RU2526462C1 - Method of treating patients with ischemic heart disease - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method includes carrying out reflexotherapy and hydromassage. Introduction of microneedles is performed in a bilateral manner into auricular zones of innervations of IX and X pairs of the cranial nerves. For this purpose in 1, 5, 9, 13 and 17 procedures the auricular needles are introduced for 30 minutes into the auricular points (AP) of acupuncture: AP 55X (antistress), AP 59X (hypotensive), AP 25Y (brainstem) and AP 82X111 (zero). After finishing the 5-th procedure the introduced needles are removed. During the 6-th procedure microneedles are introduced into the auricular zones of innervation of X pair of the cranial nerves. In 3, 7, 11, 15 and 19 procedures bilateral paravertebral electroacupuncture of points Y11-Y15 is carried out. An impact with spiked pulses with amplitude of 0.8-2.5 V, duration 1.5 ms, frequency 10 Hz is performed for 30 minutes. When the needles are introduced into the auricular points, an additional impact is performed on the corporal points of general action GI 11 (qu chi), MC (nei-guan). Acupuncture of the corporal points of general action P5 (chi-chieh), GI 34 (yang-lin-quan) is carried out with the impact by electroacupuncture on the paravertebral points. During even 2, 4, 6, 8, 10, 16, 18 and 20 procedures, hydromassage of the neck area and lower extremities is carried out. An impact is performed with pressure of massaging jet 2 atm, water temperature of 36-37°C, for 15-20 minutes.

EFFECT: method ensures correction of psychoemotional depression, reduces clinical manifestations of chronic coronary failure in the form of painful and painless ischemia, stimulates processes of metabolic adaptation of myocardium, the recovery of antioxidant protection, normalises coagulating and aggregation properties of blood, ensures normalisation of sympathovagal balance and hemodynamics, the improvement of systolic and diastolic functions of myocardium, the increase of tolerance to physical and psychoemotional load, the achievement of expressed anti-stress, anti-ischemic, anti-arrhythmic, antioxidant, anti-aggregation effects, and increases the duration of remission.

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Description

The invention relates to medicine, namely to medical rehabilitation, and can be used in clinics, hospitals, preventive medicine centers, sanatoriums.

The relevance is associated with the widespread prevalence of such a cardiovascular disease, such as coronary heart disease (CHD), which adversely affects the health, performance, and mortality from this disease, in connection with which there is a search for new effective methods of treatment.

The World Health Organization (WHO) attaches great importance to the non-drug treatment of patients with coronary heart disease, for example, using physical factors whose general mechanisms of action are associated with neuro-reflex and neuro-humoral effects on the human body through the receptor apparatus of the skin, vascular reception, vascular tone and etc.

One of the non-pharmacological methods of treating patients with coronary heart disease can be acupuncture and hydromassage. The accumulated scientific data indicate the possibility of achieving effects using acupuncture, similar to those that occur in the treatment of coronary heart disease with the help of pharmacological preparations. All this, when practicing the methods and tactics of treatment, creates the prerequisites for using acupuncture and hydromassage in the treatment of patients with coronary heart disease.

A known method of treating coronary heart disease using reflexology, which uses acupuncture of corporal points of general action (MS 1, RP 4, RP 6, VI1-V15, V 60, V 21, GI 4, E 36, P 7, P 1, P 2, R 3, VB 2) and electroacupuncture of auricular points (t. Of the heart - AT 100 ХУ1; t. Of the lungs - AT 101 ХУ11). In the presence of concomitant syndromes in patients with coronary artery disease, the same acupuncture sessions are carried out, but the effect on a number of additional auricular and corporal points is added to the treatment. The treatment results are evaluated according to clinical observations, resting ECG, physical activity tests, etc. The indicated method of IHD reflexology was tested on 48 patients aged 45-60 years. It is concluded that under the influence of reflexology in patients with coronary artery disease, the clinical condition improves, angina attacks are reduced (Reflexotherapy of coronary heart disease. Methodical recommendations. Compiled by Radzievsky S.A. et al. M., 1991).

However, the disadvantage of the above method is that microneedles were not used, the method was used as monotherapy.

There is a method of treating patients with coronary artery disease with reflexology according to a technique based on the traditional principles of combining acupuncture points, anatomical and physiological ideas about the regulation of the heart and cardiovascular system, presented in the literature and our own clinical, functional and experimental data. As a result of treatment of 60 patients with coronary heart disease with reflexology, the clinical picture improved, physical exercise tolerance increased, hemodynamic parameters improved (L. Fisenko et al. Comprehensive study of clinical, functional and biochemical parameters in patients with coronary heart disease in the dynamics of reflexology. // Actual questions of reflexology. Proceedings of the institute of reflexology. M., 1990).

The disadvantage of this method was that electroacupuncture was not used.

There is a method of treatment and rehabilitation of patients with coronary heart disease using an underwater shower massage on the collar zone, upper and lower extremities (pressure of the massaging jet - 1.0 atm, water t 36-37 ° C, duration 10-15 minutes), which had a training effect in patients with coronary artery disease with ventricular and supraventricular extrasystole, increased the level of physical performance (Tupitsina Yu.Yu., Davydova OB The use of underwater massage for patients with coronary artery disease in combination with hypertension. // In the collection of lectures and reports. Krasnoyarsk. 1999, p. .53-55).

However, this method gives insufficient effect, the pressure of the massaging jet was too small - 1 atm.

The closest in technical essence to the proposed method is a method of treating patients with coronary heart disease, in which, after clinical and functional examination, reflexotherapy was used daily on weekdays with the introduction of microneedles into the innervation zones of IX and X pairs of cranial nerves in the cavity of the auricles and acupuncture for 20 minutes of auricular points AT 55X (anti-stress), AT 59X (antihypertensive), AT 25U (brain stem) and AT 82X111 (zero), electroacupuncture of paravertebral points U11-U15 with pointed imp lsami amplitude with 0.8-2.5 V, pulse width 1.5 ms, frequency 10 Hz, the exposure unit 20 minutes from "Lasper".

The method provides a therapeutic effect in the form of reducing the frequency and duration of ischemia, improving the state of the autonomic nervous system and hemodynamics, myocardial function, quality of life, increasing exercise tolerance, and duration of remission (Lebedeva OD Optimization of restorative correction by the methods of reflexotherapy and physiobalneotherapy of structural and functional cardiac disorders in patients with hypertension and coronary heart disease. Author. Doctoral diss. M., 2004).

However, the disadvantage of this method of treating patients with coronary artery disease is that acupuncture of corporal points of general action was not used, antioxidant, anti-aggregation effects were not obtained, reflexology was used as a monofactor, the use of which is insufficient to obtain a pronounced effect.

The technical result of the proposed method for the treatment of patients with coronary heart disease is the correction of one of the most important risk factors and predictor of coronary death - psychoemotional depression, a decrease in the clinical manifestations of chronic coronary insufficiency in the form of both pain and painless myocardial ischemia, correction of ischemic syndromes: “stupidity”, “ hibernation of the myocardium, stimulation of the processes of "preconditioning" - metabolic adaptation of the myocardium, reduction of paroxysms of atrial fibrillation , restoration of antioxidant defense, improvement of blood coagulating and aggregating properties, normalization of sympathogallic balance and hemodynamics, improvement of systolic and diastolic myocardial function, increase of tolerance to physical and psychoemotional loads, achievement of pronounced antistress, anti-ischemic, antiarrhythmic, antioxidant, anti-aggregation effects activity, increased myocardial, coronary and aerobic reserves of the heart, transition in some pain CHD heavier s functional class II in lighter functional class I, reducing the amount received pharmacological medications, lengthening the period up to 1.5 years of remission, the prevention of cardiovascular events and sudden cardiac death.

The specified technical result is achieved by alternating, every other day, exposure to patients with coronary heart disease reflexology in the form of acupuncture on auricular points for 30 minutes: AT 55X (anti-stress), AT 59X (hypotensive), AT 25U (brain stem) and AT 82X111 (zero ), acupuncture of corporal points of general action: GI 11 qui-chi, MS 6 nei-guan only with the introduction of needles into the auricular points, the introduction of microneedles into the auricular receptor zones IX and X of the pairs of cranial nerves in the cavity of the auricle, electroacupuncture on paravertebral point U11-U15, acupuncture points corporal general steps: P5 Chi-Chieh, VB 34 Jahn-lin-Quan only when exposed to paravertebral electroacupuncture points, treatment time 30 minutes, on the course of 10 treatments; hydromassage on the collar region and lower extremities, the pressure of the massaging jet - 2 atm, water t 36-37 ° C, duration 20 minutes, for a course of 10 procedures, conducted every other day with reflexology procedures.

Method description

Before starting treatment, patients undergo a clinical and functional examination, including taking an anamnesis, complaints, measuring blood pressure and pulse, ECG, Holter ECG monitoring, echocardiography, psychodiagnostic and psychophysiological research with psycho-emotional stress, bicycle ergometry, and laboratory tests.

Patients take acupuncture in turn with hydromassage procedures, the total duration of treatment is 4 weeks. Treatment is carried out against the background of drug treatment.

Reflexology in the form of acupuncture and electroacupuncture is carried out as follows. In the 1st procedure, microneedles are introduced into the auricular receptor zones of the IX pair of cranial nerves in the auricle cavity. When exposed to auricular acupuncture during 1, 5, 9, 13, 17 procedures, auricular needles are inserted for 30 minutes into auricular points (AT): AT 55X (anti-stress), AT 59X (hypotensive), AT 25U (brain stem) and AT 82X111 (zero), and during the insertion of needles into auricular points, acupuncture affects corporal points of general action: GI 11 qui-chi, MC 6 nei-guan. At the end of the 5th procedure, microneedles introduced into the auricular receptor zones of the IX pair of cranial nerves in the 1st procedure are removed and, in the 6th procedure, the microneedles are reintroduced into the auricular receptor zones of the X pair before the end of the course. During 3, 7, 11, 15, 19 procedures, bilateral paravertebral electroacupuncture of the points U11-U15 is performed. Pairs of electrodes from each channel of the electrostimulator are fixed on acupuncture needles and electrostimulation is carried out with spiky pulses with an amplitude of 0.8-2.5 V, a pulse duration of 1.5 ms, a frequency of 10 Hz, an exposure of 30 minutes from the apparatus "Lasper". In addition, when exposed to electro-acupuncture on paravertebral points, acupuncture additionally affects corporal points of general action: P5 chi-jie, VB 34 yang-lin-quan. In total, 10 reflexology procedures are performed in the form of acupuncture and electroacupuncture.

Additionally, every other day with reflexology procedures, hydromassage of the collar region and lower extremities is carried out at a massage jet pressure of 2.0 atm, water t is 36-37 ° C, lasting 15-20 minutes, 10 treatments per treatment course.

Examples of the method

Patient S., born in 1957, was admitted with complaints of pain in the heart area of a constricting nature, palpitations, interruptions in the work of the heart, poor sleep, depression, anxiety. A history of coronary heart disease, paroxysmal atrial fibrillation for 6 years. Examined with the help of complaints collection, survey, examination, ECG, Holter ECG monitoring, echocardiography, bicycle ergometry, psychodiagnostic and psychophysiological studies, biochemical studies. A course of treatment for reflexology was prescribed in the form of acupuncture and electroacupuncture with procedures every other day, a total of 10 procedures per treatment course. During the 1st, 5th, 9th, 13th, 17th procedures, auricular needles were inserted for 30 minutes into auricular points (AT): AT 55X (anti-stress), AT 59X (hypotensive), AT 25U ( brain stem) and AT 82X111 (zero) and corporal points of general action: GI 11 qui-chi, MC 6 nei-guan. In the 1st procedure, microneedles were introduced into the auricular receptor zones of the IX pair of cranial nerves. At the end of the 5th procedure, microneedles introduced into the auricular receptor zones of the IX pair in the 1st procedure were removed, and in the 6th procedure, the microneedles were reintroduced into the auricular receptor zones of the X pair of cranial nerves in the auricle cavity until the end of the course. During the 3rd, 7th, 11th, 15th, 19th procedures, bilateral paravertebral electroacupuncture of points U11-U15 was performed. Pairs of electrodes from each channel of the electrostimulator were fixed on acupuncture needles and electrostimulation was performed with spiky pulses with an amplitude of 0.8-2.5 V, a pulse duration of 1.5 ms, a frequency of 10 Hz, an exposure of 30 minutes from the Lasper apparatus. In addition, during paravertebral electroacupuncture procedures, acupuncture of corporal points of general action was performed: P5 chi-jie, VB 34 yang-lin-quan.

A day later, with the reflexology procedures, the patient took a hydromassage on the collar region and lower limbs at a pressure of a massaging jet - 2 atm, water t 36-37 ° C, lasting 15-20 minutes, only 10 procedures per treatment course.

At the end of treatment, they again conducted a clinical and functional examination of the patient, in the same volume, to assess the effectiveness of treatment, after which a final conclusion was drawn up and according to which, according to the clinical and instrumental examination, the patient showed a significant improvement in clinical and functional indicators , expressed in a reduction of depression by 29%, anxiety, a decrease in the manifestations of chronic coronary insufficiency in the form of pain and "mute" ischemia by 3 times, as well as a decrease in paroxysms arrhythmias by 2 times, improving the performance of the antioxidant system, coagulating and aggregating properties of the blood, improving the systolic and diastolic functions of the myocardium, increasing tolerance to physical and psycho-emotional stress.

When conducting a patient examination 12 months after the end of treatment, no deterioration was noted. When examining the patient 18 months after the end of treatment, an increase in heart rhythm disturbances, deterioration of antioxidant defense, depression was noted, as a result of which a preventive maintenance course of treatment with a complex of reflexology and hydromassage was performed with a good effect.

Patient I., born in 1960, was admitted with complaints of frequent interruptions and pain in the heart, depression, anxiety, and poor sleep. Suffers from coronary heart disease for 7 years, frequent paroxysms of atrial fibrillation - tachyforms. After examination using the collection of complaints, a survey, examination, ECG, Holter monitoring of ECG, echocardiography, bicycle ergometry, psychodiagnostic and psychophysiological studies, biochemical studies, a course of acupuncture and electroacupuncture treatment was prescribed with procedures every other day, only 10 procedures per treatment course . During the 1st, 5th, 9th, 13th, 17th procedures, auricular needles were inserted for 30 minutes into auricular points (AT): AT 55X (anti-stress), AT 59X (hypotensive), AT 25U ( brain stem) and AT 82X111 (zero) and corporal points of general action: GI 11 qui-chi, MC 6 nei-guan. In the 1st procedure, microneedles were introduced into the auricular receptor zones of the IX pair of cranial nerves. At the end of the 5th procedure, microneedles introduced into the auricular receptor zones of the IX pair in the 1st procedure were removed, and in the 6th procedure, the microneedles were reintroduced into the auricular receptor zones of the X pair of cranial nerves in the auricle cavity until the end of the course. During the 3rd, 7th, 11th, 15th, 19th procedures, bilateral paravertebral electroacupuncture of points U11-U15 was performed. Pairs of electrodes from each channel of the electrostimulator were fixed on acupuncture needles and electrostimulation was performed with spiky pulses with an amplitude of 0.8-2.5 V, a pulse duration of 1.5 ms, a frequency of 10 Hz, an exposure of 30 minutes from the Lasper apparatus. In addition, during paravertebral electroacupuncture procedures, acupuncture of corporal points of general action was performed: P5 chi-jie, VB 34 yang-lin-quan.

A day later, with reflexology procedures, the patient took hydromassage on the collar region and lower extremities at a pressure of a massaging jet - 2 atm, water t 36-37 ° C, lasting 15-20 minutes, only 10 procedures per treatment course.

During the examination of the patient immediately after treatment, there was a decrease in anxiety and depression by 38%, a reduction in paroxysms of atrial fibrillation by 3 times, a decrease in the number of episodes of pain and painless ("dumb) myocardial ischemia by 2 times, an improvement in the antioxidant system, coagulating and aggregation properties blood, increased performance.

During the examination of the patient 1 year after the end of treatment, no deterioration was noted. When examining the patient after 1.5 years, an increase in episodes of atrial fibrillation, depression, and deterioration of the antioxidant, blood coagulation systems were noted. A preventive maintenance course of treatment with a complex of reflexology and hydromassage with a good effect was carried out.

The proposed method for the treatment of patients with coronary heart disease with angina pectoris I-II functional class (FC) was applied to 90 patients in the age range from 18 to 65 years on the basis of the city clinic №84 and FGU "RSCVM and K".

The pathogenesis of coronary heart disease is based on the imbalance between the oxygen demand of the myocardium and its delivery, caused by the disturbance of coronary circulation. Factors that reduce myocardial blood supply with a decrease in oxygen transport to the heart include atherosclerosis of the coronary arteries and thrombosis with a disorder of microcirculation. Factors that increase myocardial oxygen demand include activation of the sympathoadrenal system, including stress, inadequate physical activity, arterial hypertension, tachycardia, tachyarrhythmia, and myocardial hypertrophy.

In recent years, it has been confirmed that the pathogenesis of coronary heart disease is determined along with damage to the coronary channel of the myocardium, the state of neurohumoral regulation, an important method for assessing the function of the autonomic autonomic system of the heart, as a result of the action of a combination of central autonomic and reflex factors that affect the heart rhythm (Amiyants V.Yu. . and others, 2009). Most often, both groups of factors are involved in the development of the disease.

With an increase in oxygen demand of the myocardium, normal expansion of the coronary arteries and arterioles occurs with an increase in coronary blood flow by 5-6 times. With stenotic atherosclerosis, the capabilities of the coronary arteries are reduced.

In the pathogenesis of myocardial hypoxia caused by atherosclerosis of the coronary arteries, a certain role belongs to systemic hemodynamic shifts - rises in blood pressure, tachycardia with shortened diastole, and an increase in the mass of circulating blood. The development and progression of coronary heart disease is also facilitated by the factors of the occurrence of thrombosis - disorders of the coagulation and anticoagulation (anti-aggregation) blood system. Of great importance are the pathophysiological (including stress) mechanisms underlying the spasm of the coronary arteries.

Myocardial changes due to ischemia occur as follows: activation of anaerobic glycolysis in cardiomyocytes (hyperproduction of lactate), a change in the mechanical properties of the myocardium (impaired diastolic function and contractility in the ischemia zone), a change in the electrical properties of the myocardium (ST segment shift and other ECG changes), the appearance of angina pectoris ( pain syndrome). After restoration of blood flow in the ischemic zone, postischemic myocardial dysfunction (“stunned” myocardium) remains for some time.

From the standpoint of the polygenicity of coronary heart disease, treatment should be carried out by acting on several links of pathogenesis at once in order to obtain an additive effect, reduce the side effects of factors when using gentle technologies.

The treatment of IHD involves two factors. The first is the prevention of severe complications and death, an increase in life expectancy, which improves the prognosis. The second is a decrease in the frequency and decrease in the intensity of angina attacks (transfer from a more difficult functional class (FC) to a less severe one, for example, from 3rd to 2nd or from 2nd to 1st), which improves the quality of life.

The objective of the strategic plan - the prevention of severe complications and death, increasing life expectancy - are solved in the framework of secondary prevention.

Its main non-drug component is the fight against risk factors (RF), the most important of which are depression and anxiety states closely associated with it. It is impossible to achieve success in optimizing the quality of life of patients with angina pectoris without psychological rehabilitation. It is known that virtually every patient with stable angina pectoris needs psychological rehabilitation, and especially when he has psychoneurotic disorders.

The course of reflexology (RT) leads to the mobilization of central and local stress-limiting systems, the limitation of hyperadrenal effects and increased resistance of the heart and blood vessels to them, which affects the key mechanisms of the pathogenesis of IHD. Reflexotherapy acts on reflex changes in muscle tone, impaired trophism of the ligamentous apparatus due to visceral segmental disorders and biomechanical disorders. In coronary artery disease, segmental muscle lesions, functional trophic changes in muscle tissue related to visceroreflex myomatoses are observed, which are associated, in turn, with sympathetic innervation in the corresponding segments. Preservation of myofascicular tone, the predominance of sympathetic influences on the heart are a constantly acting focus of irritation that supports angina pectoris and makes it difficult to restore the functional state of the cardiovascular system (CVS) during the rehabilitation of patients with coronary artery disease. The inclusion of reflexology in rehabilitation complexes for coronary heart disease leads to the elimination of constantly acting and excessive sympathetic effects on the heart, supporting, aggravating myocardial ischemia, to reduction, weakening of intensity and shortening of the duration of angina attacks, improves coronary circulation, increases the economization of cardiac activity, myocardial, coronary and coronary reserves, reduces the frequency of heart rhythm disturbances due to the restoration of the function of the autonomic nervous system, benefits permanently of its sympathetic part.

Hydromassage, with IHD, angina pectoris I-II FC is one of the types of hydrotherapy procedures with enhanced mechanical irritation of skin receptors. With it, the temperature and mechanical effects on the body of water are successfully combined with additional mechanical irritation of the skin with a stream of water under high pressure.

Hydromassage is a combination of the influence of a common bath of fresh water and massage with a water jet under pressure. Thermal and mechanical irritation of the skin and deeper tissues causes the expansion of superficial blood vessels, increased tissue oxygenation, improved lymph flow, redistribution of blood and increased return of blood to the heart. As a result of hydromassage, upward flows of afferent impulse activate the centers of the autonomic nervous system, subcortical structures and change the excitability of the cerebral cortex, reduce vascular tone. And the effect of hydromassage on the collar region affects extracardiac regulation mechanisms, since this region is a powerful receptor field with an upward effect on the reticular formation, at the level of which the sympathetic innervation of the heart is formed. Of great importance in this process was massaging with a jet of water of the lower extremities, which contributed to the active influence on the microcirculation processes, providing hemodynamic unloading of the heart. The skin venous system has a large potential capacity and is considered as a “reservoir” of blood, a rapid change in its volume can affect the general hemodynamics. Arteriovenous anastomoses have a high density of adrenergic innervation and even respond to minor irritations, therefore skin vessels are very sensitive to the action of thermal and mechanical stimuli of hydromassage, which contribute to a significant narrowing or expansion of peripheral vessels, causing redistribution of blood in the body, and the post-load on the heart is reduced . Hydromassage at a pressure of a massaging jet of 2 atm, in comparison with 1 atm, increases oxygen consumption and assimilation, increases aerobic reserve, and has a more pronounced potentiating training effect. The positive effect of hydromassage on the cardiovascular system of patients with coronary heart disease is determined by the formation of a training effect on the part of CVS, favorable shifts in the indices of central and peripheral hemodynamics.

Recently, the problem of correction and prevention of such a topical independent risk factor for cardiovascular diseases as depression, anxiety conditions discussed in the Russian national recommendations on cardiovascular prophylaxis (2011), as well as in the Recommendations of the European Society of Cardiology Cardiovascular Prevention in clinical practice (2012), as a predictor of coronary death and complications, in connection with which a search for new methods of exposure, including non-pharmacological ones, is being conducted.

Psychological testing after complex treatment of RT and hydromassage in patients with coronary artery disease significantly decreased depression by 27.9% p <0.05, decreased reactive anxiety by 36.5%, improved health - C by 21.4%, the number of correct answers according to test with a psychoemotional load of 38.5%. In addition, in patients with coronary artery disease there was an improvement in mood - H and a decrease in the number of erroneous answers by 10.7% p <0.05, which indicates an improvement in the psychoemotional state of patients, whereas when using only RT, this positive dynamics of all indicators of the psychoemotional state was significantly less pronounced.

In the control group there were no significant positive dynamics.

A decrease in the clinical manifestations of coronary insufficiency in patients with coronary heart disease with I-II FC angina pectoris was accompanied by a decrease in the number and duration of episodes of myocardial ischemia, both painful and painless, and an increase in exercise tolerance. In 49% of patients with coronary artery disease, there was a transition of the functional class (FC) from II to I, that is, the transition of patients from a more severe to a lighter functional class, which was accompanied by a decrease in the number of pharmacological drugs (nitroglycerin) taken in 68% of patients.

Our proposed method for the treatment of coronary heart disease patients statistically significantly increases the therapeutic effect, which was manifested in an improvement in patients with coronary heart disease subjective state, psychoemotional status in the form of a decrease and complete disappearance of depression, anxiety, in reducing the number and duration of myocardial ischemia attacks (table 1) as pain and painless (“silent” ischemia), in the reduction of paroxysms of atrial fibrillation by more than 2 times, in antistress, antianginal and antiarrhythmic effects, increase and performance, reducing the number of pharmacological drugs taken. A decrease in myocardial ischemia, or an anti-ischemic effect, indicates a decrease in the destruction of cardiomyocytes, and, accordingly, an increase in the reserve and functional capabilities of the body.

Prior to treatment, a study of coagulation, anticoagulation, microcirculation showed that all examined patients had an increased fibrinogen content of 5.17 ± 0.16 g / l, p <0.01 (in healthy patients, 4.05 ± 0.21 g / l), an increase in the prothrombin index - 99.92 ± 3.2%, p <0.05 (in healthy 73.5 ± 6.2%).

It should be noted that the recalcification time indicator was reduced in patients with coronary artery disease and amounted to 100.87 ± 4.9 s p <0.02 (in healthy patients 123.1 ± 9.7 s); plasma heparin tolerance was reduced to 463.4 ± 31.5 with p <0.02 (in healthy 584.15 ± 51.75).

Platelet aggregation induced by adenosine diphosphate - ADP, tended to increase to 36.44 ± 1.24% P <0.1 (in healthy 29.22 ± 4.06%). Platelet aggregation induced by adrenaline - ADR is increased to 69.66 ± 3.3% p <0.01 (in healthy 39.32 ± 4.58%).

After the course of RT and hydromassage, the value of fibrinogen significantly decreased, and fibrinolytic activity increased. In patients with initially low indicators of plasma tolerance to heparin and recalcification time, these indicators significantly increased. In patients with initially high rates of platelet aggregation induced by ADP and ADR, these parameters significantly decreased. In the control group, there was only a tendency to increase plasma tolerance to heparin and the time of recalcification. The anti-aggregation effect of the RT complex and hydromassage was to reduce the ability of platelets and other blood cells to aggregate and to reduce the likelihood of thrombosis. Our proposed method allowed us to reliably and significantly reduce the coagulating and aggregation properties of blood by 23% in the largest number of patients, compared with patients receiving only RT. Thus, the combination of these two therapeutic factors, such as RT and hydromassage, leads to a synergy of effects, has the most pronounced antiplatelet, anti-aggregation effect and prevents the formation of blood clots in the vessels of the heart and brain, leading to heart attack and stroke. Thus, our proposed method significantly reduces the risk of myocardial infarction, cerebral stroke and sudden cardiovascular mortality.

According to the evaluation of the results of daily monitoring of ECG (table 1) and echocardiography (table 2), under the influence of RT and hydromassage, the vegetative support of the cardiovascular system improved, the systolic and diastolic functions of the left ventricle of the heart were corrected, and functional tolerance tests showed increased tolerance to loads, an increase in the coronary reserve of the heart, and, in addition, the reduction of paroxysms of atrial fibrillation, which is a serious violation of the heart rhythm.

The method provides reliable treatment of patients and the ability to track the dynamics of the state of the human body. A positive effect of the proposed method for the treatment of coronary heart disease is the ability to assess the clinical data of the subject (complaints, medical history, examination), high information content and reliability in comparison with known medical technologies. The therapeutic effect persists in patients 18 months.

According to DEHOKG (Table 2), in patients with coronary heart disease, contractile function significantly improved after treatment with RT complex and hydromassage (increase in ejection fraction - PV by 14.9% and contractility fraction - FS by 33.9%, in patients of the 1st group who received RT, and by 23.5% and 50.4% in patients of the 2nd group who received the RT complex and hydromassage, a decrease in the final systolic size - CSD by 15.8% and 19.5%, respectively) and diastolic function (increase in the fraction of the fast phase - PBS by 44.4% and 60%, indicators of transmitral blood flow according to Doppler echocardiography - V _E by 12.2% and 11.1%, ratio V _E / V _A by 23.6% and 37.5% and a decrease in the coefficient of the fast phase - CBF by 33.3% and 42.9%, the size of the left atrium - PL by 17.1% and 19.5%, normalization of isovolumetric time relaxation - VIVR by 15.1% and 17.1% and the time delay of early diastolic filling - VZRDN by 10.7% and 9.8%, respectively, in the 1st and 2nd groups). The values of the dynamics indicators - PD in the 1st and 2nd groups (16% and 21%) - indicated moderate (1st gr.) And pronounced (2nd gr.) Correction of diastolic function of the left ventricle and left ventricular hyperfunction atria, i.e. with the use of complex treatment of RT and hydromassage, the improvement of diastolic function was more pronounced than with the use of monotherapy only with RT. To confirm the above, the data are presented in percentiles (table 2), from which when comparing the groups it follows that the greatest statistically significant effect, in relation to improving the systolic-diastolic function of the left ventricular myocardium, is noted in the group in which the treatment was carried out using the method we proposed. In the control group, no reliable positive dynamics of indicators was noted.

The problem of new ischemic syndromes, such as "stupidity", "hibernation", "preconditioning" of the myocardium in patients with coronary artery disease, is currently very relevant.

Myocardial stunning is a postischemic myocardial dysfunction; “Hibernation” is a violation of local contractility of the left ventricle due to a decrease in coronary blood flow; “Preconditioning” is one of the most important natural internal mechanisms of myocardial adaptation, increasing its resistance to ischemic damage, i.e. metabolic adaptation to ischemia, which is defined as increasing the resistance of the heart muscle to ischemic effects as a result of repeated short-term episodes of ischemia.

The participation of free radicals of oxygen, hydrogen peroxide and a hydroxyl radical in the pathogenesis of "stunned", "hibernation" of the myocardium, as well as the role of antioxidants in reducing the formation of free radicals and in reducing postischemic dysfunction, which is the basis of these syndromes, is proved. Due to the fact that in patients with coronary artery disease there is a violation of the natural mechanisms of “preconditioning”, which is manifested in the activation of free radical oxidation of lipids with the formation of a large number of radicals that damage myocardial cells, our treatment method has an effect on the above mechanisms, stimulates the processes of myocardial preconditioning

Our proposed method improves the processes of myocardial preconditioning, which is confirmed by a significant decrease in the initially elevated lipid peroxidation processes and increases the protective antioxidant system of the body, which is expressed in a decrease in malondialdehyde by 22.5% (p <0.01) and an increase in ceruloplasmin by 25 , 1% (p <0.01) (table 3). As follows from table 3, the above reliable positive dynamics of the indicators was most pronounced under the influence of the integrated use of RT and hydromassage, compared with the use of only RT. The pronounced significant positive effect of the integrated use of reflexology and hydromassage on the antioxidant system proves the effectiveness of the integrated use of RT with hydromassage, which restores antioxidant protection, in the prevention and treatment of syndromes of "stunned", "hibernation" of the myocardium. This positive effect was a completely new unexpected result of treatment with the use of the RT complex and hydromassage of patients with coronary artery disease with the syndromes of "stunned", "hibernation" of the myocardium. Apparently, antioxidant, antiatherogenic, antiplatelet, antiplatelet, vasodilating effects of reflexotherapy and hydromassage are associated with modulation of the activity of endothelial NO synthetase and increased synthesis of endothelial NO (nitric oxide).

Positive dynamics of biochemical parameters, improvement of antiaggregation (anticoagulant) properties of blood, positive vegetative changes, improvement of hemodynamics, improvement of the structural and functional state of the heart in patients with coronary artery disease contributed to the implementation of the anti-stress, antianginal and antiarrhythmic effects of complex treatment with reflexotherapy and hydromassage.

Improving the metabolic processes of the myocardium is associated with the stabilizing effect of reflexotherapy on cell membranes, normalizing the permeability of cell membranes and increasing the redox potential of tissues. An improvement in the energy potential of cardiomyocytes and a decrease in intracellular calcium contributed to an increase in the elastic properties of the myocardium, a decrease in heart rigidity, optimization of the diastole structure, as well as an improvement in the contractile function of the myocardium, and hydromassage, having a very wide spectrum of effects, including on vegetative homeostasis, the degree and severity of sympathetic influences on the heart, due to massaging with a jet of water of the lower extremities, contributed to the active influence on the microcirculation processes, ensuring digits together with hemodynamic unloading of the heart, it has provided training effect. Thus, the complex use of reflexology and hydromassage in patients with coronary artery disease reduces the body weight to the greatest extent during obesity, due to which shortness of breath during physical exertion decreases, physical performance increases both in subjective sensations and in the results of exercise tests, and the most pronounced antihypertensive effect is observed. due to the unidirectional summarizing vasodilating effect of hydromassage and reflexology, the development of summarizing vagotonic training (sympatholytic g) the effect caused by increased mechanical irritation of the skin receptors with a higher pressure of the massaging jet than in the prototype, namely 2 atm, and irritation of the skin receptors under the influence of RT.

The mood, working capacity, and sleep are improved to the greatest extent due to the unidirectional influence of both factors (RT and hydromassage) on the activity of the sympathoadrenal system, stress-limiting systems of the body, and the psychoemotional state as a whole.

The advantages of the method over other medical technologies are: reliably greater effectiveness of the combined alternate use of reflexology and hydromassage as a result of potentiation of their action, reduction in the dose of medication taken, quick examination and analysis of disorders in various body systems; increase in the effectiveness of treatment, which is expressed in the improvement of the subjective state in patients with coronary heart disease, in the correction and prevention of such a relevant independent risk factor for cardiovascular diseases, which is currently being considered in the Russian National Recommendations for Cardiovascular Prevention (2011), as well as Recommendations of the European Society of Cardiology on cardiovascular prophylaxis in clinical practice (2012), as a predictor of coronary death and complications - depression, anxiety sore conditions; a decrease in the number and duration of attacks of myocardial ischemia, both painful and painless (“silent” ischemia), paroxysms of atrial fibrillation, which is a new result of the restoration of the antioxidant protection of the myocardium and the anticoagulant properties of the blood, that is, in antistress, antianginal, antiarrhythmic, antioxidant, antiplatelet effects , economization of cardiac activity, increased myocardial, coronary and aerobic reserves of the heart, the transition in cases of functional class (FC) CHD from II to I, h This is also a new result, an increase in working capacity, a decrease in the number of pharmacological drugs taken, an increase in the period of remission up to 1.5 years, the prevention of cardiovascular complications and sudden cardiac death.

A comparative analysis showed the highest efficiency of the use of the RT and PDM complex in patients with coronary artery disease compared with treatment with reflexology alone.

A good effect from the combined use of reflexology and underwater massage shower is 69.6%, from reflexology - 41.4%. The effect of treating patients with coronary heart disease with the help of a complex of electrostimulation and an underwater shower-massage was maintained for 1.5 years in 76.7%, and the effect of treatment with RT alone remained for one year in 40%, after which repeated preventive measures are recommended treatment courses.

Analysis of the study indicated the hypolipidemic effect of the treatment (table 4). In patients of the 1st group receiving reflexology, a decrease in cholesterol levels by 26.5%, a decrease in low-density lipoproteins (LDL) by 24.6%, in patients of the 2nd group receiving complex treatment with reflexology and hydromassage, in addition to decrease in cholesterol by 33% and LDL by 30.5% increase in high density lipoproteins (HDL) by 33.3%, which indicates the synergy of the effects provided by the combined effects of RT and hydromassage, and is also a particularly valuable result of treatment, since the increase namely LP P reflects an improvement in lipid metabolism is believed to be at the moment, that is, Significant positive shifts were obtained, which were more pronounced in patients of the 2nd group who received complex treatment with RT and hydromassage from the side of the lipid spectrum. In the control group, no reliable positive dynamics of the lipid profile was observed.

The economization of cardiac activity is expressed using the heart activity economization index - IERS. The aerobic reserve is judged by the indicator: a double product - DP, which is the product of systolic blood pressure and heart rate, which is used to measure myocardial oxygen consumption, i.e. about aerobic reserve of the heart. Coronary reserve is judged by the threshold load power that a patient with coronary heart disease after treatment can perform. The improvement in systolodiastolic myocardial function (table 2) reflects an increase in the myocardial reserve of the heart. The restoration of antioxidant protection is shown in table 3.

As follows from tables 2, 3, 5, in patients with coronary artery disease after treatment with the proposed method, a significant increase in coronary (increase in threshold power of load), aerobic (decrease in double product) and myocardial reserves of the heart (improvement of systolodiastolic function), heart rate saving (decrease IERS), restoration of antioxidant protection (reduction of malondialdehyde and increased ceruloplasmin).

Prevention of cardiovascular complications and sudden cardiac death is provided by a significant decrease in psychoemotional depression (a decrease in the Beck test score) and anxiety conditions (a decrease in reactive anxiety by the Spielberger test), a decrease in the number and duration of episodes of myocardial ischemia, which is the result of a positive effect on the antioxidant system and, therefore, on ischemic syndromes ("stupidity", "hibernation" and "preconditioning" of the myocardium), antiarrhythmic effects m (reduction of extrasystole and reduction of atrial fibrillation attacks).

Table 1 Dynamics of indicators of Holter ECG monitoring in patients with coronary artery disease under the influence of various treatment methods, (M ± m) Groups
Indicators IHD patients RT RT + PDM Drug treatment Total qty ep./day Before 6.1, ± 0.2 8.8 ± 0.33 8.7 ± 0.5 After 3.7 ± 0.3 4.2 ± 0.3 7.7 ± 0.4 % meas. 39.3 52.3 11.5 P 0.001 0.001 0.001 Wed lasting. 1st episode Before 6.1 ± 0.7 6.05 ± 0.4 6.05 ± 4.5 After 4.15 ± 0.4 3.9 ± 0.3 5.0 ± 0.5 % meas. 32,0 35.5 17.4 P 0.001 0.001 0.015 Total lasts. Ish. / day Before 47.1 ± 2.9 53.3 ± 4 53.6 ± 4.0 After 15.3 ± 2.5 12.1 ± 3.3 41.5 ± 3.0 % meas. 67.5 77.3 22.6 P 0.001 0.001 0.287 Note: Before - before treatment; After - after treatment; % meas. -% of changes in the studied parameters before and after treatment; P is an indicator of the significance of differences before and after treatment.

table 2 Comparative dynamics of indicators of systolodiastolic myocardial function in patients with coronary artery disease with RT and with complex treatment with reflexology and underwater massage shower (in percentiles) Show groups Ejection fraction,% Left atrium, cm Fraction of a fast phase (PBS),% Rel E / A The time is easy. relaxed. (VIVR) 1st gr. RT D 54.65 [46.53: 56.8] 3.8 [3.4: 4.0] 38 [: 131.2] 0.9 [0.89: 0.97] 102 [95: 111] P 56.8 [49.75: 60.4 25] 3.5 [3.1: 4.0] 60 [0: 114.3] 0.925 [0.8: 1.025] 96 [89: 105] R 0,038 0,000 0.01 0.013 0,023 2nd gr. RT + PDM D 54 [46:57] 3,555 [3,3: 4,1] 38 [36.85: 40] 0.85 [0.8: 0.94] 100 [0.8: 132] P 58.5 [48: 60.5] 3.5 [3.1: 3.9] 67 [64.7: 65] 1.15 [0.9: 1.2] 90 [0: 91.5] R 0.014 0.004 0.05 0,000 0,000 The control D 54 [46:57] 3.6 3.1: 4.0] 38 [35:39] 0.85 [0.8: 0.95] 98 [89: 120] P 55.5 [48.1: 60.5] 3.5 [3.2: 3.9] 50.3 [44.52] 0.95 [0.85: 1.15] 90 [85:95] R 0.272 0.272 0,072 0.118 0.215 P - Wilcoxon test. Data are presented as median (Me) and percentiles (25%: 75%).

Table 3 Dynamics of changes in the state of the antioxidant system of an organism in patients with coronary artery disease during treatment with a complex of RT and PDM (M ± m) Indicators RT + PDM R Reflexology R Malonic one 41.8 ± 2.6 <0.01 41.68 ± 4.1 > 0.1 Dialdehyde eleven 32.4 ± 2.1 39.23 ± 3.2 nm / mg Ceruloplasmin, one 255.3 ± 8.48 <0.01 258.82 ± 19.61 > 0.1 mg / ml eleven 319.5 ± 7.74 286.51 ± 19.74 Note: 1 - before treatment, 11 - after treatment. P - statistical indicator: p <0.01 - statistical reliability, p> 0.1 - not statistically significant. Table 4 The dynamics of lipid metabolism in patients with coronary heart disease in groups (M ± m) Groups Total cholesterol High Density Lipoproteins Low density lipoproteins Before treatment After treatment Before treatment After treatment Before treatment After treatment RT 8.03 ± 0.5 5.9 ± 0.8 * 0.92 ± 0.081 1.01 ± 0.05 5.73 ± 0.8 4.32 ± 0.9 * RT + PDM 8.05 ± 0.18 5.4 ± 0.8 * 0.9 ± 0.038 1.2 ± 0.03 * 5.37 ± 0.12 3.73 ± 0.8 * The control 8.0 ± 0.87 7.8 ± 1.1 0.9 ± 0.08 0.93 ± 0.045 5.6 ± 0.37 5.3 ± 0.55 * - P <0.05 - significance of differences compared with baseline.

Table 5 Dynamics of indicators of economizing the work of the heart, aerobic and coronary reserves of the heart during exercise in patients with coronary artery disease (M ± m) Indicators RT RT + hydromassage Before treatment After treatment % Before treatment After treatment % Pore Power load. 425 ± 15 492 ± 25 14.5 459 ± 17 535 ± 20 15.8 IERS pok 2.48 ± 0.05 2.36 ± 0.05 4.8 2.37 ± 0.1 1.67 ± 0.1 * 28.5 heat 2.77 ± 0.06 2.5 ± 0.061 9,4 2.72 ± 0.1 1.89 ± 0.1 * 30.5 Dp pok 95.3 ± 3.0 90.0 ± 3.1 5,6 86.3 ± 2.7 74.4 ± 2.6 * 13.8 heat 136.2 ± 3.9 105.3 ± 3.4 9,4 171.7 ± 7.5 132.0 ± 5.3 * 23.1 * - P <0.05 - significance of differences compared with baseline.

Claims (1)

A method of treating patients with coronary heart disease, in which the treatment is carried out by introducing microneedles bilaterally into the auricular zones of innervation of the IX pair of cranial nerves, while during the 1st, 5th, 9th, 13th, 17th procedures auricular needles for 30 minutes at auricular points (AT) AT 55X - anti-stress, AT 59X - antihypertensive, AT 25U - brain stem and AT 82X111 - zero, at the end of the 5th procedure, microneedles inserted into the auricular receptor zones of innervation of the IX pair of cranial brain nerves are removed, and in the 6th procedure, needles are inserted into the auricular zones in nerve pair X, while during the 3rd, 7th, 11th, 15th, 19th procedures conduct bilateral paravertebral electroacupuncture points U11-U15 with pointed pulses with an amplitude of 0.8-2.5 V, duration pulses of 1.5 ms, a frequency of 10 Hz for 30 minutes using the apparatus "Lasper", characterized in that it additionally affect the corporal points of general action GI 11 qui-chi, MS 6 nei-guan only with the introduction of needles into auricular points, and acupuncture of corporal points of general action P5 chi-jie, VB 34 yang-lin-quan is carried out only when exposed to elec acupuncture on paravertebral points, in addition, in the intervals between reflexology treatments every other day, during even procedures of the 2nd, 4th, 6th, 8th, 10th, 12th, 14th, 16th The 18th, 20th, 20th hydromassage of the collar zone and lower extremities at a pressure of the massaging jet - 2 atm, water t 36-37 ° C, lasting 15-20 minutes, for a course of 10 procedures.