RU2236265C2 - Method for treating the cases of cerebrospinal vascular disorders - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves exposing cervical sympathetic nodes and plexuses to pulsating low frequency currents. Vector traction of cervical vertebral column segment is carried out. Carbon dioxide baths are administered at T 35° C for 12 min in 10 baths long course. First, six carbon dioxide baths are given additionally saturated with carbon dioxide to 1.3 g/l after the fourth bath having natural carbon dioxide concentration of 0.8-1.0 g/l.

EFFECT: enhanced effectiveness of treatment.

4 dwg

Description

The invention relates to medicine, is intended for the complex treatment of patients with cerebrospinal vascular disorders using physical / including spa / medical factors: vertical (in the chair) vector (optimized) traction of the cervical spine according to the method of I.I. Velikanova. I.G. Ignatieff (patent No. 1805945 dated 03/25/1991) in the conditions of the Kislovodsk resort using natural carbon dioxide mineral baths (UMV) / narzan / with different concentrations of carbon dioxide.

The prototype of the method is the work of I.I. Velikanov, D.I. Velikanov, S.M. Bichenkov “On the possibility of rehabilitation treatment of patients with combined cerebrospinal vascular pathology in the low- and mid-mountain resort of Kislovodsk” (Actual problems of rehabilitation medicine, balneology and physiotherapy, M. 2001. - P.45), which shows the possibility and effectiveness of the treatment of the mentioned pathology with the testing of the treatment complex, which consisted of the internal intake of sulfate narzan, diet therapy, walks along the paths of terrenkur, coal acidic mineral baths (with a natural concentration of carbon dioxide), pulsed currents acting on the cervical sympathetic nodes and plexuses and traction of the cervical spine according to the method of I.I. Velikanov, I.G. Ignatyev (1991).

The work demonstrated the effectiveness of the applied treatment complex in both clinical and paraclinical indicators (according to rheoencephalography, polymodal evoked brain potentials and heart rate variability).

The disadvantage of this work is that to improve the effectiveness of treatment of patients, previously conducted studies on the leading, main role of the concentration of carbon dioxide in a carbon dioxide mineral bath and increasing this concentration to an extremely dissolved level in order to increase the therapeutic effect were not taken into account.

Materials on the role of carbon dioxide (CO ₂ ) of various concentrations in the unequal response of physiological systems to its action are available in analogues of the proposed method: I.I. Giants. The effect of single narzan baths with different concentrations of carbon dioxide on the electrical activity of the brain of patients with early clinical manifestations of cerebral atherosclerosis (in: Actual issues of balneology and physiotherapy. Pyatigorsk. 1966. - S.300-303); and I.I. Velikanov, N.I. Voronov. The effect of single and course narzan baths with different concentrations of carbon dioxide on some hemodynamic parameters of patients with early stages of cerebral arteriosclerosis (according to tachoscillography). (Questions of balneology, pharmacy and pharmacology. Pyatigorsk. 1967. - S.277-279).

The paper I.I.Velikanova (1966) showed that a single Markov renewal equation, final saturation to 1.35 g / liter CO _2, improves the bioelectric activity of the brain and its reactivity in patients to a greater extent than the bath with a natural content of carbon dioxide (0, 8-1.0 g / l). It follows from the work of I.I. Velikanov and N.I. Voronov (1967) that on hemodynamic parameters (systolic, diastolic, lateral pressure, etc.) UMV with both a natural carbon dioxide content and saturated CO ₂ has a weak bi-directional effect, increasing them by 3.2-7.5 mm Hg or decreasing by 3.4-5.1 mm Hg Also noted is the phase nature of the upcoming shifts depending on the time of the study after the bath, as well as on the initial state of hemodynamic parameters. Under the influence of the UMW course with a natural CO ₂ content (11 baths), an equalization of blood pressure (BP) was observed, and under the influence of saturated CO _{2 there} was a tendency to an increase in blood pressure from 132.8 ± 12.53 to 136.8 ± 13.7 mm Hg. Art.

S.P. Melnichuk (External respiration in patients with cardiovascular diseases in the conditions of spa treatment in Kislovodsk: Author. Diss. Doct. Medical Sciences, 1965. - P.33) based on his research, he concludes that UMF with artificially increased (up to 1.3 g / l) carbon dioxide content have the same type with conventional UMV (narzan), but a much more pronounced effect on external respiration indicators; the concentration of carbon dioxide in UMW “is a very important and main factor determining the degree of favorable (discharge) effect of the bath on the function of external respiration, and, consequently, blood circulation”.

A.A. Lozinsky (1949), Remlinger (1958) believe that carbonic mineral baths can be fully functional only when the carbon dioxide concentration is not lower than 1.0 g / l (cited by S.P. Melnichuk. 1965. - P.33).

However, in the above prototype and analogues in the aspect of the invention, there are a number of the following significant disadvantages.

1) The task was not to study the effect of a single UMW with a different concentration of CO ₂ on the clinical condition of patients in general and on patients with complex cerebrospinal vascular disorders in particular.

2) We studied the effect of single UMW with a natural concentration of CO ₂ and saturated only on the bioelectrical activity of the brain, single and course baths on some hemodynamic parameters, and they did not set the goal of their comparative effect on the clinical condition of patients (well-being, objective status).

3) We studied the effect of single normal and saturated CO ₂ on the function of external respiration, regardless of the dynamics of the clinical condition, and also did not study the effect on the patient of a course of saturated CO ₂ baths.

4) The goal was not to study the afferent flow from the autonomic innervation (sympathetic and parasympathetic) to the sinus node and, therefore, the regulation of the rhythm of cardiac activity with the extrapolation of these changes to the regulation of all physiological systems.

5) The task was not to study a heavier contingent of patients with combined cerebrospinal vascular disorders, as well as to study the conductivity of impulses along the somatosensory pathways of the spinal cord (at the level of the cervical thickening) and the brain stem and their changes under the influence of UMV with different concentrations of CO ₂ .

Based on the foregoing, the following task was posed in the proposed method - to study the effect of two types of bathtubs for a single and course application: 1st — UHMW with a natural concentration of CO ₂ No. 10 and 2nd — UHM of the saturated CO ₂ No. 6, followed by 4 baths with a natural concentration of CO ₂ on the following indicators:

a) the level of blood pressure;

b) the clinical condition of patients (subjective and objective);

c) the dynamics of afferent flows along the vegetative paths to the sinus node (according to the study of heart rate variability with the inclusion of an ortho test);

d) the conductivity of afferent somatic impulses at the level of the cervical thickening and auditory tract at the level of the brain stem when applying somatosensory and auditory stimuli:

e) the dynamics of cerebral and spinal circulation, indicators of blood inflow and outflow through the intra- and extracerebral vessels (carotid and vertebral).

To solve this problem, the following apparatuses and methods were used.

1. The apparatus “Neuron-Spectrum-4" of the company "Neurosoft" (Ivanovo), with which we studied the evoked potentials of the brain (somatosensory and auditory), as well as indicators of the autonomic regulation of heart rhythm (HRV).

2. Rographic prefix RG-02 (Lviv), with the help of which the condition (tone, elasticity) of extra- and intracranial vessels of the brain in 2 leads was studied: frontomastoid and occipitomastoid.

All patients of both the main group and the comparison group received the following treatment: diet, walking along the paths of terrencur, internal use of mineral water (sulfate or dolomite narzan), diadynamic or sinusoidal modulated currents to the cervical sympathetic nodes and plexuses and vector traction in the chair according to the method I.I. Velikanova, I.G. Ignatyeva (patent No. 1805945 dated 03.25.1991). The difference between the main (experimental) and comparison groups was that the patients of the main group received 6 saturated and 4 ordinary UMV, and patients ppy comparing received all 10 baths with ordinary (natural) CO ₂ concentration, final saturation carbonation Markov renewal equation was carried out using a saturator: a tank saturator fed Markov renewal equation t ° + 38 ° C, then from a cylinder of carbon dioxide through a tube with holes at the bottom of the saturator was passed carbon dioxide to as long as the pressure in the saturator did not reach 2.5 atmospheres. After that, the supply of CO _{2 was} stopped, and the saturation of the UWW with carbon dioxide under this pressure was carried out for 30 minutes. During this time, the water t in the saturator decreased and the water entered the bath with t ° + 35 ° C, CO ₂ concentration _of 1.3 g / l.

Before and 1.5 hours after UMW with a natural concentration of carbon dioxide at the beginning of treatment, the following studies were carried out: blood pressure in the brachial artery was measured, heart rate variability (HRV) was recorded using an orthostatic test, REG was recorded in the frontastomoidal and occipitomastoidal leads: patients were questioned about their well-being. A day later, similar studies were carried out on an ultra-saturated solubility up to the maximum solubility of CO ₂ (1.3 g / l). The parameters of both types of baths were the same: t ° + 35 ° C, duration - 12 minutes.

Depending on the treatment complex, all patients were divided into the main (experimental) and comparison groups (control). The clinical characteristics of patients in groups are presented in table 1. As can be seen from the table, both groups of patients did not have significant clinical differences, i.e. were comparable.

Studies of cerebrospinal neurodynamics, hemodynamics and autonomic regulation of heart rate were carried out before and after course treatment, as well as before and after 1.5 hours of rest after taking a single carbon dioxide mineral bath with varying degrees of carbonation.

An analysis of the indicators of autonomic regulation of the heart rhythm under the influence of a single carbon dioxide mineral bath (UMW) with a natural content of CO ₂ and saturated to the maximum concentration of CO ₂ revealed that after taking UMV with a natural concentration of carbon dioxide, heart rate decreased from 70.7 ± 1.81 to 66 , 2 ± 1.7 beats. in min (reliably according to the criteria of nonparametric statistics - p = 0.0001 according to Dickson-Mood and p = 0.0004 according to the Wilcoxon rank criterion).

Under the influence of a saturated carbonate mineral bath (RLMS), heart rate decreased from 67.9 ± 1.67 to 65.3 ± 1.51 (reliably by the Fisher exact method, p = 0.041: Dixon-Mud and Wilcoxon criteria - p <0.05) .

The total power of the spectrum of autonomic regulation of heart rhythm (Tr) was initially reduced (1122 ± 215.6 ms ² ). After 1.5 hours after receiving UMV with a natural concentration of CO ₂ , the spectrum power slightly increased and amounted to 1278 ± 168.1 ms ² (reliably by the Fisher exact method - p = 0.024 and Wilcoxon's signed criterion p = 0.008). After a single RWMF, the total power increased to a greater extent - from 918.2 ± 145.7 to 1428.1 ± 239.8 ms ² (approaching a reliable value according to Student's t-p = 0.075; reliable according to Fisher - p = 0.0076 and according to the criteria of nonparametric statistics). The dynamics of the balance of the parts of the autonomic nervous system (LF / HF) was as follows: under the influence of the “usual” UMW, the predominance of parasympathetic influences in the initial state increased from 2.22 ± 0.346 to 1.82 ± 0.323, approaching reliable shifts according to the exact Fisher method (p = 0.088) and the Wilcoxon sign criterion (p = 0.059). After receiving the SUMF, the dynamics of LF / HF was less pronounced - the LF / HF criterion decreased from 2.37 ± 0.442 to 2.123 ± 0.344 (reliably by Wilcoxon's sign criterion, p = 0.0004).

The VLF% indicator, indicating the contribution to the structure of the spectrum of humoral-metabolic and cerebral ergotropic influences in the initial state, was high - 56.09 + 3.27 (with the norm of 17.5-39.8). Under the influence of a conventional UMW, it somewhat (statistically unreliable - p> 0.05) decreased to 53.61 ± 3.45. Under the influence of RLMS, this indicator practically did not change.

In an orthostatic test in the initial state, parasympathetic reactivity (coefficient 30/15) was reduced to 1.09 ± 0.01 (with a norm of 1.2-1.35). Under the influence of a single UMW with a natural concentration of CO _2, this criterion increased insignificantly (and unreliably) from 1.09 ± 0.01 to 1.11 ± 0.01 (- p> 0.05): while after taking the SUMW , it significantly increased from 1.08 ± 0.009 to 1.15 ± 0.02 (according to Student's test - p = 0.0005, according to Fisher - p = 0.023, highly reliable according to the criteria of nonparametric statistics). Sympathetic autonomic support / according to the LF% indicator / for an orthostatic test, low in the initial state - 24.55 ± 2.67 (with a norm> 38.3) increased after taking the “usual” UMV to 28.5 ± 3.64% (reliably by Wilcoxon's sign criterion - p = 0.0044). After taking the SILV, this indicator increased significantly from 25.38 ± 3.1 to 31.58 ± 3.33 (approaching the conditional norm: reliably according to the criteria of nonparametric statistics).

Thus, the effect of SEMI has a more pronounced positive effect on the autonomic regulation of heart rhythm, increasing the contribution of segmental (reflex) regulation of both the sympathetic and parasympathetic parts of the autonomic nervous system. Amphotericity (bidirectionality) of the action of a carbon dioxide mineral bath increases with the saturation of narzan to the maximum solubility of carbon dioxide. The labilization (“loosening”) of the rigid autonomic regulation of heart activity / typical for patients with combined cerebrospinal vascular pathology / under the influence of UMV leads to more adequate adaptive reactions from the side of the heart (with an extension of their range) to the action of “disturbing stimuli” - UMV, orthoprobe. RLMS in this regard have a more pronounced positive effect compared to narzan baths with a standard concentration of CO ₂ .

Dynamics of cerebral circulation under the influence of a single additional saturation CO ₂ bath according rheoencephalography (REG) reflected in Table 2.

As can be seen from the data in the table, the pulse blood filling of the vessels of the basin of the internal carotid artery (FM abduction) increased 1.5 hours after the reception of the SCLM by 8.72% - from 0.872 ± 0.055 to 0.948 ± 0.729 on the right (reliably by the Wilcoxon sign criterion p = 0, 0176) and by 5.79% - from 0.777 ± 0.069 to 0.822 + 0.067 on the left (p = 0.0123). Also, the blood supply to the vessels in the vertebrobasilar basin (WBB) - / O-M lead / - increased by 11.2% - from 0.626 + 0.037 to 0.696 + 0.048 on the right (p-0.055) and by 16.95% - from 0.5221 ± 0.037 to 0.610 ± 0.047 on the left (p = 0.011).

The tone of the arteries of large and medium caliber remained virtually unchanged (in terms of α / T REG), but venous outflow of blood from the cranial cavity (according to the diastolic index REG - DSI) significantly improved, mainly on the right (from 89.03 ± 2.81 to 86 , 91 ± 2.29; p = 0.003).

The asymmetry coefficient of the pulse blood supply to the vessels of the pool of the internal carotid artery decreased insignificantly, and in the vertebrobasilar pool the asymmetry alignment was a reliable value from 45.56 ± 12.21 to 24.70 ± 3.93% (p = 0.0095 according to Fisher). The alignment of the asymmetry of blood supply to blood vessels according to LB Ivanov and VL Makarov (Lectures on clinical rheography. M., 2000, - 320 p.) Is an important indicator of improving cerebral circulation.

Due to a more pronounced increase in pulse blood flow through the vessels of the vertebrobasilar system, the vertebral-carotid index (V / C) significantly (p = 0.007) increased from 0.715 ± 0.033 to 0.762 ± 0.043.

Under the influence of a single UMW with a natural concentration of CO _{2, the} dynamics of the indicators of cerebral circulation was less favorable compared with that when taking saturated CO ₂ baths (see Table 2). So, RI in the basin of the internal carotid artery decreased on the right from 1.00 ± 0.09 to 0.887 ± 0.051 (according to Fisher p = 0.0901) and on the left - from 0.865 ± 0.066 to 0.835 ± 0.05 approached a reliable value (p = 0.069 by Wilcoxon's signed criterion). In the vertebrobasilar basin, RI either decreased unreliably or did not change. The tone of large and medium-sized arteries in the basin of the internal carotid artery (FM and O-M leads) increased slightly (reliably by Wilcoxon's sign criterion). Venous outflow of blood was either difficult in the FM lead or had a different focus in the OM lead. The asymmetry coefficient in the FM lead increased slightly - from 18.00 ± 3.74 to 21.51 ± 3.81 (p = 0.0878 according to the Wilcoxon sign test), and in the vertebrobasilar basin (OM lead) decreased from 32, 73 ± 15.12 to 27.18 ± 6.90 (Fisher p = 0.0472). The V / C coefficient decreased slightly from 0.721 ± 0.039 to 0.716 ± 0.03 (according to Wilcoxon's signed criterion, p = 0.078).

Thus, a comparison of the effect on the cerebral circulation of a single bath with a natural content of CO ₂ and saturated CO ₂ revealed a more favorable effect of a saturated CO ₂ bath — a greater increase in pulse blood flow to the brain, especially in the vessels of the vertebrobasilar system with a decrease in the asymmetry of blood flow along the sides of the pool , improvement of venous outflow of blood, decrease in initially increased tone of large and medium caliber arteries.

The results of the course treatment of the entire array of patients are shown in table. 3. All patients were discharged with positive dynamics.

As can be seen from the data in the table in the main group, the percentage of patients discharged with significant improvement is much higher compared to the control group (II) (48.6% and 11.4%, respectively). The treatment results are highly reliable - the criterion χ ² = 13.22 (p <0.001).

The method is illustrated by the following examples.

EXAMPLE 1

Patient V-tsky, 39 years old, engineer, medical history No. 1605, was treated from 12/24/2001 to 01/14/2002 with a diagnosis of chronic cerebrovascular insufficiency, mainly in the vertebrobasilar system. ISMOS in the vertebrobasilar system (from 1996), cervical radiculomyelosemia; osteochondrosis C _VI -Th _I III art., Kimmerle syndrome, protrusion of C _4-7 discs craniocervicalgia, vertebrogenic brachialgia; humeroscapular periarthrosis, arterial hypertension.

Received complaints of headache attacks, dizziness, incl. systemic nature, aggravated by turning the head, shakiness when walking, hearing loss, tinnitus, pain in the craniocervical junction, cervical spine, shoulder muscles and right shoulder joint, decreased strength in the muscles and numbness of the fingers, fatigue, distracted attention, decreased memory for current events.

For 10 years, vertebrogenic pain in the cervicothoracic spine has been worrying with a gradual attachment and an increase in the above symptoms. In 1996, against the background of psychophysical overstrain, he suffered an ischemic stroke in the vertebrobasilar system. Inpatient treatment with vasoactive and metabolic drugs with a positive effect was carried out; the condition is regarded as a stroke with minimal residual symptoms. In subsequent episodes of cerebrovascular accident was not observed. In 2001 - exacerbation of vertebrogenic symptoms.

Upon admission to the neurological department of the Kislovodsk clinic: pulse - 72 per minute, satisfactory properties, blood pressure 140/95 mm Hg, temporal blood pressure on the right - 80, left 70 mm Hg

Movements in the cervical spine are limited: turn right - up to 60 °, left - 80 °, back - up to 20 °. When turning the head there is pain, discomfort in the SHOP. Soreness of paravertebral points along the spine. The pupils are wide, the reaction to light is weakened, weak convergence on both sides: a decrease in corneal reflexes; asymmetry of a grin, deviation of the tongue and uvula to the right, a labial-chin reflex, a carpal reflex of Rossolimo (s) are revealed. Reflexes on the arms - styloradial s> d, with biceps and triceps - reduced (d = s). Knee reflexes - with a hyperkinetic component (d = s), Achilles - satisfactory (d = s). In the Romberg position, it is unstable; when performing a finger test, a slip is missed, more to the left. Sensory impairment on the upper extremities according to segmental type. Muscle tone is reduced, mainly in the lower extremities. Positive symptom of rotated feet (d), Bogolepova. There are no pathological stop signs.

On the ECG, there are signs of left ventricular myocardial hypertrophy, impaired repolarization of the anterior septum region.

On the R-grams of the cervical spine - ossification of the occipital-axial ligament: straightening of the cervical lordosis, restriction of flexion and extension. Sealing of end plates C _II - _VIII ; Schmorl's hernia C _VI-VII . Conclusion: osteochondrosis C _VI -Th _I III art., Kimmerle syndrome.

MRI of the cervicothoracic spine - C _5-6 eccentric protrusion and C _4-5 and C _6-7 concentric disc protrusions. segmentally deforming the dural sac, partially stenosing the lumen of the spinal canal, compressing the anterior subarachnoid space. The contours of the spinal cord at this level are deformed. Reducing the height of the discs C _4-7 . prolapse of the lower locking plate C ₇ into the vertebral body as a forming Schmorl hernia. Signs of spondylarthrosis.

REG - pulse blood supply is moderately reduced in all basins against the background of increased arterial tone in small-caliber arteries and microvasculature with asymmetry of pulse blood supply between the sides, mainly in the air force (48%).

HRV is the initial decrease in the total power of the spectrum of neurohumoral regulation (1166), the excessive influence of the parasympathetic component (HF-57.9%) with an inadequate effect of the sympathetic component (LF-19.2%). During orthoprobe, reduced activation of the sympathetic part of the autonomic nervous system was noted: (coefficient 30/15-ue).

Cerebrospinal evoked potentials are a violation of somatosensory conduction at the cervical-stem level.

The patient underwent balneotherapy (carbon dioxide mineral baths No. 10, including 6 saturated with carbon dioxide to the maximum concentration of CO ₂ and 4 with a standard concentration of CO ₂ ), physiotherapy (diadynamic currents to the projection of the vertebral artery No. 6) and “gentle” traction of the cervical spine (SHOP) at OPT 15 ° forward with a pull force of 1.5-2.0 kg No. 10, massage of the cervical-collar zone No. 8.

As a result of the therapy, dizziness and shakiness during walking disappeared, the hemodynamic parameters returned to normal. concentration has improved. Pain vertebrogenic symptoms were reduced in the cervicothoracic spine (SHGP), muscles of the shoulders), numbness of the fingers disappeared, and the frequency and intensity of craniocervicalgia decreased. However, moderate pain in the right shoulder remains, “crunching” when turning the head.

At discharge: pulse - 60 per minute, satisfactory properties. HELL 130/80 mm Hg, temporal HELL d - 70, s - 60 mm Hg Pupils of normal size and shape, live photoreactions. A slight weakness of convergence persists. There are no reflexes of oral automatism. Tendon reflexes are satisfactory, with no clear difference between the parties. Movements in the SHOP in full, paravertebral points are sensitive, there are no symptoms of tension of the cervical roots. In the Romberg position it is stable, the finger test carries out clearly, with a slight intention on the left. Sensitivity is not impaired. Muscle tone is not changed, there are no pathological stop signs. Discharged with significant improvement.

According to the REG data, a moderate increase in pulse blood supply was noted both in the carotid and vertebrobasilar systems (by 15.2%); a tendency to normalize vascular tone, a decrease in the asymmetry between the sides of the CHD (up to 5.7%).

According to HRV, after a course of treatment, an increase in the average heart rate by 5 beats was noted. in minutes A slight increase in the total power of the spectrum of vegetative regulation.

More pronounced changes occurred in the structure of the spectrum of vegetative regulation - the contribution of very slow waves (VLF), reflecting humoral-metabolic and cerebral ergotropic effects, slightly decreased (by 2.3%), but the contribution of slow waves (LF), reflecting sympathetic influences, increased by 20 , 8%: contribution of fast waves (HF) - parasympathetic influences / initially excessively high / decreased by 18.5%. The balance of the ANS divisions has changed from parasympatheticcotonia to eutonia; sympathetic activation slightly increased during an orthostatic test.

According to the somatosensory evoked potentials of the brain, an improvement was observed at the cervical-stem level.

Figure 1-18 shows the data according to the research results.

EXAMPLE 2

Gnoyev, 53 years old, doctor, medical history No. 144. He was treated from 07/27 to 08/18/2002 with a diagnosis of chronic cerebrovascular insufficiency, mainly in the vertebrobasilar system, the initial manifestations of cervical radiculomyelosemia: extravasal commissive-irritative effect on the vertebral arteries, cervical osteochondrosis; vertebrogenic craniocervicalgia; arterial hypertension, including regional cerebral.

Received with complaints of dizziness, incl. when turning the head, hearing loss, pronounced noise in the ears, head, pain in the craniocervical junction, cervical spine, numbness of the fingers, including in the daytime, irritability, fatigue, distracted attention, decreased memory for current events.

For 2 years, vertebrogenic pain in the cervical spine has been worrying with a gradual attachment and an increase in the above symptoms. In 2002, dizziness, noise in the ears and head joined, numbness of the fingers began to disturb in the daytime. History - episodes of increased blood pressure.

Upon admission to the neurological department of the Kislovodsk clinic: pulse - 74 per minute, satisfactory properties, blood pressure 140/90 mm Hg

Movement in the cervical spine is limited. When turning the head there is pain, discomfort in the SHOP. Soreness of paravertebral points in the cervicothoracic spine. Pupils of normal size and shape, the reaction to light is weakened, weak convergence on both sides; tremor of the eyelids. The Marinesco-Radovici reflex (s> d), the Rossolimo carpal reflex (s) are revealed. Reflexes on the hands are reduced (d = s). Knee reflexes - with a hyperkinetic component (d = s), Achilles - satisfactory (d = s). In the Romberg position, it is unstable, the finger test performs satisfactorily. Muscle tone is not changed. There are no pathological stop signs.

On the ECG, there are signs of left ventricular myocardial hypertrophy, intraventricular conduction disturbances.

REG - a moderate decrease in pulse blood supply, mainly in the vertebrobasilar pool against the background of arteriovenous dystonia with signs of obstruction of the venous outflow, increased arterial tone in the arteries of small caliber and microvasculature.

HRV - the initial decrease in the total power of the spectrum of neurohumoral regulation (168), the humoral-metabolic effects on autonomic regulation (VLF-62.5%) with a decrease in reflex effects (HF-21.5%: LF-16%) dominate. During orthoprobe, decreased activation of the sympathetic part of the autonomic nervous system was noted: (coefficient 30 / 15-1.11 cu).

The patient underwent balneotherapy (carbon dioxide mineral baths No. 10, including 1 saturated with carbon dioxide to the maximum concentration of CO ₂ and 9 with a standard concentration of CO ₂ ), physiotherapy (diadynamic currents to the projection of the vertebral artery No. 6) and “sparing” traction of SHOP during optic surgery 0 ° forward with a traction force of 1.5 kg No. 10, massage of the cervical-collar zone No. 8.

As a result of the therapy, the frequency, intensity of dizziness and noise decreased, the quality of sleep improved, vertebrogenic pains decreased, and the numbness of the fingers disappeared, including in the daytime.

After a course of treatment according to the REG data, a slight increase in pulse blood supply in the vertebrobasilar system was noted (by 5.4%); decrease in dystonia, a tendency to normalize vascular tone.

In the study of HRV, conducted on “one-time” procedures for taking mineral baths with different concentrations of carbon dioxide, the following data were obtained.

1. In a single UMW procedure with a standard concentration of CO ₂ : a native of average heart rate of 15 beats occurred. in minutes;

- the total power of the spectrum of vegetative regulation increased 5.1 times;

- the contribution of very slow waves (VLF-humoral-metabolic and cerebral ergotropic effects) decreased by 11.8% in the structure of the spectrum;

- the contribution of slow waves (LF - sympathetic influences) remained virtually unchanged (increased by 1.7%);

- the contribution of fast waves (HF-parasympathetic influences) increased by 10.1%;

- the balance of the departments of the ANS remained at the level of ytoniya:

- at the orthoprobe, parasympathetic reactivity did not significantly change (coefficient 30/15 remained low); sympathetic activation remained unchanged.

2. On a single procedure UMV, saturated with CO ₂ :

- there was a decrease in average heart rate by 26 beats. in minutes;

- on the background recording, TP increased by 5.7 times;

- in the structure of the spectrum, the contribution of very slow waves (VLF - humoral-metabolic and cerebral ergotropic effects) practically did not change (increased by 0.7%);

- the contribution of slow waves (LF - sympathetic influences) significantly decreased (by 22.1%);

- the contribution of fast waves (HF - parasympathetic influences) significantly increased by 21.4%.

- sympathicotonia was replaced by parasympathicotonia;

- parasympathetic reactivity increased at the orthoprobe (coefficient 30/15 entered the conditional norm); sympathetic activation increased and became adequate.

The above-described shifts were recorded immediately after RLMS and showed up to the maximum after 1.5 hours of rest after RLMS.

Thus, in this example, there is a tendency toward a more powerful positive modulating effect on the body’s regulatory vegetative apparatus (in terms of effects on the sinus node and autonomic regulation of the heart) of a single REMV procedure compared to UMV with a standard concentration of CO ₂ , which is manifested primarily in a more a significant increase in the total power of the spectrum of autonomic regulation of the heart, an increase in parasympathetic influences, a decrease in sympathetic influences and an improvement in the parasympathetic reaction vnosti and vegetative support activities.

At discharge: pulse - 72 per minute, satisfactory properties, blood pressure 140/90 mm Hg Pupils of normal size and shape, photoreactions are satisfactory. A slight weakness of convergence persists. Hyperalgesia of the outer zones of Zelder. An unstable Marinesco-Radovici reflex is detected (s> d). Hand reflex Rossolimo (s). Reflexes on the hands are moderately reduced (d = s). Knee reflexes are elevated (d = s), Achilles reflexes are satisfactory (d = s). Movements in the SHOP in full, paravertebral points are sensitive, there are no symptoms of tension of the cervical roots. In the Romberg position - it is stable, the finger test performs satisfactorily. Muscle tone is not changed. There are no pathological stop signs. It is discharged with improvement.

On Fig.19-22 shows data from the results of the study.

EXAMPLE 3

Patient B-ev, 51 years old, administrator, medical history No. 253, was treated from 03/05 to 03/27/2002 with a diagnosis of chronic cerebrovascular insufficiency, spondylogenic radiculoischemia C _5-8 on the left: cervical osteochondrosis: consequences of polio ( from 1954).

He was admitted with complaints of headache attacks, discomfort in the cervical spine and shoulder muscles, weakness of the muscles of the left arm, irritability, sleep disturbance, decreased RAM.

He had a history of acute poliomyelitis in childhood, during the last 6 years - pain, discomfort in the SHOP, shoulder girdles, severe weakness in the muscles of the arm, headache. Outpatient treatment (metabolic drugs, physiotherapy, massage) was repeatedly performed with an unstable positive effect for up to 2-3 months.

Upon admission to the neurological department of the Kislovodsk clinic: pulse - 74 per minute, satisfactory properties, blood pressure 120/80 mm Hg

Movement in the cervical spine is limited. Soreness of paravertebral points of the cervical spine. Reflexes on the hands — on the right — are satisfactory, on the left — are reduced, knee reflexes are d> s. In the Romberg position is stable, the coordination test performs satisfactorily.

The patient received a course of treatment, including hardware-based physiotherapy, “sparing” traction of SHOP during OPT and 10 carbon dioxide mineral baths (6 of them are DUM B and 4 UMB with a standard concentration of CO ₂ ).

According to HRV, after a course of treatment, the average heart rate decreased by 14 beats. in minutes;

- on the background recording, the total power of the spectrum of vegetative regulation (TR) increased from reduced to conditionally normal;

- the contribution of very slow waves (VLF - humoral-metabolic and cerebral ergotropic effects) significantly decreased by 35.9% in the structure of the spectrum;

- the contribution of slow waves (LF-sympathetic influences) increased by 22%;

- the contribution of fast waves (HF - parasympathetic influences) increased by 13.9%;

- the balance of the departments of the ANS has changed from sympathicotonia to eutonia;

- parasympathetic reactivity increased at the orthoprobe (coefficient 30/15 entered the “corridor” of the conditional norm); sympathetic activation increased.

The state of cerebral circulation according to the REG of the patient In-va. 51 g. (Historical source No. 253) and its dynamics under the influence of a single UMB with a natural concentration of CO ₂ and UMB saturated with CO ₂ ; as well as in the course of the course application of the SLMWs are shown in FIGS. 27-30.

Reception UMV with a natural concentration of CO ₂ (Fig.27) contributed to a certain decrease in pulse blood vessels in both the carotid and vertebrobasilar pools. So, the RI in the F-M lead decreased from 1.2 to 1.0 (d) and from 1.1 to 0.75 (s); in the O-M lead, RI decreased from 1.0 to 0.87 (d) and from 0.6 to 0.53 (s), and the asymmetry coefficient increased.

The same directionality of the shifts in the REG indices, although to a lesser extent, was observed when taking the 1st SCLM (Fig. 28), and especially after taking the 6th SCLM (Fig. 29).

After a course of 6 PCAs and 4 baths with a natural concentration of CO ₂ at the end of treatment (Fig. 30), the pulse blood filling of the vessels in the carotid pool increased significantly (from 1.25 to 1.75 d and from 1.1 to 1.4 s ) and to a lesser extent in the vertebrobasilar system (from 0.64 to 0.72 d and from 0.95 to 0.86 s). The asymmetry coefficient in the vertebrobasilar system decreased from 48.5 to 19.5, i.e. normalized. This is an important indicator of improving cerebral circulation (LB Ivanov. AV Makarov. Lectures on clinical rheography, M., 2000. - 320 p.).

UMV is known to have an amphoteric effect on the autonomic nervous system - more often, activation of parasympathetic influences predominates. However, depending on many reasons: the initial balance of autonomic regulation, on the ratio of the central and peripheral effects of CO ₂ on the vasomotor center and blood vessels, the action of UMV can be either parasympathetic or in sympathicotonic. So, M.E. Marshak (Physiological significance of carbon dioxide. Publishing House of Medicine. M., 1969. - 144 p.) Showed that the direct action of CO ₂ on the vasomotor center and the reflex action of CO ₂ on this center through the chemoreceptors of the synocarotid and aortic reflexogenic zones has a vasoconstrictive effect, and the prevalence of local action of CO ₂ on the vessels reduces their tone and has a vasodilating effect.

In the given case, with a single administration of UMV, the sympathicotonic effect prevailed, and in the course, the parasympatheticotonic effect on the vessels of the brain prevailed.

Patient B-ev was discharged with improvement on the part of objective and subjective symptoms.

EXAMPLE 4

P-Noah P-howl. 36 years. serviceman, medical history No. 727, was treated from June 17 to July 10, 2001 with a diagnosis of the consequences of repeated craniocervical injuries, post-traumatic encephalopathy, osteochondrosis of the cervical and lumbar spine, cervical myelosemia with paresis of C _5-7 myotoma, more than tetraparesis, in the right limbs.

Received with complaints of headache, dizziness, incl. when turning the head, pain and craniocervical junction, cervical and lumbar spine, weakness and numbness of the hands, irritability, fatigue, distracted attention, decreased memory for current events.

In 2000, he suffered repeated craniocervical injuries, without specialized treatment. During the year, the above symptoms arose and grew. In 2001, inpatient treatment was carried out in the hospital of the Ministry of Internal Affairs (vasoactive and metabolic drugs).

The patient underwent balneotherapy (carbon dioxide mineral baths No. 10), physiotherapy (diadynamic currents to the projection of the vertebral artery No. 6) and sparing traction of the SHOP with optic surgery 5 ° forward with a pulling force of 1.5 kg No. 12, massage of the cervical-collar zone No. 8 .

As a result of the therapy, the frequency, intensity of dizziness and noise decreased, the quality of sleep improved, the mood background was leveled, vertebrogenic pains and paresthesias in the right arm and leg were reduced. It is discharged with improvement on the part of the subjective on objective symptoms.

In the study of HRV performed at the beginning and at the end of the course treatment, the following data were obtained: after the end of the course therapy, the average heart rate decreased by 5 beats. in minutes;

- on the background recording, the total power of the spectrum of autonomic regulation (TR) increased 2 times:

- in the structure of the spectrum, the contribution of very slow waves (VLF - humoral-metabolic and cerebral ergotropic effects) practically did not change (increased by 0.42%);

- the contribution of slow waves (LF - sympathetic influences) remained virtually unchanged (increased by 0.15%);

- the contribution of fast waves (НF - parasympathetic influences) remained practically unchanged (increased by 0.15%);

- the balance of the departments of the ANS remained at the level of parasympathicotonia;

- parasympathetic reactivity increased at the orthoprobe (coefficient 30/15 entered the “corridor” of the conditional norm); sympathetic activation increased.

Thus, in the examples given, the amphotericity of the action of the course of the SILV is traced depending on the initial autonomic balance: with the initial sympathicotonia (2nd example), at the end of the course of treatment, along with an increase in the total spectrum power, a transition to eutonia occurred (due to increased segmental parasympathetic and decreased cerebral ergotropic effects on the sinus node), with the initial parasympathicotonia (1st example) at the end of the course with the inclusion of 6 PCL, along with an increase in the total spectrum power, a transition to ayton was also observed ii (by reducing segmental parasympathetic and increasing segmental sympathetic and cerebral ergotropic effects on the sinus node); in addition, the course of saturated UMW has a more noticeable modulating effect on the ANS than the course of UMW with a standard concentration of CO ₂ (4th example).

EXAMPLE 5

B-P-va V.I., 47 years old,

East b-zni No. 745, was treated at the clinic from 07/03/02 to 07/26/02.

Diagnosis: CNMC in CHD with PNMK; cervicothoracic osteochondrosis; spondylogenic radiculomyelosemia C _3-5 ; epiglottis nerve neuralgia on the left, occipital nerve neuralgia on the left; hypothalamus dysfunction.

Received a standard course of treatment from 10 UMV with a natural concentration of CO ₂ .

Discharged with improvement in subjective condition.

At the beginning and at the end of treatment, a study of ASWP (acoustic stem-embedded potentials) was conducted. The results are shown in table.5-8, Fig.23.

At the beginning of treatment.

Sample 1. Auditory EP. Short latent

1k: Cz-M1

2k: Cz-M2

EXAMPLE 6

B-I-va V.I., 47 years old.

(ASWP) Acoustic stem evoked potentials at the end of treatment (after a course of 10 standard UMVs).

Sample 1. Auditory EP. Short latent

1k: Cz-M1

2k: Cz-M2

The research results are presented in table.9-12.

EXAMPLE 7

B.I.G. F.M., 61 years old.

East b-zni No. 546, was treated in the clinic from 05/15/02 to 06/07/02

Diagnosis: CNMC in CHD; sciatica radiculomyelosemia; vertebrogenic cardiac syndrome; IHD angina pectoris FC I.

Received a course of treatment of 6 PCPS and 4 standard HB.

Discharged with significant improvement.

At the beginning and at the end of treatment, an ASWP study was conducted; presented in table.13-16 and Fig.25.

At the beginning of treatment.

Sample 1. Auditory EP. Short latent

1k: Cz-M1

2k: Cz-M2

EXAMPLE 8

Patient: Mrs. F.M., 53 years old.

Date: 1.06.2002.

Department: neurology.

Diagnosis: CNMC in CHD; radiculomyelosemia at the cervical level.

At the end of treatment (after a course of 6 SEMI and 4 standard UMV), the results are shown in table 17-20, Fig.26

Sample 1. Auditory EP. Short latent

1k: Cz-M1

2k: Cz-M2

Claims (1)

A method of treating vertebrogenic cerebrospinal vascular disorders by administering low-frequency pulsed currents during the spa treatment by acting on the cervical sympathetic nodes and plexuses, vector traction of the cervical spine, carbon dioxide mineral baths T 35 ° C for 12 minutes, a course of 10 baths, characterized in that prescribe a course of 6 carbon dioxide mineral baths saturated with carbon dioxide up to 1.3 g / l, and the subsequent 4 baths with a natural concentration of carbon dioxide of 0.8-1.0 g / l.

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