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Method for outpatient rehabilitation treatment of patients with ischemic heart disease following cardiac surgery

IPC classes for russian patent Method for outpatient rehabilitation treatment of patients with ischemic heart disease following cardiac surgery (RU 2518594):
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Method of treating locally advanced vaginal cancer / 2493846
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Table for massage and gymnastics Table for massage and gymnastics / 2244503
Table has frame, desk with the opening, support of jack with the traverse provided with members for massage and gymnastics, which can be moved with respect to the opening in the desk. The table is additionally provided with electromagnetic therapy. Each therapy block is connected with the power source, programmer, timer, and commutating device.

FIELD: medicine.

SUBSTANCE: invention refers to rehabilitation of cardiac patients with ischemic heart disease following a cardiac surgery. From the 1-2 rehabilitation days, a mental training, autogenic training elements comprising a successive staged myorelaxation are involved. That is preceded by a complex of breathing exercises including an inspiratory tension in the extremity muscles and an expiratory relaxation, in a combination with the exercises including an expiratory tension in the muscles and an inspiratory relaxation. The complex is completed by doing 'full breathing' exercises. That is followed by a self-massage of the points found in the middle of a palm between the 3rd and 4th metacarpal bones, in a fossa within a knee cap in the lateral direction from a tuberosity of tibia, above the upper edge of a medial malleolus on the right. By the 10-12th rehabilitation day, the massage covers the points of the ninth rib cartilage, in front of free ends of the ninth rib, at an edge of the ninth rib cartilage on the right, in front of free ends of the eleventh rib on a lateral side of an abdomen. Then, the autogenic training is started; it involves the staged body relaxation with increasing the number of effective psychotherapeutic elements at each following stage: the first lesson includes relaxation of the upper extremity muscles to evoke a warmth sense therein; the second lesson consists in relaxation practiced on the first lesson followed by focusing on the lower extremities; the third lesson provides evoking the warmth sense within the incisional wound with underlying relaxation. The following lessons aim at doing the elements of the previous lessons; thereafter, the patient imagines the expiratory warmth growth within the incisional wound. The patient does 2-6 'full breathing' exercises at the end of each lesson.

EFFECT: higher clinical effectiveness ensured by the integrated involvement of the physical and psychophysiological factors by optimising blood circulation in the patient's organs and tissues by oxygenation, regulating the psychoemotional and psychosomatic state, improving stress resistance.

 

The invention relates to medicine, in particular to the field of cardiac rehabilitation after heart surgery.

Restorative treatment of patients with ischemic heart disease after heart surgery involves several steps.

The first stage (surgical clinic) - period unstable clinical condition of the patient and hemodynamics with subsequent progressive improvement in clinical status and hemodynamics.

The second phase (follow-up) - the period of stabilization of the patient and hemodynamics. At this stage, the patient is transferred from the Department of rehabilitation (suburban hospital) or local cardiological sanatorium.

The third stage (outpatient) is carried out at the clinic, and includes a Spa treatment.

Each of the stages of rehabilitation has its own objectives, due to the clinical and functional status of patients.

Autogenic training proposed in 1932 by German physician Johann Heinrich Schultz (1884-1970,). Examining self-reports of people immersed in a hypnotic state, I.G. Schultz noticed that physiological changes are accompanied by certain feelings. For example, the relaxation of muscles accompanied by a feeling of heaviness, and filling with the blood capillaries of the skin - the feeling of warmth. They had proposed a method of inducing physiological shift in the way the passive focusing on the beginnings of feelings, calling this shift. So focus on the real gravity of the body promotes muscle relaxation, and concentration on the real warmth of the body - the blood flow in the capillaries of the skin.

The known method of autogenic training, in which I repeat previously learned by heart medical poetic texts. And use the entry lines of text, each line of which represent the first letter of the text string. The rest of the line is used for applying marks or marks that after repeating lines of text are grouped in columns (RF patent No. 2272658).

The known method of autogenic training, which includes mental training elements autogenic training, containing the sequentially through the stages of relaxation of the muscles, represent the flow of energy through the body, involving breathing, engaging the imagination. This gradual relaxation of the body is performed with the increase in the number of effects on the body elements in a particular sequence. After each stage they control the pulse frequency and the next stage is transferred only at the optimum frequency pulse (Patent for invention №2155075 A61M 21/00). The disadvantage of this method is low efficiency.

The purpose of the invention to improve the treatment efficiency due to integrated use of the education of the physical and physiological factors.

The objective is achieved by implementing the method of rehabilitation treatment of patients with ischemic heart disease after heart surgery in terms of clinics, including mental training elements autogenic training, containing the run sequentially through the stages of relaxation of the muscles, represent the flow of energy through the body, wherein the pre-perform a set of breathing exercises, including exercises, in which you are inhaling, stretch the muscles of the upper and lower extremities, as you exhale, contrary to relax, and alternate them with exercises in which you want when you exhale, stretch the muscles, and when the breath to relax the muscles, completes the inclusion complex of exercises "full breath"; perform self-massage of points located in the heart of the palm between the 3rd and 4th metacarpal bones, in the pit in the field kneecap, lies lateral to the tibial tuberosity, above the upper edge of the inner ankle, at the same time,on the first day in the pit in the area of the patella lies lateral to the tibial tuberosity, above the upper edge of the inner ankle to the right, on the second day; to 10-12 day rehabilitation massages points of the cartilage of the ninth rib, before the free ends of the ninth rib, massage the point in front of the free end of the eleventh rib on the lateral surface of the abdomen, done is make an impact on point, located at the edge of the cartilage of the ninth rib on the right; proceed to autogenic training, during which a gradual relaxation of the body with an increase at each subsequent stage number of effects on the body elements of psychotherapy: on 1 lesson, carry out the relaxation of the muscles of the upper extremities, causing a sensation of heat in them, during the 2 classes provide relaxation for the first lesson, then focus on the lower extremities, 3 lesson on the background of the relaxation causes a sensation of heat in the surgical wound, in subsequent studies the exercise of elements of previous stages and then the patient is that the exhalation flows radiation energy generated in the field postoperative wounds and rush to the external environment, and heated them space is painted in pale pink color and is in contact with the whole body of the patient, the patient is freed from the fear of recurrence of pain in the heart area, gaining confidence in a favorable outcome, feels smooth heart beats; end classes run 2-6 exercises "full breath".

The method is as follows.

The patient is prescribed method of rehabilitation treatment of patients with ischemic heart disease after heart surgery in terms of clinics, including 1-2 d is I rehabilitation mental training, elements autogenic training, containing the run sequentially through the stages of muscle, characterized in that the pre-perform a set of breathing exercises, including exercises, in which you are inhaling, stretch the muscles of the upper and lower extremities, and when you exhale, on the contrary, is to relax, and alternate them with exercises in which you want when you exhale, stretch the muscles, and when the breath to relax the muscles. Completes complex with the inclusion of exercises "full breath"; perform self-massage of points located in the heart of the palm between the 3rd and 4th metacarpal bones, in the pit in the area of the patella lies lateral to the tibial tuberosity, above the upper edge of the inner ankle to the right. By 10-12 day rehabilitation massages the following points: the cartilage of the ninth rib, before the free ends of the ninth rib on the edge of the cartilage of the ninth rib on the right, before the free end of the eleventh rib on the lateral surface of the abdomen; begin autogenic training, during which a gradual relaxation of the body with an increase at each subsequent stage number of effects on the body elements of psychotherapy: on 1 lesson, carry out the relaxation of the muscles of the upper extremities, causing a sensation of heat in them, during the 2 classes perform relaxation on the first busy the Yu, then focus on the lower extremities, 3 lesson on the background of relaxation, causing a sensation of heat in the surgical wound, in subsequent studies the exercise of elements of previous stages and then the patient is that on the exhale in the surgical wound to feel the heat intensify. Completed classes run 2-6 exercises "full breath".

Classes are held daily under the guidance of a practitioner of physical therapy. Tasks of a practitioner of physical therapy are to encourage independent practice each patient, to assimilate elements of auditory training, striving to be calm, leisurely, sure that the classes with the Methodist and independent studies lead to a steady improvement in his physical and mental condition.

The complex treatment of patients with elements of breathing exercises helps to optimize blood circulation in organs and tissues of the patient, the saturation of tissues, including the myocardium with oxygen.

"Full breath" yoga combines all the good sides of the upper, middle and lower breathing without having their disadvantages. It drives the whole lung breathing apparatus. The chest cavity expands in all directions and every part of her respiratory mechanism works in the full measure of our possible the tee.

One of the most important features of this method of breathing that when all the muscles of the breathing apparatus are in action, while other forms of breathing some muscles even absolutely not moving. In the complete breathing are driven by the muscles that move the ribs and the lungs expand. Aperture has full freedom to carry out its purpose and to assist the action of the lungs greatest assistance. The bottom edges are drawn by the diaphragm down, while other muscles hold them in place, and midwivery pulled up, causing the middle part of the chest is expanded to the maximum. The upper part of the lungs filled with air, too, in full, by the action of the same midwivery muscles. Such a General and simultaneous action of all the muscles of the upper, middle and lower part of the chest and diaphragm gives the best results.

For self-massage using point relating to reflex points related to heart activity. In addition to these points can be involved points on the back of the hand point Hye-su and in the upper third of the leg - zu-San-Li.

The inclusion in the comprehensive treatment of the elements of auto-training allows you to adjust various emotional and psychosomatic condition, including borderline disorders, vegetariani and neuroses bodies. One is a belt it can be used to eliminate bad habits, pathological inclinations (nikotinizm, overeating) and their prevention, to improve and restore health, increase creativity, neuro-mental stability under stressful conditions, etc. Obtained in the process of mastering the way skills can be applied in real life, including in situations of direct impact of stressful factors invisible to others without interrupting the main activity or communication. The way available for most people as healthy and patients with borderline mental disorders. It is harmless, no side effects. Saves patients time and money on buying expensive medications.

To evaluate therapeutic effectiveness of the proposed method we used in the dynamics of methods of assessing the quality of life of patients.

Constitution of the world Health Organization describes health as a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity. Creating a working definition for this concept, in 1957, the working group of the who expert Committee proposed to include under the term "health status or the quality of the human body, providing adequate functioning of the organization the ISM in these conditions (genetic or environmental).

Respectively, and the purpose of healing is, as you know, maintaining or restoring human health not only in physical but also in mental and social aspects. This purpose must meet all kinds of medical activity on the identification, treatment and prevention of diseases.

Was used the questionnaire of quality of life in heart failure (MLHFQ), developed by T. Rector, J. Cohn in 1987, which contains 21 questions, the answers to which allow you to define how existing heart failure limits: first, the physical and functional capabilities of the patient to cope with normal daily loads (self, tolerance to physical, social, emotional stress, the need to have adequate sleep and rest, mobility and independence), and secondly, socio-economic aspects and public relations of the patient (place in the family and participate in family life, material the provision and cost of treatment, professional responsibilities, communication with friends and recreation), thirdly, positive emotional perception of life (the feeling of being a burden to family and friends, loss of control over life and a fear for the future and hopelessness).

This survey successfully used in many studies, including in Russia.

Answer 21 the proposed issue due is to be given to patients themselves. The result can be gained sum of scores from 0 (incredible, absolutely the best quality of life) to 105 (incredible, extremely low quality of life). When analyzing the results, it should be remembered that a large quantity of quality of life indicates a lower (worse) level of quality of life, and Vice versa, lower - higher (better) level of quality of life.

Assessment of quality of life questionnaire MLHFQ was held in Tarkhovskoe military sanatorium 42 patients who received treatment after heart surgery at the age from 51 to 73 years, male 36, female 6.

The survey was conducted on admission of patients for treatment in the sanatorium and before completion of treatment. Comparing the values obtained when the first study of the patient and at discharge. Turned out that the quality of life of patients improved on average 1.2-1.4 times. Significantly improved mental status of patients, reduced complaints, false angina that played a role in the improvement of the subjective condition of patients, increasing their vitality, the emergence of the right of self-assessment of the status and critical attitude to cardialgia.

The method of rehabilitation treatment of patients with ischemic heart disease after heart surgery in terms of clinics, including with 1-2 days of rehabilitation: the mental training, the elements of autogenous is trenirovki, contains the run sequentially through the stages of muscle, characterized in that the pre-perform a set of breathing exercises, including exercises, in which you are inhaling, stretch the muscles of the upper and lower extremities, and when you exhale, on the contrary, is to relax, and alternate them with exercises in which you want when you exhale, stretch the muscles, and when the breath to relax the muscles, and ends the inclusion complex of exercises "full breath"; perform self-massage of points: in the center of the palm between the 3rd and 4th metacarpal bones, in the pit in the area of the patella lies lateral to the tibial tuberosity above the upper edge of the inner ankle to the right; to 10-12 day rehabilitation massages the following points: the cartilage of the ninth rib, before the free ends of the ninth rib on the edge of the cartilage of the ninth rib on the right, before the free end of the eleventh rib on the lateral surface of the abdomen; begin autogenic training, during which a gradual relaxation of the body with an increase at each subsequent stage number of effects on the body elements of psychotherapy: on 1 lesson, carry out the relaxation of the muscles of the upper extremities, causing a sensation of heat in them, during the 2 classes provide relaxation for the first lesson, then concentrate the attention is on the lower extremities, 3 lesson on the background of the relaxation causes a sensation of heat in the surgical wound, in subsequent studies the exercise of elements of previous stages, and then the patient is that on the exhale in the surgical wound sensations of heat increases; end classes run 2-6 exercises "full breath".

 

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