At present, the application of systems analysis methods to clinical practice is a burning problem. The methods objectively present behaviour of a state vector of human organism in different groups of patients in respect of whom advanced technologies of clinical examination and rehabilitation of patients with chronic obstructive pulmonary disease are developed. It increases the effectiveness of treatment and quality of life of patients observed. There are no recommendations on optimal clinical examination programme and rehabilitation of patients with chronic obstructive pulmonary disease in the North in clinical practice for patients with chronic obstructive pulmonary disease and in standards of chronic obstructive pulmonary disease out-patient treatment. There are no studies on immunorehabilitation of this category of patients in the North in available literature.
Objective: to analyze differential diagnostic parameters in patients with moderate bronchial asthma with pulmogenic arterial hypertension with essential arterial hypertension. Material and Methods: 25 patients with moderate bronchial asthma with pulmogenic arterial hypertension (the 1st group) and 25 patients with moderate bronchial asthma with essential arterial hypertension (the 2nd group) were included in the study. Both groups of patients received step therapy (berodual + inhaled glucocorticosteroids). All patients underwent complex ultrasound examination of intracardiac hemodynamics, examination of blood flow in the right ventricle excretory tract. Systemic arterial pressure was measured according to N. S. Korotkov’s method. ECG was studied (24-hour monitoring). Cold test (at -20 °C-40 °C) was performed in both groups of patients, blood gas composition and pulmonary ventilation function indices were studied. Results: As a result of research established reliable differences in the spirographic indices, blood gas composition in patients with moderate bronchial asthma with pulmogenic arterial hypertension (the 1st group), and reliable differences in partial pressure of oxygen and carbon dioxide (p < 0,05). The 1st group of patients has also higher values of PaCO2 and reliably (p < 0,0,5) and lower values of PaO2, SaO2 in comparison with the comparison group of patients with bronchial asthma of average severity with essential arterial hypertension (the 2nd group). Our data have shown, that in the 1st and 2nd group patients systolic-diastolic cardiac function indexes reliably (p < 0,05; p < 0,001) differed from those ones in healthy subjects. At the same time systolic pressure in the pulmonary artery in the 1st group patients was higher than in the 2nd group patients, and left ventricular ejection fraction was significantly different from that in healthy people and was lower in the 1st group patients than in the 2nd group. We have revealed a reliable correlation between systolic blood pressure and Sа02 (r = 0,52, p < 0,05), studied after cold test, which confirmed the hypothesis of the formation of pulmogenic arterial hypertension against the background of hypoxia. More pronounced changes of FEV1, Sа02, systolic blood pressure in group 1 patients were to some extent due to significant cold hyperresponsiveness in this category of patients. Conclusions: the results of our studies have shown that the decrease of FEV1, FEV50, FEV75, PaO2, SaO2, increased systolic pressure in the pulmonary artery, signs of right heart hypertrophy, disturbances of systolic-diastolic heart function were more pronounced in moderate bronchial asthma patients with pulmogenic arterial hypertension than in moderate bronchial asthma patients with essential arterial hypertension. The proportion of patients (in %) with rhythm disturbances, especially sinus tachycardia, extrasystoles were detected significantly more frequently in group 1 patients than in group 2 patients, which was due to a more pronounced disturbance of systolic-diastolic heart function, higher systolic pressure in the pulmonary artery in persons with moderate bronchial asthma with pulmogenic arterial hypertension.
The aim of the study is to study features and prevention of complications in patients with chronic obstructive pulmonary disease (COPD) with comorbid conditions (CC). Clinical manifestations and dynamics of indicators echocardiography (EHCG) and spirography in visiting northern residents were evaluated for 10 years. We examined in dynamics 82 COPD patients with CC from the main and 85 from control groups in whom indicators of echocardiography and spirography were studied. The most pronounced therapeutic effect was observed in patients of the main group receiving the most optimal program for the management of patients.
~ 5 Х анты-Мансийская государственная медицинская академия-наш надежный партнер и верный друг, с которой мы связаны вот уже 83 года и для нас, конечно же, очень приятно, что проведенная в мае 2017 г. Всероссийская научно-практическая конференция «Сложные клинические случаи: методы диагностики, лечения и профилактики» была посвящена 85-летию Окружной клинической больницы. Ханты-Мансийская государственная медицинская академия-наш главный кадровый источник, а мы, в свою очередь, для неё-основная клиническая база и основной работодатель и мы очень рады такой взаимосвязи. Современная медицина уже предъявляет к специалистам самые высокие требования, а принимая во внимание, что на сегодня медицина является одной из самых активно развивающихся отраслей, можно с абсолютной уверенностью утверждать, что эти требования будут только возрастать. Выбрав медицинскую профессию современный специалист должен обладать самыми серьезными знаниями и компетенциями, должен постоянно повышать свою квалификацию, успевать овладевать новейшими методами диагностики и лечения заболеваний и мы, конечно же, крайне заинтересованы в том, чтобы к нам на работу приходили именно такие грамотные, думающие, всесторонне подготовленные специалисты. Полностью солидарна с руководством Ханты-Мансийской государственной медицинской академии в том, что современный врач, фельдшер, медицинская сестра, медицинский лаборант обязательно должны быть приобщены к научной деятельности и мы всесторонне стараемся поддержать и стимулировать это стремление в наших сотрудниках. В этой связи хочу отметить, что журнал «Научный медицинский вестник Югры» является прекрасной площадкой для молодых ученых, многие из которых-это наши сотрудники, на которой они могут обменяться опытом со своими коллегами, набраться новых идей для своих новых проектов, найти новые пути решения задач в своих исследованиях. Следует отметить, что все представленные в журнале исследования имеют прикладной, практический характер, что, конечно же, особенно ценно. Благодарю всех авторов статей за научную смелость и большую проведенную работу, желаю всем вам новых интересных открытий и идей, дальнейшего научного и профессионального роста.
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