No abstract

Background. Assessment of the compensatory capabilities of the body of patients after cardiac surgery at the stationary stage of rehabilitation is of significant scientific and practical interest from the point of view of individualization of rehabilitation therapy for such patients. Aim. The analysis of clinical and functional status of patients with acute coronary syndrome after percutaneous coronary interventions at the stationary stage of rehabilitation was carried out. Methods. The algorithm for a comprehensive assessment of health status included general clinical research methods, clinical and somatotypic status; assessment of the degree of stress of adaptive compensatory-adaptive reactions, the state of immunity and physical performance; biochemical research methods in blood serum; six-minute walk test; psychological research methods. Results. There are revealed signs of violations on the part of carbohydrate, lipid metabolism, antioxidant protection, increase of immune system reactivity, reduction of reserve capabilities of non-specific protective mechanisms, reduction of parameters of full-fledged socio-psychological functioning, which should be taken into account in the preparation of individual rehabilitation programs. Conclusion. The revealed relationship between integral leukocyte indices and a number of clinical and functional indicators allows us to recommend their use for analyzing the state of adaptive processes in the body and assessing the rehabilitation potential in patients with acute coronary syndrome after cardiac surgery.

Aim. Determination of informativeness of leukocyte indices in patients with bronchial asthma, who have comorbid diseases in clinical remission of asthma. Materials and methods. The work based on a single examination of 225 patients with bronchial asthma. Criteria for inclusion in the study are following: the presence of a verified diagnosis of bronchial asthma, the phase of clinical remission. The patients have been divided into 4 groups, taking into account the type of comorbid diseases: the 1 group (53 patients) bronchial asthma was combined with lesions of the upper gastrointestinal tract; the 2 group (73 patients) with allergic rhinitis; the 3 group (76 patients) with hypertension; the 4 group (23 patients) comparison group: the patients without comorbid pathology. According to the clinical blood analysis, 10 leukocyte indices were calculated for each group of patients and their values were analyzed taking into account the frequency and severity of deviations from the reference values. Mathematical processing of the material was carried out using the statistical software package SPSS13.0 for Windows. Results. Using leukocyte indices, it has been revealed that even during the period of clinical remission, almost all examined patients with BA have endogenous intoxication, the severity of which increases in comorbid diseases. Intoxication was inflammatory in nature and, according to the data of leukocyte indices, was due to the presence of persistent inflammation (local and systemic) and during clinical remission. Violation of immunological reactivity has been revealed in most of the examined patients. The presence of correlation relationships of leukocyte indices with a number of biochemical and immunological indicators allows one to exclude the latter from the plan of examination of patients without reducing the quality of their examination: for example, in the conditions of polyclinics, small hospitals, and resorts. Eight leukocyte indices that are the most informative at BA have been selected. Conclusion. Additional information about the condition of BA patients who have comorbid diseases during clinical remission can be used to develop programs for their comprehensive treatment and rehabilitation.

ФГБУ «Сибирский федеральный научно-клинический центр Федерального медико-биологического агентства», Северск, Томская область, Россия Обоснование. При существующем обилии методических подходов к оценке результативности медицинской реабилитации критерии эффективности комплексного воздействия лечебными физическими факторами сегодня по-прежнему не соответствуют требованиям доказательной медицины. Цель исследования-разработать метод оценки эффективности реабилитационных мероприятий у больных с острым коронарным синдромом после эндоваскулярных кардиохирургических вмешательств. Материалы и методы. Основу исследования составили результаты одноцентрового когортного проспективного клинического исследования лиц с инфарктом миокарда после эндоваскулярных кардиохирургических вмешательств. Продолжительность участия пациентов в исследовании составила 21 день. Результаты. Разработан интегративный подход и представлено пошаговое описание технологии создания многокритериальной унифицированной системы оценки эффективности реабилитации лиц с кардиоваскулярными заболеваниями после чрескожных коронарных вмешательств. Изложен алгоритм расчета интегрального показателя здоровья и оценки результативности реабилитационных мероприятий на основании учета динамики клинико-лабораторных и функциональных показателей, а также психологических характеристик конкретного пациента. Предложено рассматривать интегральный показатель здоровья в качестве параметра оценки реабилитационного потенциала пациентов с кардиоваскулярными заболеваниями после чрескожных коронарных вмешательств. Заключение. Авторская система оценки эффективности комплексной медицинской реабилитации отличается от подобных интеллектуальных продуктов отсутствием субъективизма в определении степени выраженности клинических симптомов патологического процесса, невозможностью произвольного определения веса признаков, приведением разнотипных параметров, выбранных в качестве критериев оценки эффективности, к унифицированным стандартным значениям, получением однозначного численного выражения результата медицинской реабилитации, позволяющего сравнивать итоги проведения реабилитационных мероприятий в различных лечебно-профилактических учреждениях.

A comprehensive examination and health improvement of 40 patients has been performed using therapeutic physical factors of the sanatorium «Belokurikha», JSC «Belokurikha Resort». High incidence of overweight, hereditary burden of cardiovascular diseases, hyperglycemia, low physical activity, dyslipidemia and atherogenic cholesterol fraction has been revealed. At the same time, 60 % of the examined patients had combination of 3–4 risk factors for cardiovascular diseases, most often obesity, dyslipidemia, hyperglycemia. It is established that appointment of pathogenetically based treatment complex, including physical therapy, manual massage, general mineral baths, peloidotherapy, Nordic walking, therapy with elastic pseudo-boiling layer has signifi cant anti-infl ammatory and hypolipidemic eff ects, helps to reduce the severity of endogenous intoxication, and to increase adaptive potential.