Vol 13, No 6 (2014)

Evaluation of long-term experience cardiac rehabilitation in a rehabilitation center «Black River» allowed to formulate general technology rehabilitation of cardiac patients in different categories. The key points of technology at the 2nd stage of rehabilitation are the risk stratification, evaluation classes severity of patients in a rehabilitation center, multidisciplinary rehabilitation. In practice cardiorehabilitation used notion of rehabilitation potential and prognosis of rehabilitation. Suggested modular design personalized rehabilitation programs. The modular structure allows individual programs to achieve optimum results of rehabilitation, facilitating current and final control effectiveness.

The article analyses the results of the pilot study of the impact of electromagnetic Terahertz range on the dynamics of mikrogemokrovotoka in operirovannom tissue loskute. The experiment was conducted on male rats breed lab rats Wistar in accordance with the requirements of the Geneva Convention «International Guiding Principles for Biomedical Research Involving Animals». Violations in the intravascular component were modeled using the technique of microcirculation of blanking dies dorsal skin flap that resulted in severe circulatory disorders in the distal half of the graft. Animals (22 rats) were divided into two equal groups, one of which after the operation had not been subjected to a control. In experimental animals unit daily for seven days of 1 times per day have noise electromagnetic radiation with a frequency range 110-170 GGz. The impact started in day surgery and continued daily until the seventh day, turn to continued daily until the seventh day inclusive under the supervision of clinical data with fotoarchive, the dynamics of Thermal Imaging and Laser Doppler Floumetria. Reliability of differences results in the experimental and control group tested the U-test of Mann-Whitney. For the first time identified the particular effects of the radiation regime containing broadband frequency fundamental molecule-metabolites: nitrous oxide and oxygen, on microcirculatory in the skin of rats loskute moved. Clinically in the experimental group of distal necrosis area averaged 26,3% compared with 46,5% in control, which is confirmed by the data of Thermal Imaging and Laser Doppler Floumetrii. The results have important practical significance in the development of new medical rehabilitation technologies for correction of microcirculatory disorders and associated equipment.

The article reveals the author’s concept of paternalnyh physician-patient relationship, defined by their types and substantiate the nature of their influence on the formation of internal picture of disease in cardiac patients. Presents the results of an empirical study on the impact of the image of a cardiologist on attitudes toward the disease of cardiac patients, their health, activity and mood. In the process of the emergence and development of disease mechanisms violated interaction between man and the environment, so that the processes are effective mental adaptation included compensatory mechanisms aimed at the restoration of the interaction to a new level - in the situation of the disease. In this case, the clinical manifestations can be very diverse, depression or euphoria; apathy, weakening of emotional response, the weakening of criticism, self-centeredness, etc. Most of the patients, according to our research, assess their condition without exaggeration tendency of its severity, but without underestimating her. For many of them characterized by a tendency in all actively contribute to the success of treatment and devote themselves to the areas of life that are possible with their disease. Clinical manifestations of physical illness is largely due to the peculiarities of the vision of the disease by the patient and his attitude to the new circumstances of life in the face of illness and treatment, that is, characteristics and features of existing internal picture of his illness. The article reveals the essence and content of internal picture of disease cardiac patients, determinants of its formation and development. As one of the dominant factors considered factor of professional and personal characteristics of the attending physician, its image, formed as objective characteristics of his personality and subjective evaluations of his patients as a professional -cardiac patients. The authors, determining the structure of the internal and external image, especially considering medical image formation through the prism of his relationship to the patient’s position in cooperation with him and his system of professional and personal orientations. Justifying the legitimacy and usefulness of the category «paternalnye relations» in the study of doctor-patient relationship, the authors reveal a new vision of the psychological essence of this category, reflecting the relations developing between subjects by virtue of their having need for medical care and personal support. Using cluster analysis of the empirical data revealed professionally qualified, information and business, alienated, paternalno-caring, paternalno-prescriptive and paternalno-affiliate doctors types, their characteristics and the professional and personal characteristics, as well as their impact on the subjective attitude of patients to their physical illness and somatic status.

The article presents the use of medical rehabilitation in 45 patients in the acute phase cardioembolic stroke. Evaluation of the effectiveness of rehabilitation on a scale Barthel and Rankin and convincing evidence of the 0 that with increasing degree of heart failure require strict application of restrictive measures. The most common complication of rehabilitation patients in these patients was orthostatic hypotension. We have developed an approach for the management of orthostatic hypotension with verticalization of stroke patients, which included: correction of water and electrolyte balance by optimizing fluid therapy; correction medical treatment of heart failure; sparing regimen verticalization. It is proved that in the context of basic medical treatment, early verticalization on complex «ERIGO» was more effective than the control group in the application of restrictive measures. With the development of arrhythmias in these patients require additional antiarrhythmic therapy on the background of ongoing rehabilitation. Exacerbation of symptoms of heart failure in the form of paroxysmal arrhythmias, pulmonary hypertension rise requires additional use of drugs, as well as compensation for medical rehabilitation programs in the form of reducing the volume and intensity.

The study of the effectiveness of a 3-week rehabilitation program in patients with systolic and diastolic dysfunction of LV after acute coronary syndrome was performed. The study demonstrated the positive impact of the program on various aspects of rehabilitation of patients with reduced and preserved LVEF: hemodynamics, risk factors for cardiovascular disease, blood lipid profile, exercise tolerance.

Coronary heart disease (CHD) is the leading cause of death worldwide. A number of patients, despite conducted medical and surgical therapy over time reappears in the form of coronary artery disease refractory angina. One of the new treatments for refractory angina in patients who can not be carried out surgical treatment and medication is not effective, is the method of shock wave therapy (SWT). When UVT acoustic wave focuses on the periphery of the ischemic area of the myocardium. Effects on endothelial cells causing «shear effect», stimulates the synthesis of nitric oxide causes vasodilation and myocardial perfusion improvement also results in the release of several inflammatory factors promoting neoangiogenesis. The efficacy of using UHT treatment of CHD patients with refractory angina. There were 46 male patients with coronary heart disease c refractory angina III-IV functional class (FC). Age 59 to 71 years, average 65.8 + 1.4 years. Two groups of 23 people, most (OG) and control (CG). OG patients along with standard medical therapy was prescribed a course of UHT heart. The course consisted of UHT heart 9 procedures. Exposure was conducted for 3 zone 100 beats per zone at an energy level of 4.0. The acoustic wave is induced on the boundary of the identified areas of hypokinesia and normokinezii, areas of hibernating myocardium. After a course of UHT number of angina attacks requiring additional nitropreparatov receiving short-acting, decreased in OG group with 18,2 ± 1,9 to 3,2 ± 0,9 per week (p <0.01) in the CG group 15, 9 ± 2,1 to 7,3 ± 1,2 (p <0.01). 6 months after the end of UHT number of angina attacks decreased in the exhaust gas from 18,2 ± 1,9 to 2,2 ± 1,6 (p <0.01), a week in the CG group 15,9 ± 2, 1 to 10,3 ± 1,5 (p <0.05). Patients OG fewer ischemic segments with 4,3 ± 0,4 to 2,8 ± 0,1 (p <0.01).