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Section 2. Mediobescience
Bularkieva Eliza Alymkulovna, Scientific Secretary of the Kyrgyzian Scientific Research Institute of Balneology and Rehabilitation Sagymbayev Marat Akimovich, Director of the Kyrgyzian Scientific Research Institute of Balneology and Rehabilitation, Corresponding member of Kyrgyz Republic National Academy of Science, D. M. Sc., Professor
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SCIENTIFIC SUBSTANTIATION OF THE ORGANIZATION OF THE HEALTH STAGE OF REHABILITATION OF PATIENTS WITH PRIORITY DISEASES OF THE POPULATION OF KYRGYZSTAN
Abstract: Improving the effectiveness of rehabilitation of patients with acute myocardial infarction in medical institutions on the basis of analysis of the quality and effectiveness of its delivery. Keywords: acute myocardial infarction, rehabilitation, efficiency, sanatorium stage.
the same time, the total economic losses from disability in 2008 amounted to more than 17 billion soms (Kydyralieva R. B., 2012). The increase in the incidence of CAD in our country is more than 21% in the last 15 years. The average mortality rate from CAD in the Central Asian region is 4.2 times higher than the death rate for the European Union. The most common cause of death from cardiovascular disease is acute myocardial infarction (AMI), the overall mortality rate is about 30% (WHO — World Health report., 2005).
In this regard, the desire to organize the most effective medical care for patients with AMI is one of the urgent tasks of modern healthcare. In our country, a stage-by-stage rehabilitation of patients with MI was developed, and among the proposed stages an important role is assigned to the stage of medical rehabilitation, during which the process of physical rehabilitation of patients with myocar-
Introduction: Diseases of the circulatory system, nowadays, are one of the most important public health problems in the world and in our country, among which an important place is occupied by acute myocardial infarction (AMI). According to the State Statistics Committee of Russia, only for 4 years the mortality rate from AMI increased by 12.5% (Bokeria L. A. 2005). The age-standardized mortality rates for men of working age from AMI are more than 8 times higher than for a similar contingent of the female population of Russia (Bokeria L. A. and others, 2005). In Kyrgyzstan, CVD occupies the 1 st place in the structure of total mortality. The standardized death rate from CVD is 53.7 per 100,000 population. The increase in mortality for the years from 1990 till 2004 in working age was an average of 16.2%. The maximum increase in mortality was observed at the age of 30-39 years and amounted to 19.6% of the CAD.(Mirrahimov V. M.,2012). At
dial infarction became widespread. There is a sufficient number of published works on the development and organization of rehabilitation of patients after AMI in the second half of the XX century (Kochorova L. V., 1981; Romanov A. I., 1985; Niko-laeva L. F., Aronov D. M., 1998; Chasov E. I., 2010; Gusev A. O., Kovalchuk V. V., 2011, Gusev A. O., 2014.), and foreign authors (Koch M., Blumenthal W., 1981; Cassak D., 1984). However, over the past 20-30 years, both diagnostic (coronaroaortography) and therapeutic (stenting, shunting) methods and possibilities for patients with AMI have changed markedly. The organization of inpatient care for the population (differentiation of bed capacity according to the degree of intensity of treatment and care and the restructuring of the hospital bed facility) and the entire health care system in connection with the introduction of the CMI system have undergone considerable reform. Meanwhile, if clinical aspects of the rehabilitation of patients with AMI are covered in many studies (Barbarash R. L. h oth.., 2001; Povo-rinskiy A. L., Sokolova L. A., 2008; Aronov D. M. h gp., 2009; Arutyunov G. P. and oth., 2003, 2009) and quite extensively are covered in the literature the issues of disability after the disease of the circulatory system (BSC) (Baskakova N. P., 2006; Maru-sheva L. G., German S. V., 2010; Domanyanko A. A., Nadel R. V., 2010; Samorodskaya I. V., Fufaev E. N., 2011), then the organizational issues of rehabilitation of patients after AMI, with modern methods of diagnosis and intensive treatment of such patients, the need of the population in inpatient beds after AMI in the literature is not enough, which determines the relevance of the chosen research topic.
The aim of the study is to substantiate the need for medical rehabilitation for patients after acute myocardial infarction and to develop proposals for optimizing the work of inpatient departments of medical rehabilitation of the cardiac profile.
Objectives of the study are:
1. To analyze the statistics of the morbidity of the population with cardiovascular diseases
2. To present the features of the medical and statistical characteristics of patients with acute myocardial infarction (AMI) hospitalized in the cardiology department of the Kyrgyzian Scientific Research Institute of Balneology and Rehabilitation.
3. Determine the need of the population in hospital beds for the rehabilitation of patients after AMI and develop proposals for improving the work of cardiac sections in a medium-altitude mountains hospital.
Subject of the study: patients with myocardial infarction hospitalized for phased rehabilitation in the cardiology department of the Kyrgyzian Scientific Research Institute of Balneology and Rehabilitation.
In the course of the study from 2012 to 2015, 1280 outpatient cards of patients who were on dispensary registration in the Centers of Family Medicine (CFM) Bishkek City, were studied, 148 medical history of patients who received rehabilitation treatment in the department of cardiology of the Kyrgyzian Scientific Research Institute of Balneology and Rehabilitation, as well as 142 questionnaires for doctors of Centers of Family Medicine (CFM) and the Kyrgyzian Scientific Research Institute of Balneology and Rehabilitation.
The program of rehabilitation measures included:
I. Dietary food. Lipid-lowering diet
II. Basis maintenance medication was conducted in accordance with international recommendations and included: antihypertensive, lipid-lowering and antiplatelet therapy.
III. Physiotherapy in combination with clima-totherapy:
1. Morning hygienic gymnastics from 5 to 15 minutes
2. Therapeutic gymnastics was prescribed during the day in the form of aerobic exercise at a free pace on the main muscle groups — the neck, back, abdomen, limbs starting at 5, then gradually adjusted to 10-12 repetitions per procedure. Breathing exercises and stretching exercises were necessarily included.
3. Special physical training was conducted on the cardiorespiratory complex, the company "Schiller" with computerized ECG and blood pressure monitoring.
4. Walking was also used as a means of physical training — walking on an even surface from 500 m gradually to 3 km a day, then later as mastering in the form of a terrenkur. Assignments were made in free regime on the territory of the sanatorium and sleep on the open veranda. Classes were conducted indi-
Table 1. - Achieving target levels of underwent AMI, who were
vidually with a specialist in exercise therapy, taking into account the individual tolerability of physical exertion, the severity of the disease and concomitant pathology.
IV. Psychological rehabilitation was carried out by a doctor-psychotherapist and was conducted both individually and in the form of group psychotherapy. If necessary, psychopharmacotherapy was prescribed. risk factors for CAD in patients who on rehabilitation treatment
Years of observation
No. Risk factors for CAD 2014 2015 2016 (6 months)
Аbs. % Аbs. % Abs. %
1. Arterial hypertension 14 65,3 21 90,2 18 87,2
2. Smoking 7 41,3 5 40,1 2 54,8
3. Hypercholesterolemia 4 26,7 9 43,8 3 72,5
4. Overweight 10 14,3 6 18,3 4 29,0
5. Dyslipidaemia 9 16,1 8 53,3 3 22,5
6. Impairment of glucose tolerance 6 9,0 11 74,7 6 86,0
7. Diabetes 4 7,1 13 64,7 5 80,0
Specialized cardiologic rehabilitation of patients with AMI under conditions of mid-range hospital is more effective than rehabilitation in outpatient settings in Bishkek, since it allows reaching the target
levels of the main risk factors for CAD to a much greater extent. A phased combination of sanatorium and outpatient rehabilitation is advisable.
Practical recommendations:
1. To use the stage of sanatorium rehabilitation 2. Conduct regular monitoring of the quality and
of patients who underwent AMI, in the conditions effectiveness of rehabilitation care for patients with
of an medium-altitude mountains hospital. AMI in regions and in the country.
References:
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