TO QUESTION OF STEP-RELATIVE TREATMENT OF PATIENTS WITH ISCHEMIC HEART DISEASE AFTER SURGICAL MOVICARDS RAVASCULARIZATION

Abstract

Among the methods of surgical treatment of coronary heart disease (CHD ), coronary anesthesia and mammary coronary artery bypass graft are most commonly used. The purpose of any of these cardiosurgical interventions is to restore coronary blood flow, eliminate the main clinical manifestations of coronary heart disease, improve the quality and life expectancy of operated patients and increase their physical capacity.

The aim of the study – to learn the clinical, functional and psychological characteristics of patients with coronary heart disease after surgical revascularization of the myocardium at admission for rehabilitation at different times after surgery and to develop and study the effectiveness of the program of medical rehabilitation.

Materials and Methods. According to our observation, there were 65 patients at the age of 58.7 ± 8.9 after aortic coronary artery bypass grafting, which were received at restoration treatment at different times. Patients in the first group (17 people) received rehabilitation 7 days after surgery, patients in the second group (48 persons) – 1 to 2 months after surgery. The research algorithm (before and after treatment) included complete clinical observation of the objective and subjective status of patients, laboratory diagnosis (biochemical blood test, lipidogram, blood sugar, insulin, NOMA index, leptin) and instrumental methods of examination (ECG, ultrasound scan) Heart, ECG monitoring for holter, measurement of blood pressure, heart rate, six-minute test (TCH)). To assess the psychological state, the HADS scale and the Spielberger scale of anxiety were used, and the quality of life was estimated on the scale SF-36. The course of regenerative treatment (VL ) included: a mode of motor activity, trained, climatic, diet, physiotherapy (magnetolazerotherapy), balneotherapy ("dry" carbonic baths) and exercise therapy. The course of treatment was 21 days.

Results and Discussion. After the course of regenerative treatment, we observed a decrease in anxiety by 27.4 % in the first group and by 25.6 % in the second, depression – by 25.3 % and 21.7 % in the first and second group, respectively; reduction in reactive anxiety in both groups by 31.8 % and 26.4 % (p≤0.05), as well as a significant increase in the distance that the patient could undergo in 6 minutes in both groups by 18.3 % and 10.5 % respectively; increase of physical activity tolerance by 43.1 and 35.0 % (p≤0.05) and quality of life indicators.

Conclusions. Thus, early onset of rehabilitation contributes to the restoration of the psycho-emotional state, increase of physical capacity, which will strengthen the effect of surgical and medical treatment received in the stationary phase, adapt the patient to future household loads, social communication, work activity.