RU2585239C1 - Method for assessing effectiveness of rehabilitation in patients with exertional angina - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology. Patient exertional angina comparative evaluation of average heart rate and blood oxygen saturation in process of dough 6-minute walking before and after rehabilitation. At increase in distance mileage, reduction of average heart rate and maintaining the average blood oxygen saturation 95 % and more in 6-minute test walking rehabilitation is considered to be effective.

EFFECT: method allows to simplify analysis, higher safety and accuracy of estimation.

1 cl, 2 ex

Description

The invention relates to medicine, namely cardiology, and can be used to assess the effectiveness of rehabilitation in patients with exertional angina.

To assess the effectiveness of rehabilitation in patients with exertional angina, it is recommended that functional stress tests be performed to assess the intensity of physical activity. The closest analogue is the treadmill test [Rehabilitation of patients with a cardiological and cardiosurgical profile (cardiological rehabilitation). National recommendations. - Minsk, 2010. - S. 75], which consists of walking on a treadmill with an ever-increasing load. During the test, evaluate electrocardiographic and hemodynamic parameters, as well as clinical symptoms [Functional tests in cardiology / D.M. Aronov, V.P. Lupanov. - M .: Medpress-inform, 2007. - S. 22-26, 67-69].

Disadvantages: the difficulty of performing for the patient, the possibility of developing an attack of angina pectoris, ventricular tachycardia, impaired coordination.

Effect: simplicity and safety with high accuracy of the method.

This result is achieved by comparing the average values of heart rate, oxygen saturation and distance traveled during the 6-minute walk test on the second day of stay in the spa conditions and on the 14th day of rehabilitation. With an increase in the distance traveled, a decrease in the average value of the heart rate and maintaining the average value of oxygen saturation in the blood of 95% or more during the test, rehabilitation is considered effective.

The 6-minute walk test is currently used to diagnose the functional class of chronic heart failure, and it has been used for the first time to evaluate the effectiveness of rehabilitation in patients with angina pectoris.

The method is as follows. A 6-minute walk test is performed in the morning before breakfast or 2 hours after breakfast without canceling the planned drug therapy. Use a remote heart rate monitor with the function of a GPS-navigator, for example Forerunner 405 (Germany). The electrodes of the device are fixed on the front surface of the chest at the level of the lower third of the sternum, approximately in the V intercostal space. Enter individual values (gender, date of birth, body weight) of the patient into the program of the device and program the display and signals (heart rate, distance traveled, travel time). Turn on the device, register the heart rate at rest in the patient’s standing position. Then, a pulse oximeter, for example XY-300 “Armed” (Russia), is put on the index finger of the hand, the initial value of oxygen saturation is measured in a standing position and the patient is offered to go the maximum distance for 6 minutes under the control of the heart rate monitor and pulse oximeter.

After 6 minutes, the doctor records the distance traveled by the patient, the value of the heart rate and the value of oxygen saturation in the blood. Using monitoring, average values of heart rate and oxygen saturation in the blood are obtained.

Evaluation of the effectiveness of rehabilitation in patients with angina pectoris is performed by comparing the average values of the heart rate and oxygen saturation in the blood during the 6-minute walk test, obtained before and after the rehabilitation, and when increasing the distance traveled, reducing the average heart rate and maintaining an average oxygen saturation of 95% or more during a 6-minute walk test, rehabilitation is considered effective.

The rehabilitation program for patients with exertional angina is described in the monograph “Ust-Kachka Resort: Treatment Techniques”, Moscow-Perm-Ust-Kachka, 2009, p. 80-85, 100-101.

Examples of specific performance.

Example 1

Patient G.T.V., age 73, retired, was undergoing rehabilitation in the sanatorium-resort conditions of the Ust-Kachka resort from 06/18/2012 to 07/01/2012 with a diagnosis of Coronary heart disease, angina pectoris II functional class , post-infarction cardiosclerosis (2004).

Associated disease: Hypertension, stage III, 2 degrees of blood pressure, risk 4 (very high). Dyslipoproteinemia: type IIb (according to Frederickson).

Complication: Chronic heart failure stage I (2 functional class according to the classification of the New York Heart Association).

A standard examination was performed: OAK, determination of glycated hemoglobin, fasting plasma glucose, serum creatinine, lipid spectrum, ECG alone, 24-hour ECG monitoring, echocardiography.

The diagnosis of angina pectoris of functional class II stress was established on the basis of the absence of characteristic changes on the ECG at rest and during daily monitoring of the ECG, as well as recording the ECG when performing a 6-minute walk test, during which a heart rate of 78 per minute was achieved.

The patient took the following drugs: acetylsalicylic acid 75 mg per day, bisoprolol 2.5 mg per day, atorvastatin 10 mg per day, arifon retard 1.5 mg per day.

06/19/2012. on the 2nd day of rehabilitation, a 6-minute walk test was performed.

The test methodology was as follows. The study was performed in the morning 2 hours after breakfast in order to assess the initial tolerance to physical activity. We used a remote heart rate monitor with the function of the Forerunner 405 GPS navigator. The electrodes of the device were fixed on the front surface of the chest at the level of the lower third of the sternum, approximately in the V intercostal space. The patient entered individual values (gender, date of birth, body weight) into the patient’s program, set the necessary display parameters: heart rate, distance traveled, movement time, and turned on the device. We performed registration of the heart rate at rest in the patient's standing position. Then the patient put on an XY-300 “Armed” pulse oximeter on the index finger of the hand, measured the initial value of oxygen saturation in a standing position and offered to walk the maximum distance for 6 minutes under the control of the heart rate monitor and pulse oximeter. The test was performed twice with an interval of 12 days.

In the first case, the test was performed on the second day of admission, in the second case - before discharge.

The following test results were obtained.

1. The initial value of the heart rate standing 70 per minute, oxygen saturation 96%. The initial parameters of blood pressure: 140/90 mm Hg The average heart rate during the test was 74 per minute, oxygen saturation - 95%. The values of systolic and diastolic blood pressure after the test amounted to 150/90 mm Hg The value of heart rate after the test was 86 per minute, oxygen saturation - 95%. The distance covered was 423 m. During the test, there were no complaints about well-being.

2. The initial value of heart rate standing 64 per minute, oxygen saturation 98%. The initial parameters of blood pressure: 130/80 mm Hg The average heart rate during the test was 70 per minute, oxygen saturation - 96%. The values of systolic and diastolic blood pressure after the test was 140/90 mm Hg The value of heart rate after the test was 78 per minute, oxygen saturation - 96%. The distance covered was 445 m. During the test, there were no complaints about well-being.

The presented example demonstrates the positive impact of the rehabilitation phase of outpatient treatment of patients with angina pectoris I-II FC. On the 14th day of rehabilitation, better test results were obtained: the distance traveled increased by 22 meters, the average heart rate during the 6-minute walk test decreased by 4 beats per minute, the average value of oxygen saturation in the blood remained within normal values during functional test. The proposed modification of the test made it possible to more objectively evaluate the clinical and functional state of patients with exertional angina before and after rehabilitation.

Based on the results of the test, a conclusion was drawn on the effectiveness of the treatment (rehabilitation), the appropriateness of sanatorium-resort treatment and the correction of the therapy due to the group of pulsating drugs (the dose of bisoprolol was increased to 5 mg per day), and a drug with a vasodilating effect was added to the antihypertensive therapy. losartan at a dose of 50 mg per day, as well as cardiomagnyl at a dose of 75 mg per day and rosuvastatin at a dose of 20 mg per day.

Example 2

Patient T.T.S., age 67, retired, was undergoing rehabilitation in the sanatorium-resort conditions of the Ust-Kachka resort from 11/14/2012 to 12/01/2012 with a diagnosis of Coronary heart disease, angina pectoris II functional class .

Associated disease: Stage II hypertension, grade 2 blood pressure, risk 4 (very high).

Complication: Chronic heart failure stage I (1 functional class according to the classification of the New York Heart Association).

A standard examination was performed: OAK, determination of glycated hemoglobin, fasting plasma glucose, serum creatinine, lipid spectrum, ECG alone, 24-hour ECG monitoring, echocardiography.

The patient situationally took the following drugs: amlodipine 5 mg per day, captopril 25 mg per day.

November 15, 2012, on the 2nd day of rehabilitation, a 6-minute walk test was performed.

The test methodology was as follows. The study was performed in the morning 2 hours after breakfast in order to assess the initial tolerance to physical activity. We used a remote heart rate monitor with the function of the Forerunner 405 GPS navigator. The electrodes of the device were fixed on the front surface of the chest at the level of the lower third of the sternum, approximately in the V intercostal space. The patient entered individual values (gender, date of birth, body weight) into the patient’s program, set the necessary display parameters: heart rate, distance traveled, movement time, and turned on the device. We performed registration of the heart rate at rest in the patient's standing position. Then the patient put on an XY-300 “Armed” pulse oximeter on the index finger of the hand, measured the initial value of oxygen saturation in a standing position and offered to walk the maximum distance for 6 minutes under the control of the heart rate monitor and pulse oximeter. The test was performed twice with an interval of 12 days.

In the first case, the test was performed on the second day of admission, in the second case - before discharge.

The following test results were obtained.

1. The initial value of the heart rate standing 75 per minute, oxygen saturation 97%. The initial parameters of blood pressure: 125/80 mm Hg The average heart rate during the test was 94 per minute, oxygen saturation - 95%. The values of systolic and diastolic blood pressure after the test was 140/80 mm Hg The value of heart rate after the test was 100 per minute, oxygen saturation - 95%. The distance covered was 435 m. During the test, complaints arose about non-intense pain behind the sternum, which stopped on their own during short rest.

2. The initial value of the heart rate standing 76 per minute, oxygen saturation - 97%. The initial parameters of blood pressure: 120/80 mm Hg The average heart rate during the test was 97 per minute, oxygen saturation - 95%. The values of systolic and diastolic blood pressure after the test was 140/80 mm Hg The value of heart rate after the test was 104 per minute, oxygen saturation - 95%. The distance covered was 430 m. During the test, there were no complaints about well-being.

The presented example demonstrates the absence of the influence of the rehabilitation program in a patient with exertional angina. On the 14th day of rehabilitation, the results were slightly worse compared with the indicators obtained before rehabilitation. The distance traveled decreased by 5 meters, the average heart rate during the 6-minute walk test increased by 3 beats per minute, and after the test increased by 4 beats per minute, the oxygen saturation in the blood remained unchanged during the functional test - the lower limit of the norm.

Based on the results of the testing, a conclusion was drawn on the ineffectiveness of the treatment (rehabilitation), the lack of sanatorium and resort measures and the need for correction of the therapy - the appointment of bisoprolol 10 mg per day, perindopril 5 mg per day, as well as cardiomagnyl 75 mg per day and atorvastatin 40 mg per day.

The proposed method differs from the known following features.

In the proposed method, the effectiveness of the rehabilitation of patients with angina pectoris is assessed by comparing the average values of heart rate and oxygen saturation in the blood during the 6-minute walk test, obtained before and after rehabilitation, and with increasing distance traveled, reducing the average frequency heart rate and maintaining an average value of oxygen saturation in the blood of 95% or more during the 6-minute walk test, rehabilitation is considered effective.

Claims (1)

A method for assessing the effectiveness of rehabilitation in patients with exertional angina by assessing the heart rate during the exercise test before and after rehabilitation, characterized in that the test is used for a 6-minute walk, the oxygen saturation in the blood is also measured and the distance traveled is increased ways, reducing the average value of heart rate and maintaining the average value of oxygen saturation in the blood of 95% or more during the test, rehabilitation is considered effective.