo-electromagnetic valve which electromagnet anchor is connected to electric pulse production unit outputs. Unit for electrically stimulating perineal muscles and prostate having stimulating catheter electrode and reservoir containing rinsing solution attached to catheter electrode are available in the device. Electric stimulation unit output is connected to input of unit for producing pressure pulses. Periodic pulsating pressure source is manufactured as elastic pneumatic chamber brought in continuous mechanical engagement with electromagnet anchor of the pneumo-electromagnetic valve and tightly joined via tube, cylindrical tube cavity and radial holes therein to the elastic shell of the massage member.
EFFECT: enhanced effectiveness of treatment; accelerated treatment course.
3 cl, 10 dwg
SUBSTANCE: method involves carrying out endoscopic operation. SCENAR-therapy is additionally administered with pulsating bipolar electric current being used without constant component as pulses at succession frequency from 10 to 350 Hz including swinging frequency mode within 30-120 Hz bandwidth with 2 to 8 pulses formed as batches at succession rate of 540 Hz to 4.5 kHz. The signal is modulated by varying ratio of action time to pauze duration within 1:1-1:5. 1-3 SCENAR-therapy courses are administered with 1-3 months long pauses. The first course begins at the first menstrual cycle occurred after endoscopic operation. Each course is carried out according to a scheme. 15-20 sessions are administered during the first menstrual cycle and 7-10 sessions are administered during the second menstrual cycle. The 25-40 min long sessions are applied daily.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves concurrently acting upon patient auditory system with acoustic signal produced by a musical composition selected on basis of patient health state and electric signals of the same musical composition acting upon patient skin. The electric signals amplitude-modulated with depth of 15-85%, act upon the patient via adhesive skin electrodes during 15-40 min. Hearing-add device is subjected to acoustic signals amplitude-modulated with depth of 15% and higher. Amplitude-modulation frequency is selected within the limits of 1.2-9.8 Hz. Modulation is carried out with frequency corresponding to patient disease frequency and action power is chosen on basis of subjective patient sensations. Device has unit for performing musical composition, the first and the second power amplifier, matching unit, adhesive electrodes and electroacoustic converter as well as electrostimulation modulator, acoustic modulator, the first and the second modulation depth regulator, the first and the second power control unit. Musical signal reproduction output unit is connected to the first inputs of electrostimulation modulator and acoustic modulator, which second inputs are connected to input of introduced controllable modulation frequency oscillator and modulation depth regulators are connected to their third inputs. Electrostimulation modulator output is connected to adhesive electrodes via the first power amplifier and matching unit. Sound modulator is connected to the electroacoustic converter via the second power amplifier. The first and the second power regulator are connected to the second inputs of the first and the second power amplifier. Unit for recording sessions is additionally introduced for replicating therapeutic sessions, its first input being connected to the electrostimulation modulator and the second one to the sound modulator output.
EFFECT: enhanced effectiveness of treatment.
4 cl, 1 dwg
SUBSTANCE: method involves specifying disease stage, determining suggestibility degree, programming on abstinence from alcohol consumption for a 6-12 months long period the patient determines on the own free will. Treatment is administered with bipolar electric asymmetric current pulses of 3-5 mA being applied on the background of relaxing melody later on in reanimation room. Assurance in overcoming difficulties of life and becoming free of alcohol addiction is suggested on this background. Placebo is concurrently intravenously administered as drop infusion imitating coding preparation as alcohol receptor blocker. Suggestive accentuation is concentrated on possible complications caused by alcohol consumption after introducing the preparation. The aversion against alcohol is invoked by making drop infusion of medicament mixture causing fever sensation and myorelaxation. The patient swallows 2-3 gulps of alcohol and the provoked responses are associated to them with a cause-effect relation like alcohol-bad health state and fixed with intramuscular placebo injection simulating oil code preparation.
EFFECT: enhanced effectiveness of treatment; prolonged remission period.
FIELD: medicine, neurosurgery.
SUBSTANCE: the present innovation deals with surgical treatment of neurological complications in patients with degenerative-dystrophic vertebral lesion and partial disorder of conductor-segmental spinal functions. One should surgically remove spinal compression due to resecting anterior departments of affected osseous-cartilaginous structures of vertebral-motor segment. One should apply electrodes: one pair - intraoperationally epidurally upon dura mater above anterior spinal departments being above the level of its lesion; then another pair of electrodes - by puncturing into area of posterior departments being below the level of its lesion to conduct electrostimulation. Moreover, therapy should be supplemented with phonophoresis with neuroprotector preparations. Electrostimulation of posterior spinal departments starts on the 2nd d, and that of anterior departments - on the 3d or 4th d after operation. Parameters of curative electrostimulation should be matches for every patient individually with the help of electroneuromyography. The innovation enables to decrease postoperative complications.
EFFECT: higher efficiency of therapy.
2 cl,1 ex
FIELD: medicine, traumatology, neurosurgery, microsurgery, neurotraumatology.
SUBSTANCE: one should fulfill autoneuroplasty of nervous defect, implantation of wire electrodes epineurally for both ends of contact areas of nerve's affected part at arranging insulation-free electrodes with their opened active ends along the direction of affected nerve. Moreover, before implantation of wire electrodes one should divide their ends into fibers to obtain filamentous wires and embrace nerve trunk and autoneurotransplant along their circumference. Electrodes should be placed at distal and proximal ends of affected nerve being about 5-10 mm above and below neurorhaphy area to perform electrostimulation. The method enables to accelerate regeneration of nervous fiber and decrease lesions of nervous tissue.
EFFECT: higher efficiency of therapy.
1 cl, 5 dwg, 1 ex
FIELD: medicine, physiotherapy.
SUBSTANCE: at the first stage, one should affect with magnetic field upon vertebral reflexogenic areas - volar surfaces - located at colored plates as straps. At the second stage, one should affect with magnetic field upon the area of vertebral column that helps to improve psychoemotional state in patients.
EFFECT: higher efficiency of therapy.
2 cl, 1 ex
FIELD: medicine, neurology, psychiatry.
SUBSTANCE: one should affect with amplipulsephoresis of "Berlition" preparation in rectified mode. One should apply types III and V of operations at modulation frequency being 130-150 Hz, modulation depth of 50-75%, impact duration for every type of operation lasts for 5-7 min. During the 1st d electrode-cathode should be located in inferior cervical - superior thoracic department of vertebral column, and electrode-anode - at anterior and posterior surfaces of forearms. During the 2nd d - in inferior thoracic - superior lumbar department of vertebral column and at anterior-lateral and posterior surfaces of shins, correspondingly. The present method improves clinico-electrophysiological and biochemical parameters.
EFFECT: higher efficiency of therapy.
5 ex, 8 tbl