The problem of tissue hypoxia of the myocardium in diseases of the cardiovascular system (CVS), being one of the topical in cardiology, stimulates the search for new means to improve myocardial trophism [1].
At the same time, existing methods of non-drug therapy, in particular ozone therapy (OST) as a type of oxidative therapy, can help in its effective solution.
The antihypoxic effect of ozone ensures the correction of disturbed processes of transport and utilization of oxygen by tissues, which is confirmed by the analysis of indicators of the kinetics of oxygen metabolism [2–6].
Assessment of the state of peripheral blood flow has proven itself as an objective criterion for the effectiveness of rehabilitation of patients with CVS pathology. Microcirculatory bed (MCB), being the final link of the circulatory system,
The aim of this study is to study the effect of OST on the kinetics of oxygen metabolism and the state of the microcirculation system (MCC) in postinfarction patients under conditions of sanatorium treatment (SCL).
To achieve this goal, 145 patients aged 39-69 years (55.2 ± 2.6 years) with stable angina pectoris after myocardial infarction from 4 months to 1 year (6.8 ± 0.47 months) undergoing SKL in the Central Clinical Sanatorium. F.E. Dzerzhinsky during the warm season. In 141 (97.2%) patients, it was planned to undergo reconstructive surgery on the coronary vessels in the next 6-10 months. All patients received traditional SCR in a sparing regimen, weak effects and low physical activity (up to 60 W).
Depending on the therapy, they were divided into 2 groups: the 1st group included 89 patients (77 men and 12 women) with grade I-IIA heart failure (FC II-III NYHA), who underwent a course of intravenous administration of ozonized saline , obtained on the medical ozonator Medozon, 200 ml with a concentration of 2.0-2.4 mg / l, 2-3 times a week in the amount of 5-10 procedures against the background of prescribed drug therapy (nitrates, β-blockers, calcium antagonists, etc. .); Group 2 – 56 patients (49 men and 7 women) with the same pathology, but who received only drug therapy.
Clinical examination of patients included: clinical examination, electrocardiography (ECG), veloergometry (VEM), echocardiography (EchoCG). The kinetics of oxygen metabolism was analyzed in dynamics by the method of transcutaneous polarography on a TM-300T apparatus.
The study of the MCC parameters was carried out using laser Doppler flowmetry (LDF) and computed capillaroscopy. Statistical processing of the material was carried out using the Statistica for Windows 7.0 software package (Stat-Soft, Inc.).
All patients before SCL had pronounced pathological changes in the type of tissue respiration inhibition. Therefore, the assessment of the impact of OST on energy metabolism was relevant (Table 1).
(tab. 1)After the course of OST, an increase in the functional reserves of respiratory enzymes was noted, which was manifested in a decrease in the critical oxygen concentration to 6.29 ± 0.33 mm Hg. (p <0.01), time of depletion of oxygen reserves up to 131.79 ± 8.48 s (p <0.01), time of depletion of half of oxygen reserves up to 32.64 ± 2.53 s (p <0.01) , in an increase in the rate constant of oxygen uptake to 0.04 ± 0.002 s – 1 (p <0.01). All this indicated the normalization of the processes of oxygen utilization by tissues.
In patients before SCL, there was a pronounced prevalence of anaerobic over aerobic processes in the energetics (see Table 1)…
After the course of OST, patients in group 1 showed a decrease in the time of aerobic processes from 84.33 ± 3.08 to 74.41 ± 3.25 s (p <0.01), the time of anaerobic processes from 67.51 ± 3.61 up to 60.20 ± 3.32 s (p <0.05) and the coefficient of anaerobic glycolysis from 0.86 ± 0.04 to 0.78 ± 0.03 (p <0.05).
In dynamics, this reflected the adequacy of anaerobic and aerobic processes under conditions of improved tissue oxygen consumption.
A decrease in the oxygen reserve ratio from 3.72 ± 0.34 to 3.03 ± 0.29 (p <0.05) indicated a balance in the processes of delivery and consumption of oxygen by tissues resulting from treatment.
In group 2, of all the parameters of the kinetics of oxygen metabolism after SCR, only a decrease in the critical oxygen concentration from 7.34 ± 0.31 to 6.48 ± 0.37 mm Hg was significant. (p <0.05), which indicated an increase in the functional reserves of respiratory enzymes. The change in other indicators was insignificant(see Table 1) .
The results obtained indicated that in patients with inhibited tissue respiration, OST, in combination with drug treatment, contributed to the correction of the impaired process of transport and utilization of oxygen by tissues, normalization of the energy reserves of cells, while the use of one drug treatment only activated tissue respiration.
Under the influence of OST, according to LDF data (Table 2),
(table 2)in patients of the 1st group, an improvement in the MCB state was noted, which was manifested by an increase in the MCC index from 3.26 ± 0.22 to 4.52 ± 0.28 pf. units (p <0.05); root-mean-square deviation, reflecting the functioning of mechanisms of modulation of tissue blood flow, from 0.30 ± 0.07 to 0.47 ± 0.04 pf. units (p <0.05); the coefficient of variation characterizing the vasomotor activity of microvessels, from 7.7 ± 0.6 to 9.3 ± 0.4% (p <0.05).
Analysis of the amplitude-frequency spectrum of the LDF-gram revealed a decrease in the amplitude of vasomotor oscillations due to an increase in blood flow to the MCB, which was apparently associated with an increase in the partial pressure of oxygen in the tissues under the influence of OST. An increase in the MCC efficiency index (fluxmotion index) from 1.10 ± 0.10 to 1.39 ± 0.12 pf. units (p <0,
The suppression of the mechanisms of active modulation of tissue blood flow was accompanied by a compensatory increase in the role of passive modulation, aimed primarily at unloading the venular link of the MCC system. It is in this connection that an increase in the contribution of the respiratory (high-frequency) and pulse (cardiofrequency) rhythmic components to the general level of fluxmotions should be considered. In addition, there was a favorable dynamics of the changed indicators during stress tests, in particular occlusal.
Thus, during its implementation, there was an increase in the increase in blood flow during the period of hyperemia in patients after OST by 44.2% and a tendency to normalize the half-recovery time of blood flow. A decrease in the reserve of capillary blood flow could be explained by an increase in blood flow into the MCB of functioning capillaries under the influence of ozone, which is consistent with literature data [10].
In the 2nd group of patients, significant dynamics of MCC parameters was observed only when analyzing the spectral components of the LDF-gram and manifested itself in an increase in low-frequency and pulse oscillations(see Table 2).
An important object of investigation of the MCC system is the capillaries of the skin, and especially the capillaries of the nail fold, due to the parallel arrangement of their skin surface with sufficiently good visualization throughout.
In the observed groups of patients, the analysis of the static and dynamic parameters of capillary hemodynamics and the assessment of transcapillary blood flow, as well as the degree of OST influence on the efficiency of the MCB functioning, was carried out, since its changes took place in 98.6% of cases, characterized mainly by spastic and congestive-stasic hemodynamic types. MCC.
In patients of the 1st group, with computerized capillaroscopy, only a decrease in the number of lipid inclusions in the lumens of capillaries from 0.87 ± 0.12 to 0.54 ± 0.08 U / s (p <0.05) and an increase in the blood flow velocity both in women from 306 ± 32 to 385 ± 40 μm / s (p <0.05), and in men from 293 ± 36 to 528 ± 49 μm / s (p <0.05).
Among the qualitative parameters, it should be noted that if before the onset of SCL, stasis was noted in 26.9%, and sludge syndrome – in 19.5% of patients, then after it, they occurred in 12.8 and 10.3%, respectively.
In group 2, changes in all quantitative and qualitative indicators of the MCC were insignificant.
Thus, the inclusion of medical ozone in the complex of drug therapy led to an increase in the speed of capillary blood flow, the density of the capillary network, a decrease in the number of lipid inclusions, a decrease in stasis and sludge syndrome to normal values. These changes indicate the possibility of correcting pathological disorders in the MCB and a sufficiently high efficiency of OST to achieve these goals.
When assessing the correlation dependence of the functional reserve of the MCC on the state of global myocardial contractility – ejection fraction (EF) – unidirectional changes in these parameters were revealed, although the degree of correlation was low, especially in the group of patients with preserved myocardial contractility (EF not less than 50%).
In general, under the influence of OST in patients of the 1st group, according to EchoCG data, there was a significant increase in EF from 59.39 ± 2.11 to 64.57 ± 2.14% (p <0.05) and left ventricular stroke volume with 58.86 ± .21 to 65.54 ± 3.17 ml (p <0.05), which indicated an improvement in myocardial contractile function. In group 2, these indicators were unreliable.
An improvement in the pumping function of the heart was confirmed by ECG data in the form of a decrease or disappearance of ischemic changes, as well as by the results of the VEM test. After treatment, the number of positive and non-informative samples decreased in both groups.
According to the results of VEM, the use of OST in combination with medication treatment led to an increase in exercise tolerance by 19.1% in women and 28.3% in men, the volume of work performed by 32.2 and 39.4%, respectively. The economizing effect was more clearly demonstrated by the dynamics of the ratio of the increase in the double product during physical activity to the power of the threshold load (ΔDP / W).
Under the influence of OST, this indicator decreased by 31.7%, which indirectly indicated a decrease in oxygen consumption by the myocardium per unit of power of the performed load. In the 2nd group and in men,
Analyzing the data obtained, we can talk about the high efficiency of the OST method as a training factor in order to increase the functional reserves of the CVS. The use of ozone in combination with drug therapy increased the efficiency of the circulatory system (reduces the rate of expenditure of myocardial reserves, double product and myocardial oxygen demand) and its power (increasing the body’s tolerance to physical activity, increasing the volume of work performed and the left ventricular productivity index).
After SCL in patients of the 1st group, complaints of pain in the heart area (by 47.2%), dyspnea (by 38.2%), tachycardia (by 21.3%), and unstable blood pressure (by 49.4%) decreased. , headache (by 42.6%), irritability (by 47.2%), sleep disturbance (by 28.1%), increased fatigue (by 61.8%). In the 2nd group, positive dynamics was observed only in a decrease in the number of complaints of cardialgia (by 33.9%), instability of blood pressure (by 30.4%), tachycardia (by 17.9%), increased fatigue (by 51.8%). ).
According to the results of the study, a high clinical efficiency of the use of OST was established in the amount of 6 to 8 procedures of intravenous administration of ozonized saline solution at the SCL stage in patients after a heart attack. The use of OST had a favorable effect on the electrophysiological parameters of the heart, led to a decrease in the incidence of episodes of myocardial ischemia, significantly improved exercise tolerance, which led to a decrease in the functional class of angina pectoris and heart failure.
Evaluation of hemodynamic parameters revealed a positive trend, indicating an improvement in coronary blood flow, a decrease in total peripheral resistance, and an increase in exercise tolerance. The analysis of the parameters of the kinetics of oxygen metabolism and the MCC indicators showed a significant positive dynamics, leading to a balance in the processes of oxygen delivery to tissues and its consumption, improvement of metabolic processes at the cellular level of tissue respiration and at the level of the microvasculature. After the course of OST, 21.3% of patients reduced the dosage of their medications.
Thus, the use of OST in combination with drug therapy largely helps to eliminate metabolic disorders that occur during myocardial ischemia, which serves as the basis for using it in cardiac patients for the correction of clinical, hemodynamic and metabolic disorders.
In patients after myocardial infarction, the use of OST in combination with traditional drug therapy makes it possible to shorten the period of post-infarction rehabilitation with a decrease in tissue hypoxia, improvement of microcirculatory parameters and the general clinical condition of patients.
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