RESUMEN
The review presents current data on the management of patients with atherosclerosis obliterans of the lower extremities. The main approaches to medical rehabilitation of patients with diseases of the arteries of the lower extremities are considered, tools for determining the rehabilitation potential depending on the stage of lower limb ischemia are proposed. The programs of physical and psychological rehabilitation, as well as the methods of physical and balneotherapy in accordance with the stages of medical rehabilitation, are determined. Modern rehabilitation methods are presented.
Asunto(s)
Arteriosclerosis Obliterante , Aterosclerosis , Balneología , Arterias , Humanos , Pierna , Extremidad InferiorRESUMEN
Successes achieved in the treatment of patients with coronary heart disease (CHD) after acute coronary syndrome and cardiosurgical interventions require the development of new, more advanced methods for their rehabilitation. This is because of metabolic disturbances persistence in the deeply ischemic myocardium in patients with coronary heart disease even after restoration of blood flow through the coronary arteries by surgical or endovascular methods due to the development of the phenomenon of «stunning¼ and hibernation. The discovery of the development of their own adaptation to ischemia phenomenon opens up new possibilities in the correction of the metabolism of the ischemic myocardium, which significantly increases the efficiency of patient postoperative rehabilitation. PURPOSE OF THE STUDY: The scientific rationale for improved cardiac rehabilitation programs for patients after acute coronary syndrome and cardiac surgery. MATERIAL AND METHODS: 120 patients who were randomized to 3 groups (40 patients each) were examined: the main and two control, comparable in the major clinical manifestations of the disease. Improved methods of physical training with the inclusion of interval cyclic training for the first time in cardiology on treadmills and sensory tracks and therapeutic exercises in the gym (daily, 5 times a week, for a course of 10 procedures) were performed for patients of the 1st control group. Therapeutic procedures that improve metabolic processes in the ischemic myocardium were used in patients of the 2nd control group: enhanced external counterpulsation, general dry air carbon dioxide, infrared matrix laser therapy. Rehabilitation by the complex of the above physical training and factors which restored metabolic processes in the ischemic myocardium was carried out to patients of the main group. Methods had a cardioprotective effect and increase myocardial adaptation to ischemia. RESULTS: The greatest anti-ischemic, antianginal, antihypoxic effects were achieved in patients of the main group compared with the control groups. What may be due to the correction of metabolic disorders and the development of cardioprotection of ischemic myocardium. The consequence is a significant increase in the rehabilitation effect of improved cardiovascular training. CONCLUSION: The achieved result is due to the integration of improved cardiac training techniques and a procedure package aimed at cardioprotection and metabolic myocardium adaptation to ischemia, which included enhanced external counterpulsation, general dry air carbon dioxide and infrared matrix laser therapy.
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Síndrome Coronario Agudo , Contrapulsación , Síndrome Coronario Agudo/cirugía , Síndrome Coronario Agudo/terapia , Terapia por Ejercicio , Humanos , Revascularización MiocárdicaRESUMEN
AIM: To study the impact of external counterpulsation (ECP) on endothelial function and microcirculation in patients after myocardial revascularization (stenting and coronary artery bypass grafting) for functional class (FC) II-III chronic heart failure (CHF). SUBJECTS AND METHODS: Sixty patients aged 50 to 75 years after myocardial revascularization for FC II-III CHF were examined. All the patients received one-hour ECP sessions 5 times per week. The treatment cycle consisted of 35 sessions. To evaluate the microcirculatory bed, capillary blood flow was studied by laser Doppler flowmetry. RESULTS: The cycle of ECP in patients with FC II-III CHF after myocardial revascularization had a corrective effect on the microhemodynamic system. Microcirculatory changes were due to the normalized myogenic and neurogenic tone of arterioles and to increased oscillations in the endothelial range. The pronounced beneficial effect of ECP on the cardiovascular system in the examined patients was confirmed by a significant increase in exercise tolerance and by a statistically significant improvement in the results of 6-minute walk test. There was a decrease in FC heart failure. CONCLUSION: ECP is an effective, non-invasive treatment in patients with heart failure.
Asunto(s)
Enfermedad Coronaria/cirugía , Contrapulsación , Insuficiencia Cardíaca/complicaciones , Microcirculación/fisiología , Anciano , Enfermedad Coronaria/fisiopatología , Insuficiencia Cardíaca/cirugía , Humanos , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Based on the innovative "kinesio-taping" technique proposed by the Japanese researcher Kenzo Kace, we have designed a new physiotherapeutic complex including the well-known physiotherapeutic methods of lymphatic drainage with intermittent pneumatic compression and underwater massage shower. The objective of our study was to evaluate the efficiency of the application of the "kinesio-taping" technique for the non-pharmacological rehabilitative treatment of the patients presenting with stage I-III lymphedema of the lower sextremities. The secondary objective was to evaluate the possibility of correction of endothelial dysfunction in the patients with lymphedema after the application of the "kinesio-taping" technique. The study included 30 patients with stage I-III lymphedema of the lower extremities randomized into two groups. Group 1 was comprised of 15 patients who were consistently treated by a combination of intermittent pneumatic compression, "akinesio-taping", and underwater massage shower. Group 2 contained 15 patients treated with the use of intermittent pneumatic compression and underwater massage shower. The results of study give evidence of positive changes in microcirculation of the patients comprising group 1 that suggest the improvement of endothelial function, vasodilation of precapillaries, enhancement of the blood flow in the microcirculatory system, and reduction of the influence of the ineffective shunting blood flow. The data obtained confirm the effectiveness of the new non-pharmacological rehabilitation complex that includes the innovative lymph-draining method of kinesio-taping, intermittent pneumatic compression and underwater massage shower for the treatment of patients with lymphedema of the lower extremities. The effectiveness of this complex is due to combined stimulation of the lymphatic and venous drainage systems and coupled to the stimulation of blood flow in the microcirculatory bed and the formation of a positive endothelial response.
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Quinesiología Aplicada , Linfedema/terapia , Aire Comprimido , Vendajes de Compresión , Drenaje , Endotelio Vascular/patología , Femenino , Humanos , Pierna/patología , Linfedema/rehabilitación , Masculino , Masaje , Persona de Mediana EdadRESUMEN
Dynamics of cytochrome oxidase inactivation was studied in ischemic liver tissue using tetramethyl paraphenylene diamine (TMPD-oxidase) and cytochrome c (cytochrome c oxidase) as substrates. The cytochrome c ovidase activity was determined in presence of low concentrations (0.03%) of Triton X-100 (the total activity) and without the detergent (the free activity). Within 60 min after the restriction of oxygen supply to the liver tissue TMPD-oxidase was inactivated almost completely, at the same time cytochrome c oxidase maintained its activity. The free enzymatic activity became equal to the total activity; this phenomenon demonstrated an increased permeability of the external mitochondrial membrane for cytochrome c. The decrease in the TMPD-oxidase activity was considered to be due to the cytochrome c solubilization. This assumption was supported by the experiments, in which the addition of cytochrome c into the incubation mixture restored the enzymatic activity to the initial level. Hypotonic solutions and treatment of mitochondria with phospholipase A were found to simulate the impairment of the organelles in ischemic liver tissue. Increased peroxidation of unsaturated fatty acids in presence of ascorbic acid and ferrous ions was not accompanied by solubilization of cytochrome c.