RU2392919C1 - Method of treating patients suffering from cardiovascular diseases - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to physiotherapy. The method involves artificial general carbon dioxide saturated siliceous baths with underlying conventional pharmacotherapy. Carbon dioxide is supplied under pressure 2.3 atmospheres, at dosing rate 15-20 litres per minute for 2-3 minutes to enable its optimum concentration 0.7-1.4 g/l. Then silicon is added to concentration 100-150 mg/l. The bath temperature is 36-37C, a procedure lasts for 10-15 minutes. After bath, relaxation for 30-40 minutes follows. The procedures are performed before noon, daily 5 times a week, followed by 2 days of rest; the therapeutic course is 10-12 procedures. ^ EFFECT: method reduces intensity of ischemia of target organs (heart, kidneys), prevents progression and development of complications of cardiovascular diseases, and improves energy and adaptive capacity of a body. ^ 4 ex

Description

The present invention relates to medicine, namely to the rehabilitation treatment of patients with arterial hypertension and coronary heart disease and can be used in hospitals, clinics, resorts, rehabilitation medicine centers.

The relevance of therapeutic problems associated with major cardiovascular diseases, which include hypertension and coronary heart disease, is determined by the high prevalence among the adult population of the Earth and the negative impact on human health, performance and longevity, which prompts the search for new methods of rehabilitation treatment. Coronary heart disease (CHD) is the leading cause of death in many economically developed countries, including Russia, where 10 million able-bodied people suffer from CHD, more than a third of them have clinical manifestations of angina pectoris. According to the results of the Framingham study in patients with stable angina, the risk of developing non-fatal myocardial infarction and death from coronary heart disease within 2 years is 14.3% and 5.5% in men and 6.2% and 3.8% in women, respectively (Diagnosis and treatment of stable angina pectoris. Russian recommendations (second revision) // Appendix to the journal Cardiovascular Therapy and Prevention 2008; 7 (6), pp. 4-40).

Arterial hypertension plays a primary role as a risk factor for formidable cardiovascular complications: myocardial infarction and cerebral stroke, the development of heart failure and terminal nephropathy, the extreme severity of peripheral arterial atherosclerosis and the development of gangrene of the lower extremities, as evidenced by numerous studies. 40% of Russia's population suffers from arterial hypertension. Moreover, by effectively treating this particular group of patients, it is possible to achieve a significant reduction in the risk of cardiovascular complications (Diagnosis and treatment of arterial hypertension. Recommendations of the Russian Medical Society for Arterial Hypertension and the All-Russian Scientific Society of Cardiology. Moscow 2008, p.32).

In this connection, the World Health Organization (WHO) and the International Society for the Study of Arterial Hypertension (MTH) (1999) play an important role in non-drug treatment, which is a natural factor (climate, mineral and gas waters) and various types of energy obtained through special devices, the so-called preformed physical factors. The general mechanisms of action of physical factors are interconnected with neuro-reflex and neuro-humoral influences on the body, realized through the receptor apparatus of the skin, vascular reception and vascular tone, aggregation properties of platelets, dissociation and oxygen capacity of the blood. Of great importance in the mechanism of the therapeutic action of physical factors is the change in the sensitivity of vascular receptors of the carotid and aortic zones. A decrease in the sensitivity of vascular adrenergic receptors with the use of carbon dioxide has been proven. Improving systemic and regional hemodynamics leads to an improvement in the pumping and contractile function of the heart while facilitating its working conditions (peripheral vasodilating effect and reduced afterload, lengthening diastole), which, together with improved oxygen delivery to tissues, is an important mechanism for eliminating hypoxia inherent in absolutely all cardio vascular diseases. Favorable changes in peripheral and central hemodynamics under the influence of physical factors are supplemented by changes in regional hemodynamics (heart, brain, liver, kidneys), the disturbances of which form important links in the development and progression of many diseases of the cardiovascular system. Thus, the advantage of the action of physical factors is a wide range of their influence, providing the multifaceted, polysystemic nature of the body's response, increasing the general adaptive capabilities of the body (E.I. Sorokina. Physical methods of treatment in cardiology, M .: Medicine, 1989, 384 p. )

It is known that the physiological role of carbon dioxide in a healthy person is to regulate vascular tone, with respect to which both indirect reflex vasoconstrictor action and direct local vasodilating effect on the vessels of the heart, brain, and skeletal muscles are distinguished. The presence of carbon dioxide in the blood leads to a shift of the oxyhemoglobin dissociation curve to the right and facilitates the release of oxygen to tissues. Penetrating through the skin into the internal environment of the body, carbon dioxide also has a direct effect on angioreceptors, stimulates the release of vasoactive substances from the nerve endings, causing peripheral vasodilation.

There is a method of treating patients with cardiovascular pathology, in particular arterial hypertension, using common siliceous, carbonic baths (O.B. Davydova, I.M.Kasyanova, S.A. Krikorova. Balneotherapeutic value of siliceous compounds in silicon-containing waters with their external use. // Questions of balneology, physiotherapy and physiotherapy. - 1992. - No. 5-6, p.30-34).

However, this method is not effective enough, since the therapeutic effect of silicon baths with a concentration of 50 mg / l does not significantly differ from the effect of fresh baths and is characterized only by a tendency to normalize microcirculation and the state of the sympathoadrenal system in only 20% of patients, which is an effect comparable to placebo effect. Natural waters containing silicon have a silicon concentration that ranges from 50 to 250-300 mg / l. The authors themselves considered the study of siliceous baths to be incomplete, since they studied only the lowest therapeutic concentration (50 mg / l) accepted for external use.

The closest in technical essence to the proposed method is a method of treating patients with cardiovascular diseases: arterial hypertension and coronary heart disease, using common silicon baths with a silicon concentration of 100-150 mg / l, a temperature of 36-37 ° C, lasting 10-15 minutes, for a course of 10-12 procedures.

It has been established that water-soluble silicon compounds affect the structure of biological membranes. Integrating into the cell membrane, silicon is able to make up for the carbon lost during the oxidation process and fill the membrane “gaps”, accumulating in the nuclei and mitochondria of cells, silicon changes the metabolism of cells and the permeability of cell membranes for various electrolytes. One of the active principles of silicon baths is silicic acid. In recent years, data have appeared on the effect of silicon on intracellular metabolism, the structure and permeability of biological membranes, the composition of the supramembrane layer of plasma plasmolemma cells and cholesterol levels in the blood. Silicon entering the body accumulates in various organs, in particular the myocardium, liver, and at the cellular level it is concentrated in the nuclei and mitochondria. In this case, positive changes in the processes of phosphorylation, calcium metabolism, phosphorus, protein and lipid metabolism are detected. Silicon, integrating into the structure of cell membranes of the endothelium and smooth muscle cells, eliminates hypervolemia and, by lowering peripheral resistance, lowers blood pressure. Defects in the transmembrane transport of cations are considered the genetic basis of arterial hypertension. In patients with arterial hypertension and their relatives, the permeability of cell membranes for sodium ions is increased, as a result of which its passive entry into the cell is increased. Sodium overload leads to an increase in intracellular calcium, which is the direct cause of increased vascular tone (T. Knyazeva et al. "Non-drug technology for the rehabilitation and secondary prevention of cardiovascular diseases" // Issues of balneology and physiotherapy No. 5, 2007, p. .49-52).

However, this method of treating patients with arterial hypertension and coronary heart disease using only siliceous baths was not effective enough, since the therapeutic effect was obtained in a limited number of patients: with hypertension, the effect was observed only in patients with moderate hypersympathicotonia and hyperreninemia, with mild cardiac hyperkinesis; in patients with coronary heart disease - only in the absence of pronounced phenomena of increased activity of the sympathoadrenal system and impaired myocardial function of the left ventricle.

The technical result of the proposed method for the treatment of patients with arterial hypertension and coronary heart disease is to increase the effectiveness of treatment, further reduce the severity of lesions of target organs (heart, kidneys), prevent the progression and development of cardiovascular complications, increase the energy and adaptive capabilities of the body, increase the period of remission , the possibility of applying the method in patients with concomitant diseases.

The specified technical result is achieved by the fact that the patient is treated with artificially prepared common siliceous-carbonic baths saturated with carbon dioxide supplied under a pressure of 2.3 atmospheres, at a rate of 15-20 liters per minute, for 2-3 minutes until the optimum concentration of 0, 7-1.4 g / l, and then adding silicon to obtain a concentration of 100-150 mg / l at a bath temperature of 36-37 ° C for 10-15 minutes, followed by a 30-40-minute rest, daily in the morning 5 times a week with 2 days of rest, for a course of treatment 10-12 procedures .

Thanks to the introduction of carbon dioxide and silicon into the treatment solution, the therapeutic effect of these factors on the main pathogenetic links of cardiovascular diseases is significantly enhanced due to the differentially selected silicon concentration of 100-150 mg / l and carbon dioxide 0.7-1.4 g / l in artificially prepared baths outside the spa.

The optimal concentration of saturated carbon dioxide in water is on average 0.7-1.4 g / l. Since the studies established the minimum therapeutic concentration of carbon dioxide in the bath, corresponding to 0.7-0.8 g / l, and the maximum 1.2-1.4 g / l, since water saturated with carbon dioxide is less than 0.7 g / The physiological effect does not differ from the action of fresh baths, and with an increase in the concentration of carbon dioxide in the bath over 1.4 g / l, the latter intensively leaves the water. The optimal silicon concentration is a concentration of 100-150 mg / l, since the silicon concentration of 50 mg / l does not significantly differ from the action of fresh baths, and other silicon concentrations have not been studied.

The proposed method of treatment is as follows. The patient is placed in a pre-prepared therapeutic bath of 200 liters. The bath is pre-filled with fresh water from a tap at a temperature of 40 ° C, then carbon dioxide is supplied through a pearl grate using a compressor from a cylinder under a pressure of 2.3 atm at a speed of 15-20 l / min for 2-3 minutes until a carbon dioxide concentration of bath 0.7-1.4 g / l. Next, 20-30 grams of siliceous salt (Na ₂ SiO ₃ ), previously dissolved in a glass of water, is added to the bath with dissolved carbon dioxide to obtain a silicon concentration of 100-150 mg / l and carbon dioxide 0.7-1.4 g / l After stirring the water, the patient receives the procedure while in the bath for 10-15 minutes. The water temperature in the bath is 36-37 ° C. After the procedure, the patient rests for 30-40 minutes. The procedures are carried out daily in the morning, 5 days a week with 2 days of rest on weekends. The course of treatment consists of 10-12 therapeutic baths.

An example implementation of method No. 1.

Patient S., 31 years old. Diagnosis: Hypertension stage I, stage II. Dyslipidemia. Medium additional risk (2). An increase in blood pressure is noted within 3 years, after childbirth, the patient smokes for 5 years. Upon admission, he complains of headaches in the occipital region associated with increased pressure, fatigue, sleep disturbance, discomfort in the heart, periodically rapid heartbeat. The maximum increase in blood pressure to 170/100 mm Hg, usually 150-160 / 90 mm Hg Throughout the year, he constantly takes RENITEK, 5 mg / day. An objective examination: of normal physique, the skin is clean, high humidity. Height 165 cm. Weight 65 kg. BMI = 23.9 kg / m ² . OT = 78 cm. Heart sounds are loud, quickened, emphasis II tone on the aorta. Heart rate (HR) 76 beats per minute. HELL 160/90 mm Hg The liver is not enlarged. No peripheral edema. According to the BPMS data, increased average daily blood pressure values are noted, the morning pressure rise rate is increased, high pressure variability per day is increased, the pressure load indicators are increased mainly in the daytime. On the ECG - sinus tachycardia. A heart rate of 79 beats per minute, metabolic disorders of the left ventricular myocardium - in the form of a decrease in the amplitude of the T waves. According to echocardiography - a eukinetic type of central hemodynamics with increased cardiac output and total peripheral vascular resistance, signs of impaired myocardial diastolic function. In blood tests, elevated levels of total cholesterol to 5.9 mmol / L and triglycerides to 2.7 mmol / L, an increase in the level of sodium in the blood plasma are noted. The patient underwent general siliceous-carbonic baths with a silicon concentration of 150 mg / l and carbon dioxide 0.7 g / l at a temperature of 36-37 ° C, the duration of the baths was 10-15 minutes, followed by a 30-minute rest, daily 5 times a week with 2 days off, 12 baths per course. The first bath was carried out at a temperature of 36 ° C for 10 minutes, the subsequent bath at a temperature of 37 ° C for 15 minutes. After 3 baths, the patient noted a decrease in headaches, an improvement in night sleep, a decrease in heart rate, an improvement in mood, blood pressure decreased to 140/80 mm Hg, heart rate decreased to 66 beats / min. After the course of treatment, consisting of 12 baths, there are no headaches, the heartbeat does not bother, the patient rested, her sleep normalized. Blood pressure stabilized at 120/80 mm Hg. Heart rate of 60 beats per minute. On the ECG - an improvement in myocardial metabolism in the form of normalization of T. teeth. According to echocardiography: positive dynamics in the form of a decrease in increased cardiac output and a decrease in increased total peripheral vascular resistance, an improvement in myocardial diastolic function. According to the daily monitoring of blood pressure: the average blood pressure per day decreased by 20% and 15%, high pressure variability decreased by 22% and 10%, the daily pressure profile improved, blood pressure rises in the morning disappeared, and the "pressure load" indicators returned to normal. In blood tests, there was a decrease in total blood cholesterol to 5.0 mmol / L, a decrease in blood triglycerides to 1.8 mmol / L, the sodium content in the blood plasma was normalized. The portability of the procedures was very good. Under the influence of treatment, the patient's overall cardiovascular risk decreased. The results of the treatment are regarded as a significant improvement. Subsequently, when examining the patient, one year after the treatment, the achieved effect is preserved.

An example implementation of method No. 2.

Patient D, 61 years old. Diagnosis: ischemic heart disease. Angina pectoris II FC. Atherosclerotic cardiosclerosis. Dorsopathy of the spine. Chronic gastritis. Hyperbilirubinemia. Chronic venous insufficiency of the lower extremities of the II degree. The patient complained of shortness of breath during fast walking, periodically rapid heartbeat during physical exertion, general weakness, increased fatigue, sleep disturbances. Upon admission: satisfactory nutrition. The skin is clean. The borders of the heart are increased to the left. Heart sounds are muffled, the rhythm is correct. HELL 120/80 mm Hg Heart rate 60 beats / min. According to the ECG - moderate changes in the myocardium in the posterior wall of the left ventricle. According to ECG monitoring: 2 episodes of pain myocardial ischemia were noted in the form of ST segment depression by 1.5 mm, episodes lasted from 2 to 7 minutes, the total duration of ischemia per day was 14 minutes, with a maximum shift of the ST segment below the isoline by 1.9 ± 0.61 mm. According to echocardiography: zones of hypokinesia, hypokinetic type of central hemodynamics with an increase in total peripheral vascular resistance were detected. In blood tests: periodic elevations of total bilirubin in the blood to 40 mmol / l, increased platelet aggregation ability, impaired plasma tolerance to heparin. The patient was treated with drug therapy (beta-blockers, angiotensin-converting enzyme inhibitors) with silica-carbon dioxide baths with a silicon concentration of 100 mg / l and carbon dioxide 1.4 g / l at a temperature of 36-37 ° C for 10-12 minutes daily 5 once a week with 2 days of relaxation, only 12 baths. After the course treatment, there is an improvement in well-being, the disappearance of heaviness behind the sternum and shortness of breath during physical exertion, and an improvement in sleep. According to echocardiography - a positive trend in the form of the disappearance of the hypokinesis zone. According to daily monitoring of the ECG, no episodes of myocardial ischemia were detected. In blood tests, a decrease in platelet aggregation ability. The portability of the procedures is good. The result of treatment is regarded as a significant improvement. During the follow-up examination after 6 months, the achieved treatment effect was maintained.

An example implementation of method No. 3

Patient P., 63 years old. Diagnosis: Hypertension III stage, II degree. Ischemic heart disease. Angina pectoris II FC. Risk 4 (very high). Metabolic syndrome. Gout. Upon admission, he complains of headaches and heaviness in the head, dizziness, chest pain associated with physical exertion, shortness of breath when walking, interruptions in the work of the heart, poor sleep. An objective examination: Increased nutrition. Height is 164 cm. Weight is 86 kg. BMI = 32 kg / m ² . Hyperemia of the face and anterior chest. The borders of the heart are increased to the left. Heart sounds are muffled, extrasystoles 4 per minute. Heart rate 78 beats / min. HELL 180/90 mm Hg The abdomen is increased in volume due to subcutaneous fat. Waist size 103 cm. Deformation of the big toes. With an ECG: sinus rhythm, atrial extrasystoles. ECG monitoring: atrial extrasystole, episodes of pain and painless myocardial ischemia with a total duration of 18 minutes per day. With BPPM: high average values per day, day and night, insufficient nighttime pressure drop, high pressure variability and the speed of morning pressure rise.

ECHOCG: hyperkinetic type of central hemodynamics with increased cardiac output.

In blood tests, levels of total cholesterol, low-density lipoproteins and triglycerides are increased, platelet aggregation ability is increased, plasma tolerance to heparin is impaired, blood glucose levels are increased to 6.2 mmol / l, uric acid to 460 mmol / l. The patient received medical therapy (statins, angiotensin converting enzyme inhibitors, beta-blockers, antiplatelet agents) underwent general siliceous-carbonic baths with a silicon concentration of 100 mg / l and carbon dioxide 1.4 g / l at a temperature of 36-37 ° C, duration 10- 15 minutes, 12 baths per course. The portability of the procedures is good. Subjective improvement in well-being after 5 baths, blood pressure decreased to 160/80 mm Hg. At the end of the bath course, there are no headaches and pains in the heart area, it does not feel any interruptions, and sleep has improved. Blood pressure stabilized at 135/80 mm Hg.

In case of BPM: the average blood pressure values and “pressure load” parameters decreased, the daily blood pressure profile and pressure variability improved. According to ECG monitoring, a significant decrease in the number of extrasystoles per day and a decrease in the number and duration of episodes of ST segment depression per day. According to echocardiography, the phenomena of cardiac hyperkinesis decreased, which indicates the economization of cardiac activity. In blood tests, elevated numbers of lipids, glucose, and uric acid decreased. The results of treatment of the patient are regarded as improvement, in the future, during the follow-up examination, the achieved effect lasted up to 8 months.

An example of method No. 4, carried out by the closest analogue.

Patient N. 54 years old. Diagnosis: Hypertension II stage, III degree. Metabolic syndrome (abdominal obesity, dyslipidemia). High additional risk (3). Chronic venous insufficiency of the lower extremities of the II degree. Polyosteoarthrosis. Received complaints of headaches in the occipital and parietal regions, severity in the head and in the region of the heart, associated with an increase in blood pressure above 160/90 mm Hg, shortness of breath when walking, sleep disturbance, periodically pain in large joints (knee, shoulder) elbow) when moving. An increase in blood pressure over 10 years to a maximum of 200/110 mm Hg, accompanied by general weakness in the body, joint pain for 5 years, notes an increase in weight of 6 kg over the past 2 years, hot flashes. An objective examination: Increased nutrition. Height 176 cm, weight 86 kg. BMI = 28 kg / m ² . Waist 96 cm. The skin is clean, high humidity. Heart sounds are muffled, emphasis II tone on the aorta. Heart rate of 80 beats per minute. HELL 170/100 mm Hg The abdomen is increased in volume due to subcutaneous fat. Varicose veins are visualized in the area of the large saphenous vein with nodes soft to the touch, pastes of the legs. According to the ABPM: the average blood pressure values and the “pressure load” indicators, the morning pressure rise rate, high pressure variability and the violation of the circadian rhythm of blood pressure in the form of insufficient pressure drop at night are increased. On the ECG: heart rate of 76 beats per minute, signs of left ventricular hypertrophy. On echocardiography - a hyperkinetic type of central hemodynamics, signs of left ventricular and left ventricular hypertrophy, impaired diastolic function of the left ventricular myocardium. In blood tests: increased total blood cholesterol, triglycerides and low density lipoproteins, increased platelet aggregation ability, impaired plasma tolerance to heparin. The patient on the background of drug therapy (noliprel, statins) conducted general silicon baths with a silicon concentration of 150 mg / l at a temperature of 36-37 ° C for 10-15 minutes daily 5 days a week, for a course of 12 baths. After 5 baths, the patient noted an improvement in well-being - headaches and heaviness in the head decreased, blood pressure decreased to 150/85 mm Hg. At the end of the course exposure, there was no headache, the severity in the region of the heart and hot flashes decreased, sleep improved, mood improved, pastorality of the legs disappeared. Blood pressure decreased to 140/80 mm Hg, heart rate 60 beats / min. According to the ABPM: there was a slight decrease in average blood pressure values, the “pressure load” indicator, pressure variability and circadian rhythm. Significant dynamics of the ECG and echocardiography were not noted. In blood tests - a slight decrease in total cholesterol, low density lipoprotein cholesterol. Treatment results are regarded as improvement. Long-term results showed the preservation of the hypotensive effect for 6 months after treatment.

The proposed method of treatment was applied in 120 patients with arterial hypertension of the I-III stage, I-II degree (according to the WHO classification, 1999, and GFCF, 2004) with blood pressure levels of 140-179 / 90-109 mm Hg . and coronary heart disease, angina pectoris I-II FC. The average age of the patients was 50.9 + 1.6 years, the duration of the disease was 13.2 + 0.8 years. Women were 67%, men 33%.

Patients' blood pressure was measured both by the traditional method of N.S. Korotkov and by the method of 24-hour blood pressure monitoring (ABPM) using an automatic monitor ABPM-02 (Meditech, Hungary) every 15 minutes during wakefulness and every 30 minutes during sleep. We took into account the average values of systolic and diastolic pressure for 24 hours, day, night, pressure variability, indicators of "pressure load", daily index, the speed of morning rise in pressure. ECG monitoring was carried out using a domestic microprocessor cardioregistrator "Medicom - IN 21" (Moscow). ECG recording was carried out for 18-24 hours at rest and during physical exertion, modified leads V ₂ and V _{5 were used} . Ischemia episodes were defined as a horizontal or oblique decrease in the ST segment by 1 mm or more at a distance of 60 ms from point J, or an oblique decrease in ST by 2.0 mm or more at a distance of 80 ms from point D. The ischemia episode was considered completed if it lasted more than 1 minute, the minimum time to normalize changes in the ST segment is more than 1 minute. At the same time, the maximum and minimum heart rate were determined, the total number of ventricular extrasystoles, the total amount of QRS were calculated. Echocardiography was performed on a Combisson 320 instrument, and the end-diastolic (CRD) and end-systolic sizes (CSR), the volume of the left ventricle according to the formula of Teicholtz et al. Were measured. (1972), minute blood volume (IOC), ejection fraction (EF), percentage of anteroposterior shortening of the left ventricle (% S), rate of circulatory myocardial shortening (ΔS). Lipid metabolism was assessed by the content of total cholesterol and triglycerides on a Chemetrics analyzer (USA) using Merk kits (Germany), beta-lipoproteins by the turbodynamic method, alpha-cholesterol was determined in the supernatant after deposition of low and very low density lipoprotein cholesterol heparin in the presence of divalent manganese ions. The atherogenic coefficient was calculated as the ratio of the difference between the content of total cholesterol and beta-cholesterol to the level of alpha-cholesterol (A.N. Klimov, 1980). To assess hemostasis, platelet aggregation was determined upon induction with adrenaline and adenosine diphosphate, plasma fibrinolytic activity and fibrinogen content, plasma recalcification time, and plasma tolerance to heparin were determined. The condition of the sympathoadrenal system was assessed by excretion of catecholamines (adrenaline and norepinephrine) with daily urine. The condition of the renin-angiotensin-aldosterone system was evaluated by the content of renin and aldosterone in blood plasma by the radioimmunological method using test kits from CIS BIO INTERNATIONAL (France). Glucocorticoid function of the adrenal cortex was determined by the content of cortisol in blood plasma by the radioimmunological method using test kits of Beloris joint venture (Belarus). The state of the water-electrolyte balance was determined by the content of sodium and potassium electrolytes in blood serum using the Vital Diagnostics diagnostic kits (St. Petersburg, Russia) on a Vitatron spectrophotometer (Holland). Before assessing the body's water balance, daily diuresis was determined by the ratio of the liquid drunk per day to the excreted. All studies were performed before and after the course of treatment. The results of the study were statistically processed using the Statistica application programs. We used the method of variation statistics with the calculation of the arithmetic mean value (M), the standard error of the arithmetic mean (± m) to determine the significance of the difference in arithmetic mean values using the Student-Fisher t-test. Differences between the two averages were considered significant at p <0.05.

After examination, all patients were divided into two groups, comparable in age and main clinical manifestations, and received basic drug therapy.

The first group of patients (60 people) additionally in the first half of the day had common silicon baths with a silicon concentration of 100-150 mg / l, a temperature of 36-37 ° C for 10-15 minutes, followed by a 30-40 minute rest, 5 days a week with 2 days of rest, for a course of 10-12 medical procedures.

The second group of patients (60 people) also received combined siliceous-carbonic baths with a silicon concentration of 100-150 mg / l and a carbon dioxide content of 0.7-1.4 g / l at a bath temperature of 36-37 ° in the first half of the day C for 10-15 minutes a day, followed by a 40-minute rest, 5 days a week and 2 days of rest, for a total of 10-12 procedures.

Evaluation of the effectiveness of treatment was carried out on the basis of the results of direct and long-term observations in patients with hypertension and coronary heart disease.

At admission, patients complained of headaches in the occipital region (48%), pain in the parietal (8%), frontal (13%) and temporal areas (14%); dizziness (21%); heaviness in the head (16%); noise and ringing in the head (3%); sleep disturbance (30%); memory impairment (8%); reduced ability to work (32%); weakness (29%). Pain behind the sternum with radiation to the left shoulder, left arm, arising from physical or emotional stress, were detected in (26%); prolonged aching or aching pains in the left half of the chest in (36%); interruptions in heart function were noted (22%); palpitations (44%); shortness of breath during physical exertion (44%); pain in the knee joints (9%); pain in the calf muscles of the legs (6%).

A history of a critical course of arterial hypertension occurred in (11%) patients and was accompanied by nausea, vomiting (11%); flickering of “flies”, “net”, “fog” before the eyes (7%); chills or trembling in the body (7%).

Of the concomitant diseases, the most noted were: dorsopathy of the spine - in 36% of patients; dyshormonal myocardial dystrophy in 7%; atherosclerosis of the vessels of the lower extremities - in 3%; type II diabetes mellitus - in 6% of patients, chronic venous insufficiency of the lower extremities - 9%; peptic ulcer of the stomach and duodenum - in 9.2%, dyscirculatory encephalopathy in 6%; obesity in 14%; polyosteoarthrosis in 14%; vertebro-basilar insufficiency 6%, chronic non-specific lung diseases - 7%.

The data of single measurements of blood pressure showed a significant increase in systolic pressure by 38.6 ± 3.6 mm Hg, p <0.01; diastolic - up to 14.63 ± 2.2 mm Hg, p <0.01, compared with healthy individuals; heart rate increase to 74.32 ± 1.69 beats / min (by 5.3 ± 0.4 beats / min), p <0.01, which indicates hypersympathicotonia. The mean values of SBP and DBP were also significantly increased (p <0.01) for all time periods in patients compared with healthy individuals. 36% of patients showed high pressure variability. Depending on the night fall in blood pressure (circadian index SI) MAG patients were divided into the following 4 groups: 1 ^I - patients with nocturnal blood pressure reduction sufficient non-dippers (29%) (in which SI was at least 10%); 2 ^I - patients with an excessive decrease in pressure at night over-dippers (11%) (in whom SI was more than 20%); 3 ^I - patients with night-time night-peakers hypertension (9%) (in whom blood pressure indicators at night exceeded daytime and SI had a negative value); 4 ^I - patients with a normal decrease in blood pressure during the night hours of dippers (51%) of patients (in whom the daily index was 10-20%). Inadequate nightly decrease in systolic and diastolic pressure, according to Staessen SA et al. (1994), is associated with a higher incidence of strokes, and in women with a frequency of coronary heart disease (IHD) and mortality from myocardial infarction. The “pressure load” for the time index of hypertension (IVH) and the area index (PI) was increased (p <0.01) both day and night. It is known that the duration of an increase in blood pressure during the day is an important risk factor for cardiovascular complications, in particular, the occurrence of coronary heart disease and myocardial infarction).

Thus, in addition to increased single BP, patients had increased average BP values, variability and “pressure load” both in 24 hours and separately in the daytime and at night; the diurnal (circadian) rhythm of blood pressure was disrupted in the form of an insufficient nightly decrease in blood pressure, which indicated an increased risk of mortality and death from cardiovascular complications such as cerebral stroke and myocardial infarction, coronary heart disease, as well as heart and kidney failure.

According to ECG studies, 57% of patients had signs of hemodynamic overload of the left ventricular myocardium. Left ventricular hypertrophy is traditionally considered a risk factor for sudden death, and it is more predictive than even the level of blood pressure. Metabolic changes (in the form of changes in the T wave) were detected in 28% of patients.

Heart rhythm disturbances were detected in 34% of patients with supraventricular and ventricular extrasystoles. ST segment depression was detected in 59% of patients with coronary heart disease, an average of 1.9 ± 0.3 mm, of which 61% of patients had painless ischemia, and in 39% of patients, ST segment depression was accompanied by pain in the heart. An ST segment shift of more than 2 mm was noted in 30% of patients and averaged 3.2 ± 0.1 mm. In 62% of patients, ST segment depression of more than 1 mm was associated with tachycardia, which indicated an increased oxygen demand of the myocardium as a cause of insufficient coronary blood supply in the form of "mute", painless myocardial ischemia due to tachycardia.

Under the influence of the course of common silicon-carbon dioxide baths with a silicon concentration of 100-150 mg / l and carbon dioxide 0.7-1.4 g / l, a more pronounced hypotensive effect was observed in patients with hypertension compared with patients who received only general silicon baths with a concentration 100-150 mg / l, which is accompanied by the normalization of single clinical values and average blood pressure values in the daytime and at night. In patients with arterial hypertension, under the influence of common siliceous-carbon dioxide baths, both single systolic (by 25 mm Hg) and diastolic pressure (by 23 mm Hg) decreased, while in patients after siliceous baths only by 15 and 12 mm Hg respectively for systolic and diastolic pressure (p <0.01). According to daily monitoring of blood pressure in patients under the influence of common siliceous-carbonic baths, increased variability of pressure decreased (p <0.01) to a greater extent than under the influence of common siliceous baths, the pressure load indicators decreased, and the daily blood pressure profile improved (p <0.05). The vagotonic effect of the baths under the influence of siliceous-carbonic baths was manifested in a significant (p <0.01) more pronounced reduction in heart rate (HR) compared to silicon baths: for patients of the 2nd group from 78.0 + 1.54 to 63, 54 beats / min (by 19%), compared with patients of the 1st group, in which heart rate decreased from 74.72 + 2.59 to 64.0 + 1.2 beats / min (by 14%) (p <0, 05). The above correlates, according to the literature, with a decrease in target organ damage and risk factors for the development of formidable cardiovascular complications. The data obtained in our study on the greatest decrease in the level of catecholamines under the influence of common siliceous-carbonic baths compared to siliceous baths, a significant decrease in the initially elevated levels of adrenaline and norepinephrine.

Under the influence of siliceous-carbonic compared to siliceous baths, significant positive changes in the indicators of carbohydrate, lipid and water-electrolyte exchanges were observed (p <0.05). A significant decrease in the increased level of glucose in capillary blood, a decrease in the increased level of total cholesterol in the blood, cholesterol of low density lipoproteins and triglycerides, an increase in the decreased level of high density lipoproteins under the influence of siliceous-carbonic baths to a greater extent than under the influence of siliceous ones were noted. Normalization of electrolyte metabolism in the body was manifested in a decrease in elevated levels of sodium and an increase in decreased levels of potassium in the blood. A positive effect on electrolyte metabolism was confirmed by a decrease in elevated sodium levels in blood plasma, an improvement in microcirculation processes, manifested in a decrease in the increased aggregation ability of platelets, was also more pronounced under the influence of siliceous-carbonic baths compared to siliceous ones.

As a result of the treatment with silica-carbon baths in patients with coronary heart disease, a significant, more pronounced in comparison with siliceous baths effect on coronary circulation and contractile function of the myocardium, increased tissue resistance to hypoxia and adaptive capabilities of the body as a whole were noted. Siliceous-carbon dioxide baths with a silicon concentration of 100-150 mg / l and carbon dioxide 0.7-1.4 g / l had a positive effect on the clinical manifestations of the disease: they reduced the manifestation of angina pectoris, lowered high blood pressure in patients with concomitant hypertension. Also, compared to siliceous baths, under the influence of siliceous-carbon dioxide baths, coronary circulation improved: a decrease in the average duration of an episode of pain and painless ischemia (p <0.05), a decrease in the number of supraventricular and ventricular extrasystoles per day (p <0.05) , the coronary reserve increased, the volume of work performed increased (p <0.05). The hypoglycemic effect was accompanied by a decrease in increased fasting blood sugar levels in capillary blood: in patients under the influence of siliceous baths, from 10.03 + 0.08 to 8.87 + 0.17 (12%) mmol / l, p <0.01, and in patients under the influence of siliceous-carbonic baths - from 6.8 + 0.19 to 5.4 + 0.11 (21%) mmol / l, p <0.01.

The improvement in microcirculation due to the improvement of cellular metabolism under the influence of siliceous and siliceous-carbonic baths was accompanied by a decrease in the increased level of platelet aggregation stimulated by adenosine diphosphate in group 1 from 53.33 + 0.89 to 45.67 + 0.44 (by 14%), p <0.01, platelet aggregation stimulated by adrenaline with from 55.0 + 1.77 to 42.5 + 0.89 (23%), p <0.01; in group 2 - from 57.5 + 1.07 to 46.25 + 3.2 (by 20%) and from 56.66 + 1.77 to 41.67 + 0.44 (by 26%), p < 0.01 respectively.

The prothrombin index increased in outcome decreased to a greater degree also under the influence of siliceous-carbonic baths, p <0.01. We noted an improvement in the processes of atherogenesis, due, apparently, to the activation of the antioxidant system, the improvement of intracellular metabolism under the influence of common siliceous baths. A number of authors in the experiment found that mineral waters containing silicon improve lipid metabolism by incorporating silicon into the structural base of antioxidant protection enzymes: catalase, superoxide dismutase, glutathione peroxidase.

A decrease in triglycerides increased in outcome was obtained in group 1 of patients from 2.25 + 0.3 to 1.6 + 0.09 (by 29%) mmol / L, p <0.01; in group 2 - from 2.9 + 0.09 to 1.7 + 0.08 (by 41%), p <0.01; increase in high density lipoproteins: in group 1 from 1.9 + 0.02 to 2.08 + 0.08 (by 9%) mmol / l, p <0.05; in group 2 - 1.6 + 0.04 to 2.07 + 0.13 (29%) mmol / L, p <0.01. In addition, in group 2, in contrast to the first group, a significant decrease in total cholesterol from 6.85 + 0.11 to 6.3 + 0.08 (8%), p <0.01, and low-density lipoproteins was noted from 4.26 + 0.04 to 3.5 + 0.04 mmol / L (18%).

Thus, common siliceous-carbonic baths with a silicon concentration of 100-150 mg / l and carbon dioxide with a concentration of 0.7-1.4 g / l in patients with grade I-III arterial hypertension significantly reduce systolic and diastolic blood pressure by 23 % and 15%, measured by the Korotkov method in the early morning hours, as well as the average daily blood pressure by 23% and 18%, respectively, according to daily monitoring of blood pressure, which correlates with a decrease in the degree of damage to target organs (left ventricular mass, glomerular filter speed tion and risk of cardiac and cerebral complications). Silicon-carbon dioxide baths reduce high variability of blood pressure by 25% and 20% and increase the degree of night-time decrease in blood pressure by 41% and 39%, respectively, for systolic and diastolic pressure in the group of patients with insufficient decrease in pressure at night, which is associated with a decrease in hypertrophied mass myocardium, the severity of microalbuminuria and the incidence of cerebrovascular complications. A favorable rearrangement of the neuro-humoral link in the central and peripheral hemodynamics is manifested in an improvement in the diastolic function of myocardial function: a decrease in final diastolic pressure and a decrease in cardiac hyperkinesis of 35%, a decrease in increased peripheral vascular resistance by 45%, and, as a consequence of the above, economization of cardiac activity and an increase in adaptive mechanisms of the circulatory system. A significant improvement in electrolyte and lipid blood exchanges, normalization of microcirculation processes is revealed.

The course application of therapeutic siliceous-carbonic baths with a silicon concentration of 100-150 mg / L and carbon dioxide 0.7-1.4 g / L in patients with coronary heart disease is accompanied by a significant decrease in the severity of manifestations of angina pectoris, improvement of coronary blood supply and antiarrhythmic effect, concomitant arterial hypertension - hypotensive effect, normalization of the blood lipid spectrum and microcirculation.

Strengthening the hypotensive effect of siliceous-carbonic baths is due to an additional decrease in sympathetic and increase in parasympathetic effects as a result of the reflex and direct action of carbon dioxide on the centers of autonomic regulation. As a result, there is a decrease in the pulse, a decrease in the total peripheral resistance, enhancing the positive effect of silicon on hemodynamics. Short-term hypoxemia during the procedure stimulates blood circulation and has a training effect on the cardiovascular system. The training effect of carbon dioxide baths on the cardiovascular system is due to their ability to increase cardiac output due to increased venous return of blood from the periphery to the heart, which leads to lengthening of diastole (thereby reducing the number of heart contractions), and to an increase in heart systole. An increase in exercise tolerance is explained by an improvement in myocardial metabolism and coronary circulation, both in a reflexive way and due to a decrease in the sensitivity of coronary vessels to the action of narrowing influences. A very significant positive effect on renal function: an increase due to carbon dioxide, sodium natriuresis and, as a result, renal blood flow. Carbon dioxide, affecting the function of the adrenal glands, reduces the increased activity of the sympathoadrenal system.

A distinctive feature of this method of treatment is the complex effect of balneofactors on the patient's body. The antihypertensive effect of the combined siliceous-carbonic baths is caused not by simple addition of effects, but by the unidirectional vasodilating and natriuretic action of silicas and carbon dioxide, a potentiating effect on the indices of neuro-humoral regulation and water-electrolyte balance, which allows their use in a wide range of patients: with a high - and low-root forms of hypertension, with overload by volume and sodium, absolutely with all types of hemodynamics, microcirculatory disorders, proliferative and athero sclerotic disorders. The metabolic neutrality of siliceous-carbonic baths makes them preferable in patients with various types of metabolic disorders (lipid, carbohydrate, protein) and allows their use in concomitant nosologies: atherosclerosis of peripheral arteries, metabolic syndrome and diabetes mellitus, gout, etc. Joint use of balneofactors with similar effects and different ways of implementing these effects can neutralize the regulatory mechanisms that reduce the effectiveness of treatment. Thus, carbon dioxide, reducing the activity of the sympathoadrenal and renin-angiotensin systems, enhances the effects of silicas, which in turn decreases under the conditions of activation of the sympathoadrenal and renin-angiotensin systems, and the negative sodium balance under the influence of silicon enhances the antihypertensive effectiveness of carbon dioxide baths. Common siliceous-carbonic baths have a pronounced organoprotection: cardio and renoprotection, increase the energy and adaptive capabilities of the body, improve the quality of life and are a highly effective method of treating cardiovascular diseases.

Claims (1)

A method for the treatment of patients with cardiovascular diseases, including common silicon baths, characterized in that patients under the background of standard drug therapy carry out artificially prepared common silicon baths saturated with carbon dioxide supplied under a pressure of 2.3 atm, at a speed of 15-20 l minute for 2-3 minutes to obtain the optimal concentration of carbon dioxide 0.7-1.4 g / l and the subsequent addition of silicon to obtain a concentration of 100-150 mg / l at a bath temperature of 36-37 ° C for 10-15 minutes followed by 30-40 minutes m rest in the first half of the day, daily 5 times a week with 2 days of rest, for a course of treatment of 10-12 procedures.