CC BY
8
УДК:616-8:616.831-005.4
I.T. Tuxtayev
Bukhara state medical Institute Bukhara, Uzbekistan
TREATMENT IN ISCHEMIC STROKE IN NEUROLOGICAL CHANGES ACUPUNCTURE
Resume. The most significant measure of prevention of ischemic stroke caused by occlusive carotid artery disease is carotid endarterectomy. However, the risk of perioperative cerebrovascular complications, ranging from 1.6% to 24%, imposes increased requirements for determining indications for surgical treatment. Complications include ischemic disorders (71%): cerebral embolism, circulatory ischemia with compression of the common carotid artery; as well as hemorrhagic hyperperfusion injuries and brain edema phenomena against the background of venous cerebral dyscirculation (29%). Up to 60% of complications occur during the intraoperative period. The degree of preservation of the compensatory capabilities of the cerebral cortex has a great influence on the outcome and even on the very possibility of surgical treatment. Keywords. Ignareflexotherapy, effectiveness, treatment of neurological, ischemic stroke.
И. Т. Тухтаев
Бухара мемлекеттжмедицина институты Бухара, взбекстан
АКУПУНКТУРАМЕН НЕВРОЛОГИЯЛЬЩ 6ЗГЕР1СТЕР КЕЗ1НДЕ ИШЕМИЯЛЬЩ ИНСУЛЬТП ЕМДЕУ
Туйт. Kapomudmiэндартерэктомия Kapomudmi артериялардыц окклюзиялыцзацымдануынан туындаган ишемиялыц инсульттщ алдын-алудыц мацызды шарасы болып табылады. Алайда, 1,6%-дан 24% - га deuimi периоперациялыцми-цан тамырлары асцынуларынъщ цаут хирургиялыц емдеудщ керсеткштерт аныцтауга жогары талаптар цояды. Асцынуларга ишемиялыц бузылулар (71%): церебральды эмболия, жалпы каротид артериясыныц цысылуы кeзiндeгi циркуляциялыц ишемия; сондай-ац геморрагиялыц гиперперфузиялыц зацымданулар жэне веноздыц церебральды дисциркуляция аясында мидыц сну цубылыстары (29%) жатады. Асцынулардыц 60% - ы интраоперациялыц кезецге келедь Нэтижеге жэне тiптi хирургиялыц eмдeyдi жузеге асыру мумктдтне церебральды компенсаторлыц мумктджтердщ сацталу дэрежеа улкен эсер етед1
T^rndi свздер. Игнарефлексотерапия, неврологиялыц, ишемиялыц инсульттщ тшмдшт, емь
И.Т.Тухтаев
Бухарский государственный медицинский институт Бухара, Узбекистан
ЛЕЧЕНИЕ ИШЕМИЧЕСКОГО ИНСУЛЬТА ПРИ НЕВРОЛОГИЧЕСКИХ ИЗМЕНЕНИЯХ АКУПУНКТУРОЙ
Резюме. Наиболее значимой мерой профилактики ишемического инсульта, обусловленного окклюзирующим поражением сонных артерий, является каротидная эндартерэктомия. Однако риск периоперационных сосудисто-мозговых осложнений, составляющий от 1,6% до 24%, предъявляет повышенные требования к определению показаний для хирургического лечения. К осложнениям относятся ишемические нарушения (71%): церебральная эмболия, циркуляторная ишемия при пережатии общей сонной артерии; а также геморрагические гиперперфузионные повреждения и явления отека мозга на фоне венозной церебральной дисциркуляции (29%). До 60% осложнений приходится на интраоперационный период. Большое влияние на исход и даже на саму возможность осуществления оперативного лечения оказывает степень сохранности компенсаторных возможностей церебрального. Ключевые слова. Игнарефлексотерапии, эффективности, лечении неврологических, ишемическом инсульте.
Relevance. Therefore, vascular diseases of the brain have been and remain one of the main problems of moder an angioneurology in older age groups (Bakharev A V. and coauthor. 2000; Zinnatullina e S., Takhavieva f V., 2000; Caste M, 2003; Skvortsova V. I., 2003).In recent years, the problem of diagnosis and preventive treatment of cerebrovascular diseases has become increasingly relevant. Stroke is the most common cause of permanent disability (E. I. Gusev, 2007). The leading role in the diagnosis and prognosis of stroke, as well as the choice of further treatment and rehabilitation tactics is assigned to non-invasive ultrasound research methods, which make it possible to assess the parameters of cerebral hemodynamics. (I. D. Stulin, 2006). More than forty years of experience in the use of reflexology in our country and in the CIS countries has convincingly shown its capabilities in the treatment and rehabilitation of neurological patients. During this period,
many regularities and mechanisms of action of acupuncture therapy (IRT)) were revealed (VogralikVG,Vogralshs MV, 1988; Ignatov Yu. D.et al., 1990; Bogdanov N. N., 2000; Kachan A. T, 2002). We have not found any guidelines for the use of IRT in the elderly, and even more so in old age. Works on the use of IRT in the acute period of cerebral circulation disorders are isolated (Gorokhovskaya V. S., 1980; Godovanik O. O., 1997; Falev A. I. et al., 2000). Given the above, the identification of the possibilities of using acupuncture methods, along with other methods of treatment in the elderly and senile in the acute period of cerebral circulatory disorders, becomes relevant both from a practical and economic point of view. In recent years, the problem of diagnosis and prevention of cerebrovascular diseases has become increasingly relevant. Stroke is the most common cause of permanent disability (E. I. Gusev, 2007). The leading role in the diagnosis and prognosis of stroke, as well as the choice of
further treatment and rehabilitation tactics, is assigned to non-invasive ultrasound methods that allow us to assess the parameters of cerebral hemodynamics (I. D. Stulin, 2006).More than forty years of experience in the use of reflexology in our country and in the CIS countries has convincingly shown its capabilities in the treatment and rehabilitation of neurological patients. During this period, many regularities and mechanisms of action of acupuncture therapy (IRT) were revealed (VogralikVG,Vogralshs MV, 1988; Ignatov Yu. D.et al., 1990; Bogdanov N. N., 2000; Kachan A. T, 2002). We have not found any guidelines for the use of IRT in the elderly, and even more so in old age. Works on the use of IRT in the acute period of cerebral circulation disorders are isolated (Gorokhovskaya V. S., 1980; Godovanik O. O., 1997; Falev A. I. et al., 2000). Given the above, the identification of the possibilities of using acupuncture methods, along with other methods of treatment in the elderly and senile in the acute period of cerebral circulatory disorders, becomes relevant both from a practical and economic point of view. Intensive care, early rehabilitation and prevention of complications, search for new approaches to treatment will reduce the mortality and disability of patients with this type of pathology.
In recent years, the problem of diagnosis and preventive treatment of cerebrovascular diseases has become increasingly relevant. Stroke is the most common cause of permanent disability (E. I. Gusev, 2007). The leading role in the diagnosis and prognosis of stroke, as well as the choice of further treatment and rehabilitation tactics is assigned to non-invasive ultrasound research methods, which make it possible to assess the parameters of cerebral hemodynamics. (I. D. Stulin, 2006).More than forty years of experience in the use of reflexology in our country and in the CIS countries has convincingly shown its capabilities in the treatment and rehabilitation of neurological patients. During this period, many regularities and mechanisms of action of acupuncture therapy (IRT)) were revealed (Vogralik VG, Vogralshs MV, 1988; Ignatov Yu. D.et al., 1990; Bogdanov N. N., 2000; Kachan A. T, 2002). We have not found any guidelines for the use of IRT in the elderly, and even more so in old age. Works on the use of IRT in the acute period of cerebral circulation disorders are isolated (Gorokhovskaya V. S., 1980; Godovanik O. O., 1997; Falev A. I. et al., 2000). Given the above, the identification of the possibilities of using acupuncture methods, along with other methods of treatment in the elderly and senile in the acute period of cerebral circulatory disorders, becomes relevant both from a practical and economic point of view. Intensive care, early rehabilitation and prevention of complications, search for new approaches to treatment will reduce the mortality and disability of patients with this type of pathology.Carotid endarterectomy is the most significant measure for the prevention of ischemic stroke caused by occlusive damage to the carotid arteries (A. B. Pokrovsky, 2001). However, the risk of perioperative cerebrovascular complications, ranging from 1.6% to 24%, imposes increased requirements for determining indications for surgical treatment. Complications include ischemic disorders (71%): cerebral embolism, circulatory ischemia with compression of the common carotid artery; and hemorrhagic hyperperfusion damage and the phenomenon of brain edema on the background of cerebral venous discirculation (29%). Up to 60% of complications occur during the intraoperative period (M. Spenser, 1999). The degree of preservation of the compensatory capabilities of the cerebral blood flow has a
great influence on the outcome and even on the very possibility of performing surgical treatment (De Bekay, 1996).Stroke is an acute violation of the cerebral circulation, characterized by the sudden appearance of focal and General brain neurological symptoms. Causes that lead to strokes in young people: arterial dissection and coagulopathy, rarely atherosclerosis and hypertension, cardioembolism due to prosthetic heart valves, as well as: unfavorable heredity, aggravated by frequent stress, unbalanced diet, alcohol abuse and Smoking. Migraines and taking oral contraceptives and Smoking significantly increase the risk of strokes in young women. The number of disorders of cerebral circulation during pregnancy, childbirth, and the postpartum period increases due to changes in the hormonal background, hemodynamics, and blood clotting. You can suspect the presence of a stroke in a young person if there are the following signs: dizziness; weakness or numbness in the limbs on one side; numbness in half of the face; speech disorders; a feeling of "porridge 165 in the mouth"; a distorted face; a sharp deterioration in visual acuity; loss of habitual skills (writing, reading). If there is one of the first signs of a stroke, the patient should be put to bed, put a pillow under his head and call an ambulance. Stroke is the third and, according to some data, the second most frequent cause of death in the population and occupies a leading position as a cause of persistent disability worldwide. Treatment of stroke is one of the main problems of modern neurology. The results of experimental studies have shown that the acute and early recovery periods of ischemic stroke are crucial for the formation of a residual neurological defect, the degree of adaptation and functional compensation of patients. Taking this into account, in recent years the attention of researchers and practitioners has been focused on developing a set of medical measures to restore impaired body functions in the acute period of ischemic brain stroke, which is the most promising for prognosis . The main principles of treatment of acute stroke are urgency, intensity, pathogenetic orientation, and complexity. The desire to minimize the degree of brain dysfunction, normalize General hemodynamics and microcirculation disorders, and metabolic processes in brain tissues make it necessary to use a large number of medications, which does not exclude the risk of polypragmasia and the development of complications. The presence of concomitant pathology in elderly patients creates additional difficulties in choosing treatment and rehabilitation measures. The emergence of modern methods of neuroimaging and the introduction of such medical technology as thrombolytic therapy marked new horizons, but did not lead to significant radical changes in solving this problem.
The accumulated experience of new diagnostic capabilities has shown that the zone of irreversible changes in the brain during ischemic stroke increases gradually, as one or another stage of the ischemic cascade develops. It turned out that there is a so - called therapeutic window, when therapy aimed at restoring brain perfusion and neuroprotection can not only save the patient's life, but also minimize functional losses. Therefore, urgency and timeliness determine the outcome of the disease to a greater extent. Given the urgency of the problem, it is important to develop effective therapeutic measures, including not only medical, but also non-medical methods of treatment. One of them is reflexology, which includes acupuncture, thermal acupuncture, multi-needle acupuncture, electroacupuncture, craniopuncture, acupressure, acupressure, magnetic acupuncture and
other methods of influencing biologically active points.The main principles of treatment of acute stroke are urgency, intensity, pathogenetic orientation, and complexity. The desire to minimize the degree of brain dysfunction, normalize General hemodynamics and microcirculation disorders, and metabolic processes in brain tissues make it necessary to use a large number of medications, which does not exclude the risk of polypragmasia and the development of complications. The presence of concomitant pathology in elderly patients creates additional difficulties in choosing treatment and rehabilitation measures. The emergence of modern methods of neuroimaging and the introduction of such medical technology as thrombolytic therapy marked new horizons, but did not lead to significant radical changes in solving this problem.
The accumulated experience of new diagnostic capabilities has shown that the zone of irreversible changes in the brain during ischemic stroke increases gradually, as one or another stage of the ischemic cascade develops.
It turned out that there is a so - called therapeutic window, when therapy aimed at restoring brain perfusion and neuroprotection can not only save the patient's life, but also minimize functional losses. Therefore, urgency and timeliness determine the outcome of the disease to a greater extent. Given the urgency of the problem, it is important to develop effective therapeutic measures, including not only medical, but also non-medical methods of treatment. One of them is reflexology, which includes acupuncture, thermal acupuncture, multi-needle acupuncture, electroacupuncture, craniopuncture, acupressure, acupressure, magnetic acupuncture and other methods of influencing biologically active points. Purpose of research
Improving the quality of treatment of patients with stenotic lesions of the brachiocephalic arteries by increasing the tolerance of cerebral hypoxia using acupuncture in preparation for carotid endarterectomy. Results of our own research.
The features of etiopathogenesis of ischemic stroke in elderly and senile individuals include a weakening of the regulatory effect of the nervous system, which leads to a restriction of the adaptive capabilities of the body, Inertia of vascular reactivity, leading to structural and functional changes, affecting cerebral hemodynamics, changes in physical and chemical indicators of homeostasis, deterioration of hemocoagulation and rheological properties of blood, the presence of formed systemic lesions, the problem of finding ways to reduce the drug load And, if possible, replace drugs with adequate therapeutic methods of exposure without reducing the effectiveness of treatment in elderly and senile patients comes to the fore.One of the possible solutions to this problem may be the additional use of reflexotherapy (acupuncture) methods in the conventional therapy of patients with ischemic stroke in the elderly and senile age. Reflexotherapy methods contribute to the normalization
of the cardiovascular system (Kapustin a V et al., 1984; Chuvilskaya L M 1997, Shestarov And Ya., 1997) and, most importantly, brain hemodynamics (Alekseev V, Dmitriev V K, 1984; Leonova M V et al., 1990, Runova A A et al., 1997) Acupuncture has a beneficial effect on the functioning of the kidneys and bladder (Vyskrebentsov E. A, 1976; Grossu G S et al., 1984; Kamenetskaya V K ,Leontieva ML, 1984; KirgizovYu.a. et al., 1984). Under the influence of acupuncture, the activity of blood enzymes changes, as well as the function of the clotting and anti-clotting system, which is confirmed by objective examination methods (Fomberpggein K B, Malikova s F, 1972).
CONCLUSIONS
1) Reflexology is an effective method of additional treatment of elderly patients in the acute period of cerebral infarction, which allows to achieve significant results in reducing the neurological defect.
2) Comparison of the dynamics of motor disorders obtained during joint medical and IRT treatment of the main and comparison groups, significantly significant results were obtained - (0 01< P < 0 05), which makes it advisable to use the acupuncture method in elderly people in the acute period of cerebral infarction to improve recovery of strength in paretic limbs.
Authors' Contributions. All authors participated equally
in the writing of this article.
No conflicts of interest have been declared.
This material has not been previously submitted for
publication in other publications and is not under
consideration by other publishers.
There was no third-party funding or medical
representation in the conduct of this work.
Funding - no funding was provided.
Авторлардьщ улеа. Барлык; авторлар осы мак;аланы
жазуга тен, дэрежеде катысты.
Мудделер цацтьгеысы - мэлiмделген жок;.
Бул материал баск;а басылымдарда жариялау ушш
бурын мэлiмделмеген жэне бас;а басылымдардын,
;арауына усынылмаган.
Осы жумысты журпзу кезшде сырт;ы уйымдар мен медициналык; екшджтердщ каржыландыруы жасалган жок;.
Царжыландыру журпзшмедг
Вклад авторов. Все авторы принимали равносильное участие при написании данной статьи. Конфликт интересов - не заявлен. Данный материал не был заявлен ранее, для публикации в других изданиях и не находится на рассмотрении другими издательствами. При проведении данной работы не было финансирования сторонними организациями и медицинскими представительствами. Финансирование - не проводилось.
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Контактные данные
Тухтаев Ильхом Туракулович +998 90 510 37 37 [email protected]
