Method of respiratory-kinesiological rehabilitation of patients after cardiosurgical interventions

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiosurgery and can be used in treatment of patients after cardiosurgical interventions and receiving mechanical ventilation (ALV). Starting with the first post-operation day at the background of intensive therapy in lying position of patient visceral manual therapy on organs of abdominal cavity is carried out. After that impact is performed on biologically active points which are selected taking into account prevailing organ failure. Depending on state of patient's conscience either passive or active movements in joints of lower extremities are performed. In case of active movements doctor exercises dosed resistance to working extremity. Before beginning and in pauses between exercises rotation in hip joint is performed. After that, ventilation in prone-position is carried out. Slow transfer of patient into sitting position is carried out. In this position impact is performed on patient's back by means of manual therapy techniques. After that patient is placed into orthopedic arm-chair in "vertical sitting" position with gradual increase of exposure time.

EFFECT: method makes it possible to restore and support adequate function of gastrointestinal tract, facilitate early independent beginning of enteral feeding, improve ventilation function of lungs and gas-transport function of blood.

3 ex

 

The invention relates to medicine, namely to methods of treatment of patients after cardiac surgery and being on artificial lung ventilation (ALV), and may find application in the rehabilitation of patients with multi-organ failure in critical condition.

Despite modern methods of treatment of critical conditions in patients with cardiac disorders frequency of the syndrome of multiple organ failure in the postoperative period reaches 8-20%. Mortality in this syndrome reaches 40%, while failure of more than three organs or systems - more than 80%. In the structure of organ damage, respiratory distress (syndrome of acute lung injury, respiratory distress syndrome, ventilator-associated pneumonia, destructive and atrophic processes tracheo-bronchial tree) is located at the leading position and is inferior in terms of frequency and fatality outcomes only cardiac and renal dysfunction. Hypokinetic complications in a patient in critical condition (thromboembolic, hypoventilation, dysfunction of the gastrointestinal tract, disorders of the skin trophism - sores - with subsequent septic complications are the triggers for the development of most organ dysfunction. The duration and efficiency of the treatment of multiple organ failure largely depends on the elimination or significant reduction of possible negative consequences of the forced position of the patient in intensive care.

There are various exercises and techniques postoperative physical therapy, consisting of metered load on skeletal muscles and forced breathing for the involvement of additional, unused in case of involuntary passive position of the patient's respiratory volume (V. Moshkov, Therapeutic exercise in the clinic of internal diseases. - M.: Medicine, 1992. - S).

The main disadvantage of the known methods of postoperative physical therapy is the need for the patient consciousnesses necessary motor activity.

There is also known a method of carrying out physiotherapy exercises (physical therapy) or so-called "ventilation in the prone position, including the IVL in parallel with periodic rotation or abdomen, or consistently on the right side, stomach, left side, back (Vlasenko V., Ostapchenko D., Sachs, ACTING, Mitrokhin A.A., Marchenkov, J.V., G. Meshcheryakov. The use of the prone position in patients with acute parenchymal lung involvement in conditions of respiratory support // the Bulletin of intensive therapy. - 2003. No. 3. - P.3-8). In accordance with the known method the course LFC are subdivided into 3 periods: resuscitation, the period of tissue adhesions (consolidation) and the residual period of the pathological manifestations. The first period lasts 2-7 days and is characterized by pronounced shifts the body, and disturbances of vital functions. Exercise therapy in this period aimed at stimulation extraordinary factors blood circulation, improve microcirculation in the periphery, prevention hypostatic and infectious complications of the lungs, reducing stress impact of acute adynamia, etc. Selection and dosage means of exercise therapy in the intensive care period depend on the localization, the nature of the damage and the condition of the patient. In critical States included in the intensive care period, as well as in bed all events are limited to mechanical ventilation and intensive basic therapy. With the improvement of the General condition of the patient is prescribed therapeutic massage and other methods of exercise therapy.

The main disadvantage of analog is a workaround issues hypoventilation (save arterial hypoxemia after the patient on his back) and improve gas exchange at extremely problematic to use in patients with sternotomy, if there are drains on the anterior chest wall and unstable hemodynamics.

The technical result of the invention is to improve comprehensive early respiratory and musculoskeletal (medical) rehabilitation of patients in the postoperative period in the intensive care unit in a serious, including unconscious on a ventilator.

Way to REP retorno-medical rehabilitation of patients after cardiac interventions being on a ventilator is characterized by the fact that, starting from the first postoperative day, on the background of intensive therapy in the position of the patient "lying" hold visceral manual therapy on abdominal organs; then carry out impact on biologically active points, which are selected with consideration of the prevailing organ failure; according to the patient's state of consciousness, carried out either passive or active movement in the joints of the lower extremities, and with the active movements of the doctor provides controlled resistance working limbs, in addition, before and during pauses between exercises make rotation in the hip joint; then provide ventilation in the prone position and provide a smooth transfer of the patient in the sitting position and in this position make an impact on the back of the patient techniques of manual therapy; followed by the transfer of the patient to the orthopaedic chair in position vertically sitting with a gradual increase of the exposure time.

The positive results of the method are as follows:

- getting the patient is passive and controlled active load during the entire period of its on a ventilator;

- helps to restore and maintain adequate function of the gastrointestinal tract without pharmacological stimulation;

- early independence of the enteral nutrient supply immediately upon recovery of consciousness;

- helps to improve ventilation in the lung function and transport function of blood.

For the full range of activities status of patients undergoing mechanical ventilation, monitories in terms of saturation, invasive arterial pressure, heart rate and ECG. Begins respiratory-medical rehabilitation on the background of intensive therapy in the prone position is carried out by methods visceral manual therapy work with the organs of the abdominal cavity (splenic and hepatic angles of the abdominal cavity, small and large intestine), then carry out a simulated impact on the meridional biologically active points taking into account the prevailing failure (the point of activation of the meridians of the lung, small intestine, kidneys). The state of consciousness of the patient is made passive or active movement in the joints of the lower extremities: bringing the knee to the chest, straightening the knee joint in full extension. During active movements physician provides controlled resistance working limbs. Before and during pauses between exercises there is a rotation in the hip joint. A smooth transfer of the patient in the sitting position is carried out after carrying out ventilation in the prone position, and in this position, makes an impact on the back of the patient massagin the mi techniques of manual therapy, and then the patient was transferred to the orthopedic seat with stay in position vertically sitting with a gradual increase in exposure time from 10 minutes and then, in terms of monitorable parameters.

Early respiratory-medical rehabilitation (RRC) in the intensive therapy of multiple organ failure is an effective method of rapid restoration of adequate respiratory function, adaptive capacity of the cardiovascular system, stabilization, vegetative-vascular status.

Below are examples of the method of the respiratory-medical rehabilitation after cardiovascular interventions received at the clinic of anesthesiology and intensive care, Institute of complex problems of cardiovascular diseases SB RAMS.

Example 1.

Patient, 55 years history No. 2524, was admitted to the intensive care unit 18.04.2008, with a diagnosis of infective endocarditis, stenosis and insufficiency of the aortic valve, mitral valve insufficiency, functional class 4, circulatory insufficiency NYHA-IV. Operation: prosthetic aortic valve, a mitral valve replacement. Intra-operative period was complicated by myocardial infarction. In the postoperative period to maintain adequate hemodynamics were required high-dose inotropic support to ensure ventilation when R is switchesa respiratory distress syndrome forced modes of mechanical ventilation. On the background of a comprehensive intensive care of cardiac, pulmonary, renal failure from the first postoperative day exercises RRC. By 3-4 days there was a trend of recovery of functional tests (samples Martinet, Rufe - adapted methodology; sample FLAC; rate endurance; assessment of the autonomic status by index Cerdo; vegetative-vascular resistance - passive orthostatic, glasserman and kinesthetically samples) from "unsatisfactory" to normal (from 3.1 to 7.5 UNED), with a similar ratio increased endurance. Adaptive capacity was reduced from 2 days from unsatisfactory 3.3 to the voltage level of 2.9 points. The tendency to vascular type of self-regulation CCC. Obtained significant improvement indexes delivery (DO2I), consumption (VO2I) and extraction (O2R) of oxygen at the end of the session RRC and continued for 6-8 hours with return to baseline values, without changing the parameters of the ventilator. Recovery of bowel function with 4 days, the beginning of self enteral nutrition and respiration to the 5-th day; the trend towards full recovery of motor activity. Translation in the Department of surgery 29.04.2008 g, with subsequent discharge to outpatient treatment is.

Example 2.

Patient C., 58 years old, medical history, No. 2937, was admitted to the intensive care unit 07.05.2008 GS diagnosis: ischemic heart disease, angina 4th functional class, aortic stenosis, 3-rd functional class, circulatory insufficiency NYHA-111, diabetes of the 2nd type, subcompensated, diabetic nephropathy. HPNA. Surgery involves prosthetic aortic valve, mammarocoronary and coronary artery autovenous bypass of three coronary arteries. A long period of cardiopulmonary bypass and intraoperative significant blood loss has led to the development of postoperative syndrome systemic inflammatory response with the development of respiratory distress syndrome, heart failure, kidney failure. On the background of a comprehensive intensive care of cardiac, pulmonary, renal failure with the first operating day is early RRC. By the 5th day there was a trend of recovery of functional tests from "unsatisfactory" to normal (from 2.2 to 6.35 Rel. units), with the increase of the coefficient of endurance. Adaptive capacity decreased with 4 days from unsatisfactory 3.9 to the voltage level of 2.65 points. There was a trend of returning to the vascular type of self-regulation CCC. At the end of the session RRC noted significant improvements n the indicators indexes oxygen transport functions, which was preserved up to 10 hours without changing the settings of the ventilator. Recovery of bowel function with 3 days, the beginning of self enteral nutrition and respiration to the 7th day; at the same time there is a full recovery of motor activity. Translation in the Department of surgery 04.06.2003, produced at the end of dialysis treatment and subsequent discharge to outpatient follow-up care.

Example 3.

Patient T., 60 years, history of No. 7801, was admitted to the intensive care unit 19.11.2008 GS diagnosis: secondary infectious endocarditis, restenosis of the mitral valve (after commissurotomy in 1987), the insufficiency of aortic valve insufficiency tricus-pedaling valve, functional class 4, circulatory insufficiency NYHA-I1I. Surgery involves prosthetic mitral and aortic valves, plastic tricuspid valve. In the postoperative period developed heart failure, syndrome of acute lung injury after massive blood transfusion (blood loss when you access), renal failure. On the background of complex intensive therapy of multiple organ failure from the first postoperative day exercises RRC. By the 3rd day marked the restoration of the indicators of functional tests from "unsatisfactory" to "normal" and promoted the e coefficient endurance. Adaptive capacity has decreased from 2 days from 3.7 to voltage level of 2.1 points. Recovered vascular type of self-regulation CCC. Gas transport function of blood at the end of the session RRC remains stable within normal values at least 8 hours without changing the settings of the ventilator. Recovery of bowel function with 2 days, the beginning of self enteral nutrition and respiration to 4 days; the full recovery of motor activity with 5-days. Translation in the Department of cardiac surgery produced 02.12.2008, with subsequent discharge to outpatient follow-up care.

How respiratory-medical rehabilitation of patients after cardiac surgery, with ALV, characterized in that starting from the first postoperative day on the background of intensive therapy with the patient lying spend visceral manual therapy on abdominal organs; then carry out impact on biologically active points, which are selected with consideration of the prevailing organ failure; judging by the state of consciousness of the patient, carried out either passive or active movement in the joints of the lower extremities, and with the active movements of the doctor provides controlled resistance working limbs, in addition, before and during pauses between exercises carry out the rotation of the hip joint; then provide ventilation in the prone position and provide a smooth transfer of the patient in the sitting position and in this position make an impact on the back of the patient techniques of manual therapy; followed by transfer of the patient to the orthopaedic chair in position vertically sitting with a gradual increase of the exposure time.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dentistry. Method includes impact by remote electrode of apparatus "DiaDENS". Impact is performed with frequency 77 Hz for 2 minutes. Impact is performed on auricular points of acupuncture, which correspond to teeth of upper AT5, or lower AT6 jaws. When impact on auricular points is over, impact on pain zone in area of apex of cured tooth is performed. Impact is realised by point electrode of "DiaDens" apparatus with frequency 200 Hz, for 5 minutes.

EFFECT: method ensures obtaining high therapeutic result due to complex successive impact: reduces treatment terms, contributes to elimination of accompanying neurologic symptoms: sleep disorders, irritability, anxiety.

2 ex, 3 tbl

FIELD: medicine.

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EFFECT: method reduces terms of relief of pathologic psychic states reduction and increases remission duration.

4 cl, 7 ex

FIELD: medicine.

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2 ex

FIELD: medicine.

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3 tbl

FIELD: medicine.

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EFFECT: method makes it possible to carry out treatment in accordance with determined type of reduction of adaptive abilities.

7 cl, 8 tbl, 5 ex

FIELD: medicine.

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2 ex

FIELD: medicine.

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1 dwg

FIELD: medicine.

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4 cl, 4 ex

FIELD: medicine.

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6 ex, 2 tbl, 3 dwg

FIELD: medicine.

SUBSTANCE: method involves acupuncture treatment of points and regions located on a surface of an auricle corresponding to a thyroid gland, a cervical spine, a hypophysis, a hypothalamus and a brain stem, as well as treatment of a neck and a paravertebral region. In addition, covered are points and regions on the surfaces of the auricle corresponding to two superior cervical, middle cervical and inferior cervical ganglions, lymphatic throat masses, a throat, a tongue, salivary glands, lateral and posterior horns of spinal cord, a reticular formation and a cerebellum. The treatment is combined with low-intensity infrared laser light, and/or with traditional massage, and/or acupuncture, and/or with therapeutic blocks of the reflex regions functionally related to cervical, and/or thoracic, and/or lumbar sympathetic ganglions and parasympathetic cerebral ganglions, and/or of their projections and nerve plexuses related to these vegetative structures, including paravertebral portions in a projection of spinal segments C 1-3, C 5-6, C 7 - Th 1, Th 1 - Th 3, Th 5 - Th 7, Th 11 - L 3, and/or of the regions found along edges of a sternocleidomastoid muscle opposite to a mandibular angle and in their middle, and/or of the region located behind a mastoid of a temporal bone, and/or of a mammary zone, and/or of a submaxillary zone, and/or an area under a malar bone, and/or parasternal and paraclavicular areas. Treatment point is specified by thermography on the basis of hyperthermia or hypothermia, and/or by physical examination on the basis of muscular induration and/or tenderness. Besides, in hypothyroidism, or in excessive functional thyroid tension, or in impaired cold tolerance, or in decrease of body temperature, the treatment involves therapeutic courses including thermal physiotherapeutic procedures.

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6 ex, 2 tbl, 3 dwg

FIELD: medicine.

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8 cl, 5 dwg

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EFFECT: elaboration of seat-trainer for neuro-orthopedic rehabilitation.

3 dwg

FIELD: medicine.

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1 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology and angiology, and deals with correction of functions of vascular walls in patients with arterial hypertension of III degree with metabolic syndrome, after thrombosis of eye vessels. For this purpose indices of anti-aggregate, anti-coagulant and fibrinolytic activity of vascular wall are determined. On the basis of said indices calculated is total anti-thrombotic potential of vessels and if its value is 0.069 and lower, complex treatment, including application of individually selected hypocaloric diet, dosed physical load, pioglitazone 30 mg 1 time per day and valsartan 80 mg 1 time per day in the morning and amlodipine 10 mg 1 time per day during 4 months, is administered.

EFFECT: complex of drug and non-drug therapy in combination with empirically selected duration of treatment ensures correction of functions of vascular wall and, thus, reduction, of risk of thrombotic complications in said group of patients due to potentiation of therapeutic effect of separate components of therapeutic complex.

1 ex, 1 dwg

FIELD: medicine.

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EFFECT: method ensures safe increase of functional abilities of human organism without limitation for all age groups, taking into account individual pace, rhythm and coordination of movements.

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to hematology, cardiology and endocrinology and can be used for correction of disturbance of lipid composition of platelet membranes in patients with arterial hypertension with impaired glucose tolerance (AH and IGT). Method includes application of dosed physical exercise, consisting of morning gymnastics, therapeutic and preventive gymnastics and divided physical exercises during the day, daily swimming in swimming pool for not less than 20 minutes a day, metformin 500 mg 2 times per day and lisinopril 10 mg 1 time in the morning during 5 weeks.

EFFECT: combined application of all components of complex makes it possible to normalise lipid composition of platelet membranes in patients with AH and IGT and reduce risk of thrombotic complications.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, orthopedics and therapeutic exercises and can be used in case of combined pelvis and spine deformities of 1-2 degree in children with dysplastic-dystrophic syndrome. Hippotherapy in combination with complex of exercises for correction of definite group of pathologically changed muscles is carried out in the following order from initial position (i.p.) sitting on horse: asymmetric position of pelvic muscles is corrected by fixation of feet in stirrups at different level - lower position of stirrup on the side of pelvis part which is located higher, asymmetric location of back muscles is corrected by asymmetric position of arms with rein behind handrails of hippotherapeutic belt, holding rider in sagittal plane; for strengthening gluteal muscles in i.p. child in turns draws straight legs backward, leaning hands on horse body, and in turns lifts bent knees up, after that lying on back, on horse's croup in turns draws each knee to stomach; for strengthening muscles straining fascia lata, child lying on back on horse's croup on count 1-2 draws straight legs aside simultaneously, on count 3-4 fixes the position, on count 5-6 - in i.p.; for strengthening adductor muscles of hip child in i.p on count 1-2 presses horse's body with straight legs, on count 3-4 - relaxation; in order to influence back muscles child in i.p. crosses arms behind back "in lock", bends forward maximally and independently returns in i.p., after that, leaning body forward, stretches for horse's ear on the side opposite to lifted half of pelvis; for strengthening muscles of lateral and anterior body surface child in i.p., with hands on waist, makes body turns to sides, after that, draws hands "in lock" behind head and in turns stretches for opposite knee with each elbow. Tempo is medium, number of each exercise repetition to 10 times, course includes 10 procedures 3 times per week.

EFFECT: method ensures simultaneous correction of muscles of pelvic girdle and back, develops musculo-articular feeling and musculo-sensoric coordination, rebuilds incorrect motor orientation and forms new motor skills.

1 ex, 4 tbl, 3 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology, and can be used in complex rehabilitation of the patients with central spastic paresis of upper extremities. For this purpose, first under block anaesthesia of branches of a brachial plexus, hand bracing is performed from an axillary approach. In bracing, a rigid bandage is applied to a level of the lower one-third of forearm 2 cm higher than a wrist joint. It is followed with physioprocedures every 15-30 minutes in the following order: paraffin-ozokerite applications or cryotherapy during 20 min, electrical myostimulation of extensor muscles of hand and fingers, massage of the affected extremities, physiotherapy exercises, mirror therapy. Thereafter, the hand is placed in the brace and fixed with an elastic bandage. The bracing time is 3-4 hours 1-2 times a day. A number of the physioprocedures of each type makes 15-20 procedures in the course. The bracing period is 3 weeks to 3 months, and the brace is used till muscle tone recovery, and also active finger extension. For one year after the suffered stroke, the rehabilitation courses are repeated for 3-4 times a year, further the therapeutic courses are performed 2 times a year.

EFFECT: method allows ensuring considerable recovery of motor functions disordered by a local brain damage and activation of neuroplasticity mechanisms of the central nervous system for a shorter period of time in the given category of patients due to optimal selection of a therapeutic regimen and more effective bracing.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to cardiology and angiology, and deals with normalisation of functional activity of vessel wall in patients with arterial hypertension of I-II degree with metabolic syndrome, after thrombosis of eye vessels. For this purpose, indices of anti-aggregation, anti-coagulation and fibrinolytic activity of vascular wall are determined. On the basis of said indices general anti-thrombotic potential of vessels is calculated and if its value is 0.069 and lower, administered is complex treatment, including application of individually selected hupocaloric diet, dosed physical load, introduction of pioglitazone in dose 30 mg 1 time per day and lisinopril in dose 20 mg 1 time per day for 4 months.

EFFECT: complex of drug and non-drug therapy in combination with empirically selected treatment duration ensures complete normalisation of functional activity of vascular wall and, thus, reduction of risk of thrombotic complications in said group of patients due to potentiation of therapeutic effect of separate components of medicinal complex.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to devices for physiotherapy. Apparatus contains support for patient's trunk, head and arms, hull, right and left under-foot rests with feet fixers, supports for right and left under-foot rests, frame, right and left units for creating pressure on leg surface, control panel, computer. Support for trunk, head and arms has elements for fixation in order to prevent displacement of patient's body, and is installed on hull. Right and left under-foot rests with foot fixers are installed by means of supports on frame. Supports for right and left under-foot rests have possibility of displacement and fixation relative to hull. Right and left units for creation of pressure of leg surface include, respectively, right and left tubular rings, each with conductor, guides for conductors, drive mechanism of translational motion of tubular rings, elements of pressure, which form pressure zone, right and left on and off switch of pressure elements and pulsoximetric sensor. Drive mechanism of translational motion of tubular rings has electric engine, gear box or variator, right and left rockers, sensors of electric engine switching off in case when maximal effort is created on said rockers and emergency button. Pressure elements, which form pressure zone, each has lever with working and drive ends, roller for contact with leg surface and drive in form of electric magnet. Right and left on and off switches of pressure elements of drive are contact, are installed in eponymous pusher with possibility of contact with eponymous rocker, has electric connection with all electric magnets, installed on eponymous tubular ring.

EFFECT: invention provides possibility of improving coronary blood flow.

8 cl, 3 dwg

FIELD: medicine, narcology.

SUBSTANCE: one should detect satisfaction insufficiency syndrome due to performing genetic analysis by the presence of, at least, one of the genes coding the exchange of neuromediators being the constituents of human satisfaction system. One should compensate satisfaction insufficiency due to performing, at least, one complex of physical exercises. Moreover, in case of availability of pathological gene allele of dopamine D2 receptor and/or protein gene of reverse dopamine capture in patient one should apply the complex of physical exercises including those to provide sedative effect, and in case of availability of pathological gene allele of dopamine-beta-hydroxylase protein one should apply the complex of physical exercises including those that induce an activating effect. In case of availability of pathological gene allele of dopamine D2 receptor and/or protein gene of reverse dopamine capture one should apply additional food biologically active additives based upon amino acids being the precursors of neuromediators, such as taurine, D-, L-phenylalanine in combination with 5-hydroxytryptophan, hypericin and vitamin B6, and in case of pathological gene allele of dopamine-beta-hydroxylase protein one should additionally apply food biologically active additives based upon amino acids being the precursors of neuromediators, such as: taurine, tyrosine and/or dimethylaminoethanol, lecithin and group B-vitamins. The present innovation enables to take into account pathological disease mechanism.

EFFECT: higher efficiency of prophylaxis.

14 cl, 5 ex

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