Features of sanitary and resort rehabilitation of patients with coronary heart disease in the climatic conditions of the central part of Russia, who arrived from different regions of the country, taking into account chronobiological approaches and the state of the adaptation system

Shalygin L.D.¹, Kozyrev P.V.², Kalinina S.V.², Tseev Yu.K.³

Objective: Based on the adaptation reaction, clinical and functional status and effectiveness of treatment of patients with coronary heart disease who arrived in the climatic conditions of the central part of Russia from various regions of the Russian country, to substantiate the main directions for improving their medical selection and sanatorium-resort rehabilitation.

Materials and methods. 5 groups of 410 patients were examined. The 1st group (comparison group) included 104 patients with coronary artery disease, angina pectoris of functional class I-II (IHD CH I-II FC), who arrived for spa treatment from Moscow and the Moscow region, in the 2nd — 82 people who arrived for spa treatment from the European part of the country (+ 1 time zone); group 3 consisted of 80 patients who arrived for spa treatment from the Urals and Western Siberia (+ 2–3 time zones); group 4 included 75 patients who arrived for spa treatment from the region of Eastern Siberia (+ 4–6 hours The 5th group consisted of 69 patients who arrived for sanatorium treatment from the Far East region (+7–9 time zones). The study included individuals with rare and mild angina attacks without cardiac arrhythmias, circulatory insufficiency not higher than grade I.

Sanatorium-resort treatment in all groups of patients was carried out at all times of the year according to generally accepted methods used in cardiological sanatoriums, the course of treatment was 21 days. The studies were carried out against the background of a standard regime of motor and physical activity using the main forms of exercise therapy, following the diet No. 10 according to Pevsner before and after the course of complex sanatorium treatment with the use of almost the same type of treatment regimens for each group of patients studied (climatotherapy, magnetic therapy for the interscapular area, radon baths, massage of the collar zone).

Each regional group was divided into two groups A and B randomized by number, age, and nature of the disease. Patients of groups I (52 people), II (40), III (40), IV (37) and V (34 people) received electrosone as an adaptogenic therapeutic physical factor (according to the ophthalmic-occipital technique, the current frequency is 60 Hz, the current strength is up to 5 mA, from 20 minutes to 40 minutes per procedure, daily, for a course of 8 procedures from 1-2 days of the patient’s stay in the sanatorium) and a plant adaptogen extract of eleutherococcus, 30 drops 3 times a day, during the first 10 days of stay in the sanatorium. Patients of group IB (52 people), IIB (42), SB (40), IV B (38) and V B groups (35 people) received only standard spa treatment. According to the indications, the patients were prescribed medication (prolonged-acting nitrates, (beta-blockers, calcium antagonists). The studies were conducted on the 2–3 day of the patients’ stay at the sanatorium treatment and at the end of treatment 1–2 days before discharge.

The program of examination of patients included general clinical, laboratory, instrumental and psychophysiological studies. Indicators of nonspecific adaptive reaction (according to Garkavi L.H.) were studied by the percentage of lymphocytes in the leukocyte formula and their ratio to segmented neutrophils in peripheral blood in the examined patients before and after treatment at different times days. In addition, we studied the overall assessment of adaptation according to the integral index of adaptation in all groups of patients according to the original methodology developed by Klyachkin L.M. et al. (1988) with a further assessment of the degree of adaptation disorders and the effectiveness of spa treatment.

Results.Thus, in patients with coronary artery disease who come to sanatorium treatment in the climatic conditions of central Russia from different regions, various adaptation reactions develop, which are more unfavorable in patients from remote regions; the following clinical and functional states predominate — pronounced clinical manifestations, ECG signs characteristic of coronary artery disease, decreased tolerance to physical activity, arterial hypertension, decreased psychological status, a decrease in adaptation indicators, and their severity depending on the remoteness of the regions in time zones intensifies; the effectiveness of spa treatment is in direct proportion to the dynamics of clinical manifestations, clinical functional state, psychological status, adaptive reactions tion and the region of permanent residence and is characterized by a higher efficiency in patients who arrived from Moscow and the Moscow region sti, the European part of the country, the Urals and Western Siberia than in patients,arrived from the regions of Eastern Siberia, the Far East.

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