RU2398580C1 - Method of optimising functional responsiveness of cadiovascular system in elderly and senile arterial hypertension and type ii diabetes mellitus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to haematology, cardiology, endocrinology and can be used for optimising the functional responsiveness of cardiovascular system (CVS) in elderly and senile arterial hypertension and type II diabetes mellitus. That is ensured by estimating the state of functional responsiveness of the CVS in psychoemotional load. And systolic, diastolic, average dynamic pressure and heart rate (HR) are recorded. These data are used to evaluate a functional responsiveness index (FRI) before and after load by formula: FRI=(BPav.dyn. × HR)/100 (standard units). The incrementing FRI more than by 20 standard units requires a therapy to be prescribed. The therapy combines daily swimming in a pool for at least 15 minutes a day, morning hygienic gymnastics, therapeutic gymnastics and graduated physical exercises throughout a day, and also administration of irbesartan 150 mg once in the morning and pioglitazone 30 mg once in the morning. The length of treatment is at least 3 weeks.

EFFECT: method allows for well-timed diagnosis of the impaired functional responsiveness of the CVS, and combination of the presented modalities ensures the effective correction, prevention of complications of arterial hypertension and type II diabetes mellitus in the case patients.

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Description

The invention relates to medicine, to the field of cardiology and can be used in therapeutic departments of clinics and hospitals. There are no analogues of the method for normalizing the functional reactivity of the cardiovascular system in arterial hypertension (AH) with type 2 diabetes mellitus (DM) in the elderly and senile.

The aim of the invention is to increase the efficiency of correction of the functional reactivity of the cardiovascular system in hypertension with type II diabetes in the elderly and senile.

The essence of the proposed method for the correction of the functional activity of the cardiovascular system is to increase the tolerance of patients with hypertension with type II diabetes in the elderly and senile to psychoemotional stress and increase the functional reactivity of the cardiovascular system when they perform a dosed psychoemotional load and reduce the risk of cardiovascular complications with emotional stress, evaluated after conducting a dosed psychoemotional load with a constantly increasing speed for 18-20 minutes with every minute recording of central hemodynamics parameters: systolic blood pressure (BPA), diastolic blood pressure (BPA), average dynamic blood pressure (BPA) and heart rate (HR), determine the value of the functional reactivity index (PFR), which is the product of the average dynamic BP at heart rate, calculate the relative increment of the PFR value when the load is performed compared to the value at rest and the value of the PFR value is estimated type of functional reactivity of the cardiovascular system: with a PFR value of more than 20 conventional units reactivity is assessed as hyperfunctional (which occurs in hypertension), with a PFR value of less than 10 srvc. the response to the load is assessed as hypofunctional and with PFR values from 10 to 20 conventional units type of functional reactivity is assessed as normal. The time of the psycho-emotional load is no more than 20 minutes. To normalize the functional reactivity index in hypertensive patients with type II diabetes, a combination of dosed static and dynamic loads, daily swimming in the pool, irbesartan and pioglitazone for at least 3 months is used.

The inventive method is as follows. The value of the PFR indicator is determined by O. Lebedeva, S. A. Radzievsky, S. A. Bugaev A method for assessing the state of functional reactivity of the cardiovascular system RU 2207044. The patient is seated in front of a monitor screen. A cuff is placed on the patient’s left shoulder to measure systolic blood pressure, diastolic blood pressure, dynamic average blood pressure and heart rate before and during exercise. The patient is offered two sets of 4 letters: ANEU and RLOG, from which he must choose one to remember. After registering the hemodynamic parameters for 3 minutes and remembering (30 s) the selected set of letters, the psychoemotional load begins, which consists in the fact that the test person presses the key marks the scattered letters from the set he chooses as he moves on the monitor screen a square frame in random order the letters of the alphabet. The speed of advancement of the frame along the rows of letters during the sampling process increases from 3 letters in 1 s at the beginning of the load to 6 letters in 1 s, starting from 6 min of the load, and this ensures the patient’s gradual development. Errors in marking letters from the selected set are accompanied by sound signals, according to which the subject can navigate the correct execution of the load and try to adjust its performance. After the end of the load, the average values of ADs, ADd, and ADsr are calculated. din and heart rate in periods: before the load and during the load. Dynamic mean blood pressure is calculated by the formula: ADsr.din = ADd + [0.42 (ADs-ADd)].

Dynamic mean blood pressure is a complex result of all variables of blood pressure. When conducting a test with emotional stress in healthy individuals, the mean dynamic does not change significantly, and heart rate, as a rule, increases. According to studies, an increase in heart rate and blood pressure leads to an increase in myocardial oxygen demand and an increase in its energy expenditure. Under pathological conditions, for example, in hypertension with type II diabetes in the elderly and senile, vessels that are in a state of spasm are not able to provide the required increased amount of oxygen, as a result of which hypoxia can build up, arising disturbance of cerebral circulation, etc. can occur.

Based on the data obtained, an indicator of functional reactivity is calculated, which allows integratively assessing the degree of increase in the hemodynamic load on the heart and, accordingly, the risk of developing cardiovascular complications, defined as follows:

PFR = (ADdr.din HR) * / 100 (conventional units)

The increment of PFR values during the transition from rest to load fulfillment is determined by the indicator:

PFR = PFR2-PFR1,

where PFR is the difference in the values of PFR before and under load,

PFR1 - the average value of the indicator to the load,

PFR2 - the average value of the indicator under load.

According to the value of the relative increment of PFR values, the type of functional reactivity of the cardiovascular system is evaluated: if the value is *, then it is divided by 100 to obtain arbitrary units (conventional units are two-digit numbers).

In a second study in the dynamics of treatment, the patient is given to memorize a different set of letters in order to prevent addiction.

When the values of the increment after dosed psychoemotional load PFR from 10 to 20 srvc. functional type of reactivity is assessed as normal. When PFR load more than 20 srvc. type of functional reactivity is assessed as hyperfunctional. In this case, a patient with hypertension with type II diabetes in the elderly and senile must be prescribed for at least 3 months a combination of rationally dosed static and dynamic physical activity, daily swimming in the pool for at least 15 minutes a day, irbesartan 150 mg in the morning 1 time and pioglitazone 30 mg in the morning 1 time.

One of the options feasible regular physical training is described 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, 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 hypertension and type II diabetes of the elderly and senile age 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 preventive gymnastics.

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 exhale, retract the wall of the abdomen.

Exercise 7. Standing, hands free. Walking for free -1 min, then with high flexion of the hips - 10-20 movements, followed by a transition to a quiet walk -1-2 min. 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 inclinations 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 then to a prone position; f) self-massage of the abdomen with small semicircular movements in a clockwise direction -1-2 min. 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 the classes, the following set of exercises can be used.

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 pelvis turning 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 and type II diabetes of the elderly and senile is a patient with a number of concomitant disorders, especially 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 hypertension with type II diabetes in the elderly and senile 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 type II diabetes of the elderly and senile should be considered as a fractional load method.

Depending on the real life conditions of hypertensive patients with type II diabetes of the elderly and senile, 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 min; 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.).

Timely and effective correction of PFR in patients with hypertension with type II diabetes in the elderly and senile will allow them to quickly normalize the functional reactivity of the cardiovascular system, which will shorten the time of hospitalization in these patients, prevent strokes and heart attacks, reduce the number of disability and will reduce mortality among patients with hypertension with type II diabetes of the elderly and senile.

Example 1. Patient B. 61 years old, suffering from AH of the II degree, II stage with type II diabetes for 20 years was examined. In the study of hemodynamics in the initial state before the psychoemotional load, the blood pressure was equal to 148 mm Hg, blood pressure - 94 mm Hg, blood pressure - 116.7 mm Hg, heart rate - 80 beats. in 1 min. PFR before the start of the psychoemotional load was 93.3 srvc. units During the psychoemotional load, blood pressure increased to 170 mmHg, blood pressure - 105 mmHg, blood pressure to 132.3 mmHg, heart rate - up to 94 beats. in 1 min, the value of PFR increased to 124.3 conventional units, that is, the increment of PFR at the load or, what is the same - PFR, amounted to 31.0 conventional units. (from 93.3 conventional units to 124.3 conventional units), which can be regarded as a manifestation of hyperfunction of the cardiovascular system. The patient was prescribed a combination of rationally dosed static and dynamic physical activity, daily swimming in the pool for at least 15 minutes a day, irbesartan 150 mg in the morning and pioglitazone 30 mg in the morning. After 3 months of treatment, the PFR value decreased before the start of the load compared with the same before treatment: BPA - up to 130 mmHg, BPA - up to 82 mmHg, BPAdin - up to 102.1 mmHg. , Heart rate - up to 70 beats in 1 min, PFR - up to 71.5 conventional units When performing the load, a decrease compared to the state before treatment, the degree of increase in blood pressure values - up to 142 mm Hg, blood pressure - up to 88 mm Hg, blood pressure - up to 110.7 mm Hg, heart rate - up to 78 strokes in 1 min, PFR - up to 86.3 conventional units, that is, an increase in the values of PFR, or PFR, by 14.8 conventional units was noted. (before treatment - by 31.0 conventional units), which may indicate an increase in the tolerance of the cardiovascular system to psychoemotional stress, a decrease in hyperfunction of the cardiovascular system, and, consequently, an increase in cardiac activity.

Example 2. Patient B. was examined for 76 years, suffering from AH of the II degree, II stage with type II diabetes for 30 years. In the study of hemodynamics in the initial state before the psychoemotional load, the blood pressure was equal to 152 mm Hg, blood pressure - 95 mm Hg, blood pressure - 118.9 mm Hg, heart rate - 76 beats. in 1 min. PFR before the beginning of the psychoemotional load was 90.4 srvc. During the psychoemotional load, blood pressure increased to 170 mmHg, blood pressure - 102 mmHg, blood pressure. dyne up to 130.6 mm Hg, heart rate - up to 88 beats. in 1 min, the value of PFR increased to 114.9 conventional units, that is, the increment of PFR at the load or, what is the same - PFR, amounted to 24.5 conventional units. (from 90.4 conventional units to 130.6 conventional units), which can be regarded as a manifestation of hyperfunction of the cardiovascular system. The patient was prescribed a combination of rationally dosed static and dynamic physical activity, daily swimming in the pool for at least 15 minutes a day, irbesartan 150 mg in the morning and pioglitazone 30 mg in the morning. After 3 months of treatment, the PFR value decreased before the start of the load compared with the same before treatment: BPA - up to 126 mmHg, BPA - up to 78 mmHg, BPAdin - up to 98.2 mmHg. , Heart rate - up to 70 beats in 1 min, PFR - up to 68.7 standard units When performing the load, a decrease compared to the state before treatment, the degree of increase in blood pressure - up to 138 mm Hg, blood pressure - up to 84 mm Hg, blood pressure - up to 106.7 mm Hg, heart rate - up to 78 strokes in 1 min, PFR - up to 83.2 conventional units, that is, an increase in the values of PFR, or PFR, by 14.5 conventional units was noted. (before treatment - by 24.5 conventional units), which may indicate an increase in the tolerance of the cardiovascular system to psychoemotional stress, a decrease in hyperfunction of the cardiovascular system, and, consequently, an increase in cardiac activity.

As a result of the application of the proposed method for correcting the state of the functional reactivity of the cardiovascular system in patients with hypertension and type II diabetes of the elderly and senile, normalization of the functional reactivity of the cardiovascular system to a dosed psychoemotional load is achieved, which allows the method to normalize the tolerance of patients with hypertension with diabetes II type of elderly and senile age to psycho-emotional stress, reduce the degree of hemodynamic stress when exposed to stress, lowering degree of risk when psycho-emotional stresses adverse vascular responses (angina, cardiac infarction, cerebrovascular disease and others.).

Claims (1)

A method for optimizing the functional reactivity of the cardiovascular system (CVS) in patients with arterial hypertension with type II diabetes mellitus of the elderly and senile age, including assessing the state of the functional reactivity of CVS under psychoemotional stress, for which systolic, diastolic, and average dynamic (BPdr.) Pressure are recorded , heart rate (HR), on the basis of these indicators determine the indicator of functional reactivity (PFR) before and after exercise, using the formula: PFR = (ADdr.din. × heart rate) / 100 (conventional units), and when incrementing the value of FIU by more than 20 conventional units prescribe a combination of daily swimming in the pool for at least 15 minutes a day, morning hygienic and therapeutic gymnastics during the day, fractional physical exercises throughout the day, irbesartan 150 mg in the morning 1 time and pioglitazone 30 mg in the morning 1 time for at least 3 months.