RU2466757C1 - Method of treating vibration sickness associated with dyscirculatory encephalopathy and hypertension - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves simultaneous exposure to fluctuating currents and variable magnetic field. The exposure involves variable magnetic field of the half-sinusoidal form. The exposure is generated by two field magnets of the diameter of 5 cm. The magnets are arranged on sinocarotid neck areas. The exposure has induction 35 mTl, frequency 50 Hz. A procedure length is 15 minutes. The therapeutic course is 10 days.

EFFECT: clinical effectiveness ensured by improved cerebral and peripheral hemodynamics, cognitive cerebral functions and cardiovascular action.

3 tbl, 2 ex

Description

The present invention relates to medicine, namely physiotherapy, neurology, cardiology, and is intended for the treatment of vibration disease (WB) associated with discirculatory encephalopathy (DE) and hypertension (GB).

A known method for the treatment of VB using peloidoamplipulse therapy. In this case, therapeutic mud at a temperature of 38-40 ° C was placed in cotton bags, one of which was placed on the cervicothoracic spine, an electrode-anode was placed on top of it, two other bags with therapeutic mud were placed on the back surfaces of the hands and connected to a forked cathode electrode . The rectified mode of sinusoidally modulated currents, type of operation I and III, modulation frequency of 100 Hz, modulation depth of 50% (after 5 procedures, frequency of 70 Hz, depth of 75%), duration of current transmissions of 2-3 s, and the total duration of the procedure were used. 25 minutes The current strength is dosed depending on the individual sensitivity of the patient - until a sensation of painless vibration appears. The course of treatment is 10 procedures (Patent for the invention of the Russian Federation No. 2104060).

When applying the known method of treating VB, peloidoamplipulotherapy is used, which requires a specially equipped mud bath from a medical institution, the use of sapropel leads to additional material and time costs (loading and unloading of dirt in cotton bags). The use of mud applications and electro-mud is contraindicated for high blood pressure, exacerbation of osteoarthritis and osteochondrosis (Water-heat therapy / V.T. Olefirenko. - M .: Medicine, 1978. - P.238-239), which are the most common concomitant diseases WB.

A known method of treating patients with hypertensive discirculatory encephalopathy of the I-II stage (patent for the invention No. RU 2405591 C1). To implement this method, patients receive complex medication and physiotherapy: a 12-day course of an antioxidant and antihypertensive drug (cytoflavin 10 ml in 200 lm of 5% glucose and internal enalapril 5-10 mg, 1 time per day are injected dropwise), and also on the first day they act with an electric current on the brain structures using the Transair-03 apparatus according to the transcranial technique - the electrodes are placed on the skin of the eyebrows (cathode) and in the region of the mastoid processes (anode), the shape of the bipole pulses of electrical current rectangular, frequency 77 Hz, the current of 1-2 mA, duration of exposure is increased during the treatment from 15 to 30 minutes; the next day, they are exposed to the magnetic field from the Pole-2 apparatus by paired inductors with a rectangular core, which set the working surface marked “N” in the contact area of the synocarotid zone, the magnetic field generation mode is intermittent, the shape of the magnetic field is sinusoidal, frequency 50 Hz, magnetic induction 25 mT, exposure time 10 min. Transcranial exposure to electric current and exposure to an alternating magnetic field alternate every day. The course of treatment is 10-12 procedures.

Significant disadvantages of this method are:

- the use of medications, in particular the antihypertensive drug enalapril, which has an additional chemical load on the body. The drug has a number of side effects and contraindications: headache, dizziness, fatigue, increased fatigue, cramps, insomnia, nervousness, tinnitus, glossitis, nausea, dry cough, hypotension, palpitations, pain in the heart and abdomen, diarrhea, impaired function kidney and liver, impotence, neutropenia, hair loss, Quincke's edema, skin rash, increased blood transaminases and bilirubin (Russian Drug Register. Encyclopedia of drugs. - M.: RLS-2004 LLC, 2004. - S.1024) ;

- two physical factors are used alternately and on different days, additionally loading physiotherapy rooms;

- the total number of procedures with pulse currents of 5-6 and magnetic current of 5-6 is clearly insufficient, which is why the authors used additional medications;

- the transcranial technique uses an electric current of the least physiological, “rough” - rectangular shape and constant frequency - 77 Hz, which, in turn, inevitably leads to tissue getting used to physical effects and reduce the therapeutic effect;

- the Polyus-2 apparatus has full-time paired inductors with a rectangular core measuring 5 × 15 cm. At the same time, the magnetic field has a certain amount of field lines and the use of cores of this size inevitably involves various anatomical formations in it, which contradicts the authors' statement (p. .7) "... on two therapeutic fields, act on a small area and not influence other nearby anatomical and physiological formations." The synocarotid zone is located in the middle third of the neck and its area is on average 5-7 cm ² , which, in principle, does not allow placing regular rectangular inductors from the Pole-2 apparatus directly in this zone, and even more so in isolation affect the synocarotid formations;

- required mandatory orientation of the cores of the magnetic inductors with a surface marked "N", which complicates the procedure;

- the maximum procedure time is 30 minutes, which reduces the throughput of physiotherapy rooms;

- the patent claims the treatment of hypertensive encephalopathy. At the same time, there is no information on the effect of therapy on the main etiological component of encephalopathy - hypertension. In clinical examples, there is only data on the initial numbers of blood pressure, which were in the range 130 / 85-140 / 90, which seems doubtful in the presence of "true" hypertension. There are no average blood pressure values before and after treatment;

In our proposed method of treatment, medications are not used; simultaneously act with low-frequency pulse currents and an alternating magnetic field, which allows you to give the patient a full course of treatment and does not require visits to two physiotherapy rooms; fluctuating currents are used, to which tissues are not used, they are the most physiological, better tolerated by patients; the Adapton Emit-1 apparatus is equipped with 2 full-time cylindrical magnetic inductors 5 cm in diameter, which allows them to be placed exactly on the synocarotid zones; there is no need for the orientation of magnetic inductors with a surface marked "N", which simplifies the procedures; the duration of the procedures is 15 minutes, which is 2 times shorter; reliable positive results were obtained in the frequency of positive EEG results, dynamics of clinical symptoms, blood pressure and cognitive functions, as well as differences between the final total scores after treatment. A comparative analysis of the parameters of the procedures and treatment results for this analogue and the claimed method are presented in table 1.

A known method of treating WB associated with GB. To do this, first in the morning hours, they act electromagnetically (electrosleep from the ES-4T apparatus according to the orbital-occipital technique, current frequency 10-20 Hz, current strength 7-10 mA, duration of the procedure 30 minutes, 10 courses per day, daily), and then mud applications are applied to the cervical-collar zone and hands (duration of procedure (15-20 minutes, temperature 38-46 ° C, in the course of 10 procedures, every other day). The data are presented in the Patent for the invention of the Russian Federation (No. 2314084).

Table 1 Comparative evaluation of the method and treatment results according to the known analogue and the claimed method Indicators Comparison groups p, χ ² , at times analog
n = 38 claimed method
n = 47 The use of medications cytoflavin, enalapril - - The duration of the procedure (min) up to 30 fifteen 2 times shorter Course Duration (days) 10-12 10 1.2 times shorter Electrotherapy current shape rectangular fluctuating - frequency Hz 77 57-30 - current strength, mA 1-2 individually selected - tissue addiction there is no - tissue effects rude physiological - number of procedures 5-6 10 2 times Magnetotherapy inductor size rectangular 5 × 15 cylindrical, diameter 5 cm - core orientation N not required - field shape sinusoidal semi-sinusoidal - induction, MT 25 35 - The percentage of patients discharged with "improvement" on DE (%) no data 42 of 47
89.4 ± 2.9 - The percentage of patients discharged with "improvement" in GB (%) no data 95.7 (45 people out of 47) - Cognitive tests no data positive dynamics - The frequency of lowering blood pressure (%) no data one hundred - The frequency of lowering blood pressure in the hyperkinetic variant (%) no data one hundred - GARDEN after treatment (mmHg) no data 126.9 ± 1.79 - DBP after treatment (mmHg) no data 82.3 ± 1.16 - The deterioration in the treatment process (%) 0 0 - Cancellation of treatment during balneoreaction (%) 0 0 - Positive ECG dynamics (%) no data 72.3 (34 people out of 47) - Pronounced positive dynamics of the EEG,% 60.5 (23 people out of 38) 93.6 (44 people out of 47) χ ² = 4.0
p <0.05 Normalization of Doppler ultrasound indicators 86.8 (33 people out of 38) 87.2 (41 people out of 47) P> 0.1

Continuation of table 1 Indicators Comparison Groups and Study Period p, at times analog
n = 38 claimed method
n = 47 before treatment after before treatment after Headache 2,4 1.4 2.5 1,2 - Unsteady / unstable gait 1.4 0.6 1,0 0.5 - Dizziness 2.6 1,6 2.1 1,6 - Noise in the head 2.2 2.0 2.2 0.7 2.9 Sleep disturbance 2.0 1,2 2.1 1,2 - Fatigability 2.6 1.7 2.7 1,6 - Impaired memory 2.7 2,4 2.5 0.8 3.0 Decreased performance 2.7 1.3 2,8 1.4 - Anxiety increase 2.6 2.2 2.7 0.9 2,4 Emotional lability 2,3 1,2 2.5 1,2 - Average points 23.5 ± 1.3 15.6 ± 1.3 * 23.7 ± 1.5 11.2 ± 1.3 *; ** ** p <0.02 Note: before treatment / after treatment * - significant shifts (p <0.05); ** - significant differences between the final results of points for the analogue and the claimed method according to the final results

At the same time, this method requires a special purpose of electric sleep procedures in the morning to eliminate the negative effects of mud therapy on the cardiovascular system. In this case, a rough, least physiological — rectangular pulse shape is used in electrotherapy (Electrotherapy / V.G. Yasnogorodsky. - M.: Medicine, 1987. - P. 49). The implementation of the method requires a specially equipped mud bath from a medical institution, significant time costs (the patient receives electrotherapy in the morning - 30 minutes, then mud therapy - 15-20 minutes), the course of treatment is 20 days. There are also a large number of contraindications to peloid therapy, which are indicated above. In this case, systolic blood pressure (SBP) after treatment by analogy does not reach the target level of 136.6 ± 1.87 mm Hg. A comparative analysis of the parameters of the procedures and treatment results for this analogue and the claimed method are presented in table 2.

Closest to the proposed method is a method of treating a vibrational disease with concomitant discirculatory encephalopathy

table 2 Comparative evaluation of the results of treatment of VB according to the known analogue (electrosleep and peloids) and the claimed method Indicators Comparison groups p, χ ² , many times shorter analog
n = 30 claimed method
n = 47 The duration of the procedure (min) 45-50 fifteen in 3.0-3.3 Course Duration (days) twenty 10 in 2 Current shape rectangular fluctuating - The percentage of patients with WB discharged with "improvement" (M ± m) no data 40 of 47
85.1 ± 2.7 - The percentage of patients discharged with "improvement" on DE (%) no data 42 of 47
89.4 ± 2.9 - The percentage of patients discharged with "improvement" in GB (%) 96.7 95.7 (45 people out of 47) p> 0.1 Test "10 words" (M ± m), points no data 5.3 ± 0.5 / 7.2 ± 0.6 * - Clock drawing (M ± m), points no data 6.3 ± 0.3 / 8.2 ± 0.8 * - Schulte table (s) no data 59.0 ± 2.7 / 38.9 ± 3.3 * - Cognitive Evoked Potentials (A _p300 uV) no data 3.6 ± 0.4 / 8.9 ± 0.9 * - The frequency of lowering blood pressure (%) 96.7 one hundred p> 0.1 The frequency of lowering blood pressure in the hyperkinetic variant (%) one hundred one hundred p> 0.1 The deterioration in the treatment process (%) 0 0 - Cancellation of treatment during balneoreaction (%) 0 0 - Negative ECG dynamics (%) 0 0 - Positive ECG dynamics (%) 30 (9 people out of 30) 72.3 (34 people out of 47) χ ² = 4.1
p <0.05 Rheoencephalography OMO (reduction in CI;%) 15 (4 people out of 30) 44.7 (21 people out of 47) χ ² = 4,5
p <0.01 Vertebral artery rheoencephalography (RI, c.u.) no data 0.62 ± 0.07 / 1.10 ± 0.08 * - Rheoencephalography of the internal carotid artery (V max, Ohm / s) no data 0.78 ± 0.08 / 0.99 ± 0.09 - Ultrasound dopplerography of the vertebral artery (linear blood flow velocity, cm / s) no data 18.6 ± 1.9 / 31.6 ± 2.3 * - Pronounced positive dynamics of the EEG,% no data 93.6 (44 people out of 47) - GARDEN after treatment (mmHg) 136.6 ± 1.87 126.9 ± 1.79 p <0.001 DBP after treatment (mmHg) 88.8 ± 1.24 82.3 ± 1.16 p <0.001

Continuation of table 2 Indicators Comparison groups p, χ ² , at times analogue (electrosleep and peloids)
n = 30 claimed method
n = 47 Daytime Hypertension Reduction (%) GARDEN 30 (9 people out of 30) 80.1 (38 people out of 47) χ ² = 5.3
p <0.001 DBP 39 (12 people out of 30) 80.1 (38 people out of 47) χ ² = 3.0
p> 0.1 Reduced hypertonic load at night (%) GARDEN 55 (17 people out of 30) 74.5 (35 people out of 47) χ ² = 2.4
p> 0.1 DBP 48 (14 people out of 30) 70.2 (33 people out of 47) χ ² = 1,1
p> 0.1 Quality of life criteria (FA; RF; B; OZ; ZhS; SA; RE; PZ; SS) no data improvement by 12-53% - Note: before treatment / after treatment * - significant shifts (p <0.05); FA - physical activity, RF - the role of physical problems, B - pain, OZ - general health, FS - vitality, SA - social activity, PE - the role of emotional problems, PP - mental health, SS - comparison of health (MOS SF-36) .

(Application for invention of the Russian Federation No. 2010109159). In this case, a fluctuating current was applied from the Adapton Emmit-1 apparatus, which was applied to the bifurcated electrodes of four pairs of independent circuits of the apparatus located transversely on the skin of the forehead and cervical spine, in the area of the hands and affected elbow joints, an alternating current without amplitude modulation at the first 3-4 procedures, followed by pulse signal generation, with amplitude modulation and frequencies of 57-30 Hz, with current strength up to moderate asynchronous vibration, with the exposure time of the procedure 15 minutes and the duration of the course of treatment - 10 it.

When using this method of treatment, a positive effect on the manifestations of VB with concomitant DE was noted. At the same time, hypertension in this category of patients is observed in 36.6% of cases (Effect of low-frequency magnetotherapy and EHF puncture on the heart rate of working vibro-hazardous professions with arterial hypertension / V.A.Drobyshev, M.I. Loseva, T.M. . Sukharevskaya, A.I.Michurin // Occupational medicine and industrial ecology. - 2001. - No. 6. - S.20-23). In addition, they have blood pressure variability in 98% of cases, left ventricular hypertrophy - in 94% and decreased ergonomic function of the heart - in 61% (Adaptive capabilities of the cardiovascular system in workers of mining and metallurgical enterprises of the Ural region / L.A. Konevskikh: abstract of thesis ... doctor of medical sciences. - Ekaterinburg, 2006. - P.38).

The objective of the invention. Improving the effectiveness of treatment by improving cerebral and peripheral hemodynamics, improving cognitive functions of the brain and indicators of the cardiovascular system.

The problem is solved in that they carry out the action of fluctuating currents, and also additionally and simultaneously act on a semi-sinusoidal alternating magnetic field from two magnetic inductors with a diameter of 5 cm, located on the synocarotid zones of the neck, with an induction of 35 mT, a frequency of 50 Hz, with exposures of the procedure of 15 minutes and the duration of the course of treatment is 10 days. The method is carried out as follows: at the same time, they are affected by two physiotherapeutic factors from the Adapton-Emit-1 apparatus, which generates fluctuating currents that are applied to the bifurcated electrodes of four pairs of independent circuits of the apparatus located transversely on the skin of the forehead and cervical spine, in the area of the hands and injured elbow joints, alternating current, without amplitude modulation in the first 3-4 procedures, in the next - pulse signal generation, with amplitude modulation and frequencies of 57-30 Hz, with current strength up to Eren asynchronous vibration, and an alternating magnetic field from two half-sine magnetic inductors 5 cm in diameter, located on the neck sinocarotid zones, induction 35 mT, frequency of 50 Hz, with a 15 minute exposure procedure and duration of course of treatment - 10 days.

Significant differences of the claimed method are:

- simultaneous exposure to two physiotherapeutic factors - fluctuating currents and a magnetic field;

- exposure to a more physiological magnetic field - semi-sinusoidal;

- the size of the inductors in diameter is 5 cm, which provides an accurate effect on the sinocarotid zones;

- magnetic induction is 35 MT.

The advantage of the claimed method lies in the systematic approach to treating patients with VB who have multifocal damage to the organs of support and movement, nervous, cardiovascular and other systems (Occupational diseases / edited by E.M. Tareev and A.A. Bezrodny. - M .: Medicine, 1976.- 408 p.). In addition, in this category of patients there are manifestations of DE in the form of violations of the psychoemotional status and neurotic disorders: anxiety-hypochondriac syndrome (34.1%), depressive (21.3%), conversion (35.1%), with elements of personality psychotization with a significant predominance of reactive anxiety (Psycho-emotional disturbances in vibrational disease / E.N. Yanshina, P.N. Lyubchenko // Occupational medicine and industrial ecology. - 2001. - No. 2. - P.32-35.).

In the inventive method, fluctuating currents are used, which, compared with analogues, do not lead to rapid and pronounced adaptation of tissues to an electric signal (General physiotherapy / V.M. Bogolyubov, G.N. Ponomarenko. - M. - St. Petersburg., 1996. - C .124-125), the mode of continuous generation of a complex-modulated signal contributes to a more complete and faster leveling of the pain syndrome, and pulsed generation leads to a more pronounced normalization of blood circulation, including cerebral, and trophic effect (General physiotherapy / V.M. Bogolyubov, G. N.Po Omarenko. - M. - St. Petersburg., 1996. - P.124 .; Electropulse therapy device "Adapton Emmit-1" / V.Yu. Gulyaev, V.A. Matveev, I.E. Oransky. - Ekaterinburg, 1996. - 52 p.). The impact of physical factors on reflexogenic zones, which include synocarotid zones (in particular, UHF therapy), allows you to normalize blood pressure and reduce sympathetic activity, reducing the number of heart contractions, reducing the minute volume of blood flow by the heart, causing vasodilation (Private physiotherapy / ed. Prof. G.N. Ponomarenko. - M .: Medicine, 2005. - P.54).

In contrast to the prototype, the claimed method improves cerebral blood flow, cognitive functions and physical activity of patients to a greater extent (Table 3). So, after treatment according to the prototype, the RI of the vertebral artery became 0.84 ± 0.09 cu, according to the claimed method - 1.10 ± 0.08 cu (p <0.05), linear blood flow velocity, respectively - 25.2 ± 1.6 and 31.6 ± 2.3 cm / s (p <0.05), indicators of the Schulte Table - 49.2 ± 2.8 and 38.9 ± 3.3 s (p <0.02), cognitive evoked potentials (A _p300 ) - 6.2 ± 0.9 and 8.9 ± 0.9 μV (p <0.05), FA and the Russian Federation improved by 15.7-23.2% and 33.3-44% (p <0.05 and 0.01). There is no negative effect on the cardiovascular system. This higher clinical effect is achieved through the use of more physiological parameters of the magnetic field (inductor with a diameter of 5 cm, half-sinusoidal field, magnetic induction - 35 mT).

Clinical trials of the claimed method for treating WB associated with DE and GB were carried out in the neurological clinic of the Federal State Institution “Yekaterinburg Medical Scientific Center for Prevention and Health Protection of Industrial Workers” (EMRC) of Rospotrebnadzor during 2009-2011, which was confirmed by case histories of 47 patients.

The inclusion criteria were miners in contact with local vibration, with a reliably established diagnosis of WB associated with GB and DE; voluntary informative consent to the study.

Exclusion criteria were patients with stage III hypertension; contraindications to physiotherapy; rejection of the study.

Clinical example 1. Patient 3-t A.I., 48 years old. Case history No. 46526, was in the neurological department of the EMRC from 04/19/11 to 05/07/11. On admission, complaints of persistent pain in the wrist, elbow and shoulder joints were noted; chilliness, numbness of the hands and attacks of "whitening" of the tips of the fingers. Periodic headaches in the occipital region, dizziness, impaired memory and attention, irritability, emotional instability, poor sleep, decreased performance. Periodic pain in the cervical and lumbar spine.

Table 3 Comparative evaluation of the results of treatment of VB known (prototype) and the claimed method Indicators Comparison groups p, at times prototype claimed method The duration of the procedure (min) fifteen fifteen p> 0.1 Course Duration (days) 10 10 p> 0.1 The percentage of patients with WB discharged with "improvement" (M ± m) 69 of 82
84.2 ± 4.9 40 of 47
85.1 ± 2.7 p> 0.1 The percentage of patients discharged with "improvement" on DE (%) 74 of 82
90.2 ± 4.2 42 of 47
89.4 ± 2.9 p> 0.1 The percentage of patients discharged with "improvement" in GB (%) no data 95.7 (45 people out of 47) - Test "10 words" (M ± m), points 5.0 ± 0.5 / 7.0 ± 0.7 * 5.3 ± 0.5 / 7.2 ± 0.6 * ** p> 0.1 Clock drawing (M ± m), points 6.1 ± 0.4 / 8.4 ± 0.7 * 6.3 ± 0.3 / 8.2 ± 0.8 * ** p> 0.1 Schulte table (s) 58.5 ± 2.5 / 49.2 ± 2.8 * 59.0 ± 2.7 / 38.9 ± 3.3 *; ** ** p <0.02 Cognitive Evoked Potentials (A _p300 uV) 3.5 ± 0.5 / 6.2 ± 0.9 3.6 ± 0.4 / 8.9 ± 0.9 *; ** ** p <0.05 The frequency of lowering blood pressure (%) no data one hundred - The frequency of lowering blood pressure in the hyperkinetic variant no data one hundred% - Deterioration during treatment no data 0 - Cancellation of treatment during balneoreaction (%) no data 0 - Negative ECG dynamics no data 0 - Positive ECG dynamics (%) no data 72.3 (34 people out of 47) - Rheoencephalography OMO (reduction in CI;%) no data 44.7 (21 people out of 47) - Rheoencephalography 0.61 ± 0.08 / 0.62 ± 0.07 / ** p <0.05 vertebral artery (RI, cu) 0.84 ± 0.09 * 1.10 ± 0.08 *; ** Rheoencephalography of the internal carotid artery (Vmax, Ohm / s) 0.76 ± 0.07 / 0.98 ± 0.08 0.78 ± 0.08 / 0.99 ± 0.09 ** p> 0.1 Ultrasound dopplerography of the vertebral artery (linear blood flow velocity, cm / s) 18.1 ± 1.8 / 25.2 ± 1.6 * 18.6 ± 1.9 / 31.6 ± 2.3 *; ** ** p <0.05 Pronounced positive dynamics of the EEG,% no data 93.6 (44 people out of 47) - GARDEN after treatment (mmHg) no data 126.9 ± 1.79 - DBP after treatment (mmHg) no data 82.3 ± 1.16 -

Continuation of table 3 Indicators Comparison groups p, at times prototype claimed method Daytime Hypertension Reduction (%) GARDEN no data 80.1 (38 people out of 47) - DBP no data 80.1 (38 people out of 47) - Reduced hypertonic load at night (%) GARDEN no data 74.5 (35 people out of 47) - DBP no data 70.2 (33 people out of 47) - Quality of life criteria (FA; RF; B; OZ; ZhS; SA; RE; PZ; SS) performance improvement by 17-50% improvement by 12-53% 1.1-1.4 times Quality of life criteria for FA and RF improvement by 15.7-23.2% improvement by 33.3-44% ** p <0.05 ** p <0.01 Note: before treatment / after treatment * - significant shifts (p <0.05), ** - significant differences between the final test results of the prototype and the claimed method according to the final results; FA - physical activity, RF - the role of physical problems, B - pain, OZ - general health, FS - vitality, SA - social activity, PE - the role of emotional problems, PP - mental health, SS - comparison of health (MOS SF-36) .

From the anamnesis of the disease: work experience as a driller at the mine - 27 years.

Sick for about 12 years. Initially, pains appeared in the interphalangeal joints, then numbness and chilliness of the hands. After 2-3 years, pain in the elbow joints, as well as pain and difficulty in movement in the cervical spine, joined. Over the past 3-4 years, headaches, dizziness of a non-systemic nature, poor sleep, irritability, memory impairment, shortness of breath during physical exertion, increase in blood pressure to 160/100 mm Hg began to worry. Antihypertensive drugs are not systematically taken.

WB with concomitant osteochondrosis with a primary lesion of the cervical spine was established in 2001. The diagnosis of hypertension was made in 2006.

Repeatedly treated with drugs in the hospital and physiological factors in the dispensary.

An objective examination: the right nasolabial fold is smoothed, slight deviation of the tongue to the right, convergence, tremor of the eyelids, instability in the Romberg position, positive proboscis reflex, tenderness of the paravertebral points and spinous processes (C ₄ -C ₇ ), as well as stiffness in the cervical spine are weakened . The hands are moderately moist, edematous, hyperemic, pronounced marbling and hyperkeratosis of the palms. Symptom of the “white spot” - 6 s, a positive symptom of Paul on both sides, decreased pulsation of the left radial artery, Soreness during movement and palpation of the elbow joints. The vesicular breathing, heart sounds are rhythmic, the borders of the heart are expanded in the left parts to 1.0 cm. The emphasis is on II tone on the aorta. HELL 160/100 mm Hg, pulse 92 beats per minute.

On the ECG: sinus rhythm 86 beats per minute, left ventricular myocardial hypertrophy, moderate diffuse changes in the processes of repolarization in the myocardium.

Ultrasound of the heart: hyperkinetic type of blood circulation, diastolic dysfunction of the left ventricular myocardium, left ventricular myocardial hypertrophy and interventricular septum.

Rheovasography:

forearms on the right: RI = 0.50 cu, Vmax. = 0.82 Ohm / s, Vavr. = 0.28 ohm / s;

left forearm: RI = 0.52 cu, Vmax. = 0.86 Ohm / s, Vcp. = 0.27 ohm / s;

right hand: RI = 0.71 cu, Vmax. = 0.66 Ohm / s, Vcp. = 0.62 ohm / s;

left hand: RI = 0.68 cu, Vmax. = 0.60 Ohm / s, Vcp. = 0.59 Ohm / s.

Cold test: temperature of the third finger of the left hand until the test is 22.5 ° C, after 25 minutes - 19.8 ° C.

Vibration Sensitivity: Reduced.

X-ray:

The cervical spine. Conclusion: osteochondrosis of the cervical spine With ₄ -C ₇ , stage I, I degree.

Elbow joints. Conclusion: osteoarthrosis of the left elbow joint, stage 0-I.

ABPM: With daily monitoring, the maximum blood pressure in the daytime is 173/112 mm Hg, the maximum blood pressure in the night is 163/105 mm Hg. Hypertensive load - time index (IW) in the daytime: GARDEN -76%, DBP - 87%; at night: GARDEN - 86%, DBP - 89%.

Electroencephalography: moderate diffuse changes in the bioelectric activity of the brain against the background of dysfunction of nonspecific median structures. Indirect signs of discirculatory disorders in the veterobasilar basin (VBB).

Rheoencephalography: a moderate decrease in pulse blood flow in the vertebral artery system (RI: 0.55 cu, right and 0.58 cu, left), a marked increase in the tone of large vessels (Vmax: 0.67 FMO, left; 0, 65 FMO, right; 0.53 OM, left; 0.52 OM, right). Venous dysfunction (A vein / art - 94%).

Doppler ultrasound: no hemodynamically significant disorders in the carotid and WBB were detected. Moderate S-shaped bend of the right vertebral artery.

Cognitive evoked potentials: mild cognitive impairment (P 337).

Neuropsychological testing:

1. Mini mental test (MMSE) - 24 points.

2. Test for the reproduction of 10 words in Luria - 6 points.

3. Schulte table - 52 s.

4. Test drawing hours - 8 points.

5. Hospital scale of anxiety and depression - 17 points.

Laboratory data: general analysis of blood, urine, without features.

Biochemical blood test: bilirubin - 7.2 μmol / l; cholesterol - 7.8 mmol / l; triglycerides - 1.96 mmol / l; β-lipoproteins - 7.4 g / l; gamma-glutamyltransferase - 24.6 ME; sugar - 5.6 mmol / l; total protein - 72.3 g / l; ALT - 37.5 ME; ACT - 42.1 ME.

Quality of life assessment data (a brief questionnaire for assessing the status of health - the official Russian version of MOS SF-36): FA - 45.7; RF - 47.3; B - 48.6; OZ - 41.5; ZhS - 52.9; CA - 60.7; RE - 40.0; PZ - 33.0; SS - 44.8.

Diagnosis: Vibration disease, I degree: vegetosensory polyneuropathy of the upper extremities, peripheral angioedema of the upper extremities.

Concomitant diagnosis: Stage II hypertension, 2 degrees, risk factor 3, circulatory failure 0. Discirculatory encephalopathy 1 tbsp. Cervical osteochondrosis C ₄ -C ₇ with a mild pain syndrome. Osteoarthrosis of the left elbow joint.

The treatment was carried out according to the method described above from the Adapton-Emit apparatus with fluctuating currents supplied to the bifurcated electrodes of four pairs of independent circuits of the apparatus located transversely on the skin of the forehead and cervical spine, in the area of the hands and affected elbow joints, the current was alternating, without amplitude modulation on the first 3-4 procedures, the next - pulse signal generation, with amplitude modulation and frequencies of 57-30 Hz, with a current strength of up to moderate asynchronous vibration, and at the same time with an alternating magnetic field of the floor sinusoidal form from two magnetic inductors with a diameter of 5 cm, located on the sinocarotid zones of the neck, induction of 35 mT, frequency of 50 Hz, with exposure time of the procedure 15 minutes and the duration of the course of treatment is 10 days.

After treatment, the patient disappeared headaches and dizziness, normalized sleep, improved memory, stabilized emotional background, and aching pain in the elbow joints significantly decreased. Complete regression had numbness of the hands.

The manifestations of hyperhidrosis and swelling of the hands decreased, the symptom of the “white spot” - 4 s, the symptom of Paul became negative.

On an ECG: an improvement in the processes of repolarization in the myocardium of the left ventricle.

Rheovasography:

forearms on the right: RI = 0.66 c.u., Vmax. = 0.98 Ohm / s, Vavr. = 0.38 ohm / s;

left forearm: RI = 0.62 cu, Vmax. = 0.96 Ohm / s, Vcp. = 0.37 ohm / s;

right hand: RI = 0.91 cu, Vmax. = 0.96 Ohm / s, Vcp. = 0.32 ohm / s;

left hand :: RI = 0.98 cu, Vmax. = 0.95 Ohm / s, Vcp. = 0.39 Ohm / s.

Cold test: temperature of the third finger of the left hand before the test 25.9 ° C, after 25 minutes - 25.8 ° C.

Vibration sensitivity: normal.

Improved ABP indicators: With daily monitoring, the maximum blood pressure in the daytime is 130/82 mm Hg, the maximum blood pressure in the night is 133/95 mm Hg. Hypertensive load - time index (IW) in the daytime: SBP - 46%, DBP - 57%; at night: GARDEN - 36%, DBP - 49%.

Electroencephalography: moderate diffuse changes in the bioelectrical activity of the brain against the background of mild dysfunction of nonspecific median structures. Indirect signs of discirculatory disorders in VBB. Pronounced positive dynamics.

Rheoencephalography: a slight decrease in pulse blood flow in the vertebral artery system (RI: 0.59 cu, right and 0.60 cu, left), a moderate increase in the tone of large vessels (Vmax: 0.87 FMO, left; 0.85 FMO, right; 0.60 Ohm, left; 0.62 Ohm, right). Mild venous dysfunction (A vein / art - 80%).

Doppler ultrasound: no hemodynamically significant disorders in the carotid and WBB were detected. Moderate S-shaped bend of the right vertebral artery.

Cognitive evoked potentials: mild cognitive impairment (P 322).

Neuropsychological testing:

1. Mini mental test (MMSE) - 28 points.

2. Test for reproducing 10 words in Luria - 8 points.

3. Schulte table - 48 s.

4. Test drawing hours - 10 points.

5. Hospital scale of anxiety and depression - 12 points.

Biochemical blood test: bilirubin - 7.2 μmol / l; cholesterol - 6.9 mmol / l; triglycerides - 1.87 mmol / l; β-lipoproteins - 6.9 g / l; gamma-glutamyltransferase - 24.6 ME; sugar - 5.6 mmol / l; total protein - 72.3 g / l; ALT - 37.5 ME; ACT - 42.1 ME.

Quality of life assessment data: FA - 89.7; Russian Federation - 87.8; B - 62.9; OZ - 65.3; ZhS - 75.9; CA - 83.7; RE - 70.3; PZ - 86.0; SS - 75.5.

The effectiveness of the treatment is “improvement”.

Follow-up data: not available. The patient was discharged 05/07/11

Clinical example 2. Patient K-s VV 57 years old. Case history No. 53205 was in the neurological department of the EMRC from 09.09.10 to 09.25.10. On admission complaints were noted of constant pain in the hands, coldness, numbness and paresthesia of the hands. Frequent headaches, impaired sleep, memory and attention, dizziness, noise in the head, anxiety and irritability. Pain in the wrist, elbow, and shoulder joints, which intensified at rest, after work, and at night.

From the anamnesis of the disease: work experience as a driller at the mine - 27 years. Sick for about 15 years. Initially, pains appeared in the interphalangeal joints, then numbness and chilliness of the hands. Over the past 5 years, frequent headaches, impaired sleep, memory and attention, dizziness and irritability have been troubling. Over the past year, pain in the shoulder, elbow, and wrist joints has joined.

The diagnosis of WB was made in 2002. Hypertension was verified in 2007.

Repeatedly treated with drugs in the hospital and physiological factors in the dispensary and resorts.

An objective examination: the nasolabial fold is smoothed out (on the left), the tongue deviation to the left, convergence, tremor of the eyelids, instability in the Romberg position, positive proboscis reflex, polyneuritic type hypesthesia from the middle third of the forearm are weakened. Brushes are moist, moderately edematous and hyperemic. Symptom of the “white spot” - 5 s, a positive symptom of Paul, a decrease in pulsation on the radial arteries, severe pain on palpation of the extensor muscles of the hands and fingers. Soreness during movement and palpation of the elbow joints, limitation of range of motion by 5-10 °, the institution of arms behind the back is limited to the level of Th _X-XI . Vesicular breathing, rhythmic heart sounds, heart borders within normal limits. An accent of the 2nd tone on the aorta was heard. HELL 160/100 mm Hg, pulse 82 beats per minute.

On the ECG: sinus rhythm of 73 beats per minute, moderate diffuse changes in the processes of repolarization in the myocardium.

Ultrasound of the heart: hyperkinetic type of blood circulation.

Rheovasography:

forearms on the right: RI = 0.53 cu, Vmax. = 0.88 Ohm / s, Vavr. = 0.29 Ohm / s;

left forearm: RI = 0.50 cu, Vmax. = 0.81 Ohm / s, Vcp. = 0.26 Ohm / s;

right hand: RI = 0.70 cu, Vmax. = 0.62 Ohm / s, Vcp. = 0.60 Ohm / s;

left hand: RI = 0.66 cu, Vmax. = 0.60 Ohm / s, Vcp. = 0.55 Ohm / s.

Cold test: temperature of the third finger of the left hand before the test 25.1 ° C, after 25 minutes - 20.6 ° C.

Vibration sensitivity is reduced.

X-ray:

Elbow joints. Conclusion: osteoarthrosis of the left elbow joint, stage 0-I.

Shoulder joints. Conclusion: internal shoulder epicondylosis.

ABPM: with daily monitoring, the maximum blood pressure in the daytime is 163/109 mm Hg, the maximum blood pressure in the night is 153/100 mm Hg. Hypertensive load - time index (VI) in the daytime: GARDEN - 56%, DBP - 67%; at night: GARDEN - 56%, DBP - 69%.

Electroencephalography: pronounced diffuse changes in the bioelectric activity of the brain against the background of dysfunction of nonspecific median structures. Indirect signs of discirculatory disorders in VBB.

Rheoencephalography: a moderate decrease in pulse blood flow in the vertebral artery system (RI: 0.53 cu, right and 0.52 cu, left), a marked increase in the tone of large vessels (Vmax: 0.63 FMO, left; 0 62 FMO, right; 0.50 OM, left; 0.51 OM, right). Venous dysfunction (A vein / art - 99%).

Doppler ultrasound: no hemodynamically significant disorders in the carotid and WBB were detected.

Cognitive evoked potentials: mild cognitive impairment (P 448).

Neuropsychological testing:

1. Mini mental test (MMSE) - 23 points.

2. Test for the reproduction of 10 words in Luria - 4 points.

3. Schulte table - 67 s.

4. Test drawing hours - 6 points.

5. Hospital scale of anxiety and depression - 17 points.

Laboratory data: general analysis of blood, urine without features.

Biochemical blood test: bilirubin - 6.4 μmol / l; cholesterol - 7.7 mmol / l; triglycerides - 1.90 mmol / l; β-lipoproteins - 7.8 g / l; gamma-glutamyltransferase - 0.62 μmol / h.ml.

Quality of life assessment data: FA - 50.1; RF - 48.3; B - 42.9; OZ - 44.6. ZhS - 51.4; CA - 52.3; RE - 44.5; PZ - 33.0; SS - 45.6.

Diagnosis: Vibration disease, II degree, autonomic sensory polyneuropathy syndrome of the upper extremities with angiospasm of the fingers, internal shoulder epicondylosis, periarthrosis of the shoulder joints.

Concomitant diagnosis: Stage I-II hypertension, 2 degrees, risk factor 2, circulatory failure 0. Discirculatory encephalopathy 1 tbsp. Osteoarthrosis of the left elbow joint. Internal shoulder epicondylosis.

The treatment was carried out according to the method described above from the Adapton-Emmit apparatus with fluctuating currents supplied to the bifurcated electrodes of four pairs of independent circuits of the apparatus located transversely on the skin of the forehead and cervical spine, in the area of the hands and affected elbow joints, the current was alternating, without amplitude modulation, in the first 3-4 procedures, in the next ones - pulse signal generation, with amplitude modulation and frequencies of 57-30 Hz, with a current strength of up to moderate asynchronous vibration, and at the same time with an alternating magnetic field, the field sine wave output from the two magnetic inductors 5 cm in diameter, located on the neck sinocarotid zones, induction 35 mT, frequency of 50 Hz, with a 15 minute exposure procedure and the duration of treatment - 10 days.

After treatment, the patient disappeared headaches and dizziness, stabilized the emotional background, improved memory, normalized sleep. Significantly reduced aching pain in the hands and elbow joints. Joint movements have become painless.

The manifestations of hyperhidrosis, hypothermia, and swelling of the hands decreased, and Paul's symptom became negative. Significantly reduced the area of sensitive disorders.

HELL 125/82 mm Hg, pulse 72 beats per minute.

On an ECG: sinus rhythm of 75 beats per minute.

Ultrasound of the heart: marked decrease in stroke volume of the heart from 96 ml to 81 ml.

Rheovasography:

forearms on the right: RI = 0.67 cu, Vmax. = 0.98 Ohm / s, Vavr. = 0.29 Ohm / s;

left forearm: RI = 0.68 cu, Vmax. = 0.96 Ohm / s, Vcp. = 0.26 Ohm / s;

right hand: RI = 0.89 cu, Vmax. = 0.87 Ohm / s, Vcp. = 0.88 Ohm / s;

left hand: RI = 0.86 cu, Vmax. = 0.90 Ohm / s, Vcp. = 0.85 Ohm / s.

Cold test: temperature of the third finger of the left hand before the test 26.1 ° C, after 25 minutes - 25.6 ° C.

Vibration sensitivity is slightly reduced.

ABPM: with daily monitoring, the maximum blood pressure in the daytime is 134/85 mm Hg, the maximum blood pressure in the night is 127/90 mm Hg. Hypertensive load - time index (IW) in the daytime: SBP - 36%, DBP - 27%; at night: GARDEN - 16%, DBP - 9%.

Electroencephalography: mild diffuse changes in the bioelectrical activity of the brain against the background of mild dysfunction of nonspecific median structures. Indirect signs of discirculatory disturbances in the vebrobasilar basin of the WBB. Pronounced positive dynamics.

Rheoencephalography: a slight decrease in pulse blood flow in the vertebral artery system (RI: 0.63 cu, right, 0.67 cu, left), slight increase in the tone of large vessels (Vmax: 0.83 FMO, left; 0.86 FMO, right; 0.53 OMO, left; 0.54 OMO, right). Mild venous dysfunction (A vein / art - 81%).

Doppler ultrasound: no hemodynamically significant disorders in the carotid and WBB were detected.

Cognitive evoked potentials: mild cognitive impairment (P 368).

Neuropsychological testing:

1. Mini mental test (MMSE) - 26 points.

2. Test for the reproduction of 10 words in Luria - 7 points.

3. Schulte table - 53 s.

4. Test drawing hours - 8 points.

5. Hospital scale of anxiety and depression - 12 points.

Biochemical blood test: bilirubin - 6.4 μmol / l; cholesterol - 6.5 mmol / l; triglycerides - 1.80 mmol / l; β-lipoproteins - 6.6 g / l; gamma-glutamyltransferase - 0.62 μmol / h.ml.

Quality of life assessment data: FA - 83.4; Russian Federation - 89.6; B - 55.3; OZ - 61.6. ZhS - 72.7; CA - 89.7; RE - 71.5; PZ - 86.0; SS - 74.1.

The effectiveness of the treatment is “improvement”.

Follow-up data: the duration of subjective improvement is 11 months.

The patient underwent BPA after 11 months: with daily monitoring, the maximum blood pressure in the daytime is 133/89 mm Hg, the maximum blood pressure in the night is 122/83 mm Hg. Hypertensive load - time index (VI) in the daytime: SBP - 19%, DBP - 17%; at night: GARDEN - 12%, DBP - 9%.

Claims (1)

A method of treating a vibrational disease associated with discirculatory encephalopathy and hypertension, including the action of fluctuating currents, characterized in that it is additionally and simultaneously exposed to a half-sinusoidal magnetic field from two magnetic inductors, 5 cm in diameter, located on the synocarotid zones of the neck, with an induction of 35 mT, with a frequency of 50 Hz, with exposures of the procedure of 15 minutes and the duration of the course of treatment - 10 days.