RESUMEN
The article presents the remote results of treatment of an obliterating atherosclerosis of arteries of the lower extremities of the II stage at patients of advanced and senile age after the combined use of ozone therapy and gravitational therapy. We performed a prospective randomized study in three parallel groups (139 patients). The 1st group (n=57) received standard medical therapy in combination with ozone therapy; the group was divided into two subgroups: for patients of subgroup 1a (n=28) - intravenous ozonized physiological solution was performed, for patients of subgroup 1b (n=29) - major ozonized autohemotherapy. For patients of the 2nd group (n=62) - a comprehensive treatment, including gravitational therapy in addition to medical ozone, was carried out. In this group were also identified two subgroups: subgroup 2a (n=31) - patients received standard medical therapy in combination with ozonized physiological solution and gravitational therapy, subgroup 2b (n=31) - standard medical therapy in conjunction with major ozonized autohemotherapy and gravitational therapy. The 3rd control group (n=20) included patients, who received only standard medical therapy. Dynamics of changes of a stage of a disease and the number of surgeries in the remote period was estimated (up to 7 years). After 6 months of follow-on stages of the distribution of the disease patients significantly (p>0,05) did not differ from the initial amount. Analysis of survival and probable risk at 7 years of follow-Cox regression method revealed a maximum efficiency in the subgroup 2a where the risk of probability of surgeries and also increases in a stage of a disease effectively decreased.
Asunto(s)
Arteriosclerosis Obliterante/terapia , Gravitación , Extremidad Inferior , Oxidantes Fotoquímicos/uso terapéutico , Ozono/uso terapéutico , Anciano , Terapia Combinada/métodos , Humanos , Estudios ProspectivosRESUMEN
Analysed herein are the results of treating a total of 139 patients presenting with stage II chronic lower limb ischaemia. The patients were subdivided into three groups, depending on the variant of treatment performed. Group One patients (n=57) received standard conservative therapy combined with ozone therapy, with the Group being further subdivided into two subgroups: patients of subgroup 1a (n=28) were subjected to intravenous administration of ozonated physiological solution (OPS), subgroup 1b patients (n=29) were given big autohemoozonetherapy (BAT). Group Two patients (n=62) underwent complex treatment including beside medical ozone gravitation therapy (GT). Group Two patients were also subdivided into two subgroups: subgroup 2a patients (n=31) received standard conservative therapy combined with OPS and GT, subgroup 2b patients (n=31) received standard conservative therapy in combination with BAT and GT. Group Three (Control Group) was composed of 20 patients receiving standard conservative therapy alone. The highest efficacy was observed in the subgroup of patients receiving OPS and GT, with the patients of this subgroup showing a statistically significant increase in the pain-free walking distance by 116.5% and in the ankle-brachial index by 49.2%, also demonstrating the most pronounced positive dynamics of lipid metabolism parameters: a decrease in total cholesterol by 21.3%, low density lipoproteins by 25.4%, very low density lipoproteins by 24.2% and triglycerides by 18.5%. Besides, a tendency was observed towards normalization of the haemostasis system indices: fibrinogen decreased by 21.8%, prothrombin index by 13%, fibrin monomer complexes retraction by 18.2%, and the clotting time increased by 20.7%. Hence, combined use of ozonated physiological solution and gravitation therapy in treatment of patients with stage II chronic lower limb ischaemia promotes a considerable increase in the pain-free walking distance and ankle-brachial index, as well as contributes to correction of lipid metabolic disorders and haemocoagulation.
Asunto(s)
Arteriosclerosis Obliterante/terapia , Terapias Complementarias/métodos , Isquemia/terapia , Extremidad Inferior/irrigación sanguínea , Ozono/uso terapéutico , Anciano , Índice Tobillo Braquial , Arteriosclerosis Obliterante/complicaciones , Arteriosclerosis Obliterante/diagnóstico , Arteriosclerosis Obliterante/fisiopatología , Enfermedad Crónica , Terapia Combinada , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Masculino , Persona de Mediana Edad , Oxidantes Fotoquímicos/uso terapéutico , Gravedad del Paciente , Resultado del TratamientoRESUMEN
The authors carried out a comparative analysis of the results of management of patients presenting with stage II lower-limb atherosclerosis obliterans according to the classification of A.V. Pokrovsky (1973) in three clinical groups. Group One patients (n=118) were subjected to conventional conservative therapy combined with gravitational therapy, Group Two patients (n=28) underwent plasmapheresis on the background of standard conservative therapy, and Group Three patients (n=40) in the composition of the combined therapy received gravity therapy and plasmapheresis. Prior to treatment, the patients were found to have alterations in the lipid spectrum mainly at the expense of an increase in the level of triglycerides, elevated concentration of C-reactive protein, and pronounced circulatory impairments in the lower extremities on ultrasound Doppler examination. After treatment, the most effective correction of the levels of C-reactive protein, fibrinogen and triglycerides appeared to be in those groups where patients received plasmapheresis. The use of gravitational therapy ensured a considerable increase in the regional blood flow. A combination of plasmapheresis and gravitational therapy in the composition of comprehensive therapy made it possible to act upon various links of pathogenesis of atherosclerosis obliterans and to substantially improve the treatment outcomes in this cohort of patients.