RU2326663C1 - Method of vascular antiaggregatory activity normalization at metabolic syndrome - Google Patents

Abstract

FIELD: medicine; cardiology.

SUBSTANCE: for this purpose complex therapy is performed including individually selected hypocaloric diet, dosed physical activity, isradipin 2.5 mg twice a day and tocopherol acetate 0.2 g 1 capsule twice a day.

EFFECT: lowered risk of thrombotic complications.

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Description

The invention relates to medicine, namely to cardiology and angiology.

Analogues of this method of normalizing the antiplatelet activity of blood vessels in the metabolic syndrome (MS) were not found.

The literature contains recommendations on the appointment of a low-calorie diet and physical training for metabolic correction in the metabolic syndrome (Almazov V.A., Blagosklonnaya Y. V., Shlyakhto E.V., Krasilnikova E.I. Metabolic cardiovascular syndrome. St. Petersburg. : Publishing House of St. Petersburg State Medical University. 1999. - 208 pp.) And reducing the degree of abdominal obesity, which is its component with the help of recommendations more focused on the use of a low-calorie diet (Savelyeva L. Modern approaches to the treatment of obesity. // Doctor, 2000, No. 12, - p. 12-14; Kadyrova R.Kh. , Salkhanov B.A. Nutrition for obesity. Alma-Ata "Kazakhstan", 1990) or physical training (Moshkov V.N. Physical education for obesity. M .: Medicine, 1976. - 56 p.).

In individuals with MS, isradipine is used as a hypotensive agent and tocopherol acetate as an antioxidant.

The aim of the invention is to increase the efficiency of correction of attenuation of antiaggregatory activity of blood vessels in patients with MS.

The essence of the proposed method lies in the fact that in order to normalize the antiaggregatory activity of blood vessels, patients with MS undergo long-term treatment with a low-calorie diet, dosed physical activity and isradipine and tocopherol acetate preparations.

The method allows to translate the state of antiplatelet activity of the vascular wall in patients with MS to a level close to that for healthy people for 5 months. With long-term compliance with these recommendations according to the claimed method, it is possible to maintain the antiaggregatory activity of the vascular wall in the optimal mode of operation, significantly reducing the risk of thrombotic complications, reducing the number of cases of temporary disability, disability and mortality among vascular patients.

The inventive method is as follows.

The basis for assessing the antiaggregatory activity of blood vessels is the method for assessing platelet aggregation (AT) (A. Shitikova, in the book: Hemostasis. Physiological mechanisms, principles for the diagnosis of the main forms of hemorrhagic diseases. Edited by N. N. Petrishchev, L. P. Papayan. St. Petersburg: 1999. S. 49-52).

Blood is taken with sodium citrate 3.8% in a 9: 1 ratio, centrifuged for 5 minutes at 1000 rpm to obtain platelet-rich plasma (BTP). Part of the plasma is taken, and the remaining is centrifuged at 3000 rpm for 20 min, receiving platelet-poor plasma (BeTP). BTP is standardized by the number of platelets by diluting the original BTP with an autologous BeTP sample (up to 200 · 10 ⁹ / L). The concentration of blood platelets in the initial BTP is calculated in the Goryaev's chamber (in 50 large squares). The volumes of mixed BTP and BeTP are determined by the formula:

V _BeTP = V _BTP · [(N / 200000) -1],

V _BeTP - volume of platelet-poor plasma,

V _BTP - the volume of platelet-rich plasma,

N is the counted platelet concentration in the original BTP (cells / μl).

From a selected volume of standardized plasma, 0.02 ml of plasma is applied to a glass slide and 0.02 ml of a collagen inducer solution at a standard concentration with another pipette (1: 2 dilution of the main suspension). Plasma is mixed with inducers with a glass rod and the stopwatch is turned on. The mixture is stirred so that the liquid occupies a circle with a diameter of about 2 cm.

Shaking the glass in a circular motion in the transmitted light of the illuminator, on a black background they monitor the occurrence of aggregates through a magnifying glass. When distinct aggregates appear, the solution becomes clear and some of the aggregates adhere to the glass, the stopwatch is turned off, fixing the time of platelet aggregation.

The reaction is repeated 2-3 times with each inductor, finding the arithmetic mean value for each inductor.

The antiaggregatory activity of the vascular wall is determined by the method (Baluda V.P., Lukyanova T.I., Baluda M.V. Method for determining the antiaggregatory activity of the wall of human blood vessels. // Labor. Delo, 1983. - No. 6. - p.17- twenty). The basis of this method is the determination of the time of elongation of platelet aggregation in plasma obtained from blood after temporary venous occlusion.

A cuff of the sphygmomanometer is applied to the shoulder of the arm, from the vessels of which blood has not yet been taken, and a pressure of 10 mm Hg is created. higher than systolic. After 3 minutes, 9 ml of blood is taken in 1 ml of a 3.8% sodium citrate solution. It is immediately centrifuged for 5 minutes at 1000 rpm to obtain platelet-rich plasma. The plasma is aspirated with a pipette and immediately placed in melting ice, where it is stored until the start of the study. The sample is centrifuged for 20 minutes at 3000 rpm to obtain platelet-free plasma. After counting the platelet count in platelet-rich plasma obtained before venous stasis, it was diluted with BeTP taken before (1 test) and after (2 test) venous stasis to a concentration of 200,000 platelets / μl. The resulting mixture is shaken and incubated for 10 minutes at 20-22 ° C, then AT is carried out with ADP (0.5 × 10 ^-4 M), collagen (dilution 1: 2 of the main suspension) and thrombin (0.125 units / ml) on glass.

By lengthening the time of platelet aggregation after venous stasis, we judged the anti-aggregation activity of blood plasma due to the entry of prostacyclin into the bloodstream from the vascular wall. The vascular wall anti-aggregation activity index (IAASC) was calculated by the formula:

The normal values for ADP, collagen and thrombin can be considered IAASC 1.65-1.78, 1.50-1.60 and 1.35-1.67, respectively.

The use of several aggregation inducers with the subsequent calculation of the arithmetic mean of the obtained IAASC values with all the inductors to obtain the value of the complex anti-aggregation index of the vascular wall (CAISS) (norm 1.50-1.68) allows to detect the weakening of the antiplatelet activity of vessels in CAISS-1 40 and below, which dictates the need for immediate treatment of patients according to the scheme below.

To create a negative energy balance in the body of patients, they are recommended an individually selected hypocaloric diet.

The caloric content of the daily diet individually for each patient with MS is calculated in kcal according to the formula:

for women 18-30 years old (0.0621 × body weight, kg + 2.0357) × 240,

31 years-60 years (0.0342 × body weight, kg + 3.5377) × 240,

over 60 years old (0.0377 × body weight, kg + 2.7545) × 240,

for men 18-30 years old (0.0630 × body weight, kg + 2.8957) × 240,

31 years - 60 years (0.0484 × body weight, kg + 3.6534) × 240,

over 60 years old (0.0491 × body weight, kg + 2.4587) × 240.

The coefficient obtained remains unchanged with minimal physical activity, multiplied by 1.3 for moderate and 1.5 for high physical activity (as a rule, in patients with MS the level of physical activity is low).

3 main meals and 2 intermediate meals are recommended. With the regular skipping of one of the main meals, the frequency of obesity increases significantly, a positive correlation between obesity and skipping breakfast is also revealed.

The following daily calorie distribution is recommended: breakfast - 25%, 2nd breakfast - 10%, lunch - 35%, afternoon tea - 10%, dinner - 20%.

To compile the patient’s menu, special tables are used with indications of the chemical composition and calorie content of the products, given that the main sources of energy are proteins (1 g contains 4 kcal), fats (9 kcal), carbohydrates (4 kcal) and alcohol (7 kcal).

The second component of the proposed method is feasible regular physical training.

In real life conditions, it is possible to carry out three forms of physical activity: 1) morning hygienic gymnastics (exercise); 2) therapeutic and preventive gymnastics; 3) fractional physical exercises throughout the day.

1. Morning hygienic gymnastics (exercise).

Morning exercises should be done after sleep before breakfast in a ventilated room. Under the influence of classes, the body is freed from the state of inhibition of physiological processes that occurs during sleep.

The sequence of exercises involves alternating the load on various muscle groups (arms, legs, body). Exercises are performed with a gradually increasing excursion of breathing, stretching, limited use of force conditions. The breathing during exercises should be free, rhythmic, without delay, mainly through the nose; the exhalation should be longer than the inhalation (inhalation 2-3 s, exhale 3-5 s).

With good health, the load can be strengthened by the number of repetitions, speeding up the pace, increasing the amplitude of movements and reducing pauses between exercises.

With fatigue, you should reduce the load, increase the duration of pauses between exercises, fill them with calm breathing.

After gymnastics, you need to go to a wipe or take a shower.

Morning exercises should cause a sense of vitality, increased activity, better health and performance.

If you feel unwell, develop shortness of breath or pain in the heart and behind the sternum, you should temporarily interrupt classes and consult a doctor.

During the day, patients with MS are recommended preventive gymnastics. Depending on the initial training, it is possible to use at the beginning of a lightened version of physical activity, and subsequently a strengthened version.

2. Complexes of therapeutic and preventive gymnastics for persons suffering from MS.

2.1. A lightweight version of therapeutic gymnastics.

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. During the exercise, a gradual deepening of breathing.

Exercise 2. Circular movements in the shoulder joints. When breeding - inhale, while mixing - exhale with a slight tilt of the body and retraction of the abdominal wall - 6-8 times. Fingers touch shoulders, elbows pressed to the body.

Exercise 3. Standing, hands on the belt. Alternately transferring the severity of the body from one leg to the other with slight bending of the legs in the knee joint, without taking the feet off the floor. Do the exercise 10-16 times with muscle tension in the legs.

Exercise 4. Standing, legs spaced shoulder width apart, hands on the belt. Torso forward, touch left sock with your right hand. 4-6 times alternately. When the position is straightened, inhale; when tilted, exhale. Looking forward.

Exercise 5. Standing, arms along the torso. At the same time, take straight arms and one leg to the sides with alternating leg abductions. 4-6 times in each direction alternately. A wave of arms and legs, breathing free, do not hold.

Exercise 6. Standing, legs to the sides, hands in front of the chest, palms down. With the turn of the body, spread your arms to the sides with the turn of the palms up - inhale. Return to the starting position with a slight tilt of the body forward - exhale. 3-5 times in each direction alternately. Coordinate breathing with the movement of the body and hands. By the end of the exhalation, retract the wall of the abdomen.

Exercise 7. Standing, hands free. Walking freely - 1 min, then with high flexion of the hips - 10-20 movements, followed by a transition to a quiet walk - 1-2 minutes. Rhythmic breathing, medium depth.

Exercise 8. Sitting on the edge of the chair, hands on the waist. Bending back and bending forward of the body. Repeat 6-10 times. Do not hold your breath.

Exercise 9. Sitting on the edge of the chair, focus with tassels on the edge of the chair, and with your feet somewhat in front of the chair. Squats with an emphasis on the edge of the chair - 4-6 times. When squatting, exhale.

Exercise 10. Standing sideways to the back of the chair, hold on to it with one hand. Swing your free straight arm with your legs back. Return to starting position. Repeat 4-6 times with each hand and foot. Do not hold your breath.

Exercise 11. Standing, legs apart, arms at the waist. Turns the body to the right and left - 6-10 times alternately. Do not turn your head, look forward.

Exercise 12. Standing, legs together, arms down. To spread your arms to the sides - inhale, bend your leg at the knee and press your hands to your stomach - exhale. 3-5 times each leg in turn. Strive to maintain balance; as you exhale, draw in your stomach.

Exercise 13. Standing, legs together, hands down. Lateral slopes of the body with bending of the opposite arm ("pump"). Do not hold your breath, strive for a greater excursion of movement.

Exercise 14. Standing. Walking is calm with uniform breathing of medium depth. 1-2 minutes

Exercise 15. Lying on a rug with a pillow placed under the head. Go to the half-sitting position and hug the bent hips - exhale, return to the starting position - inhale. Do not hold your breath. Strive in a half-sitting position to maintain balance. Run 4-6 times.

Exercise 16. Lying, arms to the sides, legs apart. Semicircular movements with the right straight leg to the left with the turn of the pelvis - exhale - return to the starting position - inhale. 3-5 times in each direction. Alternately left and right with the greatest possible excursion of the leg movement, while maintaining the emphasis of the hands on the floor.

Exercise 17. Sitting on the floor; a) get on all fours; b) move to a kneeling position; c) raise your hands up - inhale, tilt the body, and take your hands back - exhale. When tilting, belly retract. Repeat 4-6 times; e) move to a standing position, and the son-in-law to a lying position; f) self-massage of the abdomen with small semicircular movements in a clockwise direction - 1-2 minutes. Rest 1 min; g) calm breathing; h) exercise in protruding (calm) and retracting (active) the abdominal wall. Combine abdominal retraction with expiration through the mouth. Repeat 4-6 times.

Exercise 18. Standing, arms bent. Vigorous walking on the spot or in a room with high flexion of the hips and waved arms - 20-30 steps. Do not hold your breath.

Exercise 19. Sitting on a chair, legs apart, hands on the waist or rest against the edge of the chair. Circular movements of the pelvis with retraction of the abdomen when the pelvis is brought back. 4-6 times in each direction.

Exercise 20. Standing. Calm walking with breathing of an average depth of 2-3 minutes.

With the initial sufficient training or exercise tolerance arising during classes, it is possible to use the following set of exercises.

2.2. A reinforced version of therapeutic gymnastics.

Exercise 1. Standing. Walking calm with rubbing the palms of the chest, abdomen, lower back. It takes 1-2 minutes.

Exercise 2. Standing, arms down. Simultaneous bending with tension and free “throwing” of arms forward, to the sides and up 12-16 times. When bending, exhale; when leveling, inhale.

Exercise 3. Standing, arms at the waist, legs shoulder width apart. Lateral movements of the pelvis to the right and left, back and forth. It is performed 6-10 times alternately. Breathing is free.

Exercise 4. Standing, feet shoulder width apart, arms down. Circular movements of straight arms in the shoulder joints, 6-10 times with maximum excursion, do not hold your breath.

Exercise 5. Standing, arms in front of the chest, bent at the elbows. Walking with high flexion of the hips, with the touch of hands. 6-10 times each leg alternately. The movements are vigorous, while flexing the thigh - exhale through the mouth.

Exercise 6. Walking calm 1-2 minutes.

Exercise 7. Sitting on the edge of the chair, hands on the waist. Bending and bending of the body. The exercise is performed 8-10 times. The movements are energetic. When straightening, inhale; when bent, exhale.

Exercise 8. Standing sideways to a chair, hold on to the back, the other hand at the waist. Alternating swings with a straight leg forward with the greatest possible excursion. Leg sweep combined with exhalation. It is carried out 4-6 times.

Exercise 9. Standing, legs apart, arms to the sides. Tilts the body forward with a touch of the right brush of the left toe of the foot, the other hand is pulled up. Return to starting position. Combine the slope with the exhale, while straightening, inhale 4-6 times.

Exercise 10. Walking calm with breathing of medium depth. 1-2 minutes

Exercise 11. Standing, hands in a fist and lowered: a) bending the arms at the elbows with force and unbending them with the back, with the greatest possible straightening and tension and a delay in tension for 2-3 seconds. Standing, hands on the waist; b) half-squats, followed by lifting on toes and straining the legs. The exercise is performed 4-6 times with the greatest possible rectification and tension, and a delay in the stress state for 2-3 seconds.

Exercise 12. Sitting on the edge of a chair. In the position of the leg raised and bent at the knee joint, alternately shake the tibia and thigh muscles with the hands. Reduce muscle tension. 1-2 minutes

Exercise 13. Sitting on the edge of the chair, straight legs divorced. Breeding and mixing straight arms and legs. When breeding, inhale, while mixing, exhale. It is carried out 4-8 times.

Exercise 14. Standing. Walking is calm with the transition to a rhythmic calm run (jogging) in place or with movement. If tired, go for a walk with moderate breathing. 2-5 min.

Exercise 15. Lying on the mat. Simultaneous lifting of the body and legs as you exhale. 4-6 times. Arms and legs straightened, keep balance.

Exercise 16. Lying on the mat, emphasis with brushes on the floor. Cross movement with straight legs - “scissors”. 4-8 times. Do not hold your breath.

Exercise 17. With a quick straightening of the legs, move to a sitting position, then lie down. You can help with a wave, 4-6 times.

Exercise 18. Lying on your back, legs bent. Calm breath 4-6 times.

Exercise 19. Lying on your back, arms spread apart with the emphasis of the hands on the floor. With the turn of the pelvis to the left, bend the legs, turn the pelvis with the legs crossed to the right and stretch the legs. Repeat such circular movements with legs 3-6 times in each direction alternately. Do not tear your hands off the floor. Do not hold your breath.

Exercise 20. Lying on your back, arms and legs apart. Alternate turns of the body to the right and left with the laying of one hand on the other. Do not move your legs. With arms apart, inhale, while turning, exhale. It is carried out 3-6 times.

Exercise 21. Lying on your back, arms along the body: a) turn on your left side; b) turn on the right side; c) go to the supine position; d) get on your knees; e) move to a standing position; f) walking in a place with high hip flexion and arm movement - 20-30 steps; g) sit on the mat; h) lie on your back, calm breathing. Repeat the whole complex 3-4 times.

Exercise 22. Standing. Walking calm with breathing of medium depth - 1-2 minutes.

Exercise 23. Standing, legs spaced the width of the foot, hands on the waist. Circular motion of the pelvis, right and left 6-8 times. Do not hold your breath.

Exercise 24. Standing with legs wide apart, hands in front of the chest. Alternately bending the leg with the transfer of body weight to it with stretching the arms to the toe of the bent leg. 4-6 times in each direction. The other leg is straight. When straightening, inhale, while tilting - exhale.

Exercise 25. Standing, legs spaced shoulder width apart, arms at the waist. Circular head movements 4-10 times in each direction.

Exercise 26. Standing, legs spaced shoulder-width apart, arms at the waist. Tilt the body to the right, pulling the left hand up - inhale. Return to starting position - exhale. 4-6 times alternately.

Exercise 27. The same, arms to shoulders. Circular movements of the hands with a maximum excursion in the shoulder joints, when breeding - inhale, while reducing and retracting the walls of the abdomen - exhale. The breath is deep.

Exercise 28. Standing. Calm walking and breathing of medium depth. Reduced overall load. 1-2 minutes

3. Fractional exercise throughout the day.

A patient with MS is a patient with a number of concomitant disorders and, above all, the cardiovascular system. This circumstance limits the simultaneous use of great physical activity in the process of morning gymnastics, as well as in the main occupation of therapeutic and prophylactic gymnastics. That is why an increase in the physical activity of people suffering from MS should be carried out by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of patients with MS should be considered as a fractional load method.

Depending on the real life conditions of patients with MS suffering from varying degrees of abdominal obesity, various exemplary fractional exercise options can be recommended to increase physical (motor) activity throughout the day.

Option 1.

Exercise 1. Sitting - spread your elbows to the sides - inhale, stretch your arms forward with tension - exhale, 4-6 times.

Exercise 2. Sitting - stand up with the deflection of the body and sit down - 8-10 times.

Exercise 3. Sitting - an imitation of the movements of a boxer with a possibly large rotation of the body - 10-12 times.

Option 2

Exercise 1. Standing - walking with high flexion of the hips -16-30 times.

Exercise 2. Standing - circular movements of the head to the right and left - 3-8 times in each direction.

Exercise 3. Standing - legs spread apart - imitation of the movement of the pigtail - 10-12 times.

Exercise 4. Sitting - transition to a standing position - 10-12 times.

Option 3

Exercise 1. Walking is calm - 1 min.

Exercise 2. Walking accelerated - 1 min.

Exercise 3. Walking with a high flexion of the hips and alternate wave of hands 20-30 times.

Exercise 4. Walking calm with breathing - 1-2 minutes; the run is calm on the spot or with movement around the room - 2-5 minutes.

Option 4

Walking walk of various extent.

Option 5

Physical labor in various versions and of various durations depending on the conditions (cleaning the premises, home maintenance, work on cleaning the territory, garden works, etc.).

Another component of treatment is isradipine 2.5 mg 2 times a day and tocopherol acetate 0.2 g 1 capsule 2 times a day.

The introduction of this method of treatment of the weakening of the antiaggregatory activity of blood vessels in patients with MS in the practice of medical institutions will solve a number of pressing socio-economic problems of our time. Effective treatment in patients with MS of antiaggregatory activity of blood vessels will allow them to level the risk of platelets, which will shorten the period of temporary disability in these patients, prevent strokes and heart attacks, reduce the number of disability exits and reduce mortality among this group of patients.

Example. Patient C., 40 years old, 92 kg, body mass index 30.1 kg / m ² , suffering from arterial hypertension with metabolic syndrome for 6 years, was examined during a physical examination for arterial hypertension. Blood was taken from the patient and examined according to the above scheme with the assessment of IA-ACC, with ADP, collagen and thrombin and the calculation of CAISS.

Inhibition of the antiplatelet function of the vascular wall was revealed in the patient. IAASC for ADP was 1.52, for collagen and thrombin 1.36 and 1.26, respectively. CAISS amounted to 1.38. The patient was recommended for adequate control of blood pressure and normalization of the state of the vascular wall to follow a low-calorie diet (2081.0 kcal), train according to an individually selected scheme and take isradipine 2.5 mg 2 times a day and tocopherol acetate 0.2 in 1 caps. 2 times a day with a monthly examination. So, after 5 months, a decrease in body weight to 81.0 kg was revealed, a body mass index to 26.5 kg / m ² with a normalization of IAASC for ADP - 1.68, collagen - 1.53, thrombin - 1.61. The value of CAISS was 1.60, which indicated the normalization of the antiaggregatory activity of the vessels in the patient. The patient was recommended to follow the recommendations given to her in the future.

Claims (1)

A method of normalizing the antiaggregatory activity of blood vessels in the metabolic syndrome, including an individually selected hypocaloric diet, dosed physical activity, isradipine 2.5 mg 2 times a day and tocopherol acetate 0.2 g, 1 capsule 2 times a day.