No abstract

The objective of the research was to analyze the effectiveness of using suggestive therapy in the patients with acute coronary syndrome by assessing the dynamics of the clinical condition and indicators of anxiety. Materials and Methods. There were examined 135 patients with non-ST-segment elevation myocardial infarction, 60 patients with the use of the conservative treatment and 75 patients who underwent percutaneous coronary intervention. The dynamics of objective indices, adaptation changes and anxiety indices in the groups of patients with traditional treatment and in the groups of patients with suggestive therapy in addition to the traditional rehabilitation measures, were analyzed. Results. Analyzing the dynamics of adaptive indices, it was determined that in the group of patients with non-ST-segment elevation myocardial infarction, who were performed conservative therapy, the dynamics was less significant, which is related to the general desadaptative syndrome. Changes in the group of patients undergoing percutaneous coronary intervention and suggestive therapy, with a decrease of blood pressure, heart rate, and a decrease in the index of functional changes from 3.78±0.15 points before the intervention up to 2.92±0.13 points after suggestive therapy (p<0.01) were more significant. In all groups of patients, high levels of reactive anxiety were observed at the beginning of treatment. As a result of treatment, a decrease in anxiety was noted, but more pronounced changes were seen in the group with the use of suggestive therapy (p<0.05). Conclusions. The use of suggestive therapy methods when treating the patients with acute coronary syndrome is an important intervention, that provides a comprehensive approach considering all the components, enhances the patients’ adaptive abilities in the rehabilitation phase, improves the quality and effectiveness of restorative treatment. The use of suggestive therapy at the rehabilitation stage improves the clinical course, reduces anginal manifestations, stabilizes blood pressure and increases exercise tolerance.

На сучасному етапі особлива увага спрямована на удосконалення лікування хворих після гострого коронарного синдрому із розробкою індивідуального підходу до відновного лікування та реабілітації. Пошук нових науково обґрунтованих програм базується на комплексному підході з урахуванням медичних, фізичних та психологічних особливостей кожного пацієнта із можливістю реалізації їх як на стаціонарному, так і амбулаторному етапі надання допомоги. Мета роботи. Проаналізувати ефективність відновного лікування та реабілітації хворих після гострого коронарного синдрому залежно від застосованих методів реваскуляризації та програм відновного лікування. Матеріали та методи. Проаналізовано динаміку гострого коронарного синдрому в Івано-Франківській області в період 2014-2019 рр., оцінено ефективність застосування розробленої програми відновного лікування у хворим із гострим коронарним синдромом залежно від застосованого методу реваскуляризації та реабілітації. Вивчено динаміку клінічного перебігу, рівні тривоги, якість життя та віддалені наслідки захворювання. Результати. Аналіз динаміки гострого коронарного синдрому в Івано-Франківській області вказує на стабільний відсоток хворих протягом 2014-2019 рр. із зростанням кількості хворих,яким проведено черезшкірні коронарні втручання. Застосування розробленої програми відновного лікування хворих сприяло корекції клінічних, психологічних характеристик хворих, а також підвищенню якості життя, що забезпечує позитивний вплив на віддалені наслідки перебігу захворювання, попереджаючи виникнення раптової коронарної смерті, повторних інфарктів міокарда та госпіталізацій. Висновки. Динаміка основних показників здоров’я населення Івано-Франківської області вказує на низку особливостей, що потребує удосконалення надання допомоги хворим на гострий коронарний синдром. Розроблена програма відновного лікування хворих на гострий коронарний синдром з елевацією сегмента ST після черезшкірного коронарного втручання характеризується покращенням клінічного перебігу захворювання, зменшенням проявів тривоги та поліпшенням якості життя хворих. Така стратегія забезпечує мультидисциплінарний підхід з урахуванням клінічних, психологічних складових, компонентів ставлення до здоров’я та реалізацію медичної, фізичної та психологічної складових комплексного підходу щодо надання допомоги таким хворим.

Background: Rehabilitation of patients following myocardial revascularization remains major problem in today’s world. Through psychological support and training, it is possible to develop a positive attitude to health and illness, optimize an individual’s inner health perception, and improve a person’s self-image as healthy and their knowledge of how to maintain that health. Aim of the study: To examine new rehabilitation interventions for patients following myocardial revascularization. Material and methods: 60 patients were reviewed following myocardial revascularization, using clinicalanamnestic, instrumental methods, assessment of quality of life, cognitive therapy and physical rehabilitation. Rehabilitation of the patients was performed using the author’s program “Psychological rehabilitation of patients with ischemic heart disease and myocardial infarction by optimization of the inner picture of health”. Results: Training by optimization of the patients’ inner picture of health leads to a reduction in the manifestations of anxiety and depression, improves subjective and objective indicators, quality of life, and changes the patient’s attitude to illness. At the beginning of the observation period, there were subclinical signs of anxiety in the majority of patients, with an average score of 11.23±0.70. During the course of treatment, there was a decrease in the mean score of anxiety in the group receiving suggestive therapy of 7.58±0.69 (22.6%), and in the group using of optimization of IPH there was a decrease of 7.69±0.63 (30.8%). A reduction in manifestations of depression was found, from 8.89±0.64 at the beginning of treatment to 7.65±0.51 after 1 month of the treatment. For patients participating in the optimization of IPH program, the average score was 8.85±0.65 and 6.85±0.49, respectively. In terms of indices of quality of life, after 6 months an increase in most scales was noted. The use of suggestive therapy contributed to a gradual decrease in volumetric indices of LV EDV, from 135.61±10.66 cm3 at the beginning of the observation to 108.90±5.98. During the same period of observation, there was a decrease in the values of EDD and ESD and a significant increase in EF from 49.65±1.93% to 55.29±1.88. Conclusions: In order to maximize the benefits of rehabilitation, it is important to develop strategies for the optimization of the inner picture of health. A change in attitude to disease leads to an improved perception of the patient to health, motivation for treatment, and the need for active participation in rehabilitation interventions.

Àêòóàëüí³ñòü òåìè äîñë³äaeåííÿ. Ó ñó÷àñíîìó ñâ³ò³ ³øåì³÷íà õâîðîáà ñåðöÿ º îäí³ºþ ç íàéïîøèðåí³øèõ çàõâîðþâàíü ñåðöåâî-ñó-äèííî¿ ñèñòåìè.  öåíòð³ óâàãè íàóêîâö³â çàëèøàþòüñÿ ïðîáëåìè ðîçðîáêè ïðèéîì³â ÿê³ äàþòü çìîãó ï³äâèùèòè ÿê³ñòü ðåàá³ë³òàö³¿ õâîðèõ íà ³øåì³÷íó õâîðîáó ñåðöÿ [4; 5; 7; 11; 14]. Îñîáëèâå ì³ñöå çàéìàþòü ì³aeäèñöïë³-íàðí³ äîñë³äaeåííÿ, äå, îêð³ì òðàäèö³éíèõ ë³êóâàëüíèõ ìåòîä³â, âèêîðèñòîâóþòü ïñèõîëî-ã³÷íó ðåàá³ë³òàö³þ [10; 11; 16; 19]. Ó êàðä³îëîã³÷íèõ õâîðèõ åìîö³îãåíí³ ÷èííèêè "çàïóñêó" õâîðîáè º íåçàïåðå÷íèìè, àäaeå ñàìå åìîö³¿ ïîñòàþòü ò³ñíèìè ñóïóòíèêàìè âèíèêíåííÿ òà ïðîÿâó ñåðöåâî-ñóäèííèõ çàõâîðþâàíü [14; 15; 17; 19], à åôåêòèâí³ñòü ðåàá³ë³òàö³¿ ÷àñòî çàëåaeèòü â³ä åìîö³éíîãî íàëàøòóâàííÿ õâîðîãî [4; 11]. Ðåçîííî ïðèïóñòèòè, ùî çäàòí³ñòü ïîñòóãîâóâàòèñÿ åìîö³ÿìè, äîñÿãàòè ñòàíó êîìôîðòíî¿ ðåëàêñàö³¿ òà óñâ³äîìëåííÿ ìîaeëèâîñò³ ñàìîìó êåðóâàòè õî÷à á îêðåìèìè ïðîöåñàìè ìîaeå ñòàòè âàaeëèâèì ÷èííèêîì ïîêðàùåííÿ ÿêîñò³ ðåà-á³ë³òàö³¿ êàðä³îëîã³÷íèõ õâîðèõ. Îäíèì ç îñîáëèâèõ ìåòîä³â, ÿê³ ìîaeóòü áóòè çàñòîñîâàíèìè äëÿ ï³äâèùåííÿ ÿêîñò³ ðåàá³ë³òàö³¿ êàðä³îëîã³÷íèõ õâîðèõ ó êë³í³÷íèõ äîñë³äaeåííÿõ, º ñóãåñòèâíà òåðàï³ÿ àáî ìåòîä âåðáàëüíèõ ñóãåñò³é, ñóòü ÿêîãî çâîäèòüñÿ äî äîñÿãíåííÿ ê볺íòîì çà äîïîìîãîþ ïñèõîëîãà ñòàíó êîìôîðòíî¿ ðåëàêñàö³¿ ³ ñïðèéíÿòòÿ ñåáå

Досліджено динаміку змін якості життя пацієнтів з ішемічною хворобою серця (ІХС) з гострим коронарним синдромом (ГКС) без елевації сегмента ST, з консервативною чи інвазивною тактикою лікування у процесі реабілітації за традиційними підходами та у ході реабілітації за «Програмою психологічної реабілітації кардіологічних хворих шляхом оптимізації внутрішньої картини здоров'я». Доведено, що показники якості життя пацієнта можуть виступати критерієм ефективності реабілітації кардіологічного хворого.

The implementation and improvement of new treatment methods for patients with acute coronary syndrome poses new challenges in finding the newest methods of rehabilitation and restorative treatment. The effectiveness of such interventions depends on the integrated approach and patient’s involvement. Accepting the disease, the patient builds an idea about the disease and integrates the internal picture of the disease into a new internal picture of health. The ability to see illness only as part of health is a strategy of self-preservation and self-renewing behaviour. Objective of the study. To evaluate the clinical-pathogenetic regularities of the effectiveness of the restorative treatment in patients after acute coronary syndrome (ACS) at the stages of rehabilitation. Materials and methods. There were 135 patients with acute coronary syndrome without ST segment elevation were examined, who were divided into the groups depending on the used treatment tactics – conservative or invasive – PCI. Clinical-anamnestic indices, psychometric, subjective and objective data were analyzed. Along with the traditional treatment, there was used the rehabilitation of patients according to the author’s method, based on a multidisciplinary approach with optimization of the internal picture of health. The examinations were performed before the beginning of rehabilitation, after 1 week, 1 month and 6 months. Results. The use of the program, along with the traditional treatment of patients, helped to improve the effectiveness of treatment by normalization of the major objective indices, reduction of the anxiety levels, and improvement of life quality. More pronounced dynamics was noted in patients with acute coronary syndrome without ST segment elevation with invasive treatment tactics. Conclusions. Clinical-psychological rehabilitation of patients with acute coronary syndrome without ST-segment elevation can improve the effectiveness of rehabilitation and rehabilitation, regardless of treatment tactics, although the effect is somewhat higher in patients with invasive therapy tactics. This approach helps to improve the course of the disease. A multidisciplinary approach involving a cardiologist and a physical restorative and rehabilitation physician, a psychologist and a physiotherapist is important.

Abstract. Cardiovascular diseases are the first ones in mortality among other diseases. Particular attention should be paid to patients after acute coronary syndrome, since their quality of life, the possibility of restoration of work capacity. Objective of the research. To evaluate indicators of medical care provision for patients with acute coronary syndrome in the Precarpathian region. Materials and methods. The medical-geographical indicators, data of the local registry (2014-2018) included clinical and objective parameters, peculiarities of the course, rehabilitation and treatment of patients with acute coronary syndrome. Results. The peculiarities of the course of acute coronary syndrome, clinical characteristics of patients depend on the form of IHD and the applied method of ACS treatment. There is an increase of the number of PCI performance and the reduction of TLT, the percentage of admission of patients up to 2 hours remains low. The increase of PCI performed in the districts of the region in the dynamics from 2014 to 2018 has been determined, as well as the geographical peculiarities of the Ivano-Frankivsk region. The percentage of patients’ undergoing rehabilitation after acute coronary syndrome remains low. Conclusions. The Precarpathian region has a number peculiarities that are related to the location of the region. Taking into account the characteristics will contribute to the improvement of the organizational model of medical care provision in the region.