Effect of Ozone Therapy and Nauheim Baths on Patients with Cardiovascular Disease

The protection and promotion of health is one of the priority tasks of government health care system, in accordance with which a fundamentally new direction of activity is being developed – the transition from a system focused on the treatment of patients and rehabilitation of disabled people to a system based on the priority of forming a culture of health and aimed at preventing diseases. [1]. 

High-intensity work, prolonged psychological stress, the impact of environmentally unfavorable factors, chronic stress, the growth of psycho-emotional disorders, neuroses, depression, increased irritability, decreased performance, changes caused by somatoform dysfunctions of the autonomic nervous system lead to growth and

“Rejuvenation” of hypertensive and ischemic heart disease, chronicity of a number of diseases [2].

The issues of correction of prenosological conditions require a new approach to solving this problem [3]. Therefore, the topic of preventive therapy of borderline states of the body becomes relevant. 

The borderline state according to Galen and Avicenna is not health and not a disease, but the third functional state of the body between norm and pathology. 

The transition from health to illness is associated with a decrease in the adaptive capabilities of the body, with a decrease in the ability to adequately respond to various kinds of stress. At the same time, on the border between health and disease, a number of transitional states appear, which are called prenosological [4]. 

Number of people in “Third state” even in economically developed countries where health care is in priority conditions, accounting for 50–80% of the total population [5]. At present, the following classification of the functional states of the body has become widespread [6]:

The state of the physiological norm. It is characterized by satisfactory adaptation to environmental conditions. There are sufficient functional capabilities of the organism. Homeostasis is maintained with a minimum tension of regulatory systems.

Pre-nosological conditions. With them, to maintain the balance of the body with the environment, it is necessary to mobilize functional resources, which requires the tension of regulatory systems. Various degrees of tension of adaptation mechanisms develop. 

The body’s adaptive capabilities under resting conditions are not reduced, but the ability to adapt to stress is reduced. Homeostasis is maintained only due to a certain tension of the regulatory systems.

Premorbid conditions. The state of unsatisfactory adaptation to environmental conditions. The functional capabilities of the body are reduced. Homeostasis is preserved only due to a significant tension in regulatory systems or due to the inclusion of additional reserve capabilities.

Disruption of adaptation mechanisms. A sharp decrease in the functional capabilities of the body. Homeostasis is broken. Specific pathological changes develop at the organo-systemic level.

According to this classification, borderline states include prenosological and premorbid conditions, and restorative medicine should develop methods of rehabilitation that correspond to the level of the body’s adaptive capabilities: health improvement – for people with prenosological conditions, treatment and prophylaxis – for people with premorbid conditions. 

As for people with a breakdown in adaptation, they are sick and need treatment, the purpose of which is to increase the adaptive capabilities of the body and normalize the functional state, the transition from the breakdown of adaptation to the premorbid state, and then to the prenosological state, followed by the normalization of functions.

It should be noted that the problem of assessing the adaptive capabilities of the body in people in states bordering health and disease is extremely difficult. In the borderline state, pathological reactions and reduced performance are combined. In this case, a pathological reaction is the earliest, main and completely reliable sign of a borderline state. 

The borderline state is, to a certain extent, a person’s loss of health, which often manifests itself in an abundance of subjective complaints and objective psychosomatic pathological reactions, a decrease in working capacity [7]. 

Therefore, for early detection of borderline states of the body with premorbid development of cardiovascular pathology, in our study, we proposed to move away from the traditional nosological approach. Currently, the priority belongs to the problem-oriented approach, which is based on the identification of syndromic-pathogenetic mechanisms of pathological conditions in a specific individual. 

The priority direction in this study was the reorientation of the medical strategy from identifying the signs and symptoms of the disease to the maximum objectification of health parameters, and, first of all, to the assessment of the adaptive characteristics of the organism, prenosological diagnosis and correction of early disorders of homeostasis [8].

Given the magnitude of the problem, early prenosological diagnosis was carried out using modern computer technologies and high-resolution examination methods, which made it possible to comprehensively assess the state of the body’s health according to the criteria of “health”, “pre-illness”, “illness”, adaptive reserves and to predict the development of pathological processes. It is the study of early signs of homeostasis disorders and their preventive correction at this stage with the help of non-drug treatment methods that this work is devoted to.

In this regard, one of the most promising areas in medicine should include application of methods of “gas” therapy (GT):Influence of ozone therapy on the kinetics of oxygen metabolism and the microcirculation system in the treatment of postinfarction patients

Ozone (O 3 ) is an allotropic form of oxygen, and, therefore, isa natural factor natural for a living organism. 

The use of ozone largely eliminates metabolic, structure and function disorders of cardiomyocytes that occur during myocardial ischemia, which is an indication of the use of OST in patients with cardiovascular pathology to correct clinical, hemodynamic and metabolic disorders, including the ineffectiveness of traditional therapy [9].

Carbon dioxide, affecting the amount of dissociated oxyhemoglobin, vascular tone, the level of oxygen utilization by tissues, thereby ensuring the completeness and intensity of metabolic and energy processes [10], is of interest for use in metabolic and antihypoxic programs, which is shown to cardiological patients and can become a significant addition for the prevention and treatment of cardiovascular diseases.

Materials and methods.

To solve the problems of this study, we examined 1847 patients with the main risk factors for the development and progression of coronary artery disease, who were treated at the Central Clinical Sanatorium named after V.I. F.E. Dzerzhinsky (Sochi), of which: women – 1111 (60.2%), men – 736 (39.8%). 

According to the nosological principle, all patients were conditionally divided into 3 subgroups according to the presence of a dominant risk factor: 764 – with arterial hypertension (subgroup A); 549 – with impaired carbohydrate metabolism, hyperglycemia (subgroup B); 534 – with a multifactorial risk complex (3 or more risk factors) and patients with angina pectoris I-II FC.

Based on the purpose of the study, patients with different risk factors were divided into 3 groups by the method of statistical randomization. Patients who received OST in the complex of sanatorium-and-spa treatment (SCL) accounted for group I. (n = 675); patients who received “dry” carbon dioxide baths (SUV) with the traditional complex SKL – II gr. (n = 650). In III gr. (control) included patients who received only conventional SCR (n = 522). 

The observation included mainly people of working age with an average age of 44.3 ± 2.2 to 51.2 ± 2.1 years, with the duration of the disease or the onset of symptoms up to 5 years old (52.2%), with an insignificant “burden” concomitant diseases, which seems relevant for studying the issue of developing prenosological diagnostics and preventive therapy.

All patients received complex SCR,OST was carried out in the form of intravenous drip infusions of ozonized physiological solution – 200.0 ml with an ozone concentration of 2.0-2.4 mg / l 2-3 times a week, obtained on a medical ozonizer of the company “Medozon”. 

The course of treatment consisted of 3–6 procedures in the SCL complex. For the SUV procedures, a special “Reabox” bath was used with a precisely dosed supply of carbon dioxide and a carbon dioxide humidifier up to 98%, a heating system and automatic maintenance of the set temperature.

The baths were dosed according to the concentration of carbon dioxide, the temperature of the air-gas mixture and the duration of the procedure, which corresponded to the following parameters: concentration of carbon dioxide – 15-20%, temperature – 28-32 ° С, duration 15-20 minutes, every other day, for a course of 8 up to 10 procedures.

Before and after the course therapy, a comprehensive clinical and laboratory-instrumental examination was carried out, which included: an assessment of the clinical state, microcirculation parameters by laser Doppler fluometry (LDF) using the LAKK-01 apparatus and on the hardware-software complex of computer capillaroscopy; study of the kinetics of oxygen metabolism (CMC) by the method of transcutaneous polarography on the device “TM-300T”, assessment of coagulogram parameters, carbohydrate and lipid metabolism, the state of lipid peroxidation (LPO) and antioxidant activity of the body by the method of induced biochemiluminescence (BCL) and by analysis of intermediate LPO products and antioxidant system (AOS) on a spectrophotometer “Unico UV 2100”.

The assessment of nonspecific adaptive reactions of the organism according to the leukogram by the method of L.Kh. Harkavi et al .; analysis of the state of the phagocytic link of the immune system; psychodiagnostic examination (test of operational determination of the level of anxiety by J. Taylor modified by T.A. Nemchinov, SAN test, Eysenck scale) and psychophysiological examination (simple and complex motor reaction, critical frequency of light flashes); analysis of heart rate variability by the method of cardiointervalography using the hardware-software complex for analysis of heart rate variability “Varicard” and the apparatus “poly-Spectrum”. Statistical processing of the material was carried out using the Statistika 6.0 software package.

Research results.

In the course of the study, the following syndromes were identified by means of a polyparametric diagnostic assessment of the state of the body in the observed individuals:

– syndrome of “metabolic disorders” (violation of lipid metabolism, glucose tolerance, tissue respiration);

– syndrome of “oxidative stress” (imbalance between free radical processes and antioxidant defense of the body);

– syndrome of “circulatory disorders”.

Moreover, these syndromes were found in various combinations in the examined patients. In a comparative aspect, the influence of OST and VTS on the indicators characterizing the syndromes under consideration was analyzed. 

In particular, lipid profiles of 745 patients with the syndrome of “metabolic disorders, dyslipidemia” were analyzed. Under the influence of ozone, a reliable dynamics of indicators was noted with a decrease in the amount of total cholesterol by 11.6%, triglycerides by 7.1% and the atherogenic coefficient by 19.4%. 

In addition, in patients of the same group, there was a tendency to an increase in high-density lipoproteins (HDL-C) and to a decrease in the amount of low-density lipoproteins (LDL-C) and very low-density (VLDL-C) lipoproteins. After treatment with the use of VCS, only a tendency towards a decrease in total cholesterol and atherogenic coefficient was revealed.

It is important and relevant in preventive medicine to identify risk groups for the development of coronary artery disease by the content of HDL cholesterol in the blood in dyslipoproteinemia [11]. When analyzing lipid profile in the group of men with high and moderate risk after OST, there was a significant positive dynamics of indicators with a decrease in the number of atherogenic lipoprotein fractions, leading to the normalization of the lipid profile (Table 1). 

After VTS, the significant dynamics of indicators was less pronounced and was noted: in the group of men with high and moderate risk – in a decrease in total cholesterol and atherogenic coefficient; with zero risk – in reducing the coefficient of atherogenicity.

Table 1 – Comparative assessment of lipid metabolism indicators by the level of risk in men in groups of patients with different methods of “gas” therapy

Parameters	OST (n = 124 people)	SUV (n = 107 people)
HDL cholesterol ≤ 1.45
Total cholesterol (mmol / L)	-18.4% **	-14.1% *
Triglycerides (mmol / L)	-11.2% *	-5.2%
HDL cholesterol (mmol / l)	+ 11.1% **	+ 7.8% z
VLDL cholesterol (mmol / l)	-16.5% *	-5.3%
LDL cholesterol (mmol / l)	-17.6% *	-15.0% z
Atherogenic coefficient, c.u.	-29.3% *	-22.1% *
HDL cholesterol> 1.45
Total cholesterol (mmol / L)	-14.7% *	-11.1% z
HDL cholesterol (mmol / l)	+11.3% *	+ 4.0%
Atherogenic coefficient, c.u.	-18.5% *	-16.6% *

HDL cholesterol> 1.45
Total cholesterol (mmol / L)	-14.7% *	-11.1% z
HDL cholesterol (mmol / l)	+11.3% *	+ 4.0%
Atherogenic coefficient, c.u.	-18.5% *	-16.6% *

Note: *, ** – reliability of differences in comparison with the initial indicator, respectively, p <0.05, p <0.01; z – there is a tendency to differ from the baseline.

table 2 – Comparative assessment of lipid metabolism indicators by the level of risk in women in groups of patients with different methods of “gas” therapy

Parameters	OST (n = 146 people)	SUV (n = 158 people)
HDL cholesterol ≤ 1.68
Total cholesterol (mmol / L)	-16.5% **	-1 5.2% *
Triglycerides (mmol / L)	-8.6% *	-4.4%
HDL cholesterol (mmol / l)	+ 9.2% *	+ 6.4% z
LDL cholesterol (mmol / l)	-16.7% *	-13.6% z
Atherogenic coefficient, c.u.	-19.9% ​​**	-18.8% *
HDL cholesterol> 1.68
Total cholesterol (mmol / L)	-17.1% *	-13.4% z
HDL cholesterol (mmol / l)	+ 4.7% *	+ 3.5%
Atherogenic coefficient, c.u.	-17.2% *	-15.2% *

Note: *, ** – reliability of differences in comparison with the initial indicator, respectively, p <0.05, p <0.01; z – there is a tendency to differ from the baseline.

When analyzing lipid profile indicators in similar groups of women after OST and WSS, the changes resembled the results of men, but with varying degrees of reliability (Table 2). 

In general, the positive dynamics of the influence of “gas” therapy methods at the initial stages of lipid metabolism disorders has been revealed, which will help to optimize the complex of preventive measures in persons with lipid spectrum disorders.

According to the literature, the effect of inhibition of atherogenesis when using OST is ensured by reducing the amount of atherogenic lipoprotein fractions and directly depends on the normalizing effect of ozone on the restoration of dynamic balance between LPO and AOS [12]. 

In addition, scientific data have been obtained on the effect of carbon dioxide and, in particular, WTS on these systems. Therefore, our task was to analyze the dynamics of LPO indicators at the initial stages of the formation of cardiovascular diseases when using the methods of “gas” therapy. 

According to the results of plasma biochemiluminescence analysis, it turned out that in the process of OST, AOS was activated, as evidenced by a 38.0% increase in the Imax / S ratio. At the same time, there was a tendency to an increase in the intensity of the BChL luminescence, but without reliable dynamics of the light sum. In patients after SWS, a decrease in the light sum indicator by 21.2% was noted, which reflected a decrease in the content of free radicals in blood plasma. In the control group, there were no significant changes in BCL indicators.

It is of interest to analyze the kinetics of LPO and AOS activation processes in the observed groups. In patients using OST towards the end of the course of treatment, there was a slight increase in LPO activity in parallel with a significant

an increase in AOS activity. In the II group. of the surveyed, a completely different picture was observed: by the middle of the treatment, some activation of LPO processes took place, which, most likely, can be explained by the restructuring processes that occur in the body of people who arrived at the resort and are associated with reactions of adaptation to new climatic and geographical conditions and to the effects of therapeutic and recreational activities traditional SKL. 

At the end of the stay at the resort, under the influence of OST, there was a significant decrease in the intensity of LPO and a slight increase in AOA, but less pronounced than in the group of patients receiving OST. In III gr. of patients by the middle of the treatment, LPO activity slightly increased and remained practically until the end of their stay at the resort, but there was no significant difference in indicators in dynamics. The AOS curve remained practically unchanged.

Thus, threefold measurement of LPO and AOS indicators revealed the peculiarities of changes in these indicators in dynamics, and also made it possible to select the optimal schemes for using the methods of “gas” therapy in combination with traditional SCR. 

Analysis of LPO intermediate products in biosubstrates and AOS indicators showed a significant increase in superoxide dismutase after OST by 11.5%, a decrease in malondialdehyde by 8.5%, and a tendency towards an increase in serum catalase and a decrease in the amount of diene conjugates. After the use of SUV, malondialdehyde indices significantly decreased by 11.9% and erythrocyte catalase increased by 6.5%, and a tendency towards a decrease in diene conjugates was revealed according to the results of the isopropanol phase of the study. In the control group, no reliable dynamics of LPO products and indicators of AOS activity was obtained. The results obtained clearly confirm the antioxidant effect of hypercapnotherapy and the normalizing effect of ozone, both on LPO processes and on the AOD system of the body.

Cardiovascular diseases are accompanied by serious manifestations of tissue hypoxia) [13, 14, 15]. The antihypoxic effect of ozone and carbon dioxide ensures the correction of pathologically altered processes of oxygen transport and utilization by tissues, which is confirmed by an analysis of the parameters of the kinetics of oxygen metabolism. 

In the group of patients with initially inhibited processes of tissue respiration after the course of OST, an increase in functional reserves of respiratory enzymes was noted, which was manifested in a significant decrease in the critical oxygen concentration by 14.4%. 

A significant decrease in the time of depletion of oxygen reserves (OIG) by 14.5%, the time of depletion of half of the oxygen reserves by 17.7% and an increase in the rate constant of oxygen uptake by 25.0% indicated the normalization of the processes of oxygen utilization by tissues.

Initially, the patients of the examined group had a pronounced prevalence of anaerobic over aerobic processes in the energetics. 

A significant decrease in the time of aerobic processes by 11.8%, the time of anaerobic processes (VAnP) by 10.8% and the coefficient of anaerobic glycolysis (CAAG) by 9.3% in dynamics reflected the trend towards a balanced ratio of anaerobic and aerobic processes and an improvement in oxygen consumption fabrics. 

A significant decrease in the oxygen reserve ratio by 18.5% indicated the adequacy of the processes of delivery and consumption of oxygen by tissues resulting from treatment. After the course of treatment with the use of SUV, a significant decrease in the critical oxygen concentration by 11.7% was noted, which indicated an increase in the functional reserves of respiratory enzymes. 

The tendency to decrease in VIZK (z = 1, 57) reflected a slight improvement in the processes of oxygen consumption by tissues, while a decrease in VANP (z = 1.59) and CAANH (z = 1.63) – the initial positive changes in the ratio of anaerobic and aerobic processes. In the control group, no significant dynamics was observed.

Thus, OST in patients with initially inhibited processes of tissue respiration contributed to the correction of pathologically altered processes of oxygen transport and utilization by tissues, and the normalization of cellular energy reserves. 

The use of dry carbon dioxide baths in complex spa treatment promoted the activation of tissue respiration, but the dynamics of indicators was less significant in comparison with group I.

When considering the effect of gas therapy methods on individuals with “Circulatory disorders” were assessed indicators reflecting the rheological properties of blood and the state of microcirculation. 

The dynamics of the coagulation system parameters was analyzed in 254 patients with initially identified rheological disorders. Under the influence of OST, there were significant changes in indicators characterizing various links of the coagulation system (Table 3). SUV and traditional SCR methods did not cause such changes in coagulogram parameters.

Table 3 – Indicators of the blood coagulation system

The results obtained indicated a positive effect of OST on all hemostasis links with a moderate hypocoagulation effect, which leads to an improvement in the rheological properties of blood and is important for the pathogenetic therapy of patients with hypercoagulable syndrome.

Microcirculation disorders play an important role in the pathogenesis of many diseases. The resulting violations of the trophism of organs and tissues contribute to a long course or progression of the pathological process. 

Microcirculation parameters were analyzed in 812 patients. In patients receiving OST, there was a significant increase in the microcirculation index by 16.9%, the standard deviation (RMS) by 52.8%, the coefficient of variation by 23.2%, and the fluxmotion index by 32.4%. 

Analysis of the amplitude-frequency spectrum of the LDF-gram revealed a tendency towards an increase in the amplitude of low-frequency (slow) oscillations and activation of vasomotions, as well as a decrease in vascular resistance. 

During the occlusion test, an increase in the increase in capillary blood flow (PCC) in the period of hyperemia by 56.7% and the half-recovery time of blood flow by 25.8% were noted. A decrease in the reserve of capillary blood flow can be explained by an increase in blood flow into the microcirculatory bed due to an increase in the number of functioning capillaries under the influence of ozone, which is consistent with literature data.

The analysis of microcirculation parameters in the group of patients after SWS revealed a statistically significant increase in the following indicators: the level of microcirculation by 28.3%, the RMS and the coefficient of variation by 63.0% and 29.2%, respectively, the index of flux emotions by 36.8%, an increase in the amplitude of low-frequency fluctuations by 13.9% and a decrease in the amplitude of pulse rhythms by 23.2%. 

There was also a decrease in the increased reserve of capillary blood flow by 13.3% and an increase to normal parameters in the half-recovery time of blood flow in the period of post-reactive hyperemia of the occlusion test with a significant increase in RCC by 68.9%. Vascular resistance decreased with high reliability (p < 0.01) after treatment.

In the control group, there was a positive dynamics of the main hemodynamic parameters, but there was no significant difference in these parameters before and after treatment. 

The results obtained indicated a positive effect of HT methods on the hemodynamic mechanisms of the microcirculatory bed, which was manifested by a decrease in the initially increased neurogenic tone, an increase in blood flow into the capillaries, a decrease in intravascular resistance, but the dynamics of positive changes was more pronounced in the second group of subjects after the use of dry carbon dioxide baths.

In the subgroup of persons with impaired carbohydrate metabolism after the course of treatment with the use of OST, there was a significant increase in the coefficient of variation by 19.0%, a tendency to an increase in the index of fluxmotions and RMS. Spectral analysis of the LDF-gram did not reveal any reliable dynamics of indicators. 

During the occlusion test, an increase in the increase in blood flow during the hyperemia period by 49.5% and a decrease in the half-recovery time of blood flow by 32.2% were noted. In the group of patients after SWS, significant dynamics was observed when analyzing the spectral components of the LDF-gram and was manifested in an increase in the amplitude of low-frequency oscillations by 7.9%. 

In addition, there was a tendency towards an increase in the microcirculation index and the fluxmotion index. In general, the effect of gas therapy methods on patients of this subgroup is less significant than on those with arterial hypertension.

CAPILLAROSCOPY INDICATORS

Subgroup A. Patients with arterial hypertension

In the subgroup with ischemic heart disease and in individuals with 3 or more risk factors after OST, there was a significant increase in PM, fluxmotion index and SD. Spectral analysis of the LDF-gram revealed a tendency towards an increase in the amplitude of pulse oscillations.

During the occlusion test, a tendency towards normalization of the half-recovery time of blood flow was noted. After a course of treatment with WSS, significant dynamics was observed when analyzing the spectral components of the LDF-gram and manifested itself in an increase in low-frequency and pulse oscillations. 

In addition, there has been a tendency towards an increase in the index of fluxmotions. Thus, in people with ischemic heart disease or in the presence of 3 or more risk factors, in order to correct microcirculatory disorders, it is more expedient to use ozone-oxygen therapy.

other indicators of microcirculation were not observed. 

The positive impact of the methods “Gas” therapy for microcirculation was confirmed by the obtained results of capillaroscopy (Fig. 1).

After a course of SCL with the use of OST, patients with high blood pressure showed a positive significant dynamics with a decrease in the number of lipid inclusions fixed in the capillary network per unit of time. 

Traditional SCR methods and the use of SUV did not have a significant effect on the parameters of microcirculation, although the inclusion of SUV in the SCR complex indicated a tendency towards a decrease in the number of lipid inclusions. 

In the group of patients with impaired carbohydrate metabolism, the use of OST significantly increased the total blood flow velocity (CCR), regardless of the sex of the examined patients, and also outlined a tendency towards a decrease in the number of lipid inclusions and normalization of the parameters of the perivascular zone, which can be considered an indirect sign of improvement in lymph and hemodrainage under the ozone-oxygen therapy.

In groups II and III of the observed patients, there was no significant difference between the primary and repeated results of the MCB study. 

In the group of patients with coronary artery disease, the main positive dynamics of microcirculation parameters with a reliability of p <0.05 was noted only under the influence of OST, where, along with an increase in the blood flow rate in women and a decrease in the number of lipid inclusions in the lumens of capillaries, there was a tendency towards a decrease in the altered parameters of the perivascular zone and an increase in the total blood flow velocity in men. 

The effect of SUV on microcirculation in this group of patients revealed only a tendency towards a decrease in the number of lipid inclusions, which confirms the moderate hypolipidemic effect of carbon dioxide baths. In general, the use of methods of “gas” therapy and, mainly ozone therapy, contributed to an increase in the rate of capillary blood flow,

Features of personality and emotional-behavioral activity undoubtedly affect the development and course of coronary artery disease. It has been proven that the behavioral personality type affects the clinical and ergometric indicators that assess the state of the coronary circulation, and should be taken into account when planning rehabilitation measures [7, 16]. 

It is obvious that knowledge and consideration of the structure of personal reactions and behavior of this category of patients will help to more effectively implement an individual strategy of rehabilitation treatment. 

In the available literature on the use of ozone and carbon dioxide, there is no data on the effect of these methods on the level of adaptation reserves and the state of nonspecific resistance in patients with the most pathognomonic risk factors for coronary heart disease.

Thus, the study of the stated problems is of great scientific and applied importance. The circulatory system can be considered as a sensitive indicator of the adaptive reactions of the whole organism, and the heart rate variability reflects well the degree of tension of the regulatory systems due to the activation of the pituitary-adrenal system and the reaction of the sympatho-adrenal system arising in response to any stressful effect. 

In this regard, cardiointervalography (CIG) is a method for assessing the state of regulation of the physiological mechanism between the sympathetic and parasympathetic parts of the autonomic nervous system [17].

The main indicators in the selection of individuals for the study were a high level of anxiety, a decreased background of mood, emotional tension, increased sensitivity to external stimuli, somatized disorders. 

During the collection of anamnesis, common features were established for all analyzed cases: non-specificity of the symptoms and symptom complexes detected, their heterogeneity, subclinical level or mild severity of symptoms, absence completed forms of typical syndromes. 

The most frequent clinical manifestations were somatovegetative disorders, which were variable, not persistent and manifested sporadically in connection with a significant situation and tension, anxious expectation.

A group of 582 people was selected for analysis . When analyzing cardiovascular reflexes after a course of OST, an increase in heart rate variability was noted – a significant increase in SDNN index, an increase in the total power of the spectrum, which indicated an increase in the total activity of neurohumoral influences on the heart rate. 

Spectral analysis revealed a significant increase in the contribution of the HF-component (rapid fluctuations), the values ​​of which were initially reduced, with a simultaneous decrease in the LF / HF ratio by 31.0%, which can be explained by a decrease in the contribution of sympathoadrenal activity to heart rate modulation. 

Activation of parasympathetic regulation was confirmed by an increase in the square root of the mean squared difference between adjacent NN intervals (RMSSD), a decrease in heart rate.

When conducting orthostatic tended to increase in the K 30 / 15 thatindicated an increase in autonomic regulation with a tendency towards a decrease in the initially increased sympathetic tone and an increase in the reactivity of the parasympathetic division of the ANS. 

A similar dynamics of indicators with a greater degree of reliability of an increase in heart rate variability, a decrease in heart rate and a more pronounced activation of the parasympathetic system was revealed in patients of group II. 

In addition, in the group after SWS, a tendency to an increase in the power of high and low frequency waves was revealed, which in general led to a significant increase in the total power of the spectrum by 58.6%. After a course of treatment with the use of HT methods, a decrease in the stress index of regulatory systems was noted, which indicated an increase in the anti-stress resistance of the body. 

In the control group, there was no significant difference in indicators before and after treatment. In general, the methods of “gas” therapy led to an increase in the adaptive capabilities of the organism with an increase in TP and a balance of sympathetic and parasympathetic influences.

Analysis of the results of psychodiagnostic research identified a group of people with changes in the initial state. After treatment with HT methods, a statistically significant improvement was noted in all parameters of psychological examination according to the method of J. Taylor in the modification of T.A. Nemchina, but in the OST group, the degree of reliability of the decrease in the anxiety index was higher (Table 4).

Table 4 – Psychological test results

The dynamics of indicators in the control group was practically absent. A qualitative analysis of the activity, well-being and mood of patients revealed the following pattern. If before treatment in patients of all three groups, the ratio between the indicators of well-being, activity and mood was changed due to the relative decrease in well-being and activity compared to mood, which is an indirect sign of increasing human fatigue, then after the course of treatment, to a greater extent after the methods of “gas” therapy was observed “leveling” the ratio of these indicators, which characterized a rested person. 

According to the results of psychophysiological tests, no reliable dynamics was found in any of the groups. But, given that, against the background of the use of OST and OST, the absence of reliable dynamics of the analyzed tests was combined with a pronounced positive dynamics of indicators of psychological status, it can be assumed that there is a possibility of the existence of a delayed dynamics of psychophysiological indicators, for a short stay on vouchers at the resort.

The antistress effect of medical ozone and carbon dioxide was confirmed in the results of the analysis of general adaptive reactions as indicators of the body’s nonspecific resistance (Fig. 2). In group I patients with training reactions of high levels and activation reactions of high and medium levels of reactivity, which are the nonspecific basis of the “norm” before treatment, accounted for 60.4%, after a course of OST – 82.0%.

 At the same time, there was an increase in the number of cases with reactions of increased and quiet activation of high levels by 16.3%. Before treatment, patients with activation reactions of low levels of reactivity and training of medium levels of reactivity, which are the nonspecific basis of “pre-illness”, accounted for 26.2%, with reactions of overactivation and stress, as well as training of low levels, “Diseases” accounted for 13.4%.

THE STATE OF THE BODY BY REACTIONS OF ADAPTATION

After treatment with ozone, these patients switched to medium-level training reactions or to the “normal” reaction, and the number of persons in the “disease” group decreased to 2.2%. 

In the II group. of patients after the use of SSV, a significant dynamics of decrease in the percentage of cases in the subgroup “disease” was revealed from 10.9% to 4.2% and the number of persons in the category “pre-disease” decreased by 8.0% due to the increase in the number of patients in the subgroup

“health”. In the control group, the “normal” reactions before treatment were determined in 62.7% of cases, after the traditional sanatorium-resort treatment they remained in 66.0% of cases. At the same time, 94 people (25.8%) remained in the “pre-disease” group and 30 people (8.2%) in the “disease” category, which indicated a lesser effect of SCL on the adaptive capabilities of patients compared with groups where additional methods were used.

“Gas” therapy. In general, the dynamics of the state of the body’s reactivity and adaptive capabilities, revealed under the influence of OST and SUV, indicate the reliable effectiveness of HT methods as a training effect for correcting a pathologically altered adaptive response and increasing the level of nonspecific resistance of the body.

The results of this study, along with those previously obtained [18, 19], on the effect of HT methods on metabolism and energy metabolism in tissues, microcirculation and the state of balance of LPO and AOS processes made it possible to carry out a comparative analysis of the syndromic-pathogenetic effect of ozone therapy and hypercapnotherapy and to determine the effectiveness of these methods in persons with borderline states of the organism, taking into account the dominant syndrome of revealed early changes in homeostasis (Table 5). Moreover, we regarded the presence of one or another syndrome as a premorbid condition, and not as a risk factor.

Table 5

Syndromic and pathogenetic influence of gas therapy methods

Syndromes	OST	SUV
“Oxidative stress”	+	+
“Metabolic disorders”	+ +	+
“Hr. intoxication and VIN “	+ +	+
“Circulatory disorders”	+ +	+ +
“Chronic stress”	+ +	+ +

Note: +; ++ – the presence of changes of varying severity.

Conclusion.

The data obtained, depending on the dominant syndrome, make it possible to individually carry out non-drug correction of functional disorders using new methods of restorative treatment, such as ozone therapy, hypercapnotherapy in the form of dry carbon dioxide baths, which is most important in the primary prevention of cardiovascular diseases, and can also be successfully used in complex treatment and prevention of other diseases accompanied by pathogenetic mechanisms leading to the formation of the considered syndromes.

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