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6УДК: 616.1/.9-08:614.2
ХАРАКТЕРИСТИКА КОМОРБИДНОСТИ КАРДИОЛОГИЧЕСКИХ БОЛЬНЫХ В УСЛОВИЯХ МНОГОПРОФИЛЬНОГО СТАЦИОНАРА
Ниязов Зафар Мукимович
Абдурахманов Мухиддин Ганиевич
Даулетбаев Бахтияр Кочкарович
Саттаров Оятилло Хаятиллоуг.ли
Юлдашев Рафикжан Нуманович
Кафедра пропедевтика внутренних болезней
Андижанский государственный медицинский институт
Результаты проведенного исследования доказывают необходимость комплексной оценки состояния больного с ХСН в целом. Это обусловлено более тяжелым клиническим течением ХСН, ухудшением прогноза, а также снижением КЖ и личностными особенностями больных с ХСН на фоне коморбидности.
Выявленные в зависимости от уровня коморбидности особенности клинического течения ХСН, необходимо учитывать при выборе тактики обследования и лечения больных с ХСН. Наибольшее опасение вызывают больные с неудовлетворительной приверженностью к лечению, являющиеся мишенями для коррекционной работы в условиях терапевтической практики.
Определение степени коморбидности, позволяющее прогнозировать риск смерти больных с ХСН, даёт возможность выделять категории пациентов, требующих особого внимания, как в условиях амбулаторно-поликлинического, многопрофильного так и стационарного лечения.
Ключевые слова: коморбидность, многопрофильный стационар, кардиологических больных.
CHARACTERISTICS OF COMORBIDITY OF CARDIOLOGICAL PATIENTS IN THE CONDITIONS OF A MULTIDISCIPLINE HOSPITAL
The results of the study prove the need for a comprehensive assessment of the condition of a patient with CHF as a whole. This is due to the more severe clinical course of CHF, worsening prognosis, as well as a decrease in QOL and personal characteristics of patients with CHF against the background of comorbidity.
The features of the clinical course of CHF revealed depending on the level of comorbidity should be taken into account when choosing the tactics of examination and treatment of patients with CHF. The greatest concern is caused by patients with unsatisfactory adherence to treatment, who are targets for corrective work in a therapeutic practice.
Determination of the degree of comorbidity, which makes it possible to predict the risk of death in patients with CHF, makes it possible to distinguish categories of patients requiring special attention, both in outpatient, multidisciplinary and inpatient treatment.
Key words: comorbidity, multidisciplinary hospital, cardiac patients.
КУП ТАРМОЦЛИ ШИФОХОНАДА ЮРАК КАСАЛЛАРИНИНГ КОМОРБИДИЯСИНИНГ
ХУСУСИЯТЛАРИ
Тадцицот натижалари умуман СЮЕ билан огриган беморнинг х,олатини х,ар томонлама бах,олаш зарурлигини исботлайди. Бу СЮЕ нинг янада огир клиник кечиши,
прогнознинг ёмонлашиши, шунингдек, коморбидлик фонида СЮЕ билан огриган беморларнинг ;л ва шахсий хусусиятларининг пасайиши билан боглик;.
СЮЕ билан огриган беморларни текшириш ва даволаш усулларини танлашда коморбидлик даражасига ;араб ани;ланган СЮЕ клиник курсининг хусусиятлари х,исобга олиниши керак. Энг катта муаммо даволаш учун ;они;арсиз самарали беморлар сабаб булади.
СЮЕ билан огриган беморларнинг улим хавфини тахмин ;илиш имконини берадиган коморбидлик даражасини ани;лаш амбулатория, куп тармо;ли ва стационар даволанишда алох,ида эътибор талаб киладиган беморларнинг тоифаларини ани;лаш имконини беради.
Калит сузлар: коморбидлик, куп тармо;ли шифохона, юрак касалликлари.
Relevance. Prevention and treatment of chronic diseases are designated by the World Health Organization as a priority project of the second decade of the XXI century aimed at improving the quality of life of the world's population[2,4].
The mutual influence of diseases significantly changes the clinical picture and course of diseases, the nature and severity of complications, worsens the quality of life of the patient, restricts or complicates the therapeutic and diagnostic process [1,3].
In the medical treatment of patients of the cardiology department, up to 50% of the costs are for drugs that are not recommended by the standard for the management of patients with cardiological pathology[5].
The purpose of the study. To study the nature of therapeutic comorbidity in cardiac patients in a multidisciplinary hospital.
Materials and methods of research. The medical histories of 80 cardiological patients aged 25 to 82 years (average age 56.3±4.5 years) who were treated at the ASMI clinic were analyzed. At the same time, men accounted for 45% (36 people), women -55% (44 patients, respectively).
The results of the study. In the analyzed group of patients, the frequency of comorbidity was 97.5%. In most cases, the presence of 3 to 5 diseases was recorded simultaneously (57 people, 71.2%), but 16% of patients had a combination of 6-8 diseases at the same time.
According to the literature data on the increase in comorbidity with age, all patients were divided into 3 groups: 6 people were included in group 1 (18-44 years old), 47 patients in group 2 (45-64 years old) and 27 patients in group 3 (65 years and more), respectively. Attention is drawn to the significant average number of chronic diseases in the first age group (5), which may be due to the peculiarities of the contingent of patients in the hospital of this category (the group included two patients with infectious endocarditis and one patient each with CHD, myocarditis, restrictive cardiomyopathy and coronary heart disease). In patients of the second and third groups, there is a traditional tendency to increase their number with an increase in the age of patients (4.46 and 5.19, respectively).
Taking into account the profile of the department, intracardial comorbidity naturally prevailed among the examined patients in the structure of comorbidity. Coronary artery disease as the main disease was diagnosed in 54 patients (67.6%) and in 4 (5%) as concomitant, while 17 patients (21.3%) had manifestations of multifocal atherosclerosis, 27 patients (33.8%) had indications of a myocardial infarction; heart defects (degenerative, HRBS, congenital heart defects) — 17 patients (21.3%), in 3 cases the reason for hospitalization was infectious endocarditis (3.7%), and in 5 cases (6.3%) other causes (myocarditis, connective tissue dysplasia syndrome, exudative pericarditis and cardiomyopathy).
Various rhythm and conduction disorders, including complex ones, were registered in 24 patients (30%), while atrial fibrillation was diagnosed most often in 20 patients (25%). The incidence of hypertension in the analyzed group was 76.3% (61 patients), while the vast majority of patients were classified as very high risk (59 people).
A significant contribution to the formation of comorbid pathology was made by non-cardiac diseases, which were presented as follows: endocrine and metabolic diseases (diabetes mellitus, obesity, thyroid diseases) - 33.8% (27 patients), of which diabetes mellitus 16.3%, obesity I-II st. - 17.6%; diseases of the gastrointestinal tract (peptic ulcer, atrophic gastritis, GI) - 22.5%, (18).
Other pathological conditions were less common and were, respectively: dyscirculatory encephalopathy - 16.3%; kidney diseases (ICD, chronic pyelonephritis, kidney cysts) - 15%; chronic infection - 8.8%; respiratory diseases of pneumonia - 8.8%, peripheral vascular diseases -7.5%.
Conclusion. Thus, the analysis of medical histories showed a high frequency of comorbid pathology and a large number of chronic diseases in cardiac patients in all age groups. Despite the variety of somatic pathology in the analyzed group of patients, there was a significant predominance of intracardial comorbidity.
References:
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2. Belyalov, F.I. Treatment of internal diseases in conditions of comorbidity: [Text] : monograph / F. I. Belyalov. - 8th ed. - Irkutsk : RIO IGIUVa, 2012. - 285 p. - ISBN 978-5-89786091-3.
3. Mitrofanova, I.S. New ways to improve the effectiveness of treatment of patients with chronic heart failure [Text] / I.S. Mitrofanova, Ya.And Kotz., L.G. Vdovenko // Journal of Heart Failure. - 2008. - Vol. 9, No. 4. - pp. 164-166.-ISSN 1728-4651.
4. Cox, L. Underrepresentation of individuals 80 years of age and older in chronic disease clinical practice guidelines [Text] / L. Cox, M. Kloseck, R. Crilly // Canadian Family Physician. -2011. - Vol. 57, № 17. - P. 263-269. - ISSN 0008-350X.
5. When more is not better: treatment intensification among hypertensive patients with poor medication adherence [Text] / M. Heisler [et al.] // Circulation. - 2008. -Vol. 117, № 22. -2884-2892. - ISSN 0009-7322.
