RU2150260C1 - Method for treating the patients possessing pathologic changes of cardiorespiratory system - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying interval hypoxia training by inhaling gas mixture with low oxygen contents. Therapy selection is based on evaluating individual clinical specific properties of each patient in hypoxia test and in determining blood hemoglobin saturation with oxygen in applying pulse oximetry method. Hypoxia index is determined. Its value being less than 2, response type is interpreted as unfavorable and conservative mode of interval hypoxia training is administered. The value greater than 2, response type is interpreted as favorable and training mode is administered. EFFECT: enhanced effectiveness of treatment. 4 tbl

Description

 The invention relates to medicine and will find application in the treatment of patients with hypertension (GB), neurocirculatory dystonia (NDC), coronary heart disease (CHD), bronchopulmonary pathology (bronchitis, bronchial asthma).

 It has been established that many diseases, including cardiovascular, are based on tissue hypoxia, in which oxygen delivery to cells is disrupted as a result of pathological changes in the respiratory apparatus, cardiovascular system, blood system, leading to the development of hypoxic conditions - respiratory, circulatory hemic hypoxia (A.M. Chernukh, Yu.M. Shtyhno, V.I. Udovichenko, 1978).

 Hypoxia is the basis not only of pathological processes, but occurs in a number of burdened but physiological conditions of the body, such as the intrauterine period of the development of the fetus in the mother’s body, hard physical work, increased activity in athletes, hypoxia after eating plenty of food, hypoxia of an aging body ( Sechenov I.M. 1859, Petrov I.R. 1967, Meerson, Ryabov G.A. 1994). Hypoxia in some cases is a natural, training effect on the cell, tissues and the whole body.

 Based on this postulate, the most important in the basic non-drug therapy of diseases of the cardiovascular, bronchopulmonary systems are measures aimed at restoring impaired life support systems, including the normalization of tissue hypoxia, to stimulate adaptation reactions that lead to the formation of a state of "health". This includes training loads, physical exercises, physiotherapeutic procedures, the effects of hypoxia in the conditions of medical and resort institutions of a low-mountain resort, as well as interval hypoxic training.

 Adaptation to hypoxia dramatically increases the overall functional capabilities of the body and its resistance to various extreme and pathological factors. Disclosure of the complex of protective mechanisms of adaptation to hypoxia led to the search for new ways of adaptation (Strelkov RB, Karash Yu.M., Chizhov A.Ya. Increasing nonspecific resistance of the body using normobaric hypoxic stimulation. Reports of the USSR Academy of Sciences, 1987, P.25- 36; Tkachuk E.N., Tsyganova T.N., Dushko V.E. Intermittent normobaric hypoxia as an anti-stress factor. In the book: Medical-technical problems of individual protection of a person. M., 1989, p. AZ Mechanisms of action of interval training. "Hypoxia in medicine", M., 1993, N 1, p. 5 -eight).

 One of the problems of the clinical application of interval hypoxic training (IHT) is the selection of an individual “dose” of hypoxic exposure, where it is especially important to determine the duration of exposure and the inhaled oxygen concentration (10, 11, 12% or large values). On the one hand, the “dose” of hypoxia should be such that the body “turns on” the adaptation mechanisms of the cardiorespiratory system, which is one of the most important factors of the training action of hypoxia, but, on the other hand, pronounced tissue hypoxia should not develop during hypoxic exposure.

It has long been known that individuals with high and low resistance to hypoxia exist. However, not so long ago (Kislyakov Yu.Ya. Hemodynamics and oxygen transport in the microcirculation system. // Fourth School-Seminar "Experimental and Clinical Physiology of Respiration" L .: Nauka, 1987. P. 10-25) it was found that the decrease in pO ₂ ambient air leads in some experimental animals not to decrease, but to increase pO _{2 of} tissues.

 This allowed many authors to conclude that the training is promising specifically for hypoxia to create long-term resistance and increase the level of nonspecific resistance of the body. A significant increase in the body's resistance to various pathogenic factors after training for hypoxia in high altitude or pressure chambers has been proved (Z.I. Barbashova, 1960; E.A. Kovalenko, 1972; M.M. Mirrahimov, 1977; A.A. Andaramaev, 1978 ; F.Z. Meyerson, 1989).

 Conducted research on scientific and patent literature revealed a number of methods for treating diseases of the cardiorespiratory system, aimed at mobilizing adaptive mechanisms to ensure adequate blood supply to tissues and oxygen delivery to them.

The work of Aleksandrov O.V., Struchkova P.V., Vinitskaya R.S. et al. "Responses of the cardiorespiratory system to hypoxic effects during the course of hypoxytherapy in patients with chronic obstructive pulmonary diseases" (Hypoxia Medical J., 1997, No. 1, pp. 18-22), which presents the mechanisms of responses of the cardiorespiratory system during the course of hypoxic therapy. All subjects underwent an acute hypoxic test with a concentration of O ₂ in the respirable mixture of 11%. During the test, blood saturation with oxygen (SaO ₂ ) and heart rate (HR) with a pulse oximeter were recorded every 15 s. In this case, the initial values of the studied parameters were noted, their dynamics during the acute hypoxic test and in the process of recovery after the end of the test.

During the second test, the ventilatory and hemodynamic response to hypoxia was studied by the method of return breathing using a closed-type spirograph. During breathing, every 15 seconds, SaO ₂ and heart rate were recorded using a pulse oximeter. At the beginning and at the end of the study, blood pressure (BP) was measured. According to spirogram data, the minute volume of respiration (MOD) was calculated, the concentration of O ₂ in the inhaled air.

The curves showing the dynamics of SaO ₂ obtained from the experimental data of an acute hypoxic test (OGP) were described by the authors with a mathematical function.

According to the results of the hypoxic test, the authors identified 2 types of response to the inhalation of a gas hypoxic mixture: a fast rate of decrease in SaO ₂ and a slower rate of decrease in SaO ₂ .

In most patients and in some healthy individuals with a sharp decrease in SaO _{2, there} was an outstripping increase in minute alveolar ventilation compared with an increase in minute volume of blood circulation, the value of SaO ₂ was 11-25 mm Hg. This is regarded as a positive response to hypoxia.

In some patients with concomitant cardiac pathology, there was a delay in the increase in alveolar ventilation (it occurred only for 2-3 minutes of the test), the duration of the sample was reduced to 3-3.5 minutes, the value of SaO ₂ was 20-25 mm Hg. and increased during the test. This was regarded as a negative response to hypoxia, accompanied by an increase in ventilation-perfusion-diffusion disorders.

 The authors closely scientifically substantiated the presence of 2 types of body response to hypoxia and the need for strictly individualized hypoxic training (GT) regimens. However, the described method requires expensive equipment, complex mathematical programs to calculate the estimated parameters. All this makes the method inaccessible to real situations in practical medicine.

 AS N 935082, A 61 B 10/00, BI N 22, 06/15/82 "Method for assessing the effectiveness of hyperbaric oxygenation in the treatment of hypoxia", in which the method involving the study of red blood cell peroxide resistance before and after treatment with hyperbaric therapy, is taken as a prototype. A decrease in indicators indicates a favorable type of influence of this therapy.

 The disadvantage of this method is that expensive equipment is used to treat hypoxic conditions, an adapted room is necessary for the therapy, control studies are performed using labor-intensive methods, the method does not allow quick monitoring and individual selection of therapy.

 The aim of the present invention is to improve the method of treatment of patients with diseases of the cardiorespiratory system, accompanied by tissue hypoxia.

 This goal is achieved through periodic exposure to a gas mixture with a low oxygen content in the inhaled air. The selection of therapy is based on an assessment of the individual clinical features of each patient.

The method is as follows: upon admission to the hospital on the first day, the patient undergoes a hypoxic test: apparatus "Gipoksikator" (G) of the company "Gipoksimedikal", designed to receive hypoxic gas mixtures by the method of membrane separation of ambient air, equipped with an electronic control system for programming and holding breath sessions to determine the degree of blood hemoglobin oxygen saturation (SaO ₂₎ pulsoksimetricheskim method: the patient is located in a esle, in a relaxed state, is put on a finger pulse oximeter sensor. On the scoreboard of apparatus D, the SaO ₂ value _{of the} patient is displayed. Then, the valves set the oxygen concentration in g equal to 10%. The patient is invited to breathe through a tightly pressed plastic mask with a gas mixture GS-10. In seconds, the time of decrease of SaO ₂ on the scoreboard G from the initial level to inhalation of GS-10 to the level of SaO _{2 of} 80%, i.e., the minimum degree of saturation of hemoglobin of blood with oxygen when tissue hypoxia does not have a damaging effect, is determined (Z.A. Kolchinskaya, 1983). The nurse counts down the time with a stopwatch. This indicator indicates the degree of resistance of the body to hypoxia and is denoted as T _with (time reduction). When SaO _{2 is} reduced to 80%, the patient takes the mask away from the face and breathes the air of the room. At the same time, with the help of a stopwatch, the nurse determines the recovery time of SaO ₂ from 80% to the initial level for the patient on the scoreboard G. This indicator, which reflects the body's sensitivity to hypoxia, is indicated as T _in (recovery time) in seconds. Fix the source data. The hypoxia index is then calculated as the ratio of T _c to T _c .

If IG>2; SaO ₂ ≥ 90%, T _s ≥ 180 s, T _at ≤ 90 s - the type of response is regarded as favorable (type I);
If IG <2; SaO ₂ ≤ 90%; _With T <180 s, T _for> 90 - the response type regarded as unfavorable (II type).

 Calculations of an objective assessment of the results were obtained by mathematical processing of the dynamics of the indicators of the hypoxic test conducted in 209 patients with chronic respiratory infections.

 The favorable type indicates a high tolerance to various physical factors, high adaptive capabilities and a good initial state of the body, therapy was started with a lower concentration of oxygen in the hypoxic gas mixture.

 Patients with a favorable type of response were used according to the training regimen. Up to 15 procedures were applied per treatment course with a gradual decrease in the oxygen content in the hypoxic gas mixture from 14% to 11% with an increase in the respiration time of the hypoxic gas mixture from 3 to 5 min and the number of cycles in each procedure from 3 to 9. Total hypoxic time per course training was 424 min (Table N 1).

 An unfavorable type is characteristic of individuals with premature aging and more severe pathology of internal organs.

 In type II response, IHT was prescribed by a gentle method with an initial concentration of oxygen in the hypoxic mixture of 15% with a gradual decrease to 12%, an increase in the inhalation time of GHS from 2 to 5 minutes, while the number of hypoxic cycles in one hypoxic training session was increased from 5 to 8. The total hypoxic time for 15 IHT procedures was 357 min, which was 18.8% less than when using the training regimen with a favorable type of response to acute hypoxia (Table 2).

 Healthy persons, athletes and pilots IHT was carried out according to the scheme shown in table 3.

 Children aged 5 to 14 years received IHT according to a special scheme (Table 4).

Training results are assessed as successful if T _c increased by the end of treatment, and T _c decreased, indicating the mobilization of the body's adaptive capabilities aimed at combating hypoxia and a decrease in tissue hypoxia.

With an unfavorable type of response to hypoxic training, T _c decreased below the initial values, T _c varied in different directions: it did not change or lengthened.

 In the IHT process, a final hypoxic test may show a transition from a less to a more favorable type of response to hypoxia.

Clinical example:
Patient K., born in 1936, and / b N 3012, was in the sanatorium for 18 days. Diagnosis: mild arterial hypertension.

 On the ECG, diffuse changes in the myocardium, signs of left ventricular myocardial hypertrophy are noted.

Before the start of the course of treatment, a hypoxic test was carried out, which revealed: T _s - 245``, T _c - 60 '', SaO ₂ - 86%. IG - 4.08, revealed a favorable type of response.

The patient was prescribed a course of climatic balneotherapy, an IR laser on the region of the heart. IHT - according to the training technique (table N 1, see description). After 11 days, the hypoxic test was repeated:
T _s - 240 '', T _a - 40 '', SaO ₂ - 88%.

 The patient noted improvement, blood pressure ranged from 150/90, 130/80. There was no significant improvement on the ECG.

At the end of the course of treatment, a hypoxic test is again performed:
T _s - 410 '', T _to - 35 ", SaO ₂ - 91%, IG - 11.7;
A significant increase in T _s and a noticeable decrease in T _in compared with the initial testifies to the effectiveness of the therapy, which is objectively confirmed by the middle of the treatment period. An increase in SaO ₂ confirms a decrease in tissue hypoxia.

Clinical example:
Patient L., born in 1948, and / b N 3816, was in the sanatorium for 10 days.

 Dz: chronic non-obstructive bronchitis.

Suffers from chronic obstructive bronchitis for 10 years. Wet cough up to 3 months. per year, frequent exacerbations of pharyngitis, rhinitis. At the beginning of the treatment, the patient underwent a hypoxic test:
T _s - 106, T _c - 75, SaO ₂ - 86%; IG - 1.4;
An adverse type of response has been identified.

 Before the start of the course of treatment, the patient identified indicators of external respiration function, laboratory tests. I received a course of climatic and balneotherapy (underwater shower, inhalation, massage), IHT according to the gentle scheme (table No. 2, see description).

On day 5, the hypoxic test was repeated:
T _s - 200 '', T _a - 90 '', SaO ₂ - 88%; IG - 2.2;
A second study of the parameters of the external respiration function did not reveal dynamics. The general condition of the patient improved slightly. The hypoxic test is repeated at the end of treatment on day 10:
T _s - 280``, T _c - 75 '', SaO ₂ - 92%; IG - 3.7;
The distinct dynamics of the selected indicators allows us to judge the effectiveness of therapy, while other objective data in such a short time, despite the improvement in the patient's condition, do not allow to evaluate the effectiveness of therapy.

The inventive method can provide:
1. High treatment efficiency in the shortest possible time.

 2. Reduce treatment time.

Claims (1)

A method of treating patients with pathology of the cardiorespiratory system by periodically exposing them to a gas mixture, characterized in that the degree of saturation of hemoglobin of blood with oxygen is preliminarily determined (initial (SaO ₂ )), as well as the time during which the saturation of hemoglobin with oxygen decreases after the hypoxic mixture with oxygen content 10 % to SaO ₂ values equal to 80% (Tc), as well as the time to restore the degree of oxygen saturation of hemoglobin from 80% to the initial level (Tb); the hypoxia index is determined by the ratio Tc / Tb and, depending on its value, the duration of the procedure, the course of treatment and a greater or lesser percentage of oxygen in the inhaled gas mixture are determined.

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