RU2440833C1 - Method of rehabilitating patients with cerebrovascular diseases - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to neuropathology, physiotherapy. Method includes carrying out general magnetic therapy at the background of basic rehabilitation treatment in two stages. For this purpose device "£ÿ-3ñ" Colibri-expert is used. At the first stage impact by "running" pulses of magnetic fields in configuration "cylinder" is performed on lower extremities. Impact is carried out in first mode, with value of magnetic induction 3.5 mT and pulse frequency 100 Hz, during 10 minutes. Procedures are carried out daily, three procedures per a course. At the second stage impact on upper part of body by "rotating" pulses of magnetic fields in configuration "prism" is performed. Impact is carried out in first mode, with value of magnetic induction 3.5 mT and pulse frequency 100 Hz, during 15 minutes. Procedures are carried out daily, 7-10 procedures per a course. ^ EFFECT: method extends indications for magnetic therapy and possibility of its application in early rehabilitation period. ^ 2 ex, 3 tbl

Description

The present invention relates to medicine, namely to restorative medicine, physiotherapy, and can be used for the prevention and comprehensive treatment of patients with cerebrovascular diseases.

Cerebrovascular pathology is currently an important medical and social problem. This is due to the steady growth of this disease, high mortality and the frequency of complications (Gusev E.I. The problem of stroke in the Russian Federation: the time of active joint action / E.I. Gusev, V.I.Skvortsova // Neurology and Psychiatry. - 2007. - No. 8. - S.4-6).

Modern medicine uses a large arsenal of new physiotherapeutic equipment with high efficiency in the complex treatment of patients with cerebrovascular pathology. Among the methods of physiotherapy for the correction of cerebral hemodynamics, a special place is given to general magnetotherapy with the use of low-intensity rotating and traveling pulsed magnetic fields, which allows you to affect the whole body or most of it, the main body systems. It is known that the influence of pulsed magnetic fields is more susceptible to the nervous, cardiovascular and endocrine systems. When exposed to a low-intensity magnetic field, the amount of energy is absorbed a little, as a result, the sensitivity of tissues to a physical factor increases, the specific effects of magnetotherapy increase (Ulashchik BC General magnetotherapy and its application / BC Ulashchik, E.I. Zolotukhina // Health. - 2000. - No. 8. - S.44-46).

The vortex magnetic field is well perceived by various structures of the brain, provides a thalamocortical activating effect. Creates a spatio-temporal heterogeneous magnetic field with the combined use of several types of magnetic fields, reduces adaptation, which improves the effectiveness of treatment (Ulashchik BC Theoretical and practical aspects of general magnetotherapy / BCUlashchik // Issues of balneology, physiotherapy and physiotherapy. - 2001. - No. 5. - C.3-7).

As a prototype, a method for the treatment of vascular diseases of the brain using general magnetotherapy from the physiotherapy unit "UMTI-3F" Hummingbird-Expert using rotating pulsed magnetic fields according to the following method is used. The configuration of the “prism” solenoids with installation on the upper half of the body and head, with a frequency of 100 Hz, in 1 mode for 10-15 minutes with a magnitude of magnetic induction of 32 mT and 16 mT and for 10-20 minutes - 3.5 mT and 16 mT within 2 days; then for 5-10 minutes with a magnetic induction of 32 mT and 16 mT and 15-30 minutes - 3.5 mT and 16 mT, with a course of 10-12 daily procedures (Ponomarenko T.N. Collection of teaching materials on the use of general magnetotherapy from physiotherapeutic installation "UMTI-3F" Hummingbird-Expert, St. Petersburg - Nizhny Novgorod, 2008; Guidelines for the use of medical techniques from the apparatus of the Hummingbird-Expert, developed by IMC "Madin", Nizhny Novgorod, 1996). The above method is not effective enough, since it does not provide for the impact on all parts of the hemodynamics of cerebrovascular diseases. It does not provide a systematic approach, the maximum individualization of treatment.

The objective of the invention is to develop an effective method for the treatment of patients with cerebrovascular disease.

The technical result of the proposed method is to improve indicators of cerebral circulation, blood pressure and autonomic tone, the possibility of use in severe patients.

The proposed method is as follows: against the background of basic rehabilitation treatment, general magnetotherapy is used with a running and rotating pulsed magnetic field at the UMTI-ZF Kolibri-Expert installation in two stages.

At the first stage, “traveling” pulsed magnetic fields are applied to the lower extremities in a “cylinder” configuration at a pulse frequency of 100 Hz and a magnetic induction of 3.5 mT in 1 mode for 10 minutes with a course of 3 daily procedures.

At the second stage of treatment, “rotating” pulsed magnetic fields are exposed to the upper body in a “prism” configuration at a frequency of 100 Hz and a magnetic induction of 3.5 mT in 1 mode for 15 minutes. The course of treatment is 7-10 daily procedures.

It is this combination that allows you to expand the indications for the use of general magnetotherapy in the treatment of patients with cerebrovascular diseases and apply this method for the treatment of severe patients. At the first stage of treatment, a weak short-term effect is produced, preparing the patient's body for more powerful influences. At the second stage of treatment, the central links of hemodynamics are affected for the general restructuring of the whole organism.

The proposed method was applied in clinical practice to 44 patients (29 men and 15 women) aged 47 to 65 years. Of these, with initial manifestations of cerebrovascular insufficiency in 18 patients with arterial hypertension, with stage I-II discirculatory encephalopathy, 20 patients and 6 patients with consequences of ischemic stroke developed against the background of hypertension and atherosclerosis.

Before starting treatment, all patients underwent general and biochemical blood tests, urinalysis, ECG. The state of cerebrovascular hemodynamics, cerebral circulation compensation were evaluated according to REG, ultrasound of the main vessels of the brain and neck. For the study of cognitive disorders, visual and spatial functions, the test “clock” was used.

The main complaints of patients were headaches, dizziness, a feeling of heaviness in the head, general weakness, increased fatigue, emotional lability, decreased memory and attention, and sleep disturbances.

The research results presented in table 1 show that in the patients of the first group who received complex treatment using general magnetotherapy, the clinical symptoms and hemodynamics exceeded the results of the comparison group, in which only basic treatment was used. In the first group, positive dynamics was observed already on 3-5 days, recovery on 10-12 days; in patients of the second group, improvement was noted on the 10th day, recovery on the 14-21th day, depending on the pathology (table 1).

In the main group, blood pressure levels decreased: SBP by 18.9% (p <0.05), DBP by 10.5% (p <0.05), and BPP by 18.2% (p <0.05), pAD by 14.7% (p <0.05), heart rate by 5.3% (p <0.05), which indicates a positive effect of general magnetotherapy on central hemodynamics.

By the end of the course, according to the REG data, 82.3% of patients showed an improvement in the pulse blood supply of the vessels of the brain of the brain, a decrease in the tone of the large and middle cerebral arteries, which was confirmed by the normalization of the forms of REG - waves in the hemispheric and occipital leads, in a decrease in the amplitude asymmetry coefficient, in the improvement of the venous outflow .

According to the ultrasound scan of the main vessels of the brain and neck, an increase in the average linear velocity of blood flow was observed. In the system of the internal carotid, vertebral, main and posterior cerebral arteries by 13.7% (p <0.05), an increase in blood flow by 15% (p <0.05), a decrease in asymmetry in the area of carotid bifurcation by 4.2% ) (p <0.05) (table 2).

Against the background of the treatment, a positive dynamics of the lipid spectrum was noted. The level of total cholesterol in the main group decreased by 26.4% (p <0.05), LDL by 24.8% (p <0.05), TG by 26.6% (p <0.05), HDL increased 26.9% (p <0.05) (table 3).

When assessing cognitive impairment and visual-spatial functions during the “clock” test, the main group showed a decrease in the number of errors by 25% (p <0.05).

In the available scientific, medical and patent literature, there is information about the popularity of the method of treating cerebrovascular diseases, characterized in that, against the background of basic rehabilitation treatment, general magnetotherapy is carried out using “traveling” and “rotating” pulsed magnetic fields of the UMTI-3F physiological Colibri-Expert in two stages; at the first stage, “lowering” pulsed magnetic fields are applied to the lower extremities in a “cylinder” configuration in 1 mode at a pulse frequency of 100 Hz and a magnetic induction of 3.5 mT for 10 minutes with a course of 3 daily procedures; at the second stage of treatment, “rotating” pulsed magnetic fields are exposed to the upper body in a “prism” configuration in 1 mode at a frequency of 100 Hz and a magnitude of magnetic induction of 3.5 mT for 15 minutes with a course of 7-10 daily procedures. Thus, the claimed invention meets the criterion of "novelty."

The authors' studies proved that conducting a general magnetotherapy using the “running” and “rotating” pulsed magnetic fields of the UMTI-3F physiological installation Hummingbird-Expert in two stages against the background of basic rehabilitation treatment; at the first stage, “lowering” pulsed magnetic fields are applied to the lower extremities in a “cylinder” configuration in 1 mode at a pulse frequency of 100 Hz and a magnetic induction of 3.5 mT for 10 minutes with a course of 3 daily procedures; at the second stage of treatment, the “upper” body is subjected to the action of “rotating” pulsed magnetic fields in the “prism” configuration in 1 mode at a frequency of 100 Hz and a magnetic induction of 3.5 mT for 15 minutes with a course of 7-10 daily procedures, which improves clinical symptoms, positive dynamics of cerebral circulation according to REG and USDG, stabilization of blood pressure, normalization of autonomic tone and lipid profile, makes it possible to use in severe patients. Thus, the claimed invention meets the criterion of "inventive step".

The invention is illustrated by the following clinical examples.

Example 1. Patient N., 54 years old, was admitted for treatment with a diagnosis of Cerebrovascular disease. Atherosclerosis of the cerebral vessels. The early recovery period of acute ischemic cerebrovascular accident in the vertebrobasilar basin (07/23/10) with severe vestibulo-atactic syndrome.

Complaints of headaches, dizziness, a feeling of heaviness in the head, general weakness, increased fatigue, emotional lability, decreased memory and attention, and sleep disturbance. Suffers from hypertension for 10 years. Antihypertensive drugs were not taken regularly, often gave hypertensive crises. Blood pressure ranged from 140/90 mm Hg. up to 150/95 mm Hg, heart rate was 78 beats per minute. On the ECG: sinus rhythm, signs of left ventricular hypertrophy. Complete blood count: red blood cells 5.0 × 10 ¹² / l, hemoglobin 125 g / l, white blood cells 8.1 × 10 ⁹ / l, ESR 19 mm / h. Biochemical analysis of blood: cholesterol 6.8 mmol / L, LDL 2.5 mmol / L, HDL 1.1 mmol / L, triglycerides 2.4 mmol / L.

On REG there was a decrease in pulse blood supply to the vessels of the brain, an increase in the tone of the large and medium cerebral arteries, violation of the forms of REG - waves in the hemispheric and occipital leads, an increase in the amplitude asymmetry coefficient, and violation of the venous outflow.

On UZDG of the main arteries of the head and neck: cerebral arteriosclerosis, left-sided vertebral insufficiency.

On the left, at the mouth of the internal carotid artery, along the anterolateral wall, a local, heterogeneous, with hyperechoic inclusions atherosclerotic plaque was visualized, with uneven contours, 2.1 mm by 10.6 mm in size, stenotic vascular lumen 20-30% in diameter, LSC = 50.1 cm / s. On the right, there is an uneven thickening of the intima-media complex, LSC = 52.1 cm / s. The main cerebral artery LSC = 43.3 cm / s, the posterior cerebral artery LSC = 42.7 cm / s. In the extravertebral sections of both vertebral arteries, an “S” -sharp tortuosity was noted, s> d. In the intravertebral sections of both vertebral arteries, there was some indirectness in the course of the arteries between the transverse processes of the cervical vertebrae. Blood flows to the vertebral arteries were moderately asymmetric, sufficient, moderately difficult with the zone of local hemodynamic drops during the transition of segment V1 to V2, to the left. On the left, BFV = 29.1 cm / s, on the right, BFV = 31.2 cm / s.

Drug treatment for the patient was: gliatilin, betaserk, diroton, cardiomagnyl. The patient received climatotherapy, diet therapy, mineral drink, herbal medicine, back massage, exercise therapy.

Treatment was prescribed according to the claimed method: general magnetotherapy from the Kolibri-Expert apparatus. The first three procedures are 10 minutes each using “traveling” pulsed magnetic fields in the “cylinder” configuration to the lower extremities, at a pulse frequency of 100 Hz and a magnetic induction of 3.5 mT in I mode. From the fourth procedure, using "rotating" pulsed magnetic fields in the "prism" configuration on the upper body, at a frequency of 100 Hz and a magnitude of magnetic induction of 3.5 mT, in I mode for 15 minutes, No. 7, daily.

After 5 days, headaches, dizziness, and a feeling of heaviness in the head decreased. HELL 120/80 mm Hg, heart rate was 66 beats per minute. By the end of the course of treatment, blood counts approached normal (red blood cells 5.0 × 10 ¹² / l, hemoglobin 135 g / l, white blood cells 6.7 × 10 ⁹ / l, ESR 8 mm / h, cholesterol 5.0 mmol / l, LDL 2.0 mmol / L, HDL 1.4 mmol / L, triglycerides 1.77 mmol / L).

According to the REG data, an improvement in the pulse blood filling of the cerebral vessels, a decrease in the tone of the large and medium cerebral arteries was noted. Normalization of the forms of REG - waves in the hemispheric and occipital leads, a decrease in the amplitude asymmetry coefficient, an improvement in venous outflow.

According to the ultrasound examination of the main vessels of the brain and neck, the average linear blood flow velocity in the system of the internal carotid, vertebral, main and posterior cerebral arteries increased by 15.2% (p <0.05), the volume of blood flow by 13.5% (p <0 05), the asymmetry in the area of carotid bifurcation decreased by 3.8% (p <0.05).

Assessment of cognitive disorders, visual-spatial functions according to testing (test "clock") revealed a positive dynamics of indicators characterizing attention and memory (p <0.05). The patient was discharged with improvement.

Example 2. Patient A., 52 years old, was admitted for treatment with a diagnosis of Cerebrovascular disease. Atherosclerosis of the cerebral vessels. Chronic cerebral ischemia II with mild vestibulo-atactic syndrome. Chronic progressive course. Decompensation.

Complaints of moderate headaches, dizziness, a feeling of heaviness in the head, decreased memory and attention, sleep disturbance, numbness in the hands. In 1995, she suffered a minor ischemic stroke in the vertebrobasilar basin with transient vestibular dysfunction. Blood pressure 125/85 mm Hg, heart rate was 68 beats per minute.

On the ECG: rhythm, sinus, vertical position of the electrical axis of the heart, violation of the repolarization process in the posterior wall of the left ventricle.

Complete blood count: red blood cells 4.3 × 10 ¹² / l, hemoglobin 120 g / l, white blood cells 7.0 × 10 ⁹ / l, ESR 12 mm / h.

Biochemical analysis of blood: cholesterol 6.5 mmol / L, LDL 2-4 mmol / L, HDL 1.0 mmol / L, triglycerides 2.4 mmol / L.

On REG: increased tone of the large and medium cerebral arteries, impaired venous outflow.

On ultrasound scan of the main arteries of the head and neck: cerebral arteriosclerosis.

On both sides, in the system of the common carotid artery and in the area of carotid bifurcation, the intima-media complex is not thickened, the intima are unevenly densified. The anatomical course of the common carotid artery on the left is not changed, on the right, the unevenness of the course of arteries. Cerebral tortuosity of both internal carotid arteries was noted, the blood flow was difficult, changed, LSC = 49.6 cm / s on the left, LSC = 48.8 cm / s on the right. The main cerebral artery LSC = 42.3 cm / s, the posterior cerebral artery. LSK = 41.7 cm / s. In the extravertebral section of the vertebral artery (segment V1), on the right there is a “C-S” -shaped crimp, on the left an S-shaped crimp. In the intravertebral section of both vertebral arteries, there is some indirectness in the course of the arteries between the transverse processes of the cervical vertebrae. Blood flow through the vertebral arteries in segments in V1-V2, moderately asymmetric, sufficient, on the right, BFV = 29.8 cm / s and on the left BFV = 28.7 cm / s. In the course of segment VI on the left and during the transition in the region of segments V1-V2 on the right, moderately obstructed blood flow with zones of local hemodynamic drops was noted. The diameter of the vertebral artery on the right = 3.2 mm, on the left = 3.7 mm.

Drug treatment was diroton, cardiomagnyl. The patient received climatotherapy, diet therapy, mineral drink, aeroionophytotherapy, swimming pool, back massage, exercise therapy.

The treatment was prescribed according to the claimed method: general magnetotherapy from the Kolibri-Expert apparatus using “traveling” pulsed magnetic fields in the “cylinder” configuration to the lower extremities at a pulse frequency of 100 Hz and a magnetic induction of 3.5 mT in 1 mode of 10 minutes for 3 days. The following 7 procedures using “rotating” pulsed magnetic fields in the “prism” configuration on the upper body at a frequency of 100 Hz and a magnetic induction of 3.5 mT in 1 mode for 15 minutes per session, No. 10, daily.

After 3 days, headaches, dizziness, a feeling of heaviness in the head decreased, blood pressure returned to normal (blood pressure 120/80 mmHg). By the end of the course of treatment, blood counts improved (red blood cells 5.0 × 10 ¹² / L, hemoglobin 130 g / L white blood cells 6.7 × 10 ⁹ / L, ESR 8 mm / h, cholesterol 5.0 mmol / L, LDL 1, 7 mmol / L, HDL 1.4 mmol / L, triglycerides 1.7 mmol / L).

According to the REG data, a decrease in the tone of large and medium cerebral arteries, an improvement in venous outflow, was noted.

According to the ultrasound examination of the main vessels of the brain and neck, the average linear blood flow velocity in the system of the internal carotid, vertebral, main cerebral and posterior cerebral arteries increased by 15.2% (p <0.05), the volume of blood flow by 14.2% (p < 0.05), asymmetry in the vertebral arteries decreased by 3.7% (p <0.05).

Assessment of cognitive disorders, visual-spatial functions according to testing (test "clock") revealed a positive dynamics of indicators characterizing attention and memory (p <0.05). The patient was discharged with improvement.

Thus, the proposed method shows a high therapeutic effect and pathogenetic validity. The method allows the use of general magnetotherapy using "running" and "rotating" pulsed magnetic fields at an earlier date of rehabilitation treatment for severely ill patients with cerebrovascular diseases.

The method is simple to implement, easy to carry, does not require large financial costs, it can be used in medical and sanatorium institutions. Thus, the claimed invention meets the criterion of "industrial applicability".

Table 1 The results of treatment of patients with cerebrovascular diseases Indicators The main group (n = 44) Comparison Group (n = 30) Improvement (day of treatment) Recovery Improvement (day of treatment) Recovery Reducing headaches, dizziness, feeling of heaviness in the head, restoring sleep, increasing performance, reducing irritability 3-5 days On day 10-12 On day 10 On days 14-21 Improved hemodynamics Positive dynamics for 3-5 days Positive dynamics on day 12

table 2 The effect of general magnetotherapy on the average linear velocity of cerebral blood flow (cm / s) in patients with cerebrovascular diseases (M ± m) SLK indicators Patients with cerebrovascular disease The main group (n = 44) Comparison Group (n = 30) before treatment after treatment before treatment after treatment Internal carotid artery 50.1 ± 0.03 55.4 ± 0.05 * 50.1 ± 0.03 51.8 ± 0.04 Vertebral artery 30.1 ± 0.05 39.3 ± 0.02 * 30.0 ± 0.05 31.2 ± 0.03 Main cerebral artery 43.3 ± 0.02 48.2 ± 0.04 * 43.3 ± 0.02 44.0 ± 0.05 Posterior cerebral artery 42.7 ± 0.01 49.9 ± 0.03 * 42.7 ± 0.01 43.5 ± 0.04 * Significance of differences in indicators before and after treatment, p <0.05.

Table 3 The dynamics of the blood lipid profile of patients with cerebrovascular diseases on the background of a course of general magnetotherapy (M ± m) Groups The main group (n = 44) Comparison Group (n = 30) Indicators before treatment after treatment before treatment after treatment OHS, mmol / l 6.81 ± 0.02 5.01 ± 0.04 * 6.81 ± 0.02 6.21 ± 0.03 HDL, mmol / l 1.14 ± 0.03 1.56 ± 0.05 * 1.14 ± 0.03 1.13 ± 0.04 LDL mmol / L 2.67 ± 0.04 2.01 ± 0.05 * 2.67 ± 0.04 2.54 ± 0.03 TG, mmol / l 2.41 ± 0.04 1.77 ± 0.03 * 2.41 ± 0.04 2.25 ± 0.02 * Significance of differences in indicators before and after treatment, p <0.05

Claims (1)

A method for the treatment of cerebrovascular diseases, characterized in that, against the background of basic rehabilitation treatment, general magnetotherapy is carried out using “traveling” and “rotating” pulsed magnetic fields of the UMTI-3F Colibri-Expert physiotherapeutic installation in two stages, at the first stage to the lower limbs carry out the impact of “traveling” pulsed magnetic fields in the “cylinder” configuration in 1 mode at a pulse frequency of 100 Hz and a magnetic induction of 3.5 mT for 10 minutes with a course of 3 daily procedures s, at the second stage of treatment, the upper body is exposed to “rotating” pulsed magnetic fields in the “prism” configuration in 1 mode at a frequency of 100 Hz and a magnetic induction of 3.5 mT for 15 minutes with a course of 7-10 daily procedures.