Physical rehabilitation of patients who have suffered large-focal uncomplicated myocardial infarction in a hospital setting. Management of patients with coronary artery disease

Physiotherapy

One of the most important modern principles of treatment and prevention of cardiovascular diseases is the rational combination of various methods and means of therapy. Along with medications, more and more attention is being drawn to physical methods treatment. The basis for this is multilateral action physical factors on the body, the main of which are: the effect on blood circulation and contractility of the heart, metabolic processes in tissues, on the central and autonomic nervous systems, and the neurohumoral and biliary systems closely related to it.

Physical therapy (physis - nature) includes natural factors (sun, climate, mineral and fresh water, bathing, etc.), as well as the use of various types of energy with therapeutic purpose obtained with the help of special devices, the so-called reformed physical factors or hardware physiotherapy.

Physiotherapy is a set of special techniques and methods, which are based on the use of natural and preformed physical factors for therapeutic and preventive purposes. Physiotherapeutic factors do not cancel out other means of treatment and especially should not compete with them. Together with this, they can enhance their effect, create a more favorable background, and under certain conditions, especially when solving preventive and rehabilitation problems, acquire independent and even leading significance. Along with the above-mentioned non-specific side of the action of physiotherapy, which also includes a sedative and enhancing tissue trophism (without significant blood flow to the heart and increasing its work) effect, it is important to take into account the specific aspects inherent in the action of each of the physiotherapeutic agents. Properly selected according to the specificity of their action and dosed in accordance with individual characteristics patient, stage and phase treatment of ischemic heart disease physiotherapeutic procedures provide comprehensive beneficial influence on the main pathogenetic links of this disease.

Currently, the meaning in complex treatment patients with ischemic heart disease procedures such as electrosleep, drug electrophoresis, diadynamic and sinusoidal modulated currents, a number of balneological procedures. All of them have almost the same effect on the patient’s body, leading to improvement general condition and impaired coronary circulation, normalization of lipid metabolism and blood coagulation system.

Objectives of physiotherapy, used for the consequences of myocardial infarction (post-infarction cardiosclerosis): eliminate hypoxia, have a positive effect on blood distribution in the periphery, expand coronary vessels, mobilize collaterals as much as possible, improve myocardial nutrition, increase the functional adaptation of the body.

Physiotherapy is used in more early dates. It must be strictly differentiated. It is advisable to prescribe physical methods immediately after the end of the active processes of myocardial infarction, during the formation of post-infarction cardiosclerosis (after 3-4 weeks). During this period it is recommended:

v electrosleep (frequency 5-10 Hz), procedure duration 20-30 minutes. In one day. There are 10-12 procedures per course of treatment. Prescribed from the 20-30th day in order to restore the function of the central nervous system;

v heparin electrophoresis on the lumbosacral region. The anode is located in the interscapular region. Current strength is 0.01 mA/cm 2, procedure duration is 8-20 minutes. Daily or every other day. There are 10-15 procedures per course of treatment. Prescribed for recovery coronary circulation and metabolic processes in the myocardium;

v massage of the precordial area and cervical-collar area, duration of the procedure is 5-10 minutes, in combination with massage lower limbs(prescribed after 2 weeks);

v oxygen therapy (50-60%), procedure duration 20-30 minutes, 2-3 times a day. Daily;

v two-chamber foot sulfide (concentration 0.05-0.075 g/l), carbon dioxide (concentration 1.5 g/l), radon (concentration 1.5 kBq/l) or iodide-bromine baths (temperature 37-36 ° C), The duration of the procedure is 10-12 minutes. In one day. There are 10-12 baths per course of treatment. Prescribed from the 5th-6th week to patients with primary myocardial infarction for the formation of collaterals of venous vessels, their expansion, stimulation peripheral circulation and improving blood supply to the myocardium;

v UHF-therapy of the upper thoracic spine at level T 1 -T V ( reflexogenic zone hearts). Dose 20-40 W, procedure duration 10 minutes. Daily. There are 10-12 procedures per course of treatment;

v panangin electrophoresis on the interscapular area. The anode is placed in the lumbosacral region, the procedure lasts 10-15 minutes. In one day. A course of treatment includes up to 10 procedures. 1-2 months after myocardial infarction;

v galvanization or strophanthin-K electrophoresis on the heart area (according to the method of Tondii et al.). Electrodes 8*12 cm are placed on the front surface of the left shoulder (anode) and on the right subclavian region. Current strength is from 3 to 5 mA, procedure duration is 15-20 minutes. In one day. There are 10-12 procedures per course of treatment. Conducted in the first half of the day. Repeat course in 3-6 months. Or use electrophoresis of xanthinol nicotinate (complamin), 1 ml per pad;

v KHF-therapy of the lower third of the sternum. Intensity up to 10 mV/cm2, procedure duration 20-30 minutes, daily or every other day. There are 10 procedures per course of treatment;

v electrophoresis of pentoxifylline (trental) or acetylsalicylic acid transcardially or general according to Vermeule, procedure duration is 10-15 minutes. Daily or every other day. There are 10-15 procedures per course of treatment. Prescribed to develop collateral circulation and improve hemodynamics;

v magnetic therapy of the spinal region at levels C IV - T II. Continuous mode, 20 mT, procedure duration 15 minutes. Daily. There are 10-12 procedures per course of treatment;

v physiotherapy By special complex in bed.

After 3-4 months, aerotherapy and air baths can be used. 6-8 months after a heart attack with feeling good patient and the absence of significant changes in the ECG, oxygen, nitrogen, iodine-bromine, radon, sea, pearl or pine baths and novocaine electrophoresis, general according to Vermeule, are recommended.

Climatic treatment in local sanatoriums is indicated after 2-3 months, in remote ones - a year after myocardial infarction. At this time, swimming in the sea is allowed (at a water temperature of at least 21°C and a sea state of no more than 2 points) along the shore at a distance of 20-50 m and sunbathing according to a gentle scheme.

Thus, due to the fact that neuro-emotional factors and disorders of the autonomic nervous system play a large role in the occurrence of myocardial infarction, physical methods that have a beneficial effect on the central nervous system are used in the treatment of this form of IHD. For this purpose, electrosleep is used (a method of exposing the patient to direct current pulses rectangular shape frequency from 1-140 Hz, low strength) by following technique, up to 16-18 procedures per course of treatment or bromine electrophoresis (introduction of medicinal substances through intact skin or mucous membranes into the human body through the influence of direct electric current) - 15-20 procedures per course of treatment. Using electrophoresis, vasodilators(heparin, papaverine, euphilin) ​​can reduce the frequency of angina attacks. For correction mineral metabolism A course of potassium - magnesium - electrophoresis is carried out in the heart muscle. This method is most effective in cases of heart rhythm disturbances and weakening of its contractile function.

The use of training factors on the cardiovascular system is of great importance. These factors include various hydrotherapy procedures, gas and mineral baths. They are applied taking into account the severity coronary atherosclerosis, angina pectoris and circulatory failure. For mild angina pectoris They use coniferous, pearl, oxygen and nitrogen baths with a temperature of 35 - 36ºC (10-12 procedures per course of treatment), therapeutic showers, carbon dioxide radon and sulfide baths.

Hardware physiotherapy in the rehabilitation of patients with coronary heart disease

The use of hardware physiotherapy methods in patients coronary disease hearts (IHD), angina pectoris is aimed mainly at normalizing central mechanisms regulation of blood circulation with a concomitant increase in myocardial oxygen consumption, contractility myocardium and exercise tolerance, as well as reducing total peripheral vascular resistance and normalizing autonomic reactions.

Physiotherapy in patients with coronary artery disease should be used only in combination with drug therapy and a wide range of non-drug methods treatment (therapeutic physical training, balneotherapy, psychological correction methods).

For patients with coronary heart disease with angina pectoris of functional class I and II, physiotherapy is prescribed to eliminate the phenomena of hypersympathicotonia and increase adaptation to physical activity. Preference is given to such methods as electrosleep using a sedative technique, magnetic and laser therapy, and medicinal electrophoresis.

Patient position: lying on your back or sitting in a comfortable chair; impact zones: shoulder joints (mainly right), fifth intercostal space, sternum area (central zone or at the level upper third sternum). The waveguide is placed in contact or with a gap of 1-2 cm. Exposure is from 10-15 to 20-30 minutes, daily; There are 10-20 procedures per course.

In aeroionotherapy, regimens similar to those used in patients with hypertension are used.

Aerophytotherapy includes vapor inhalation essential oils orange, lavender, rose, mint, lemon balm, hyssop, anise, geranium, ylang-ylang, marjoram.

During PERT therapy use mode No. 3, intensity up to 20 μT, exposure time with a gradual increase from 10 to 20 minutes, daily; 10-15 procedures per course.

With Bemer therapy prescribe steps 3-5 or program P2 (intensity 10-15 μT), procedure duration 12 minutes, daily; 10-15 procedures per course.

With BLOCK, ozone therapy, UVOC, the regimens are the same as for patients with hypertension. During halotherapy, only mode No. 2 is used.

In patients with coronary artery disease with angina pectoris of functional class III, physiotherapy is prescribed in order to activate microcirculation processes in the coronary bed, improve the rheological properties of blood, reduce myocardial hypoxia and increase the degree of organic adaptation mechanisms.

One of the methods of neurotropic pulsed electrotherapy is used (electrosleep using a sedative technique, electrotranquilization, transcerebral amplipulse or interference therapy), magnetic therapy, electrophoresis of beta-blockers and metabolic drugs (sodium hydroxybutyrol, vitamin E, methionine, etc.).

To reduce general peripheral vascular resistance and enhance the propulsive ability of the myocardium, physical factors are applied to the calf region. Almost all physical factors used in hypertension Stage II, can also be used in patients of this category. Ultraphonophoresis of apressin is especially effective.

In the presence of concomitant diseases spine, you can apply applications of peloids of indifferent temperatures on the cervicothoracic or lumbar region, which helps reduce the frequency painful attacks, and also, according to HM, reduces the number of episodes of “silent”, or painless, ischemia, and reduces the frequency of cardiac arrhythmias.

In patients with coronary artery disease who have undergone myocardial infarction(THEM), physical factors begin to be more widely used in the second phase of rehabilitation - in the early post-hospital recovery period(reconvalescence phase - 3-6 to 8-16 weeks). The main goal of rehabilitation during this period is to increase coronary and myocardial reserves, economize the work of the heart, and prevent the development of late complications MI, chronic heart failure, optimization of scar formation in the infarction area.

17-23 days after the onset of acute MI, patients can be prescribed:

- electrosleep according to the sedative technique: orbitomastoid arrangement of electrodes, frequency of rectangular pulse current 5-20 Hz, current strength - 4-6 mA in amplitude value, procedure duration 30-60 minutes, 3-4 times a week; 10-20 procedures per course. The rationale for prescribing electrosleep to such patients is the presence following effects: sedative, analgesic, hemodynamic (close to the effects of beta-blockers, but without activation of the vagus nerve, which allows the method to be used for concomitant broncho-obstructive conditions), metabolic, manifested in improving the metabolism of lipids and catecholamines.

Autonomic correction under the influence of electrosleep in the form of a reduction in the manifestations of hypersympathicotonia with a decrease in myocardial oxygen demand makes the electrosleep method especially indicated in this period of rehabilitation;

- central electroanalgesia gives effects close to those of electrosleep, and is carried out with a frontomastoid arrangement of electrodes, with a pulse frequency from 800 to 1000 Hz at a current strength of 1.5 mA (average value). The duration of the procedure is 30-45 minutes, daily; 10-15 procedures per course;

- drug electrophoresis carried out using various techniques(impact on the collar area, heart area, etc.). Typically, a current density of 0.05 mA/cm2 is used with a procedure duration of 15-20 minutes; per course 6-12 procedures. Using galvanic or pulsed current, the necessary medicinal substances are administered: vasodilators, ganglion-blocking, analgesic, anticoagulating, neurotropic, affecting metabolic processes, antioxidants (papaverine, no-spa, aminophylline, obzidan, heparin, sodium hydroxybutyrate, panangin, vitamin E, etc. ).

Sometimes two drugs can be administered simultaneously from different poles. As an example of introducing two various substances You can use transcardial electrophoresis of potassium and magnesium or lithium with simultaneous electrophoresis of heparin and hexonium on the collar area or paravertebral on thoracic region spine.

- low frequency magnetic field are used using two methods. The first is to influence the projection area of ​​the lower cervical and upper thoracic autonomic ganglia of the border chain (at the CV-TIV level; the second is to influence the projection area of ​​the heart along the anterior surface of the chest. The inductor is placed contactally in the corresponding zone, the direction of the force lines is vertical, induction magnetic field 25 mT, procedure duration 10-15 minutes, daily; course 10-15 procedures.

To achieve a good vegetative-corrective effect, it is recommended to use a low-frequency magnetic field (exposure to the thoracic spine paravertebrally or to the collar region) with an induction of 15-20 mT with an exposure of 10-15 minutes, daily or every other day, depending on individual tolerance; course 8-15 procedures.

- laser therapy for the rehabilitation of patients who have suffered myocardial infarction, is used using a variety of techniques. BLOCK is prescribed according to standard methods. Currently, non-invasive transcutaneous effects of infrared pulsed laser radiation (0.89 microns) are widely used.

We present one of the methods.

Irradiation is carried out with a pulsed low-intensity laser emitter of the infarction range with a frequency of 80 Hz (without a magnetic attachment) contacting the points: point 1 - second intercostal space at the place of attachment of the rib to the sternum, point 2 - fourth intercostal space along the midclavicular line, point 3 - sixth intercostal space along the anterior axillary line , point 4 - at the corner of the left shoulder blade. Exposure time is from 1 to 3-4 minutes with a total duration of no more than 15 minutes, daily; There are 10-15 procedures per course.

Physiotherapy after cardiac surgery

For the rehabilitation of patients with coronary artery disease after surgical correction ( coronary artery bypass grafting, sympathotonia, etc.) hardware physiotherapy methods can be used within 8-10 days after surgery.

The tasks of hardware physiotherapy at this stage:

1) relief of angina pain syndrome, which persists in some patients;
2) relief of pain in chest related to surgical intervention;
3) increasing coronary, myocardial and aerobic reserves,
4) elimination autonomic dysfunction, phenomena of hypersympathicotonia, to increase oxygen supply to the myocardium.

Electrosleep is prescribed using a sedative technique: orbitomastoid arrangement of electrodes, frequency of rectangular pulse current 5-20 Hz, average amplitude current value 4-6 mA, procedure duration 30-60 minutes, 3-4 times a week; 10-20 procedures per course.

Central electroanalgesia can be used using the frontomastoid technique with a pulse frequency from 800 to 1000 Hz at a current strength of 1.5 mA (average amplitude value). The duration of the procedure is 30-45 minutes, daily; course 10-15 procedures.

Anodic galvanization collar zone or galvanic collar according to Shcherbak is used to eliminate autonomic dysfunction and reduce hyperreactivity; current density 0.01 mA/cm2, procedure duration 8-10 minutes, daily; course 10 procedures.

Electrophoresis novocaine using the transcardial method is used to relieve long-lasting pain in the chest caused by tissue trauma during surgery, placing the anode in the area of ​​greatest pain, and the indifferent cathode at the angle of the left scapula; current density 0.05-0.1 mA/cm2, procedure duration 10-15 minutes, daily; course 10-12 procedures.

SMT electrophoresis anaprilin according to the general method, according to Vermeule and paravertebral to the cervicothoracic spine (at the CIV-TVI level) is used to improve the autonomic support of cardiac activity, reduce the phenomena of hypersympathicotonia and improve myocardial oxygenation, as well as to prevent the development of heart failure.

SMT parameters: rectified mode, half-cycle duration 2:4, type of work III-IV, modulation depth 50%, frequency 100 Hz, 7 minutes for each type of work at a current strength of 5-10 mA in amplitude value daily; There are 10 procedures per course. Anaprilin is administered from the anode.

The advantage of this method is the ability to obtain a β-adrenergic blocking effect with small doses of the drug without a pronounced negative effect. inotropic effect(decrease cardiac output), what is he doing possible use it in patients with a hypokinetic type of hemodynamics with initially reduced cardiac output.

This technique is preferable to prescribe for concomitant arterial hypertension and uncomplicated cardiac arrhythmias. Contraindications include second degree AV block and complex rhythm disturbances (frequent group polytopic extrasystoles, paroxysmal disorders rhythm occurring more than twice a week, tachysystolic form of atrial fibrillation, etc.).

Low frequency magnetic therapy used for the purpose active influence on the autonomic nervous system to eliminate the phenomena of hypersympathicotonia and correct hemorheological disorders in early post-hospital (8 days after myocardial revascularization) rehabilitation.

This method of hardware therapy is used according to the paravertebral technique, on the area of ​​projection of the lower cervical and upper thoracic autonomic ganglia of the border chain (at the level of segments CVI-TII. Two rectangular inductors are placed paravertebral contact (through clothing) in the corresponding zone, the direction of the power lines is vertical, multidirectional, magnetic field induction 25 mT, procedure duration 10-15 minutes, daily; course 10-15 procedures.

Low-frequency magnetic therapy can be prescribed to patients for whom other methods of physiotherapy are contraindicated, as well as to more severe patients. The only contraindication is individual intolerance to the effects of a magnetic field (extremely rare).

Laser therapy used to increase metabolic processes in the myocardium and improve its oxygen supply, as well as to enhance regenerative processes in the myocardium and damaged tissues, increasing adaptation to physical activity using various transcutaneous methodological approaches.

Ultratone therapy method used to relieve pain after surgery, as well as to form a soft elastic scar and prevent the development of chondritis and perichondritis.

The method is based on the use of high-frequency (22 kHz) alternating sinusoidal current. Due to direct action current of supratonal frequency, capillaries and arterioles expand, local temperature increases slightly, blood and lymph circulation improves.

All this has a beneficial effect on metabolism, improves skin trophism, and enhances reparation processes. Improving microcirculation, reducing vascular spasm and reducing the sensitivity of nerve endings determine the pronounced analgesic effect of this method.

Medicinal ointments are used: lidase, dimexide, heparin ointment, pantovegin; contratubes, heparoid; exposure from 5 to 15 minutes, daily, possibly every other day with a short (5-7 procedures) duration of treatment; 10-20 procedures per course - according to individual indications.

At postoperative complications(mediastinitis, pleurisy, pneumonia, suppuration of a postoperative wound) it is possible to use extracorporeal ultraviolet irradiation of blood or BLOCK according to the standard method. Ozone therapy is also used.

Execute intravenous infusions ozonated saline solution 400 ml with an ozone concentration of 2 mg/l daily; course of up to 10 procedures.

L.E. Smirnova, A.A. Kotlyarov, A.A. Alexandrovsky, A.N. Gribanov, L.V. Vankova

Physiotherapy methods are used differentially depending on the stage and characteristics of the disease.

Physiotherapy in patients with stage I hypertension

Patients with stage I hypertension are prescribed physical factors aimed at eliminating dysfunction autonomic nervous system(VNS) and correction of functional disorders of the central nervous system, since at this stage of the disease it is these disorders that underlie the increase blood pressure (BP) and cause damage to target organs.

VNS dysfunction in the vast majority of patients manifests itself at this stage as hypersympathicotonia with cardiac hyperfunction and a hyperkinetic type of hemodynamics, i.e. their blood pressure increases due to cardiac output.

Electrosleep - using a sedative technique with orbital-mastoid arrangement of electrodes, frequency of rectangular pulse current 5-20 Hz, current strength 4-6 mA in amplitude value, procedure duration 30-60 minutes, 3-4 times a week; 10-20 procedures per course,

Electrotranquilization using the frontomastoid technique, frequency 1 kHz, pulse duration 0.5 ms, procedure duration 30-45 minutes, daily; 10-15 procedures per course. In terms of effectiveness, electrosleep and electrotranquilization are very close to each other.

- mesodiencephalic modulation (MDM) according to the following method: electrodes with moistened hydrophilic pads are placed on the patient’s head, observing the polarity - positive (+) electrode on the forehead, negative (-) on the back of the head. Select a program that may differ in pulse shape and current shape. The output current value is set individually until a pleasant sensation appears at the site where the electrodes are applied. Exposure time is 15-30 minutes, 10-15 procedures per course.

Low-frequency pulsed electrotherapy on the collar area is widely used in early stages hypertension. Use diadynamometry (DDT), sinus modeled currents (SMC) and interference currents with gentle parameters. One electrode is placed on the collar area or 3-5 cm below it. Frequency 80-130-150 Hz, total time 8-12 minutes, daily or every other day; per course from 7-8 to 10-12 procedures.

All types of low-frequency pulsed electrotherapy are used to influence the sinocarotid region. As a rule, bifurcated point electrodes are used, and the indifferent electrode is placed in the area of ​​the upper cervical vertebrae. When using DDT and SMT, gentle parameters of these currents are used with a procedure duration of no more than 2-3 minutes on each side.

In order to actively influence the autonomic regulation of the borderline sympathetic chain, an effect on the spinal region is used using a longitudinal method from the lower cervical to the upper lumbar region or a general effect according to Vermeule.

With the longitudinal technique, one electrode measuring 20x15 cm is placed in the spine at the level CIV-TII, the second electrode measuring 20x10 cm is placed in the lumbar region at the level SI-SV. In this case, it is possible to use sinus-modeled currents, interference and diadynamic currents.

You can apply SMT to the kidney area (2 electrodes with an area of ​​100 cm2 each - on the projection area of ​​each kidney and one electrode with an area of ​​300 cm2 - on the anterior wall of the abdomen); IV type of work, frequency 100 Hz, procedure duration 10-15 minutes; There are 10-12 procedures per course.

Magnetotherapy

Magnetotherapy on the frontal area using the following method: a contact-cylindrical or rectangular inductor is placed on the forehead area, the magnetic induction is 25-30 mT, the duration of the procedure is 10-15 minutes, daily; There are 10-15 procedures per course. It is used if there are contraindications to low-frequency pulse currents.

Impact on the frontal area is also possible using a combined magnetic field (alternating and constant magnetic field).

Low-frequency alternating magnetic therapy is often used on the collar area. In this case, one or two rectangular inductors with magnetic induction from 25 to 35 mT are used; Duration of the procedure is 15-20 minutes, daily; There are 10-12 procedures per course.

To influence the kidney area, you can use a low-frequency alternating magnetic field (50 Hz). Cylindrical inductors are used, which are placed in contact on the area of ​​projection of the kidneys. The magnetic field induction is 35 mT. Procedures lasting 15-20 minutes are carried out daily; There are 10-15 procedures per course.

Anodic galvanization or galvanic collar according to Shcherbak are effective methods exposure at this stage of the disease; current density 0.01 mA/cm2, procedure duration 6-16 minutes daily; There are 10-12 procedures per course.

Anodic galvanization is also used to correct kidney function. In this case, two bifurcated electrodes (anodes) with an area of ​​100 cm2 are applied to the area of ​​projection of the kidneys, and a cathode with an area of ​​300 cm2 is placed on epigastric region. The duration of the procedure is 10-20 minutes; per course 12-15 procedures.

Drug electrophoresis on the collar zone with a duration of exposure of 15-20 minutes using a wide spectrum medications(Mg2+, Ca2+, K+, papaverine, aminophylline, novocaine, no-spa, platifillin).

Drug electrophoresis of aminophylline is also possible using the bipolar method, since aminophylline is functional when administered from both the positive and negative poles. One electrode with a gasket moistened with a 2% aminophylline solution is placed on the collar area or 3-5 cm below it.

The second electrode, opposite in charge, is applied in the interscapular region; current strength from 2 to 6-8 mA, taking into account individual sensitivity to electric current, exposure 10-15 minutes, daily or every other day; for a course of 8-12 procedures.

Bioresonance therapy

Bemer therapy: the basic program is carried out on an inductor in the form of a mattress, magnetic induction stages from 5 to 7, from 8 to 20 µT, daily; 10-15 sessions per course. According to individual indications, procedures can be performed every other day.

In addition to the basic program, a local inductor is assigned individually - an applicator with magnetic induction from 83 to 130 µT. Areas of its influence: frontal and occipital regions, cervical-collar region, thoracic spine, collar area with coverage shoulder joints.

The exposure is 8 minutes with a single exposure, the total exposure with the basic program and local inductor is 16-20 minutes, the change in exposure is strictly individual.

PERT therapy: mattress applicator, mode 4, intensity up to 40 µT.

Low-intensity laser radiation of the infrared range

The impact is carried out at 3 points paravertebrally on the cervicothoracic spine CVII-TIV with continuous or pulsed laser radiation with a frequency of 1500 Hz with an exposure of 5 minutes. The total duration of exposure should not exceed 15-20 minutes.

Low-intensity infrared pulsed laser radiation can also be applied to the sinocarotid region with a frequency of 80 Hz (without a magnetic attachment) with a duration of exposure of 1-2 minutes on each side, daily; for a course of 8-10 procedures.

Ultrasound treatment of the sinocarotid region using an ultrasound head with an area of ​​1 cm, an impact intensity of 0.05-0.2 W/cm2 using a labile technique in pulsed mode with a pulse duration of 4 ms for 1-2 minutes on each side; for a course of 8-10 procedures.

Aeroionotherapy

The initial dose is 300 units, maximum - 700 units, daily; There are 10-15 procedures per course.

Aerophytotherapy includes inhalation of vapors of essential oils of vanilla, orange, ylang-ylang, hyssop, lemon, marjoram, juniper, fennel, cypress, geranium, lavender, rosemary. The air flow speed in the treatment room is up to 0.1 m/s, the vapor concentration is 0.4-0.6 mg/m3.

For halotherapy, modes No. 2 and 3 are used. Session duration is 40 minutes, daily; 10-20 sessions per course.

Ozone therapy is prescribed intravenously daily or every other day, 200 ml (concentration 1.2 mg/l); 10 infusions per course.

Physiotherapy in patients with stage II hypertension

The goal of hardware physiotherapy in patients with stage II hypertension is to improve the humoral regulation of blood pressure, primarily to reduce aldosterone levels, normalize water-salt balance and reduce total peripheral vascular resistance(OPSS).

In stage II hypertension, as a rule, the hypokinetic variant of hemodynamics predominates, i.e. the increase in blood pressure is due to an increase in peripheral vascular resistance. To improve the central mechanisms of humoral regulation of blood pressure, neurotropic methods of pulsed electrotherapy are used, but the impact parameters are different than in stage I hypertension.

The treatment complex includes methods that produce effects similar to beta-blockers: methods of neurotropic pulsed electrotherapy (sedative electrosleep, electrotranquilizer, transcerebral amplipulse therapy or interference therapy), magnetic therapy, electrophoresis of beta-blockers and metabolic drugs (sodium hydroxybutyrol, vitamin E, methionine and etc.).

Methods of neurotropic pulsed electrotherapy:

Electrosleep is used using the orbital or frontomastoid technique with a pulse current frequency of 80-100 Hz for 30 minutes every other day. This technique is usually followed for the first 6 procedures, and subsequent procedures (up to 15) are performed using a sedative technique.

Transcerebral amplipulse therapy. A variable mode is used with a modulation depth of 75%, a frequency of 30 Hz for frontal localization and 100 Hz for orbital localization, procedures for 15 minutes are prescribed daily; There are 10-15 procedures per course.

Amplipulse magnetic therapy with the specified SMT parameters and simultaneous exposure to a low-frequency alternating magnetic field on the occipital region with a magnetic induction of 30 mT, duration of procedures 15 minutes, daily; There are 10-15 procedures per course. In this case, a pronounced hypotensive effect is accompanied by an improvement in the rheological properties of blood and correction of cerebral hemodynamics.

Interference currents: frontomastoid or occipital location of electrodes, frequency from 1 to 150-200 Hz before sensation patients with mild vibration, procedure duration 15 minutes, daily; There are 10-15 procedures per course.

Drug electrophoresis on the collar area of ​​medications (Mg2+, Ca2+, K+, papaverine, aminophylline, novocaine, no-spa, platiphylline, aminophylline, apressin, methionine, etc.).

It is preferable to use sinus-modeled currents for electrophoresis.

In the collar area, exposure to other physical factors is also used: various pulsed currents, alternating and pulsed low-frequency magnetic fields, ultrasound in pulsed mode with a pulse duration of 4 ms, impact intensity of 0.2-0.4 W/cm2 for 3-5 min, daily ; There are 10-12 procedures per course. The same ultrasound parameters are used for apressin ultraphonophoresis, for which 4% apressin ointment is used.

During exacerbation of the disease to prevent the development hypertensive crisis Apressin ultraphonophoresis and electrosleep are used sequentially (almost without interval) using a sedative technique with a reduced procedure duration (up to 15-20 minutes).

The projection area of ​​the kidneys is actively used to influence physical factors in the treatment of patients with stage II hypertension. Thus, diadynamic therapy, amplipulse therapy and other types of low-frequency pulsed electrotherapy are used not using the transverse method, but paravertebrally, so that the renal parenchyma does not fall into the field of action of the pulsed current, since this may cause hematuria.

With the paravertebral technique, the current loops capture only the sympathetic renal plexus, which regulates hemodynamics and renal function, which is accompanied by a pronounced hypotensive effect. The impact parameters for all types of low-frequency pulsed electrotherapy are the same as for the treatment of patients with stage I hypertension.

Magnetic therapy assigned to the kidney projection area using the same parameters and methodological features, as in stage I of the disease.

In addition, a high frequency electromagnetic field (13.56 MHz) is used - inductothermy in the kidney area in an oligothermic dosage. Procedures are carried out daily; There are 10-12 procedures per course.

Also prescribed ultrahigh frequency electromagnetic field(460 MHz, UHF therapy) to the area of ​​projection of the kidneys; use rectangular emitters measuring 16x35 cm, exposure power 30-35 W, procedure duration 10 minutes, daily; There are 10-15 procedures per course.

In addition to electromagnetic fields of high and ultra-high frequency, ultrasound can also be used on the area of ​​​​the projection of the kidneys with an impact intensity of 0.4-0.6 W/cm2 in continuous or pulsed mode for 3-5 minutes per field, daily; There are 10-12 procedures per course.

To reduce the overall peripheral vascular resistance at this stage of the disease, they begin to affect the calf region.

Anodic galvanization is used: 2 bifurcated electrodes (anodes) with an area of ​​100 cm2 are each applied to the calf region of both legs, and a cathode with an area of ​​300 cm2 is applied to the lumbar region.

The duration of the procedure is 10-15 minutes, 3-4 times a week; per course 12-15 procedures.

Using this technique, SMT can also be used: 2 bifurcated electrodes with an area of ​​100 cm2 each are applied to the area calf muscles, electrode with an area of ​​300 cm2 - on the lumbar region; variable mode, modulation depth 50%, frequency 100 Hz, procedure duration 10-15 minutes; There are 10-12 procedures per course.

In addition to sinus-modeled currents, other types of low-frequency pulse currents can be used. To influence this area, you can also use an alternating magnetic field of low frequency (50 Hz). In this case, rectangular inductors are placed with their end surfaces on the skin of the calf area. The magnetic field induction is 25 mT. Procedures lasting 10-20 minutes are carried out daily; There are 10-15 procedures per course.

In addition to ultra-high frequency electromagnetic fields, ultrasound can also be used to influence the calf area with an impact intensity of 0.4-0.6 W/cm in continuous or pulsed mode for 3-5 minutes per field, daily; There are 10-12 procedures per course.

Ultraphonophoresis of apressin using 4% apressin ointment and the above ultrasound parameters is also effective.

Limitations for the use of physical factors in the calf muscle area are chronic thrombophlebitis, severe varicose veins in this area, and lymphedema of the lower extremities.
Aeroionotherapy is prescribed from 200 to 500 units. daily; There are 10-15 procedures per course.

The methods of aerophytotherapy, halotherapy, BLOCK, UFOK, Bemer therapy, PERT therapy, ozone therapy are similar to the methods for patients with stage I hypertension.

L.E. Smirnova, A.A. Kotlyarov, A.A. Alexandrovsky, A.N. Gribanov, L.V. Vankova

Can be mainly considered as pathogenetic, aimed at different sides pathological process: for rest and training of the heart, elimination of cardiohemodynamic disorders, external respiration And oxidative processes, restoration of the damaged functional state central and autonomic nervous system; increase immunobiological protective forces body, etc. One should also keep in mind the preventive value of physical factors, primarily preventing the development of more severe degrees of circulatory failure.

When choosing a treatment method, it is necessary to take into account the presence of concomitant diseases, for example diseases of the joints, muscles, peripheral nervous system, etc. From physical factors highest value have balneotherapy, used both at the resort and in non-resort settings.

In case of circulatory insufficiency of the I degree, during the transition to the IIA degree, balneotherapy can be used, but in case of circulatory failure of the IIA degree, cardiotonic drugs are prescribed for several days before its onset. More severe circulatory failure (II and III degree), a state of unstable compensation (hemoptysis, recent decompensation above grade IIA) are contraindications for balneotherapy. It is also not indicated for disorders in the conduction system of the heart (complete atrioventricular block, bundle branch block).

For atrial fibrillation, balneotherapy also cannot be recommended, although in itself it is not a contraindication for balneotherapy, if circulatory failure does not exceed degrees I and I-II, there is no current infectious process, angina pectoris, or severe stenosis of the atrioventricular orifice. Extrasystole, often accompanying heart defects, is not a contraindication for balneotherapy if it does not result in myocarditis.

It should be noted that balneotherapy is less effective for mitral and aortic stenosis, this is explained by overload of the weakened right heart and left atrium with mitral stenosis during bathing. With pronounced mitral and aortic stenosis, with stenosis with impaired cerebral circulation, balneotherapy is ineffective. For patients with severe aortic valve insufficiency, balneotherapy is also not indicated, since prolongation of diastole during a bath leads to increased reverse blood flow and overload of the left ventricle.

Patients with insufficiency are most indicated for balneotherapy mitral valve, combined mitral disease heart and mildly expressed stenosis. The effectiveness of balneotherapy for aortic valve insufficiency is less than for mitral valve insufficiency.

Patients with congenital defect heart, such as narrowing of the aortic isthmus, stenosis pulmonary artery balneotherapy is not subject to, but patients with patent ductus botallus and interventricular or interatrial septum in cases of mild circulatory failure, balneotherapy can be performed.

Balneotherapy is indicated only when the infectious process, after all symptoms disappear inflammatory process 10-12 months after exacerbation of endomyocarditis. Sluggish and latent forms of rheumatism or syphilis, as a rule, are not subject to balneotherapy without a sufficiently long preliminary drug therapy until all signs of the current infection disappear.

Balneotherapy causes an exacerbation of latent foci of infection and activates a chronic infection. We believe that if the inflammatory process is localized in the heart, then balneotherapy is harmful, exacerbating endomyocarditis or aortitis, but any exacerbation of the inflammatory process in the heart is undesirable. The exacerbation reaction, which many authors do not separate from the so-called balneological reaction, can aggravate the pathological organic process in the heart. If there are chronic foci of infection, they must be treated before prescribing balneotherapy, since exacerbation of focal infection during balneotherapy is very difficult to differentiate from exacerbation of rheumatic carditis or aortitis.

In case of tonsillocardial syndrome, balneotherapy is not indicated, but is necessary radical treatment tonsil infections. Sometimes it is necessary and pathogenetic treatment, for example, with sympathico-ganglionitis (treatment with ganglionic blocking agents, physiotherapy).

As N.I. Speransky and Ya.I. Danenkov showed, sometimes with a sluggish or latent form of rheumatic endomyocarditis, it is possible to carry out balneotherapy with preliminary and simultaneous use salicylates or hormones, which prevents the occurrence of an exacerbation reaction, manifested by activation of the rheumatic process.

Patients with heart disease syphilitic etiology Balneotherapy is indicated only after specific treatment has been performed.

With accompanying painful form coronary artery sclerosis, concomitant sclerosis of cerebral and kidney vessels, balneotherapy is not indicated.

cardiovascular diseases

Physiotherapy for cardiovascular diseases aimed at restoring the functional state of the heart, improving coronary circulation and myocardial contractility, its excitability and automaticity; improving the functions of auxiliary (extracardiac) circulatory mechanisms by reducing increased tone peripheral arteries and veins, general peripheral vascular resistance, which allows increasing the propulsive work of the heart with more economical consumption of oxygen; improving blood microcirculation and its function in transporting oxygen; improving the functions of the central and autonomic nervous system, neuroendocrine and immune processes underlying a number of cardiovascular diseases. Physiotherapy methods are used for coronary heart disease, hypertension, neurocirculatory dystonia, myocardial cardiosclerosis, etc.

Cardiac ischemia. F.'s use has been most studied in stable angina pectoris, post-infarction cardiosclerosis, atherosclerotic cardiosclerosis (with the so-called painless form), as well as rehabilitation treatment patients with myocardial infarction, patients who have undergone coronary artery bypass surgery and resection of a cardiac aneurysm.

Contraindications: progressive (unstable) angina pectoris, circulatory failure above stage IIB, cardiac asthma, prognostically unfavorable heart rhythm disturbances (frequent group extrasystole, frequent difficult-to-control paroxysmal cardiac arrhythmias), aneurysm of the heart and blood vessels.

The choice of F. method is determined by the degree functional impairment cardiovascular system, the state of the nervous and neurohumoral circulatory regulation systems, as well as the nature of concomitant diseases. With stable angina pectoris, myocardial infarction, incl. post-infarction cardiosclerosis, and after coronary artery bypass surgery and aneurysm resection at all stages of rehabilitation, starting from the 15-20th day of the disease or operation, as well as in patients with a predominance of excitation processes, hypersympathicotonia, extrasystolic arrhythmia, concomitant hypertension of stages I and II, diabetes mellitus(mild and moderate forms) the effect on the central and autonomic nervous system and neurohumoral regulation is carried out using electrosleep (Electrosleep) . The same patients are treated with galvanotherapy (Galvanotherapy) or Electrophoresis (medicinal) according to the methods of general influence, segmental - in the zone of projection of the sympathetic ganglia (Th I - L I) along the posterior surface of the body, in the Zakharyin-Ged zones, in the collar region and in the heart region. The procedures have a mild sedative and analgesic effect and normalize blood pressure. For electrophoresis, vasodilators, painkillers and other agents are used.

Ultrahigh frequency therapy (Ultrahigh frequency therapy) (with a frequency of 2712 MHz) are used craniocerebrally for stable angina pectoris of functional classes I and II, incl. with lipid metabolism disorders. Treatment is carried out using the Thermopulse-700 device in intermittent mode, intensity 35 W using capacitor plates with a diameter of 12 cm; daily procedures, lasting 5-15 min for the course 25-30.

Low-frequency magnetic field (see Magnetotherapy) causes restructuring autonomic regulation heart in the form of a decrease in sympathetic tone, decreased platelet aggregation and improved microcirculation, while not significantly affecting central hemodynamics. This allows it to be used in the treatment of patients with stable angina, incl. with extrasystolic and atrial fibrillation(rare and easily relieved paroxysms, permanent form with circulatory failure not higher than stage I), patients with myocardial infarction of classes I, II and III of clinical severity, starting from the 15-20th day of the disease. In this case, they act either on the projection area of ​​the lower cervical and upper thoracic autonomic ganglia of the border chain at the level of the CV-Th IV vertebrae on the side of the back, or on the projection area of ​​the heart.

Ultrahigh frequency therapy (460 MHz) when exposed to the heart area, causes dilation of the microvasculature in the myocardium, reducing platelet aggregation, which improves myocardial metabolism and accelerates reparative processes in it. Procedures are prescribed for stable angina pectoris, myocardial infarction, starting from the 15-20th day of illness. They act either on the area of ​​projection of the sympathetic ganglia C V -Th IV on the posterior surface of the body, or on the area of ​​projection of the heart along the anterior surface of the chest.

At the core clinical effect low-energy laser radiation (see Lasers) for coronary heart disease are positive changes in hemostasis and rheological properties of blood, microcirculation and mobilization antioxidant protection cells; Its analgesic effect is also important. Procedures are prescribed for stable angina pectoris, myocardial infarction in the convalescence phase, starting from the 15-20th day of the disease, in the absence of heart rhythm disturbances and circulatory failure not higher than stage I. The presence of rare extrasystoles, sinus tachycardia and bradycardia, bundle branch block is not a contraindication.

Balneotherapeutic procedures cause vasodilation, increase blood flow speed, and improve microcirculation. For stable angina of functional classes I and II, incl. with post-infarction cardiosclerosis, as well as after coronary artery bypass surgery after 6-8 months. with circulatory failure not higher than stage I and in the absence severe violations For cardiac rhythm treatment, general carbon dioxide, hydrogen sulfide, radon, sodium chloride and other types of minerals, as well as nitrogen and oxygen baths, are used. All types of baths are used every other day or 4-5 baths per week from the second half of the treatment course with a duration of 10-12 min; per course 10-12 baths.

In case of stable angina pectoris of functional class III, myocardial infarction in the convalescence phase and after coronary artery bypass surgery of class I and II severity, balneotherapy is carried out in the form of 2- or 4-chamber baths; For stage IIA circulatory failure and mild cardiac arrhythmias, dry carbon dioxide baths are used.

Hydrotherapy is used in the form of contrast baths (Baths) , underwater massage shower and other therapeutic showers. Water procedures reduce the sympathetic influences of the autonomic nervous system, reduce oxygen consumption for the heart, eliminate coronary-metabolic imbalance, which increases coronary and myocardial reserves, the threshold of tolerance to physical and cold stress, and improves vascular reactivity.

In case of stable angina pectoris, post-infarction cardiosclerosis of functional classes I and II with circulatory failure not higher than stage I and without heart rhythm disturbances, general contrast baths are prescribed: the patient is immersed in a pool with warm (38°) water. fresh water by 3 min, then he goes into a pool with cool water (28°) for 1 min while doing active movements. Three transitions to the procedure are recommended, which ends with a cool bath (by the middle of the course the temperature is reduced to 26-25°). A total of 12-15 baths per course, 4-5 baths per week. For post-infarction cardiosclerosis and after coronary artery bypass surgery (starting from the 30-35th day), foot contrast baths are used (with a temperature of 38 and 28°, from the second half of the course - 40 and 20°): a total of 12-15 baths per course.

Balneotherapy and hydrotherapy are used to treat patients with a painless form of coronary heart disease, cardiosclerosis, which can manifest as heart failure and heart rhythm disturbances. When choosing the type of treatment and method of its implementation crucial has a determination of the degree of impairment of the functional state of the cardiovascular system based on data from tests with physical activity, as well as the nature of heart rhythm disturbances.

Hypertonic disease. When choosing a F. method, one should take into account not only the stage of the disease, but also the type of hemodynamic disorders (hyperkinetic or hypokinetic). In the hyperkinetic variant, electrosleep, central electroanalgesia, galvanotherapy and medicinal electrophoresis, low-frequency magnetic field, microwave therapy, negatively charged electroaerosols are used to reduce the increased sympathetic activity of the hypothalamic centers.

In the treatment of patients with hypertension stages I and II without frequent vascular crises, significant disturbances in heart rhythm and circulatory failure not higher than stage I, balneotherapy is widely used: carbon dioxide, radon, hydrogen sulfide, sodium chloride, iodide-bromine, arsenic-containing, as well as nitrogen baths. The temperature of all baths is 35-36°, except for sodium chloride baths (35-34°). Baths are taken every other day, 4-5 baths per week, for a course of 10-12 baths.

Patients with stage IIB hypertension in combination with coronary heart disease, as well as with circulatory failure not higher than stage IIA, use 2- and 4-chamber baths or dry carbon dioxide baths (temperature 28°, duration 15-20 min, 10-12 baths per course).

For hypertension stages I and II without signs of coronary and heart failure, heart rhythm disturbances, hydrotherapy is used: pine, pearl, oxygen baths, wet wraps and therapeutic showers, incl. underwater shower-massage, as well as sauna treatments.

Cardiopsychoneurosis. In order to influence arterial hyper- and hypotension, cardialgia, and abnormal heart rhythm, electrosleep is used, medicinal electrophoresis (bromine, anaprilin) ​​is performed using the general effect method or the collar method; for the hypotensive type, caffeine-bromo-electrophoresis is used: for severe asthenic syndrome- galvanic anode collar according to Shcherbak. For the cardiac type of disease with severe cardialgia, novocaine electrophoresis using a segmental technique, darsonvalization of the heart area, ultraviolet irradiation in an erythemal dose, or massage of the heart area are prescribed.

Carbon dioxide, sodium chloride, iodide-bromine baths are prescribed for the hypotensive type of disease and severe asthenic syndrome; radon, nitrogen baths - for hypertensive, cardiac, incl. arrhythmic, symptom complexes and a pronounced predominance of the process of hypersympathicotonia, insomnia; hydrogen sulfide baths- for hypertensive and cardiac types with relatively balanced nervous processes and without signs of hypersympathicotonia and cardiac arrhythmias.

Hydrotherapy in the form of therapeutic showers (rain, circular, Scottish, underwater shower-massage), dry and wet wraps, contrast, pearl, pine baths used for all types of disease. In case of heart rhythm disturbances, a pronounced predominance of excitation processes, do not use circular and Scottish soul, as well as contrast baths.

Myocardial cardiosclerosis(consequences of rheumatic and infectious-allergic myocarditis) in patients with circulatory failure not higher than stage I, cardialgia, incl. with mild cardiac arrhythmias, is an indication for balneotherapy in the form of general carbon dioxide, radon, sodium chloride and iodine-bromine baths, and in the absence of cardiac arrhythmias - and hydrogen sulfide baths. In patients with severe mitral stenosis or after commissurotomy, preference should be given to carbon dioxide baths. Such patients are treated with inhalation of aerosols or electroaerosols; to improve immunogenesis and in order to prevent exacerbations, inductothermy is performed on the adrenal gland area (at the level of Th X -L IV).