RU2447909C2 - Method of treating patients with hypertonic disease combined with chronic psychoemotional tension - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to - physiotherapy, balneology. A method involves basic drug-induced therapy, transcranial electrical stimulation and balneotherapy. The transcranial electrical stimulation is performed within the period from 11.00 to 15.00. The exposure is enabled by a frontooccipital technique with using pulse bipolar current with gradually increased current intensity from 0.8 to 1.2 mA to make evident painless vibration observed under electrode. Duration of a procedure is 30-40 minutes. The procedures are daily; the therapeutic course is 10-12 procedures. Within the period from 14.00 to 18.00, balneotherapy is prescribed with iodine-bromine baths at the concentration of sodium chloride 10 g/l, potassium bromide 25 g/l, potassium iodide 25 g/l. The procedures are daily; the therapeutic course is 9-10 procedures.

EFFECT: method provides higher therapeutic effectiveness ensured by improved psychological status, central and intracardial hemodynamic parameters, values of lipid exchange and antioxidant protection, intensified hypotension effect and improved microcirculation in reducing drug-induced load on patient's body.

2 ex, 3 tbl

Description

The invention relates to medicine, namely to physiotherapy and balneology and can be used to treat patients with hypertension in combination with chronic psycho-emotional stress.

A known method of treating hypertensive patients with iodine-bromine baths [1]. The disadvantages of this method include the fact that the effectiveness of monotherapy with iodine-bromine baths decreases in the late stages of hypertension, in addition, to achieve a therapeutic effect, a long course of treatment is required (from 12 to 20 procedures prescribed every other day or two days in a row with the next day of rest) . In the presence of discirculatory encephalopathy, myocardial dystrophy, the most common complications of hypertension, the effect of monotherapy with iodine-bromine baths is even lower.

Closest to the claimed is a method of treating hypertension by applying transcranial electrostimulation of endorphin brain structures [2], which consists in the use of transcranial electrostimulation prescribed in stage I hypertension in several courses with an interval of 1-2 months as monotherapy, in stage II hypertensive Diseases - in several courses with an interval of 2-3 months in combination with drug treatment. The disadvantage of this method is the need for repeated courses of treatment to achieve a therapeutic effect. In addition, monotherapy with transcranial electrical stimulation has an insignificant effect on the level, depression and skeletal muscle tension that occur with chronic psycho-emotional stress, an insufficiently pronounced effect on central and intracardial hemodynamics, disturbances of which are one of the main links in the pathogenesis of hypertension.

A new technical task is to increase the effectiveness of rehabilitation treatment of patients with hypertension in combination with chronic psycho-emotional stress by improving central and intracardial hemodynamics, lipid metabolism and antioxidant defense, enhancing sedative and hypotensive effects while reducing treatment time.

To solve this problem, in a method of treating patients with hypertension in combination with psycho-emotional stress, transcranial electrical stimulation is applied to transcranial electrical stimulation in the period from 11.00 to 15.00 hours with a gradual increase in current strength from 0.8 to 0.8 by transcranial electrostimulation by pulse bipolar current 1.2 mA until a clear, painless vibration appears under the electrode, according to the frontooccipital technique, with a procedure duration of 30-40 minutes, daily, for a course of 10-12 procedures; after a transcranial electrical stimulation session, from 14.00 to 18.00, balneotherapy with iodine-bromine baths, sodium chloride concentration of 10 g / l, potassium bromide 25 g / l, potassium iodide 10 g / l, temperature 36-37 ° C, lasting 10-12 minutes is additionally carried out daily for a course of 9-10 procedures.

The essence of the method lies in the fact that they carry out complex physiological balneotherapy against the background of basic drug therapy with the inclusion of transcranial electrical stimulation and iodine-bromine baths.

The method is as follows: Against the background of basic drug therapy, including ACE inhibitors, beta-blockers, diuretics, transcranial electrical stimulation is applied in the period from 11.00 to 15.00 hours with a gradual increase in current from 0.8 to 1.2 mA until a clear, painless vibration under the electrode according to the frontooccipital technique, with a procedure duration of 30-40 minutes, daily, for a course of 10-12 procedures; after a transcranial electrical stimulation session, from 14.00 to 18.00, balneotherapy with iodine-bromine baths, sodium chloride concentration of 10 g / l, potassium bromide 25 g / l, potassium iodide 10 g / l, temperature 36-37 ° C, lasting 10-12 minutes is additionally carried out daily for a course of 9-10 procedures.

For the first time, a method of complex balneo-physiotherapy of patients with hypertension with chronic psycho-emotional stress was proposed, moreover, balneotherapy and physiotherapy are carried out at a strictly defined time of the day.

The selection of therapeutic factors and the mode of their application is based on data from the scientific and medical literature and analysis of clinical observation data.

The use of iodine-bromine baths in the claimed method is due to their pronounced inhibitory effect on the central and autonomic nervous system at all levels of its regulation, central and intracardial hemodynamics, and a decrease in the activity of the sympathoadrenal system in patients with a cardiological profile [1].

Transcranial electrical stimulation (TES) in the claimed method is prescribed for the purpose of vegetative correcting, antihypertensive effect, reduce the degree of tension of the psychophysiological regulation mechanisms [3, 4].

The temperature and exposure of iodine-bromine baths are selected in accordance with the range that is most preferred in cardiological practice; balneotherapy after TES treatment procedures enhances the hypotensive effect of TES.

The duration of the treatment course is determined taking into account the data that the improvement of clinical symptoms in balneotherapy occurs after 5-7 procedures. Therefore, the lower limit of the duration of treatment was 9 procedures. On 11-12 procedures of balneotherapy, an increase in sympathoadrenal activity, an increase in the frequency of astheno-vegetative disorders, which determined the limitation of the treatment with iodine-bromine baths by 10 procedures, are noted.

The time of the physiotherapy and balneotherapy procedures was selected taking into account the circadian daily biorhythms of the activity of the sympathoadrenal system in patients with a cardiological profile. Morning hours are the phase of the rise of the functions of homeostatic systems, the predominance of excitation processes. Physiotherapy (TES therapy) is prescribed in the morning to stimulate metabolic processes aimed at correcting lipid metabolism, reducing lipid peroxidation, increasing the body's adaptive capabilities, and enhancing the hypotensive effect of treatment by reducing hypersympathicotonia. In the afternoon hours there is an increase in inhibition processes in the central and autonomic nervous systems, the appointment of balneotherapy at this time enhances the hypotensive effect of treatment by correcting the increased activity of the hypothalamic-pituitary-adrenal system [5, 6].

The mode of the proposed method is based on the analysis of clinical observation data. Treatment by the present method received 35 patients (main group I). The control group consisted of 22 patients who received iodine-bromine baths without TES therapy (group II). The average age of the patients was 57.9 ± 1.12 years, and the average duration of the disease was 9.63 ± 1.2 years. Verification of the diagnosis of hypertension was carried out on the basis of anamnesis, daily monitoring of blood pressure, echocardiography according to WHO recommendations. The criteria for the effectiveness of treatment were: a decrease in blood pressure by at least 10% from the initial level, correction of disorders of the blood coagulation system and antioxidant defense, improvement of the blood lipid spectrum, improvement of central and intracardial hemodynamics, improvement of the adaptive capabilities of the body and psycho-emotional status.

The dynamics of the clinical manifestations of hypertension in group I (treatment by the proposed method) was more pronounced than in group II (treatment without TES-teralia), while the hypotensive effect of treatment according to the proposed method according to the measurement of office blood pressure according to the Korotkov method was more pronounced: decrease GARDEN by 13.8% (from 143.0 ± 15.97 to 120.7 ± 7.49 mm Hg (p <0.0001)) in the main group and by 9.9% (from 142.4 ± 20.5 to 132.2 ± 17.2 mmHg (p> 0.001)) in the control group, DBP - by 15.4% (from 85.3 ± 10.64 to 72.2 ± 6, 74 mmHg (p <0.0001)) and by 10.7% (from 85.8 ± 8.87 to 76.6 ± 6.51 mmHg (p <0.0001)), respectively .

Treatment with TES-therapy led to an improvement in blood coagulation, lipid metabolism and lipid peroxidation. The data are presented in table 1 “Dynamics of initially changed biochemical parameters in patients with hypertension during treatment”, where hereinafter in the tables the data are presented as the median and standard deviation (Me ± σ), * - significance of the difference in the group p <0, 05; ** - significance of differences in the group p <0.01; *** - significance of differences in the group p <0.001; ^ - significance of differences between groups.

In the control group, the dynamics of these biochemical parameters was unreliable or less pronounced.

When evaluating the indicators of systolic and diastolic function, it was revealed that the complex appointment of iodine-bromine baths and TES-therapy contributed to a significant improvement in systolic and diastolic myocardial function. The data are presented in Table 2 “Dynamics of indicators of central and intracardial hemodynamics”, where PV is the left ventricular ejection fraction, BWW is the final diastolic volume of the left ventricle, CSR is the final systolic volume of the left ventricle, E / A is the ratio of the rate of early and late diastolic filling left ventricle (norm is more than 1.0 cu), VIR is the time of isovolumic myocardial relaxation (norm is less than 90 ms). At the same time, only in the group with TES therapy was an improvement in diastolic function observed (an increase in the ratio of the velocity of the transmissible blood flow and a decrease in the time of isovolumic myocardial relaxation). In the control group, the dynamics of indicators of diastolic myocardial function was unreliable or less pronounced.

Treatment according to the proposed method contributes to the correction of psychoemotional status in patients with GB. The data are presented in table 3 "Dynamics of indicators of psycho-emotional status in patients with hypertension with psycho-emotional stress."

An integral assessment of the health index before and after treatment showed an increase in the health index in the main group by 10.88 ± 6.34 cu, in the control group - by 8.90 ± 7.61 cu The overall treatment efficiency was 85.7% in the main group and 66.7% in the control group.

Clinical examples

Example 1. Patient K.L.V., 58 years old, the duration of treatment is 15.06-5.07.09. The work is associated with chronic psycho-emotional stress (operator at the Angarsk Chemical Plant).

Diagnosis: Hypertension 2 tbsp., Risk 3. Nodular goiter. Lumbar osteochondrosis. Astheno-depressive syndrome. Upon admission, she complained of cardialgia, palpitations, shortness of breath during physical exertion, increased fatigue, fatigue, irritability, tearfulness, poor sleep, headaches. Antihypertensive therapy in the form of taking noliprel forte 1 tablet (5 mg of prestarium and 1.25 mg of arifon) per day, with blood pressure at the time of admission 164/90 mm Hg

Biochemical blood parameters before treatment: total cholesterol 5.32 mmol / L (with a norm of up to 5.17 mmol / L), high density lipoprotein cholesterol 1.01 mmol / L (with a norm of more than 1.2 mmol / L in men), low density lipoprotein cholesterol 3.63 mmol / L (normal up to 3.0 mmol / L), very low density lipoprotein cholesterol 0.68 mmol / L (normal up to 0.49 mmol / L), atherogenic index 4.26 cu (at a rate of up to 3.0 cu), fibrinogen 3.82 g / l (at a rate of up to 3.8 g / l), blood glucose 5.7 mmol / l (at a rate of up to 5.6 mmol / l ) Myocardial contractility is normal: EF according to Echocardiography 62% (with a norm of 60% or higher), the ratio of the rate of early filling of the left ventricle to the rate of late filling of the left ventricle E / A 0.72 cu (with a norm above 1.0 cu), the isovolumic myocardial relaxation time of 99 sec (with a norm of up to 95 sec) - signs of diastolic dysfunction of the left ventricle. According to a general blood test, there is an overstrain of adaptive mechanisms (a reactivation reaction according to L.Kh. Garkavi). According to the hospital HADS anxiety and depression scale, there is an increase in the level of anxiety (a total score of 9 with a norm of up to 7) and depression (a total score of 9 with a norm of up to 7). According to the MFI-20 asthenia scale, the presence of general asthenia (total score of 17 with a norm of up to 12), physical asthenia (total score of 15 with a norm of up to 12), decreased activity (total score of 17 with a norm of up to 12) and a decrease in motivation (total score) were revealed 13 with a norm of up to 12).

The treatment was carried out in accordance with the claimed method. From the first day of stay in the clinic, TES therapy was prescribed with pulsed bipolar current with a gradual increase in current strength from 0.8 to 1.2 mA until a distinct, painless vibration under the electrode appears, according to the frontooccipital method, with a duration of 30 minutes, daily, course of 10 procedures; after a transcranial electrical stimulation session, from 14.00 to 18.00, balneotherapy is carried out with iodine-bromine baths, sodium chloride concentration of 10 g / l, potassium bromide 25 g / l, potassium iodide 10 g / l, temperature 36 ° C, lasting 10 minutes, daily, course of 9 procedures.

The patient tolerated the treatment well. Clinical manifestations of balneoreaction were not recorded. No sharp fluctuations in the autonomic indices characterizing the autonomic tone and reactivity were found. After treatment by the claimed method, the patient disappeared headaches, cardialgia, palpitations, significantly reduced emotional disturbances. Blood pressure after treatment decreased from 164/90 to 129/70 mm Hg. The ratio of the rate of early and late filling of the left ventricle was normalized from 0.72 to 1.0 cu (with a norm of 1.0 and above cu). At the same time, an improvement in the lipid spectrum of the blood was observed: the concentration of total cholesterol decreased to 4.61 mmol / L, very low density lipoprotein cholesterol to 0.63 mmol / L, low density lipoprotein cholesterol to the norm 2.82 mmol / L, fibrinogen level was normalized ( after treatment 3.5 g / l). The tension of adaptive reactions decreased (after treatment, a calm activation reaction was recorded that was most favorable for achieving the clinical effect of treatment). The psycho-emotional status was normalized: the level of anxiety and depression was normal (1 and 3 points respectively), a complete relief of manifestations of asthenic syndrome was noted (the level of all types of asthenia decreased to standard values). The dose of antihypertensive drugs decreased by 2 times upon reaching the target blood pressure (129/70). Based on the totality of clinical and paraclinical data, treatment effectiveness was rated as a significant improvement.

Example 2

Patient Zh.T.I., 54 years old, term of treatment 05.06.10-26.05.10. Diagnosis: Hypertension stage 2, risk 3. Discirculatory encephalopathy. Myocardial dystrophy. Extrasystolic arrhythmia. Astheno-depressive syndrome. Osteoarthrosis of the knee. At admission, the patient was disturbed by interruptions in the rhythm of the heart, shortness of breath with moderate physical exertion, weakness, fatigue, sweating, decreased mood, tearfulness, headaches, severe dizziness, and sleep disturbances. Antihypertensive therapy: Egiloc retard 100 mg / day, fosicard 10 mg per day, cardio aspartate 100 mg per day. Upon receipt, blood pressure 151/88 mm Hg

Biochemical blood parameters before treatment: total cholesterol 7.58 mmol / l (with a norm of up to 5.17 mmol / l), HPL-CAP 1.08 mmol / l (with a norm above 1.2 mmol / l), LDL cholesterol 4, 93 mmol / l (normal up to 3.0 mmol / l), atherogenic index 6.02 cu (at a rate of up to 3.0 cu), malondialdehyde 3.9 mmol / L (at a rate of up to 3.6 mmol / L), fibrinogen 4.2 g / L (at a rate of up to 3.8 g / L ), the presence of inflammatory activity (ESR 21 mm / h with a norm of up to 15 mm / h). Myocardial contractility is normal: EF according to Echocardiography 70% (with a norm of 60% or higher), the ratio of the rate of early filling of the left ventricle to the rate of late filling of the left ventricle E / A. 0.89 c.u. (at a rate above 1.0 cu), the isovolumic myocardial relaxation time of 87 seconds (at a rate of up to 95 seconds) are individual signs of left ventricular diastolic dysfunction. According to a general blood test, the reaction of calmly activating a low level of reactivity, which is an unfavorable indicator of the adaptive capabilities of the body. According to the hospital scale of anxiety and depression, HADS there is an increase in the level of depression (a total score of 8 with a norm of up to 7). According to the MFI-20 asthenia scale, the presence of general asthenia (total score of 15 with a norm of up to 12) and physical asthenia (total score of 13 with a norm of up to 12) were revealed.

The treatment was carried out in accordance with the claimed method. From the first day of stay in the clinic, TES therapy was prescribed with pulsed bipolar current with a gradual increase in current strength from 0.8 to 1.2 mA until a clear, painless vibration under the electrode appears, according to the frontooccipital method, with a procedure duration of 40 minutes, daily, course of 12 procedures; after a session of transcranial electrical stimulation, from 14.00 to 18.00, balneotherapy with iodine-bromine baths, sodium chloride concentration of 10 g / l, potassium bromide 25 g / l, potassium iodide 10 g / l, temperature 36 ° C, lasting 12 minutes, daily, on a course 10 treatments.

The patient tolerated the treatment well. Clinical manifestations of balneoreaction are not registered. After treatment, relief of rhythm disturbances and other clinical symptoms of hypertension was noted. After treatment, blood pressure decreased to the target level (121/80 mmHg). The ratio of the rate of early and late filling of the left ventricle was normalized to 1.02 cu (with a norm above 1.0 cu). An improvement in the initially changed blood biochemical parameters after treatment was revealed: total cholesterol 7.03 mmol / L, fibrinogen 3.9 g / L, malondialdehyde 3.4 mmol / L, decrease in atherogenic index to 4.9 cu After treatment according to the claimed method, a complete relief of psycho-emotional status disorders was noted: the level of anxiety, depression and asthenia after treatment were within the standard values.

The dose of basic medications after a course of treatment by the present method decreased due to a decrease in the dosage of the drug of the Egiloc retard beta-blocker group from 100 to 50 mg / day. Immediate results of treatment were assessed as improvement (increase in the integral health index from 50.3 to 61.7% with a norm of over 75%).

For the first time, a method of complex balneo-physiotherapy of patients with hypertension in combination with chronic psycho-emotional stress was proposed, and balneo and physiotherapy are carried out at a strictly defined time of the day.

Thus, the application of the proposed method increases the effectiveness of rehabilitation treatment of patients with hypertension by improving the therapeutic effect on the main pathogenesis of hypertension, namely central and intracardial hemodynamics, lipid metabolism, lipid peroxidation system, adaptive capabilities and psychological status while reducing treatment time.

Information sources

1. Sorokina E.I. Physical methods of treatment in cardiology / E.I. Sorokina. - M .: Medicine, 1989. - P.82-91.

2. Eliseeva L.N., Zyuzina N.A., Kade A.Kh., Sorokina T.N., Method for the treatment of hypertension \ Patent No. 2254885 C1, publ. 06/27/2005 in Byul. Number 18.

3. Skvortsov VV, Tumarenko AV, Skvortsova EM The use of TES-therapy in medicine \ Physiotherapist. - 2009. - No. 11. - S.20-28.

4. Rychkova S.V. Transcranial electrical stimulation: feasibility and clinical effectiveness \ Physiotherapy, balneology and rehabilitation. - 2006. - No. 5. - S. 44-47.

5. Razumov A.N. Natural healing factors and biological rhythms in restorative chronomedicine / A.N. Razumov, I.E. Oransky. - M .: Medicine, 2004 .-- 296 p.

6. Borodin Yu.I. Fundamentals of Chronobiology and Chronomedicine / Yu.I. Borodin, V.A. Trufakin, A.V. Shurlygin. - Novosibirsk, 2000. - P. 61-64.

application

Table 1 The dynamics of the initially altered biochemical parameters in patients with GB during treatment

Note: Me is the median, σ is the standard quadratic deviation, * is the criterion for the significance of differences p <0.05, ** is the criterion for the significance of differences p <0.01, *** is the criterion for the significance of differences p <0.001, ^ is the significance of the difference between groups p <0.05.

Table 2 Dynamics of indicators of central and intracardial hemodynamics in patients with GB during treatment (Me, σ)

Note: Me is the median, σ is the standard quadratic deviation, * is the criterion for the significance of differences p <0.05, ** is the criterion for the significance of differences p <0.01, *** is the criterion for the significance of differences p <0.001, ^ is the significance of the difference between groups p <0.05.

Table 3. Dynamics of indicators of psycho-emotional status in patients with GB during treatment (Me, σ)

Note: Me is the median, σ is the standard quadratic deviation, * is the criterion is the significance of differences p <0.05, ** is the criterion for significance of differences p <0.01, *** is the criterion for significance of differences p <0.001, ^ is the significance differences between groups p <0.05.

Table 1 Indicators The inventive method (n = 35) Control (n = 22) Before treatment After treatment Before treatment After treatment Total cholesterol, mmol / l 6.43 ± 1.02 5.42 ± 0.98 ** 6.02 ± 0.64 5.92 ± 0.20 ^ HS-HDL, mmol / l 0.98 ± 0.22 1.11 ± 0.27 * 0.94 ± 0.13 0.92 ± 0.12 ^ CS-LDL, mmol / l 4.35 ± 0.89 3.56 ± 0.47 * 3.53 ± 0.98 3.21 ± 0.1.2 Glucose, mol / L 6.59 ± 1.19 5.51 ± 1.01 *** 5.98 ± 0.89 5.79 ± 1.03 ^ Ceruloplasmin, mg / l 385.4 ± 18.3 325.8 ± 16.7 ** 391.2 ± 29.3 380.1 ± 19.5 ^ APTT, sec 24.4 ± 2.07 33.6 ± 3.86 * 27.8 ± 0.87 32.2 ± 3.27 * Fibrinogen, g / l 4.23 ± 0.43 3.19 ± 0.72 ** 3.95 ± 0.52 3.10 ± 0.02

table 2 Indicators Groups The inventive method (n = 35) Control (n = 22) Before treatment After treatment Before treatment After treatment PV,% 67.8 ± 5.06 69.2 ± 5.6 * 69.0 ± 5.14 64.5 ± 4.06 BWW, ml 118.8 ± 21.2 115.1 ± 10.4 * 117.9 ± 24.5 126.5 ± 18.2 ^ CSR, ml 34.4 ± 8.6 30.9 ± 7.42 ** 39.3 ± 18.8 30.9 ± 5.78 E / A, cu 0.89 ± 0.17 0.98 ± 0.15 *** 0.85 ± 0.20 0.91 ± 0.23 ** ^ VIR, ms 80.9 ± 7.02 76.9 ± 6.52 *** 88.6 ± 7.98 87.8 ± 11.82 ^

Table 3 Indicators Groups The inventive method (n = 35) Control (n = 22) Before treatment After treatment Before treatment After treatment Anxiety, points 6.83 ± 2.86 5.46 ± 2.27 ** 5.1 ± 3.47 4.88 ± 2.89 Depression, points, 7.37 ± 3.22 5.00 ± 2.81 *** 5.7 ± 4.00 6.15 ± 3.07 ^ General asthenia, points 12.3 ± 2.95 9.07 ± 2.71 *** 14.00 ± 2.11 11.75 ± 2.58 * ^ Physical asthenia, points 11.54 ± 2.77 10.0 ± 2.97 * 12.4 ± 2.35 9.38 ± 2.31 ** Reduced activity, points 11.36 ± 2.68 9.96 ± 2.89 * 12.0 ± 2.49 11.36 ± 3.65 ^ Mental asthenia, points 10.11 ± 3.80 9.02 ± 3.55 * 11.7 ± 4.29 9.75 ± 2.72

Claims (1)

A method of treating patients with hypertension in combination with psycho-emotional stress by exposure to transcranial electrical stimulation by pulsed bipolar current against the background of basic drug therapy, characterized in that they are affected by transcranial electrical stimulation in the period from 11.00 to 15.00 h, with a gradual increase in current from 0.8 to 1.2 mA until a distinct, painless vibration appears under the electrode, according to the frontooccipital technique, with a procedure duration of 30-40 minutes, daily, for a course of 10-12 procedures; after a transcranial electrical stimulation session, from 14.00 to 18.00, balneotherapy with iodine-bromine baths, sodium chloride concentration of 10 g / l, potassium bromide 25 g / l, potassium iodide 10 g / l, temperature 36-37 ° C, lasting 10-12 minutes is additionally carried out daily for a course of 9-10 procedures.