Ключові слова
ішемічний інсульт, дисциркуляторна енцефалопатія, якість життя неврологічних пацієнтів, артеріальна гіпертензія, ніцерголін, фенібут
Як цитувати
Ovodiuk, N. M. (2018). Визначення особливостей перебігу дисциркуляторної енцефалопатії після перенесеного ішемічного інсульту на тлі артеріальної гіпертензії в державних службовців. Клінічна та профілактична медицина, (1), 42-55. https://doi.org/10.31612/2616-4868.1-4.2018.06
Анотація
Мета – визначити особливості перебігу дисциркуляторної енцефалопатії (ДЕ ІІ ст.) після перенесеного ішемічного інсульту на тлі артеріальної гіпертензії у державних службовців та оцінити якість життя даного контингенту хворих порівняно з пацієнтами з ДЕ ІІ ст. на тлі гіпертонічної хвороби. Оцінити ефективність запропонованої схеми лікування (поєднання малих доз судинного та ноотропного препаратів із комплексом фізіотерапевтичних процедур) в обох групах.
Матеріал і методи. Для проведення дослідження на базі багатопрофільного закладу охорони здоров’я пацієнтів розподілили на дві групи: до основної віднесено тих, хто перенесли ішемічний інсульт на тлі артеріальної гіпертензії, до контрольної – пацієнтів з ДЕ ІІ ст. без перенесеної гострої ішемічної події та на тлі артеріальної гіпертензії. Досліджували клініко-неврологічні та нейропсихологічні показники, показники мозкової гемодинаміки, структурні зміни мозкової тканини.
Результати. В обох групах мали місце рухові, когнітивні та психічно-вольові розлади, але в пацієнтів, які перенесли ішемічний інсульт, ці розлади були вірогідно більше вираженими, ніж у пацієнтів контрольної групи. Доведено, що пацієнти навіть із малим неврологічним дефіцитом мали вірогідно нижчу якість життя. Для лікування хворих обох груп запропоновано схему медикаментозного лікування (ніцерголін і фенібут) у невеликих дозах впродовж 2 місяців) у поєднанні з фізіотерапевтичними заходами. Внаслідок проведеного лікування стан хворих та якість їх життя вірогідно поліпшилися за клінічними та параклінічними показниками.
Висновки Отримані результати дають право пропонувати дану схему для лікування хворих із ДЕ ІІ ст. на тлі артеріальної гіпертензії та після перенесеного інсульту. Використання невеликих доз препаратів дозволяє знизити економічні витрати на лікування.
Посилання
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2. The top 10 causes of death. Available at: http://www.who.int/mediacentre/ factsheets/fs310/en/index.html
3. Mathers C. D., Bernard C., Iburg K. M. Global Burden of Disease: Data sources, methods and results. Available at: http:factsheets/fs310/en/index.html
4. Duros J. (1991). On the rupture of an aneurysm. Neurological research., 13, 4, 217-223.
5. Laakso A. Hernesniemi, J., Yonekawa, Y., Tsukahara, T. (2010). Surgical management of cerebrovascular disease. Springer Science & Business Media, 107.
6. Yuki I. Spitzer, D., Guglielmi, G., Duckwiler, G., Fujimoto, M., Takao, H., Vinuela, F. (2014). Immunohistochemical analysis of a ruptured basilar top aneurysm autopsied 22 years after embolization with Guglielmi detachable coils. Journal of neurointerventional surgery. 011260.
7. Takao, H., Kadokura, S., Suzuki, T., Kanbayashi, Y., Masuda, S., Shinohara, K., Murayama, Y. (2014). Abstract W P70: What Cfd Parameter is Different Between Growing and No Growing Aneurysm.
8. Oliynyk I. V. (2011). Medyko-sotsialni osoblyvosti hostrykh porushen mozkovoho krovoobihu ta rozrobka populiatsiinoi i tsilovoi modeli yikh profilaktyky [Medical and social features of acute cerebrovascular disorders and development of population and target model of their prevention]. К., 24 s.
9. Zozulya A. Í., Slabkiy G. O. (2013). Usovershenstvovaniye sistemy okazaniya meditsinskoy pomoshchi naseleniyu pri tserebrovaskulyarnykh zabolevaniyakh — sostavlyayushchey obshchey reformy zdravookhraneniya v Ukraine [Improvement of the system of rendering medical care to the population with cerebrovascular diseases - a component of the overall health care reform in Ukraine]. Intern. neurologist. journal, 7(61). 111–117.
10. Zozulya A. I. (2013). Puti reorganizatsii okazaniya meditsinskoy pomoshchi pri tserebrovaskulyarnykh zabolevaniyakh [Ways of reorganizing the provision of medical care for cerebrovascular diseases]. Ukrainian medical journal, №4 (96), 132–135.
11. Kovalenko V. M., Kornatskyy V. M., Revenko I. L., Handzyuk V. A. (2009). Medyko-sotsialni aspekty khvorob systemy krovoobihu [Medico-social aspects of circulatory system diseases]. Kyyiv, 146 s.
12. Vinichuk S. M., Cheren'ko T. M. (2003). Ishemicheskiy insul't: evolyutsiya vzglyadov na strategiyu lecheniya [Ischemic stroke: evolution of views on the treatment strategy]. Kiyev : Kosmopolis, 120 s.
13. Vsemirnaya organizatsiya zdravookhraneniya (2004). K sozdaniyu yevropeyskoy strategii bor'by s neinfektsionnymi boleznyami. Punkt 8(a) predvaritel'noy povestki dnya, Pyat'desyat chetvertaya sessiya Yevropeyskogo regional'nogo komiteta VOZ (6–9 sentyabrya) [To the creation of a European strategy for combating noncommunicable diseases. Item 8 (a) of the provisional agenda, Fifty-fourth session of the WHO Regional Committee for Europe (6-9 September]. URL: http://www.euro. who.int/__data/assets/pdf_fi le/0019/88201/RC54_ rdoc08.pdf. (дата звернення 30.03.2018).
14. Vsemirnaya organizatsiya zdravookhraneniya.a) Kurs na ozdorovleniye. Yevropeyskaya strategiya profilaktiki i bor'by s neinfektsionnymi zabolevaniyami. Yevropeyskoye regional'noye byuro VOZ [The course for recovery. European Strategy for the Prevention and Control of Noncommunicable Diseases.WHO Regional Office for Europe. Kopengagen, 60 s.
15. Revenko I. L. (2010). Epidemiolohiya insultu v Ukrayini. Zaporozhye Medical Journal, 12, 42–47.
16. Revenko I. L. (2011). Medyko-sotsialʹne obgruntuvannya optymizovanoyi modeli medychnoyi dopomohy khvorym iz sudynno-mozkovymy zakhvoryuvannyamy [Medico-social substantiation of an optimized model of medical care for patients with vascular-cerebrovascular diseases] Kyyiv, 212 s.
17. European Stroke Initiative Executive Committee (2003). EUSI Writing Committee / Olsen T.S. European Stroke Initiative Recommendations for Stroke Management-update. Cerebrovasc. Dis., 16(4), 311–337.
18. Treshchinskiy A. I., Glumcher F.S., Korotkoruchko A.A., Polishchuk N.Ye. (1997). Ishemicheskiy insul't (etiologiya, patogenez, klinika, intensivnaya terapiya) [ Ischemic stroke (etiology, pathogenesis, clinic, intensive care)]. Pain, analgesia, intensive care, 79–88.
19. Yamaguchi T. (2003). Sovremennoye sostoyaniye problemy ostrogo ishemicheskogo insul'ta v Yaponii: rezul'taty obshchenatsional'nogo issledovaniya 1999–2000. Jour. neurology and psychiatry. S.S. Korsakov. Stroke (attachment), 9, 72-74.
20. Huang K., Khan N., Kwan A. (2013). Socioeconomic status and care after stroke: results from the Registry of the Canadian Stroke Network. Stroke, 44(2), 477–482.
21. Cadilhac D. A., Lalor E. E., Pearce D. C. (2006) Access to stroke care units in Australian public hospitals: facts and temporal progress. Intern. Med. J., 36(11), 700–704.
22. Alberts M. J., Hademenos G., Latchaw R. (2000) Reсommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA, 283(23), 3102–3109.
23. Rudd A. G., Hoffman A., Irwin P. (2005) Stroke unit care and outcome: results from the 2001 National Sentinel Audit of Stroke (England, Wales, and Northern Ireland). Stroke, 36(1), 103– 106.
24. Lenti L., Brainin M., Titianova E. (2013). Stroke care in Central Eastern Europe: current problems and call for action. Int. J. Stroke, 8(5), 365–371.
25. Vsemirnaya organizatsiya zdravookhraneniya (2006). Khel'singborgskaya deklaratsiya o yevropeyskikh strategiyakh v otnoshenii insul'ta. Yevropeyskoye regional'noye byuro VOZ [World Health Organization (2006). Helsingborg Declaration on European Strategies for Stroke. WHO Regional Office for Europe], Kopengagen, 24 s.
26. Insul't: printsipy diagnostiki, lecheniya, profilaktiki [Stroke: principles of diagnosis, treatment, prevention] / pod red. N. V. Vereshchagina, M. A. Piradova, Z. A. Suslinoy. М., 2002.
27. Zharinov O. Y. (2005). Urazhennya holovnoho mozku pry arterialʹniy hipertenziyi. Osoblyvosti antyhipertenzyvnoyi terapiyi [Brain defeat with arterial hypertension. Features of antihypertensive therapy]. Health of Ukraine, 23–24, 36.
28. Yavorskaya V. A., D'olog N. V., Grebenyuk A. V. (2006). Profilaktika insul'ta s pozitsiy dokazatel'noy meditsiny [Prevention of stroke from the perspective of evidence-based medicine]. Health of Ukraine, 13–14.
29. Yavorskaya V. A., D'olog N. V., Grebenyuk A. V. (2006). Profilaktika insul'ta s pozitsiy dokazatel'noy meditsiny [Prevention of stroke from the perspective of evidence-based medicine]. Health of Ukraine, 15–16.
30. Dormehl I. C., Jordaan B., Oliver D. W., Croft S. (1999). SPECT monitoring of improved cerebral blood flow during long–term treatment of elderly patients with nootropic drugs. Clin. Nucl. Med., 24 (1), 29–34.
31. Appelros P., Nydevik I., Viitanen M. (2003). Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year. Stroke, 34, 122 –126.
32. Buck D., Jacoby A., Massey A., Ford G. (2000). Evaluation of measures used to assess quality of life after stroke. Stroke, 31, 2004-2010.
33. Duncan P. W., Jorgensen H. S ., Wade D.T. (2000). Outcome measures in acute stroke trials. Stroke, 31, 1429 –1438.
34. Kadykov A. S. Reabilitatsiya posle insul'ta [Rehabilitation after a stroke]. M.: Miklosh, 2003. 176 s.
35. Kadykov A. S. Reabilitatsiya posle insul'ta [Rehabilitation after a stroke]. M.: Miklosh, 2003. 176 s.
36. Panteleyenko L. V., Sokolova L. I. Yakist zhyttya pislya perenesenoho ishemichnoho insultu: nauchno-praktycheskaya ynternet-konferentsyya "Alyans nauk: uchenyy – uchenomu" [Quality of life after transmitted ischemic stroke: scientific and practical internet conference "Alliance of sciences: scientist - scientist"] (25-26 fevralya 2010 hoda).
37. Hopman WM, Verner J. Quality of life during and after inpatient stroke rehabilitation (2003). Stroke, 34, 801 – 805.
38. Diagnostic and Statistical Manual Disorders. 4th edition: DSM-IV. Washington, DC: American Psychiatric Association, 1994.
39. Rasquim S. M. Lodder J., Ponds R.W. (2004). Cognitive functioning after stroke: a one-year follow-up study. Dement. Geriatr. Cogn. Disord., 18, 138-134.
40. Desmond D. W., Moroney J. T., Paik M. C. (2000). Frequency and clinical determinants of dementia after ischemic stroke. Neurology, 54(5), 1124-1131.
41. Mackowiak-Cordoliani M. A., Bombois S., Memin A. (2005). Postsroke dementia in the eldery. Drugs Aging., 22, 6, 483-493.
42. Cherdak M. A., Parfenov V. A. (2011). Kognitivnyye rasstroystva u patsiyentov, perenesshikh ishemicheskiy insul't: obzor [Cognitive disorders in patients undergoing ischemic stroke: a review]. Neurological Journal 16, 6, 37-44.
43. Bejot Y., Aboa-Eboule C., Durier Jeome (2011). Prevalence of early dementia after first-ever stroke: a 24-year population-based study. Stroke, 42, 607-612.
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