Pulmonary rehabilitation in COVID-19 patients with pneumonia is associated with better treatment outcomes. However, existing protocols have never been evaluated in randomized control studies. The aim. To evaluate the effectiveness of newly-developed pulmonary rehabilitation protocol compared to basic Russian COVID-19 guidelines for patients with oxygenation index (OI) between 200 and 400 points without IMV. Methods. Based on literature reviews and own clinical experience, standard rehabilitation protocol was designed and tailored for specific needs of low-OI patients. Two clinical centers participated in the study and included total 73 patients in main group. Control group included 73 retrospective patients based in propensity score; this patients received standard protocol of early pneumonia activation from official COVID-19 guidelines. Ten-days clinical outcomes were assessed based on parameter distribution type. Results. Evidence show significant difference in required time of continuous oxygen support in (5.1 ± 3.3 vs 8.0 ± 4.6 days for main and control group respectively. Main group also had mildly better functional. We’ve observed less mortality in main group, but attribute it not to the program, but for growing experience of health professionals and decreased loads on health system. Malignancy as comorbidity was considered a significant cofactor also. Conclusion. New pulmonary rehabilitation protocol improves clinical outcomes in critical COVID-19 patients by decreasing the demand fox oxygen support.
По данным национального регистра, церебраль-ный инсульт в России составляет 21,4% в структуре общей смертности, при этом 31% пациентов, пере-несших инсульт, нуждаются в постоянном уходе, 20% не могут ходить и только 8% возвращаются к прежней деятельности [1].Согласно рекомендациям ВОЗ [2], выделяют три уровня последствий заболевания. Первый уро-вень -неврологические повреждения, к ним отно-сят: двигательные, чувствительные, тонусные, пси-хологические расстройства, которые выявляются в клинической картине заболевания. Второй уровень -нарушения функции, к которым могут привести неврологические повреждения, например наруше-ния ходьбы, самообслуживания. Третий уровень -ограничения, он включает нарушения бытовой и со-циальной активности, возникающие в резул ьтате неврологических повреждений и нарушений функ-ций.Таким образом, последствия инсульта прояв-ляются на клиническом, функциональном и соци-альном уровнях. После перенесенного инсульта лишь в 10-15% случаев происходит восстановле-ние на всех трех перечисленных уровнях. В этой связи актуальной является задача совершенствова-ния методов восстановительного лечения инсуль-
The article presents the results of clinical and experimental research of Russian and foreign scientists on the use of modern non-drug technology-selective pulse electrotherapy for various diseases and justification of its use in rehabilitation programs after pelvic surgery.
Background. The article presents the results of applying the method of high-intensity focused electromagnetic therapy in the complex treatment of stress urinary incontinence in women. Aim. To study and scientifically use the method of high-intensity focused electromagnetic therapy in the complex treatment of stress urinary incontinence in women. Research Objective: To study the effect of high-intensity focused electromagnetic therapy on the manifestations of urinary incontinence by assessing the ability of urinary retention (by the number of absorbent pads used) and quality of life according to the questionnaire of the International Council of Urinary Incontinence (ICIQ-SF) in women with stress urinary incontinence. Methods. The study included 40 women whose average age was 53.6 4.8 years with stress incontinence; the disease duration was 5.6 1.1 years, which were divided into 2 groups comparable by clinical and functional characteristics, the main 20 patients who underwent a course of WIFEM therapy, consisting of 67 procedures, which were carried out 23 once a week, the duration of each procedure was 28 minutes and the control ― 20 patients who underwent a course of exercises according to Kegel, daily, for a course of 20 lessons. Results. As a result of the study, it was shown that high-intensity focused electromagnetic therapy has a pronounced myostimulating effect on the pelvic floor muscles in women with stress urinary incontinence, which helps to strengthen control over urinary retention, a significant reduction and even complete disappearance of symptoms of urinary incontinence, and an increase in the psycho-emotional background and quality of life in general, as evidenced by a test to determine the amount of absorbent pads used and questionnaire data and for urinary incontinence (ICIQ-SF). Conclusion. High-intensity focused electromagnetic therapy has a pronounced myostimulating effect on the pelvic floor muscles in women with stress urinary incontinence, which contributes to increased control over urinary retention, a significant decrease or even complete disappearance of symptoms of incontinence, as well as an increase in psycho-emotional background and quality of life in general.
ФГБУ «Лечебно-реабилитационный центр» Минздрава России, директор -член-корр. РАМН д.м.н., профессор К.В. Лядов Москва Цель исследования -оценить влияние мультимодального обезболивания на раннюю реабилитацию пациентов после эндопротезирования тазобедренного сустава.Материал и методы. Проведено проспективное одноцентровое рандомизированное исследование, в которое вошли 32 пациента. Пациенты первой группы получали парацетамол, кеторолак и трамадол, второй группы -кеторолак вну-тривенно, третьей группы -эторикоксиб и габапентин. Больным второй и третьей групп проводили эпидуральную анал-гезию ропивакаином. Мультимодальное обезболивание проводилось в течение 48 часов после операции.Оценку интенсивности боли проводили при помощи ВАШ, нейропатического компонента боли -по опроснику DN4. Регистрировали время первой и второй вертикализации пациентов -ходьбы с опорой на ходунки и фиксированием пройденного расстояния за 2 минуты.Результаты. Интенсивность боли более 50 мм по ВАШ при движении хотя бы один раз за 48 часов после операции отмечалась у 9% пациентов первой группы, у 22% больных второй и у 8% пациентов третьей группы. Количество боль-ных с нейропатическим компонентом болевого синдрома уменьшилось с 25% до 3% (р0,05).Первую вертикализацию проводили через 10±8 часов после операции, вторую -через 21±8 часов. Отмечено более частое развитие нежелательных явлений у пациентов первой группы по сравнению с больными второй и третьей групп при первой (91%, 33% и 25%, р0,05) и второй вертикализации (70%, 25% и 17%, р0,05).Выводы. Мультимодальная аналгезия позволяет проводить успешную активизацию пациентов после эндопротези-рования тазобедренного сустава в первые сутки после операции. У пациентов третьей группы отмечается тенденция к оптимальной комбинации эффективности и безопасности аналгетической терапии.Ключевые слова: эндопротезирование тазобедренного сустава, болевой синдром, мультимодальное обезболивание. MULTIMODAL ANALGESIA AFTER TOTAL HIP ARTHROPLASTYI.G. Mukutsa, S.V. Tsarenko, K.V. Lyadov, E.S. Koneva, A.G. Voloshin Medical and Rehabilitation Center MoscowPurpose -to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients -ketorolac intravenously and the 3rd group of patients -etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery.Assessment of pain intensity was performed by the VAS (visual analogue scale), a neuropathic pain component -on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes.Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurre...
The aim of the study was to assess the severity of pain in patients after total replacement of joints of the lower extremities in the exercise of walking on the day of the surgery. Walking on the day of the operation was carried out for 46 patients the comparison group included 41 patients. As a result of the study, patients carrying walking on the day of operation, assessed the severity of pain in the 3.54+1.75 on a scale of pain NRS, and patients carrying walking on the next day after surgery 5.49+1.42 points. The results indicate not only the possibility of practical implementation of the function of walking on the day of operation, but also about the possibility of its implementation at a lower level of pain at the time of its implementationon the day of surgery.
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