Principles of rehabilitation of patients after myocardial infarction
Cardiovascular ZaboLevan has for a long time occupied the first place in morbidity structure of society. Ukraine, unfortunately, is no exception to this is already such a sad and familiar rules. In the structure of cardiovascular disease myocardial infarction (MI) gives the absolute number of patients with hypertension, atherosclerosis, Wallscardia and other forms of ischemic heart disease. Given that this disease is a leading cause of death and disability of patients, it is necessary to pay more attention to this « public enemy & raquo ;. And given the large « rejuvenation » infarcts which, in turn, leads to disability working layerI population, the rehabilitation of patients after myocardial infarction, is particularly important. How is the process of restoring health and performance in this category of patients, and it brings significant results? With this issue, we asked the coryphaeus of the case - MD, professor of the Institute of Cardiology. MD St.razhesko Academy of Medical Sciences of Ukraine Iryna Kazimirovna Sledzevskoy.
- Irina Kazimirovna which structures in our country are responsible for?
- Rehabilitation treatment of patients affected by myocardial infarction, is carried out in several stages:
• patient departments of hospitals (I stage);
• specialized sanatoriumsbut Spa facilities (II stage);
• outpatient facilities and institutions of Cardiovascular Surgery (III stage).
- What is the principle of gradual rehabilitation treatment?
The purpose of this principle is not only in the recovery of patients after myocardial infarction, but also as far as possibletion of social rehabilitation of each such patient. After all, man has not only get out of bed and go home, but return to the social life and become productive members of society.
In the second half of the XX century, and more precisely, in the 70s, the process of restoring health and disability of patients after myocardial infarction, acquiredincremental and in perfect form is divided into three stages.
Steps for rehabilitation of patients after myocardial infarction:
I stage of rehabilitation - is inpatient care, which in the 70's years completes all remedial actions. At this stage, eliminating the danger to lifethe patient's physical condition is stabilized, normal blood pressure (BP), as 50-70% of postinfarction patients have hypertension, which needs to be adjusted by appropriate selection of drugs and doses up to the maximum possible target blood pressure.
In addition, such a contingent patients often imeet suffer heart failure and post-MI angina, which is also necessary to consider the reduction of the physical condition of the patients. In hospital patients to help gradually get out of bed, expanding motor mode under the control of ECG and experienced cardiologist.
needy patients performedsurgery to restore perfusion ability of stenotic coronary vessels by introducing a stent that, in contrast to the more complex coronary artery bypass surgery, can be done in the acute phase of myocardial infarction. After reaching a certain level of patient physical activity, which is determined by special individual calculationstnym tables, he was transferred to Stage II restorative treatment.
At this stage not only physical but also psychological adaptation of the patient to further comfortable existence in society. Besides, a so-calledvocational rehabilitation - a return man (if possible) to the usual form of labor. All activities take place in the second stage of specialized spa complex, which can be caught and undergo rehabilitation treatment all insured persons of working age, MI.
In Ukrainee such specialized spa resorts, there are about 7, two of which are located within the Kiev region (in Koncha Zaspa - health « & raquo ;, Zhovten in Vorzel - « Ukraine »). Each resort has the ability to accept patients from several regions of Ukraine.
Due outDren sanatorium stage of rehabilitation measures, we achieved the following results:
• decreased length of stay of patients in hospital wards. Thus, in the XX century. for patients undergoing understaffed (without comorbidities and complications) Q-myocardial (massive heart attack), this figure was around6 weeks. And after the introduction of the principle of gradual rehabilitation measures and, in particular, sanatorium stage - length of stay of patients in hospitals with the same form they have managed to reduce to 3 weeks;
• significantly increased the percentage of people of working age who are unable to return to work. Today labor activity Restoreavlivaetsya 80% suffered from myocardial infarction compared with 35% of the period when the patients for a long time been on the rehabilitative treatment in hospitals;
• decreased total period of rehabilitation - from 4 months to « doetapny » period up to about 2 months after the introduction of a phased rehabilitation of patients.
Onanatorno resort-stage rehabilitation treatment lasts about 21-24 days and is completed by testing patients to determine the physical and mental condition of the patient.
III step recovery programs - the so-called ambulatory stage, during which the patient settlementle rehabilitation in sanatoria and health resorts still observed 7-10 days cardiologist, which defines its physical readiness to perform a particular type of work. Unfortunately, in Ukraine, this step is not widely applied. Those 20% of patients who were unable to restore its operation on the I and II stages of rehabilitationand such and require complex surgical procedures, such as: coronary artery bypass grafting, sent to specialized cardiac institution - Institute of Cardiovascular Surgery (in Kiev - Institute of Cardiovascular Surgery them. Amosov of Sciences of Ukraine), where he is and requires highly help.
- InWhat is the fundamental difference between the methods of rehabilitation for post-MI patients in the past and today?
- The difference is the absence in the past are no clear guidelines in the treatment of such patients. Prior to the introduction of a phased rehabilitation of the patients were on bed rest in hospital for6 weeks, and only if they were allowed to sit (motivation - the completion of the period of acute myocardial infarction). The consequences of such a long and continuous stay of the patient in the bed were frequent complications of pulmonary embolism, severe orthostasis, and so on. N.
In the 60-ies were conducted numerous scientific studies that clearly showedand that early mobilization of patients after myocardial infarction has a positive effect on the further condition of his health. And since the 70s, this algorithm rehabilitation of post-MI patients has been introduced in many countries including the Soviet Union. In Ukraine, adhere to these principles today, and, importantly, is constantly decreasing time Prebention of the patient in bed and accelerated his calling to physical activity and return to work.
- How are the principles of our work with a group of patients of similar principles in economically and socially more developed countries?
< br /> - The essential difference, because all over the world to restore the health of patients, rebare the MI, a phased algorithm. There are some differences in the structure of institutions, conduct one or another stage of rehabilitation. For example, in the US there are no separate spa facilities, but there are various sports associations, which operate on the basis of pay centers where the patient is under medical supervision ProchOdita Stage II recovery. But most European countries such as Germany, Poland, Hungary, Lithuania, and many others, as well as Ukraine, attracted to the second phase of the WHO recommended specialized spa facilities.