RU2372084C1 - Method for hyperfibrinogenemia correction in arterial hypertension with impared glucose tolerance - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely haematology, cardiology and endocrinology, and covers hyperfibrinogenemia correction in arterial hypertension with impaired glucose tolerance. It is ensured by complex treatment that involves graduated physical activities, as well as introduction of pioglitazone in a dose 30 mg once a day in the morning and lisinopril in a dose 10 mg once a day in the morning during 1.5 months.

EFFECT: invention provides effective correction of fibrinogen level that is ensured by potentiation of therapeutic effect of certain components of complex therapy; than in turn allows reducing risk of thrombotic complications in the given group of patients.

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Description

The invention relates to medicine, namely to hematology, cardiology and endocrinology.

Analogues of the proposed method for the correction of hyperfibrinogenemia in patients with arterial hypertension (AH) with impaired glucose tolerance (NTG) does not exist.

The literature contains recommendations on the appointment of physical training for metabolic correction in metabolic syndrome elements (Almazov V.A., Blagosklonnaya Y.V., Shlyakhto E.V., Krasilnikova E.I. Metabolic cardiovascular syndrome. St. Petersburg: Publishing House St. Petersburg State Medical University. 1999. - 208 p.).

Patients with hypertension with NTG are prescribed lisinopril to correct arterial hypertension.

Pioglitazone is used to correct tissue sensitivity to insulin in hypertension with NTG.

However, never before a treatment complex consisting of dosed physical activities and drugs - lisinopril and pioglitazone was not used in patients with hypertension with NTG in order to normalize hyperfibrinogenemia.

The aim of the invention is to increase the efficiency of correction of hyperfibrinogenemia in patients with hypertension with NTG.

The essence of the proposed method lies in the fact that for the correction of hyperfibrinogenemia in patients with hypertension with NTG long-term prescribed dosage physical activity and drugs - pioglitazone and lisinopril.

The method allows to correct hyperfibrinogenemia in patients with hypertension with NTG for 1.5 months, translating fibrinogenemia to a level close to that for healthy people. If you follow the recommendations of the proposed method, it is possible to maintain the level of fibrinogenemia in optimal condition, which will allow people with hypertension and NTG to significantly reduce the risk of thrombotic complications, reduce the number of cases of temporary disability, accelerate and improve the quality of treatment, reduce disability, and extend life and reduce mortality of hypertensive patients with NTG from heart attack and stroke.

The inventive method is as follows.

Hyperfibrinogenemia is established in the examined patient by the following method (Barkagan Z.S., Momot A.P. Basics of the diagnosis of hemostatic disorders. M., 1999, p. 84-86).

The following reagents are used: 1. Phosphate buffer, pH 7.0 (0.06 M) of the following composition: 190 ml 0.5 M KH ₂ PO ₄ (68.045 g per 1 l) and 110 ml 0.5 N sodium hydroxide. For operation, 20 ml of this basic buffer solution is brought to a volume of 100 ml with distilled water. 2. 0.15 M sodium chloride solution. 3. 0.04 M solution of monoiodoacetic acid in 0.06 M phosphate buffer (40 mg of monoiodoacetic acid in 5 ml of buffer). 4. Human or bovine thrombin, 50 NIH units / ml. 5. 1.5% solution of acetic acid.

Applied equipment. Spectrophotometer with optical density measurement in the ultraviolet zone.

The material for the study is a citrate platelet-poor plasma.

1.6 ml of 0.06 M phosphate buffer was added to a test tube with 0.2 ml of plasma and placed in a water bath (+ 37 ° C). After a few minutes, 0.1 ml of a 0.04 M monoiodoacetic acid solution was added to the mixture, and after 3 minutes 0.1 ml of a thrombin solution was added. After adding each component, the contents of the tube are thoroughly mixed with a glass rod (with a rough surface at the end), leaving it in the tube. The resulting mixture is incubated at + 37 ° C for at least 15 minutes (longer incubation is allowed). The resulting fibrin clot is removed by winding onto a stick, and squeezed against the wall of the tube. The clot is washed twice in 50 ml of 0.15 M sodium chloride solution. Then washed once in chilled distilled water. Water from the surface of the clot is additionally removed with filter paper. The resulting clot is dissolved with stirring in 5 ml of 1.5% acetic acid at room temperature. Dissolution complete in 5 minutes. The protein content in the solution is determined spectrophotometrically by measuring the absorbance at 280 and 320 nm. The extinction is stable, the measurement time can be arbitrarily selected.

The concentration of fibrinogen (X) in the test plasma sample is calculated by the formula

where E (280-320) is the difference between the values of extinction at 280 and 320 nm, thereby achieving the necessary correction for turbidity; 255 — coefficient for expressing the amount of fibrinogen in g / l in an analysis performed with 0.2 ml of plasma; 15,067 is the extinction coefficient for fibrinogen in an acidic medium at a wavelength of 280 nm (E 1% 1 cm).

Normally, the fibrinogen content determined by this method is 2.0-4.0 g / l.

When hyperfibrinogenemia is established in patients with hypertension with hypertension, they are prescribed therapy according to the claimed method.

The first component of the proposed method is feasible regular physical training, one of the options which are given below.

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, exhalation 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 hypertension with NTG are recommended therapeutic and prophylactic 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 prophylactic gymnastics for persons suffering from hypertension with NTG.

2.1. A lightweight version of therapeutic gymnastics.

Exercise 1. Standing. Walking is calm with a gradual acceleration and deceleration of 1-2 minutes. When performing 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 tilts 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 2 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 upwards 12-16 times. When bending, exhale, while 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 in turn. 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 minutes

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 the 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 hypertension with NTG is a patient with disorders of 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 individuals suffering from hypertension with NTG should be carried out by distributing physical activity in small doses throughout the day. This method of increasing the physical activity of hypertensive patients with NTG should be considered as a fractional load method.

Depending on the real life conditions of hypertensive patients with NTG, various exemplary options for fractional loads 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.).

The second component of the proposed method is the appointment of pioglitazone 30 mg 1 time per day in the morning, the third component is lisinopril 10 mg 1 time at the same time in the morning.

Example. Patient K., 51 years old, suffering from hypertension with NTG for 10 years, revealed hyperfibrinogenemia (6.5 g / l) during the examination. The patient was prescribed dosed physical activity, pioglitazone 30 mg once daily in the morning and lisinopril 10 mg once daily in the morning. The patient was regularly examined after the start of treatment. Simultaneously with the examination, the level of fibrinogen in the blood plasma was evaluated.

By the 6th week of treatment, the patient achieved complete normalization of the level of fibrinogen in the blood plasma (2 g / l).

The patient was asked to follow the recommendations given to her in the future.

Using the proposed method for the correction of hyperfibrinogenemia in hematology, cardiology and endocrinology will help to avoid many vascular complications in patients with hypertension with NTG, reduce the number of cases of temporary disability, reduce the duration of hospitalization, reduce disability and mortality.

Claims (1)

A method for the correction of hyperfibrinogenemia in arterial hypertension with impaired glucose tolerance, including the use of dosed physical activity, pioglitazone 30 mg 1 time per day in the morning and lisinopril 10 mg 1 time at the same time in the morning for 1.5 months.