RU2307678C2 - Method for treating stable angina pectoris cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering drug therapy with nitrates. Respiratory muscles are additionally exposed to transcutaneous AC electrostimulation with electrodes arranged posteriorly paravertebrally at the level of Th VII - Th XII and anteriorly between parasternal and clavicular median lines along 5-7 intercostal spaces. Stimulation is 20 min long and treatment course is 10 procedures long.

EFFECT: stimulated blood circulation in respiratory muscles and intracardial anastomoses.

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Description

The invention relates to medicine, in particular to cardiology, and can be used to treat patients with stable angina pectoris (SS).

Known methods of treating SS, traditionally based on the use of pharmacological preparations: nitrates, beta-blockers, calcium antagonists, metabolic agents. Despite the different mechanism of action, they contribute to the improvement of coronary blood flow and heart muscle metabolism. The disadvantages of these methods are long courses of treatment with a poorly predicted effect, an individual selection of drug therapy, the risk of adverse reactions.

The recommendations of WHO (1999) play a significant role in the non-drug treatment of SS, used as an initial or additional.

The closest technical solution, selected as a prototype, is a method of treating SS based on the improvement of coronary blood flow using surgical intervention. For cardiac revascularization, myocardiopexy surgery was proposed and used - hemming to the epicardium of a muscle with vessels and nerves passing in it. In this case, pectoral muscle, intercostal, diaphragmatic muscle flap were used. Myocardial revascularization was carried out due to the activation of existing and preexisting intracardial anastomoses [1, 2, 3].

The disadvantage of this method is not sufficiently stable and long-term clinical effect, as well as the operational impact itself with possible complications [4].

The novelty of the invention is to improve coronary blood flow due to increased circulation in the respiratory muscles and in intracardial anastomoses.

The essence of the invention lies in the fact that the method of treating SS by introducing nitrates additionally uses percutaneous electrical stimulation of the respiratory muscles with the electrodes located posteriorly paravertebrally at the level of Th VII-Th XII, in the front between the parasternal and midclavicular lines in 5-7 intercostal spaces, stimulation duration 20 min , on a course of treatment of 10 procedures. At the same time, contractions of the diaphragm and intercostal muscles, which are most actively involved in the act of breathing, occur with an increase in blood circulation in them and subsequently in the anastomoses of the arteries of the diaphragm and intercostal muscles with coronary arteries.

The method is as follows.

Patients with SS are prescribed nitrates - nitrosorbide inside at a dose of 0.06 mg / day. Additionally, electrical stimulation of the respiratory muscles is performed on the Stimul-1 apparatus according to the following procedure. An alternating current is used with rectangular pulses modulated at a frequency of 1000 and 50 Hz, with a pulse duration of 0.5-5 seconds, alternating bursts of pulses and pauses 2: 4. The interaction is carried out using two pairs of electrodes measuring 10 cm by 15 cm, which are located posteriorly paravertebrally at the level of Th VII-Th XII, in front - between the parasternal and midclavicular lines along 5-7 intercostal spaces. The duration of the procedure is 20 minutes, 10 treatments per course.

Examples of specific performance.

Example 1. Patient S., 52 years old, diagnosis: Coronary heart disease (CHD). Stable angina pectoris II functional class (FC). Suffers angina for 4 years. Complained of attacks of pain behind the sternum of a compressive nature up to 5 times a day, arising from physical exertion. On admission ECG, tachycardia and impaired repolarization of a diffuse nature were recorded (sinus tachycardia with a frequency of 94 beats per minute, in the I standard and V _5-6 leads the T wave is smoothed, in V _{1-3 a} low amplitude of the T wave is 2 mm). The echocardiogram (EchoCG) showed signs of aortic atherosclerosis and decreased contractility of the left ventricular myocardium (aortic walls are dense, final diastolic size is 50.2 mm, final systolic size is 35.1 mm, ejection fraction is 52.2%, pulmonary pressure gradient arteries - 6.7 mmHg). In addition to drug therapy (oral nitrosorbide at a dose of 0.06 mg / day), the patient was prescribed percutaneous electrical stimulation of the respiratory muscles according to the proposed method. During the treatment, the clinical condition (the nature and number of angina attacks), the dynamics of the ECG and echocardiography were analyzed. At the end of treatment, significant positive changes in the clinical condition were noted (the number of angina attacks decreased to 2 per day). On the ECG, the processes of repolarization improved (the amplitude of the T waves in the I standard and V _5-6 leads increased to 2 mm, V _2-3 to 4 mm). Echocardiography revealed an increase in myocardial contractility with an increase in ejection fraction by 19.3%.

Example 2. Patient F., 57 years old, diagnosis: IHD. Stable angina pectoris II FC. About this disease was observed for 7 years. He complained of pain in the heart region of a cutting nature after mental or physical stress up to 3-4 times a day. On the ECG, signs of a diffuse violation of the processes of repolarization were detected (in all leads a low amplitude of the T wave up to 2 mm). An echocardiographic examination revealed a decrease in left ventricular contractility with a decrease in ejection fraction to 47.7%. The patient received nitrosorbide orally at a dose of 0.06 mg / day and percutaneous stimulation of the respiratory muscles for 10 days for 20 minutes daily. After treatment, a marked improvement in well-being was noted with a reduction in angina attacks to 1 in 2-3 days. ECG data indicated an improvement in repolarization processes with an increase in the amplitude of the T wave to 5-6 mm. Echocardiography showed an increase in the contractility of the left ventricle with an increase in the ejection fraction by 16.2%.

Example 3. Patient C., 60 years old, diagnosis: IHD. Stable angina pectoris III FC. Regarding stable angina, was observed for 10 years. He complained of pains in the heart region of a pressing nature after slight physical exertion and sometimes at rest (up to 4-5 seizures per day) ECG revealed signs of myocardial ischemia (ST segment depression in I standard and V ₄ leads per 1 mm, ST segment depression in V _3-6 leads per 3 mm) and violations of repolarization processes (low amplitude of the T wave in all leads). On echocardiography, signs of a decrease in left ventricular contractility with a decrease in ejection fraction up to 48%. The patient received nitrosorbide orally at a dose of 0.06 mg / day and percutaneous stimulation of the respiratory muscles for 10 days for 20 minutes daily. A marked improvement in the clinical condition of the patient was noted (the number of angina attacks decreased to 1-2 per day, the dose of nitroglycerin used to relieve pain decreased to 1-2 tablets per day). ECG data showed an improvement in the blood supply to the heart muscle and the disappearance of signs of ischemia. Echocardiography showed an improvement in left ventricular contractility with an increase in ejection fraction of 21.7%.

To study the effect of the additional purpose of percutaneous stimulation of the respiratory muscles on cardiodynamics in the complex treatment of stable angina, we examined 2 groups of patients. In the first group, the control group, consisting of 10 patients with stable angina, the treatment regimen was used with nitrates (nitrosorbide inside at a dose of 0.06 mg / day). In the second group, the main group consisting of 8 patients with stable angina, randomized from the first functional angina class, gender and age, except nitrates, percutaneous electrical stimulation of the respiratory muscles was additionally used in the same daily dose, every day for 10 days for 20 minutes. Monitoring the effectiveness of treatment was carried out by clinical methods for the dynamics of reducing the number of angina attacks and instrumental (ECG, echocardiography by standard research methods). Statistical processing of the results was carried out by nonparametric statistical methods (sign test, Wilcoxon-Mann-Whitney test).

In all SS patients who additionally received percutaneous stimulation of the respiratory muscles, a marked improvement was observed, associated with a decrease in angina attacks. The results of ECG studies indicated an improvement in repolarization processes and the disappearance of ischemic changes. The data of echocardiography studies are presented in table 1. In patients of the main group, in contrast to the control group, after the treatment, a significant (P <0.01) improvement in the contractile function of the left ventricular myocardium was noted with a more pronounced decrease in the final systolic size of the left ventricle.

When using percutaneous stimulation of the respiratory muscles, there were no complications or worsening of the patients' condition both during and after the stimulation.

Table 1. Dynamics of echocardiographic parameters in patients with stable angina pectoris using percutaneous electrical stimulation of the respiratory muscles (M ± m) Indicators Control group (n = 10) The main group (n = 8) Before treatment After treatment Before treatment After treatment Left ventricular ejection fraction (%) 52.9 3.6 56.0 4.2 53.6 4.7 60.1 3.8 ** The final systolic size of the left ventricle (mm) 34.8 1.8 33.2 1.5 * 35.9 1.3 33.0 1.7 * The final diastolic size of the left ventricle (mm) 52.3 2.5 51.0 3.1 52.5 3.6 50.3 2.4 Pulmonary artery pressure (mmHg) 19.7 2.2 19.4 2.6 19.8 1.0 19.6 2.1 Note: * - reliability of the difference in indicators before and after treatment (P <0.05); ** - reliability of the difference in indicators before and after treatment (P <0.01).

Thus, the proposed method for the treatment of stable angina pectoris allows to achieve an earlier, pronounced and lasting clinical effect in comparison with the traditional method of therapy.

Information sources

1. Glinskaya E.P. Additional blood supply to the heart in the experiment // Surgery. - 1955. - No. 1. - S.18-21.

2. Lutsenko S.M. The creation of a circulatory circulation in the heart by hemming a diaphragmatic flap // Expert. chir. - 1956. - No. 3. - S. 57-62.

3. Zubov D.S. Myocardial revascularization during hemming of a diaphragmatic flap according to Petrovsky in an experiment // In the book: Compensation of blood circulation and innervation of organs. Ryazan, 1966. - P.61-69.

4. Zemskov N.N. Experimental materials on myocardial revascularization // News, chir. - 1962. - No. 7. - S. 47-53.

Claims (1)

A method of treating stable angina pectoris, including drug therapy with nitrates, characterized in that it is additionally prescribed transdermal electrical stimulation of the respiratory muscles with alternating current, with the electrodes located posterior paravertebrally at the level of Th VII - Th XII, in front - between the parasternal and midclavicular lines with 5-7 intercostal spaces, stimulation of 20 minutes, 10 treatments per treatment course.