Issn 2226-3551 Қазақстан Республикасының Валеология Академиясы
жүктеу/скачать 3.45 Mb. Pdf көрінісі
|
- Бұл бет үшін навигация:
- Materials and methods
| МЕДИЦИНАЛЫҚ ВАЛЕОЛОГИЯ
42 decreased myocardial contractility, myocardial, coronary and aerobic reserves of the organism, development of inflammatory and cicatricial changes in the organs and tissues of the chest. In Saint Vintsentzos Declaration formulated practical recommendations (1989), which result in most countries was developed and implemented screening program for the main socially significant diseases (BSC, etc.), which helped to reduce mortality, improve quality of life, etc. Goal: To justify the rehabilitation and recovery measures its impact on the body’s tolerance to physical stress and the condition myopically structures in patients that are performed in aerobic and mixed mode undergoing surgical and percutaneous myocardial revascularization. Materials and methods: The dynamics of the state of 45 patients was analyzed after myocardial revascularization. Patients underwent examination and rehabilitation in the conditions of the Department of preventive medicine, nutrition course sports medicine at JSC «Astana Medical University», for the period from April to August 2015 at the policlinic. The main study group consisted of 35 men, including 20 patients with myocardial infarction with subsequent emergency revascularization by balloon angioplasty and stenting, 8 patients after endovascular revascularization. The average disease duration for the group was 7.4±3.5 years, mean age of 58.6±8.4 years. The control group included 13 men with myocardial infarction with subsequent emergency revascularization by balloon angio plasty and stenting. The average disease duration of 7.9±1.3 years, mean age of 50.2±7.2 years. During the period of treatment in both groups were observed cases of acute coronary artery disease. Patients received the recommended medications, including beta blockers, calcium antagonist, antiplatelet agents and statins. Rehabilitation measures in the main group was started 3-5 weeks after myocardial revascularization under the supervision of specialists in the clinic. On 2-3rd day after the rehabilitation in the clinic conducted a test for exercise tolerance. The study was conducted according to the modified Bruce Protocol. All the patients were subjected to functional muscle test (FMT), the purpose of which was to identify the change in the function and status of segmental and associative muscles were simultaneously determined by myofascial trigger points (MFTT), areas of hypertonicity was evaluated the type and severity of muscular imbalance, as well as defects in motor stereotype.[1] The study group patients were excluded: patients with hypertension I and II stages, valvular heart disease, diseases of myocardium and pericardium, liver, kidneys, endocrine system, and advanced oncological and systemic rheumatic diseases, and chronic lung disease. Patients in both groups had no significant differences in age, clinical data, methods and means of treatment, in addition to programs of physical rehabilitation. In the main group patients were engaged in physical therapy program, including mycorrection. The control group patients took a course of rehabilitation and was doing physical therapy on the methodology of the who, recommended for patients after myocardial infarction. For all patients of the main group rehabilitation activities consisted of four components. 1. In the complex of therapeutic exercises used exercises to address muscle imbalance (relaxation of tension, concentric and eccentric tension of weakened muscles), breathing exercises. Great attention was paid to exercises for the muscles of the neck, shoulders and chest, having a common segmental innervation of the heart, i.e. from the spinal cord segments C3-C8,Th1- Th6, which have a reflex influence on neirotroficescoe processes in the myocardium. 2. Aerobic training on the cardio equipment (treadmills, exercise bikes, Ergometer). Classes are held five times a week. Their duration was 15 min (at the beginning of the rehabilitation course) with a gradual increase in workload (including adequate response) to 35 min. during the training were used intermittent option loads involving alternating «background» (50- 60% of threshold power in accordance with the data of the preliminary treadmill test) and 2-3 minute peak (70- 80% of threshold power) loads. A variety of machines and possibilities of their combinations during training allowed to undergo physical rehabilitation to all patients outside dependency whether they have concomitant diseases, injuries musculoskeletal and overweight. 3. Segmental massage (C3-Th6 ) is aimed at eliminating pathological myofascial lesions in the segmental muscles and dermatome. 4. Dosed walking(with a pedometer) daily, starting with 1-2 miles a day at a speed of 70-80 min step with the gradual increase of load up to 7-8 km a day at a speed of 80-90 step min to the end of the rehabilitation course. [4,6,7] Retest the examinee performed a similar program at the end of rehabilitation, after a cycle of physical exercises. The results of the three-week course of rehabilitation therapy was assessed by the magnitude of the changes of indexes of tolerance of the organism to physical strains and changes in the results of functional muscle test. |