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Современные подходы к реабилитации больных c хронической сердечной недостаточностью
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Аннотация
В статье представлен критический обзор по особенностям лечения больных с хронической сердечной недостаточностью (ХСН) III–IV функционального класса. Кроме обзора данных литературы по этому вопросу авторы представляют в статье положительные результаты собственных исследований по применению тренировки дыхательных мышц при ХСН. Привлечение к процессу лечения родственников больных способствовало усилению приверженности больного лечению. Для более широкого привлечения внимания врачей к проблеме авторы организовали Российское исследование по повышению приверженности больных ХСН лечению и реабилитации с помощью привлечения к этому процессу родственников больных.
Ключевые слова: хроническая сердечная недостаточность, реабилитация, тренировка дыхательных мышц, приверженность лечению и реабилитационным мероприятиям, роль родственников больного в лечении
Ключевые слова: хроническая сердечная недостаточность, реабилитация, тренировка дыхательных мышц, приверженность лечению и реабилитационным мероприятиям, роль родственников больного в лечении
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The paper provides a critical review of the specific features of treatment in patients with Functional Class III-IV chronic heart failure (CHF). In addition, the authors give the positive results of their own studies dealing with respiratory muscle training in CHF. Greater treatment adherence by a patient is promoted by the attraction of his/her relatives to the treatment process. For wider involvement of physicians in the problem, the authors arranged a Russian study to increase the adherence of patients with CHF to treatment and rehabilitation, by attracting patients’ relatives to this process.
Key words: chronic heart failure, rehabilitation, respiratory muscle training, adherence to treatment and rehabilitation measures, role of a patient’s relatives in treatment.
Полный текст
Список литературы
1. Braunwald E. The Management of Heart Failure. Circulation: Heart Failure 2008; 1: 58–62.
2. Braunwald E. Heart failure. In: Wintrobe MM, Thorn GW, Adams RD, Bennett IL Jr, Braunwald E, Isselbacher KJ, Petersdorf RG, eds. Harrison’s Principles of Internal Medicine. 6th ed. New York, NY: McGraw Hill, 1970; p. 1132–41.
3. Braunwald E. Heart failure and cor pulmonale. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw Hill, 2005; p. 1367–78.
4. Susan J. Pressler, Irmina Gradus-Pizlo, Suzanne D. Chubinski, George Smith, Susanne Wheeler, Jingwei Wu and Rebecca Sloan.Family Caregiver Outcomes in Heart Failure. Am J Crit Care 2009; 18: 149–159 doi: 10.4037/ajcc2009300.
5. Агеев Ф.Т., Даниелян М.О., Мареев В.Ю. и др. Больные с хронической сердечной недостаточностью в российской амбулаторной практике: особенности контингента, диагностики и лечения (по материалам исследования ЭПОХА-О-ХСН). Сердеч. недостат. 2004; 5(1): 4–7.
6. Даниелян М.О. Прогноз и лечение хронической сердечной недостаточности (данные 20-летнего наблюдения). Автореф. дис. ... канд. мед.наук. М., 2001.
7. Buller NP, Jones DA, Poole-Wilson PA. Direct measurement of skeletal muscle fatique in patient with chronic heart failure. Br Heart J 1991; 65: 20–4.
8. Drexler H et al. Expression, activity and functional significance of inducible nitric oxide synthase in the failing human heart. J Am Coll Cardiol 1998; 32, 955–63.
9. Lipkin D, Jones D, Round J, Poole-Wilson P. Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol 1988; 18: 187–95.
10. Mancini D, Davis L, Wexler J et al. Dependence of enhanced maximal exercise performance on increased peak skeletal muscle perfusion during long-term captopril therapy in heart failure. J Am Coll Cardiol 1987; 10: 845–50.
11. Mancini DM, Coyle E, Coggan A et al. Contribution of intrinsic skeletal muscle changes to 31P NMR skeletal muscle metabolic abnormalities in patients with heart failure. Circulation 1989; 80: 1338–46.
12. Mancini DM, Henson D, La Manca J et al. Benefit of selective respiratory muscle training on exercise capacity in patients with chronic congestive heart failure. Circulation 1995; 91 (2): 320–9.
13. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance. Circulation 1989; 79: 324–9.
14. Massie B, Conway M, Rajagopalan B et al. Skeletal muscle metabolism during exercise under ischemic conditions in congestive heart failure: evidence for abnormalities unrelated to blood flow. Circulation 1988; 78: 320–6.
15. Weiner DH, Fink LI, Maris J et al. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation 1986; 73: 1127–36.
16. Wilson JR, Fink L, Maris J et al. Evaluation of energy metabolism in skeletal muscle of patients with heart failure with gated phosphorus-31 nuclear magnetic resonance. Circulation 1985; 71: 57–62.
17. DeTroyer A, Estenne M, Yernault J. Disturbance of respiratory muscle function in patients with mitral valve disease. Am J Med 1980; 690: 867–73.
18. Hammond M, Bauer K, Sharp J, Rocha R. Respiratory muscle strength in congestive heart failure. Chest 1990; 98: 1091–4.
19. Madariaga VB, Iturri JB, Manterola AG et al. Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease. Arch Bronconeumol 2007; 43 (8): 431–8.
20. Mancini D, Nazzaro D, Ferraro N et al. Demonstration of respiratory muscle deoxygenation during exercise in patients with heart failure. J Am Coll Cardiol 1991; 18: 492–8.
21. Padula CA, Yeaw E. Inspiratory muscle training: integrative review. Res Theory Nurs Pract 2006; 20 (4): 291–04.
22. Geddes EL, O'Brien K, Reid WD et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir Med 2008; 102 (12): 1715–29.
23. Ramirez-Sarmiento A, Orozco-Levi M, Guell R et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Respir Crit Care Med 2002; 166 (11): 1491–7.
24. Weiner DH, Fink LI, Maris J et al. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation 1986; 73: 1127–36.
25. Gaspar R. Chiappa, Bruno T. Roseguini, Paulo J.C. Vieira et al. Inspiratory Muscle Training Improves Blood Flow to Resting and Exercising Limbs in Patients With Chronic Heart Failure. J Am Coll Cardiol 2008; 51: 1663–71.
26. Laoutaris ID, Dritsas A, Adamopoulos S et al. Effects of inspiratory muscle training in patients with chronic heart failure. J Am Coll Cardiol 2008; 52 (23): 1888–9.
27. Hulzebos EHJ, Helders PJM, Favie NJ et al. Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery. JAMA 2006; 296: 1851–7.
28. Колесникова Е.А. Эффективность тренировок дыхательной мускулатуры в комплексной терапии больных инфарктом миокарда в остром периоде и на различных этапах реабилитации. Автореф. дис. ... канд. мед. наук. М., 2009.
29. http: //www.controlledtrials.com/mrct/trial/439115/
30. Michalsen A, Kцnig G, Thime W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 1998; 80: 437–41.
31. Евзерихина А.В. Клиническая эффективность различных форм непрерывного образования пациентов, страдающих ХСН. Автореф. дис. ... канд. мед. наук. М., 2009.
32. Development and implementation of a comprehensive heart failure practice guideline. Heart Failure Soc Am J Card Fail 2006; 12 (1): e3–9.
2. Braunwald E. Heart failure. In: Wintrobe MM, Thorn GW, Adams RD, Bennett IL Jr, Braunwald E, Isselbacher KJ, Petersdorf RG, eds. Harrison’s Principles of Internal Medicine. 6th ed. New York, NY: McGraw Hill, 1970; p. 1132–41.
3. Braunwald E. Heart failure and cor pulmonale. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw Hill, 2005; p. 1367–78.
4. Susan J. Pressler, Irmina Gradus-Pizlo, Suzanne D. Chubinski, George Smith, Susanne Wheeler, Jingwei Wu and Rebecca Sloan.Family Caregiver Outcomes in Heart Failure. Am J Crit Care 2009; 18: 149–159 doi: 10.4037/ajcc2009300.
5. Агеев Ф.Т., Даниелян М.О., Мареев В.Ю. и др. Больные с хронической сердечной недостаточностью в российской амбулаторной практике: особенности контингента, диагностики и лечения (по материалам исследования ЭПОХА-О-ХСН). Сердеч. недостат. 2004; 5(1): 4–7.
6. Даниелян М.О. Прогноз и лечение хронической сердечной недостаточности (данные 20-летнего наблюдения). Автореф. дис. ... канд. мед.наук. М., 2001.
7. Buller NP, Jones DA, Poole-Wilson PA. Direct measurement of skeletal muscle fatique in patient with chronic heart failure. Br Heart J 1991; 65: 20–4.
8. Drexler H et al. Expression, activity and functional significance of inducible nitric oxide synthase in the failing human heart. J Am Coll Cardiol 1998; 32, 955–63.
9. Lipkin D, Jones D, Round J, Poole-Wilson P. Abnormalities of skeletal muscle in patients with chronic heart failure. Int J Cardiol 1988; 18: 187–95.
10. Mancini D, Davis L, Wexler J et al. Dependence of enhanced maximal exercise performance on increased peak skeletal muscle perfusion during long-term captopril therapy in heart failure. J Am Coll Cardiol 1987; 10: 845–50.
11. Mancini DM, Coyle E, Coggan A et al. Contribution of intrinsic skeletal muscle changes to 31P NMR skeletal muscle metabolic abnormalities in patients with heart failure. Circulation 1989; 80: 1338–46.
12. Mancini DM, Henson D, La Manca J et al. Benefit of selective respiratory muscle training on exercise capacity in patients with chronic congestive heart failure. Circulation 1995; 91 (2): 320–9.
13. Sullivan MJ, Higginbotham MB, Cobb FR. Exercise training in patients with chronic heart failure delays ventilatory anaerobic threshold and improves submaximal exercise performance. Circulation 1989; 79: 324–9.
14. Massie B, Conway M, Rajagopalan B et al. Skeletal muscle metabolism during exercise under ischemic conditions in congestive heart failure: evidence for abnormalities unrelated to blood flow. Circulation 1988; 78: 320–6.
15. Weiner DH, Fink LI, Maris J et al. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation 1986; 73: 1127–36.
16. Wilson JR, Fink L, Maris J et al. Evaluation of energy metabolism in skeletal muscle of patients with heart failure with gated phosphorus-31 nuclear magnetic resonance. Circulation 1985; 71: 57–62.
17. DeTroyer A, Estenne M, Yernault J. Disturbance of respiratory muscle function in patients with mitral valve disease. Am J Med 1980; 690: 867–73.
18. Hammond M, Bauer K, Sharp J, Rocha R. Respiratory muscle strength in congestive heart failure. Chest 1990; 98: 1091–4.
19. Madariaga VB, Iturri JB, Manterola AG et al. Comparison of 2 methods for inspiratory muscle training in patients with chronic obstructive pulmonary disease. Arch Bronconeumol 2007; 43 (8): 431–8.
20. Mancini D, Nazzaro D, Ferraro N et al. Demonstration of respiratory muscle deoxygenation during exercise in patients with heart failure. J Am Coll Cardiol 1991; 18: 492–8.
21. Padula CA, Yeaw E. Inspiratory muscle training: integrative review. Res Theory Nurs Pract 2006; 20 (4): 291–04.
22. Geddes EL, O'Brien K, Reid WD et al. Inspiratory muscle training in adults with chronic obstructive pulmonary disease: an update of a systematic review. Respir Med 2008; 102 (12): 1715–29.
23. Ramirez-Sarmiento A, Orozco-Levi M, Guell R et al. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: structural adaptation and physiologic outcomes. Am J Respir Crit Care Med 2002; 166 (11): 1491–7.
24. Weiner DH, Fink LI, Maris J et al. Abnormal skeletal muscle bioenergetics during exercise in patients with heart failure: role of reduced muscle blood flow. Circulation 1986; 73: 1127–36.
25. Gaspar R. Chiappa, Bruno T. Roseguini, Paulo J.C. Vieira et al. Inspiratory Muscle Training Improves Blood Flow to Resting and Exercising Limbs in Patients With Chronic Heart Failure. J Am Coll Cardiol 2008; 51: 1663–71.
26. Laoutaris ID, Dritsas A, Adamopoulos S et al. Effects of inspiratory muscle training in patients with chronic heart failure. J Am Coll Cardiol 2008; 52 (23): 1888–9.
27. Hulzebos EHJ, Helders PJM, Favie NJ et al. Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery. JAMA 2006; 296: 1851–7.
28. Колесникова Е.А. Эффективность тренировок дыхательной мускулатуры в комплексной терапии больных инфарктом миокарда в остром периоде и на различных этапах реабилитации. Автореф. дис. ... канд. мед. наук. М., 2009.
29. http: //www.controlledtrials.com/mrct/trial/439115/
30. Michalsen A, Kцnig G, Thime W. Preventable causative factors leading to hospital admission with decompensated heart failure. Heart 1998; 80: 437–41.
31. Евзерихина А.В. Клиническая эффективность различных форм непрерывного образования пациентов, страдающих ХСН. Автореф. дис. ... канд. мед. наук. М., 2009.
32. Development and implementation of a comprehensive heart failure practice guideline. Heart Failure Soc Am J Card Fail 2006; 12 (1): e3–9.
Авторы
Г.П.Арутюнов, Е.А.Колесникова, А.К.Рылова
Российский государственный медицинский университет им. Н.И.Пирогова, Москва
Российский государственный медицинский университет им. Н.И.Пирогова, Москва
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G.P. Arutyunov, E.A. Kolesnikova, A.K. Rylova
N.I. Pirogov Russian State Medical University
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