6 курс / Медицинская реабилитация, ЛФК, Спортивная медицина / Клиническая_геронтология_2011_№12_том_17

PREVENTION AND TREATMENT OF THROMBOTIC COMPLICATIONS OF PERCUTANEOUS INTERVENTIONS AND ACUTE CORONARY SYNDROME USING INHIBITORS OF GLYCOPROTEIN IIB/IIIA-RECEPTOR OF PLATELET

D.V. Preobrazhenskiy , D.V. Fettser1

First Moscow State Medical University,

Regional Clinical Hospital, Lipetsk

1Fettser D.V., C.M.S., MESC, Department of X-Ray

Diagnostics and Treatment of the Lipetsk Regional Clinical

Hospital.

Antithrombotic drugs are an integral part of medical treatment and intervention strategies for the reduction of thrombotic complications, including patients with acute coronary syndrome. Inhibitors of glycoprotein IIb/IIIa-receptor of platelets are a group of widely used antithrombotic drugs. The authors analyzed the results of randomized trials evaluating the efficacy and safety of the approved inhibitors – abciximab, eptifibatide and tirofiban in acute coronary syndromes and planned and emergency percutaneous coronary intervention. The results of analysis of clinical cases and other circumstances may influence the choice of these inhibitors for the prevention and treatment of thrombotic complications. An algorithm for selecting an inhibitor depending on the situation and nosology was developed in order to facilitate decision-making by cardiologist or interventional cardiologist.

OUT-PATIENT DRUG THERAPY OF ELDERLY PATIENTS WITH CHRONIC HEART FAILURE

Ye.A. Temnikova1

Omsk State Medical Academy

1 Temnikova Yelena Andreyevna, C.M.S., Associate Professor at the Department of Internal Medicine and Outpatient Therapy of the Omsk State Medical Academy. Òål.: (3812) 65-89-67. E-mail: temnikovaomsk@mail.ru.

Typical practice of out-patient drug therapy in 421 patients with chronic heart failure aged 75 years and older was analyzed. Major medical errors were associated with polytherapy, which limits the use of drugs recommended for chronic heart failure treatment. But low compliance was the main reason for the low efficiency of the treatment.

BIOLOGICAL RHYTHMS AND AGE

Ye.D. Golovanova1, G.N. Fedorov2, V.N. Grigoryeva,

S.M. Bazhenov, N.N. Silayeva, T.V. Osipova

Smolensk State Medical Academy,

Smolensk Regional Clinical Hospital for War Veterans

1Golovanova Yelena Dmitriyevna, D.M.S., Associate Professor at the Postgraduate Department of Therapy, Ultrasonic and Functional Diagnostics of the Smolensk State Medical Academy. Òål.: 8 (4812) 59-92-03.

E-mail: GolovanovaED@rambler.ru.

2 Fedorov Gennadiy Nikolayevich, C.M.S., Head of Laboratory, Senior Researcher. E-mail: Gennady-1950@mail.ru.

The relationship between circadian rhythm of glucocorticoid secretion and circadian rhythm of blood pressure was studied in 200 men with normal blood pressure and hypertension in different age periods. It was found out that in case of accelerated rate of biological aging there were marked changes in the circadian rhythm of cortisol secretion, reflected in the change of amplitude day-night period, as well as a violation of the variability of blood pressure and prevalence of pathological types of the daily index of blood pressure. In patients with slow aging function of the «biological clock» was preserved.

EMERGENCY MEDICAL CARE TO ELDERLY PATIENTS WITH ATRIAL FIBRILLATION IN CORONARY ARTERY DISEASE

AT THE PRE-HOSPITAL STAGE

V.G. Yepifanov, V.T. Dolgikh1, V.N. Lukach

Omsk Municipal Ambulance Station, Omsk State Medical Academy

1 Dolgikh V.T., D.M.S., Professor,

Head of the Pathophysiology with Clinical Course of the Omsk State Medical Academy, Academician of the Russian Academy of Medical and Technical Sciences. Òål.: (3821) 23-03-784; 8-913-155-28-60. E-mail: prof_dolgih@mail.ru.

A comparative retrospective study of outcomes of emergency medical care in 398 patients (mean age 72,9 ± 8,7 years) with coronary artery disease and uncomplicated episode of atrial fibrillation with an assessment of the management at the prehospital stage was carried out. It was found out that treatment of atrial fibrillation at the prehospital stage was ineffective in the first hour of observation. More than 86% of the atrial fibrillation attacks were eliminated by the end of the first day regardless of the applied anti-arrhythmic drug. The suggested management of patients with atrial fibrillation attack in coronary artery disease at the prehospital stage up to 24 hours allows reducing the cost of treatment without decrease in the clinical effect of antiarrhythmic therapy, it also decrease the time spent by ambulance brigade and enhance its operational turnaround.

CHRONIC HEART FAILURE AND OBESITY

IN ELDERLY PATIENTS: DIAGNOSTIC ISSUES

L.I. Malinova1, T.S. Silina, S.S. Shuvalov,

T.P. Denisova

Saratov Research Institute of Cardiology, Saratov State Medical University

1 Malinina Lidiya Igorevna, D.M.S.,

Chief Researcher of the Emergency Cardiology Laboratory of the Saratov Research Institute of Cardiology.

Òål.: +7 (905) 322-35-34. E-mail: lidia.malinova@gmail.com.

The quality of diagnostics and frequency parameters of clinical signs and symptoms of ischemic congestive heart failure (CHF) in the elderly with normal body weight and obesity were studied. An analytical evaluation of the quality of the CHF diagnosis – an index of CHF diagnosis was offered. Analysis of the strength and nature of this index in the studied group of patients allowed formulating the particular diagnostic algorithm of CHF in the elderly with normal body weight and obesity.

MARKERS OF MYOCARDIAL DYSFUNCTION IN THE ASSESSMENT OF THE SEVERITY

CHRONIC HEART FAILURE IN ELDERLY PATIENTS WITH ARTERIAL HYPERTENSION

N.V. Medvedev1, N.K. Gorshunova2

Kursk State Medical University

1Medvedev Nikolay Vyacheslavovich, C.M.S., Assistant at the Outpatient Therapy Department of the Kursk State Medical University. Òål.: 4712-26-36-90; 8-910-213-35-34. E-mail: nickolmed@rambler.ru.

2Gorshunova Nina Kornilovna, D.M.S., Professor, Head of the Outpatient Therapy Department of the Kursk State Medical University. Òål.: 4712-26-36-90; 8-960-685-36-45. E-mail: gorsh@kursknet.ru.

In order to determine the role of the biochemical and functional parameters associated with the development of myocardial dysfunction to assess the severity of chronic heart failure (CHF) in elderly

patients on a background of hypertension 198 patients with essential hypertension stage II, the average age – 65, 8 ± 1,8 years were examined using Doppler echocardiography. It was found out that the following indicators should be considered as the criteria of the severity of CHF in patients with hypertension: CHF with left ventricular systolic dysfunction – ejection fraction, end systolic size, serum brain natriuretic peptide; CHF with diastolic dysfunction – markers of left ventricular hypertrophy, diastolic index; CHF with concomitant left ventricular dysfunction – ejection fraction, the concentration of brain natriuretic peptide, diastolic indexes and end-diastolic size and volume of the left ventricle.

CARDIORENAL SYNDROME AND ANEMIA

IN ELDERLY PATIENTS WITH CHRONIC HEART FAILURE IN URBAN MEDICAL DISTRICT

A.G. Uteva1, L.T. Pimenov2

Izhevsk State Medical Academy,

Municipal Clinical Hospital # 7, Izhevsk

1 Uteva Anastasiya Gennadyevna, physician

at the Municipal Clinical Hospital # 7. Òål.: 8-919-914-11-13. E-mail: auteva@rambler.ru.

2 Pimenov Leonid Timofeyevich, D.M.S., Professor, Head of the Department of General Practice and Internal Medicine. Òål.: +7 (3412) 52-62-01.

Renal function and the prevalence of anemia in elderly patients with chronic heart failure (CHF) living in the urban area and responded to a special invitation to the physician were studied. There has been an increase in the number of patients with anemia with age. The higher the functional class of heart failure, the lower was the level of hemoglobin in the blood. Renal dysfunction in patients with chronic heart failure over 60 years showed decline in glomerular filtration rate at a normal level of creatinine and urea in the blood serum. In patients with anemia, glomerular filtration rate decreased more than 60 ml/min. According to the current conventional criteria, almost 50% of patients with chronic heart failure over 75 years suffered from chronic kidney disease.

AMLODIPINE IN THE TREATMENT

OF HYPERTENSION IN POSTMENOPAUSAL WOMEN

V.M. Tsareva1, N.Yu. Khozyainova, Yu.V. Kurbasova,

A.N. Agafonov2, N.V. Romanchenko3

Smolensk State Medical Academy,

Smolensk Municipal Polyclinic # 4,

Smolensk Regional Hospital

1Tsareva Valentina Mikhaylovna, C.M.S., Assistant at the Postgraduate Department of Therapy,

Ultrasonic and Functional Diagnostics of the Smolensk State Medical Academy. Òål.: 8-903-698-81-12.

E-mail: tsarev.al@mail.ru.

2Agafonov Andrey Nikolayevich, physician, ÌËÏÓ, Smolensk Municipal Polyclinic # 4. Òål.: 8-906-517-84-41.

3Romanchenko Natalya Vasilyevna, physician

of ultrasonic diagnostics. Òål.: 8-910-711-33-26.

Thirty six postmenopausal women with hypertension of the 1-st and 2-nd degree of medium and high risk were examined. At least 2 weeks prior to their inclusion in the study all antihypertensive drugs were abolished. All patients were administered amlodipine 5–10 mg/day. At baseline and after 24 weeks of therapy daily blood pressure monitoring, Holter monitoring and echocardiography were performed in all patients. According to the results, amlodipine therapy provided adequate control of blood pressure during the day, a positive effect on the altered blood pressure profile and the structural and functional properties of the heart, and it did not increase the electrical instability of myocardium. Amlodipine is an effective and well-tolerated antihypertensive agent with marked cardioprotective properties in postmenopausal women with hypertension.

CLINICAL AND ECONOMIC ANALYSIS

OF TREATING PATIENTS WITH HYPERTENSION USING ACE INHIBITORS

S.V. Shiganov, V.V. Bayev, P.A. Vorobyev1

Medical and Psychosocial Institute of the Khakas State University named after N.F. Katanov,

First Moscow State Medical University, Interregional Public Organization

«Russian Society for Pharmacoeconomics and Outcomes Research»

1 Vorobyev Pavel Andreyevich, D.M.S., Professor, Head of the Department of Hematology and Geriatrics, RSPOR President. Òål.: 8 (499) 782-31-09. E-mail:mtpndm@mail.ru.

The results of the comparative pharmacoeconomic evaluation of ACE inhibitors enalapril (Ozon, Russia) and perindopril (Servier, France) in terms of cost – effectiveness analysis of medicines and medical services in the municipal cardiology department were discussed.

AGING OF THE POPULATION AND HEALTH CARE MODERNIZATION PROGRAM

I.A. Gekht1, G.B. Artemyeva2

Samara State Medical University,

Ryazan Regional Health Insurance Fund

1 Gekht Igor Abramovich, D.M.S., Professor,

Head of the Health Insurance Department of the Samara State Medical University. Òål.: 8-917-259-30-36. E-mail: geht@samtfoms.ru.

2 Artemyeva Galina Borisovna, C.M.S., Executive Director of the Ryazan Regional Health Insurance Fund.

Òål.: 8-903-641-78-44.

Current demographic trends in the country should be taken into account during the modernization of health care. Aging of the population is one of the important problems, which requires both the implementation of social development projects and health-economic activities in terms of the health modernization program.

SUBJECTIVE QUALITY OF LIFE IN ELDERLY PATIENTS OF THE FEDERAL GERONTOLOGY CENTER «PEREDELKINO», MOSCOW,

AND VORONEZH REGIONAL GERONTOLOGY CENTER

I.V. Sakorenko1, N.V. Klevtsova, G.L. Zuykov,

V.A. Kostenko, T.I. Grekova, O.E. Sinitsyna2,

V.I. Dontsov

Federal Gerontology Center «Peredelkino», Moscow,

Moscow State Medical Dental University,

Voronezh Regional Gerontology Center

1Sakorenko Irina Vladimirovna – freelance laboratory member, psychologist. Òål.: 8-910-343-62-37.

E-mail: ira-vd@inbox.ru.

2Sinitsyna Olga Yevgenyevna, Director of the Voronezh Regional Gerontology Center. Òål.: (473) 236-44-17.

Different aspects of subjective quality of life of 109 patients were studied in the Federal Gerontology Center «Peredelkino» (Moscow) and in the Voronezh Regional Gerontology Center. The influence of physical, psychological and other factors was analyzed. Evaluation of subjective quality of life included satisfaction with life in general before and after admission to the Gerontology Center. It was found out that life satisfaction (overall subjective quality of life) was higher among Moscow patients compared to Voronezh ones. Subjective quality of life measured by restrictions and prohibitions was reduced in both centers; however it was lower in the «Peredelkino» Gerontology Center than in Voronezh Gerontology Center.

ПРОФИЛАКТИКА И ЛЕЧЕНИЕ ТРОМБОТИЧЕСКИХ ОСЛОЖНЕНИЙ ПРИ ЧРЕСКОЖНЫХ ВМЕШАТЕЛЬСТВАХ И ОСТРОМ КОРОНАРНОМ СИНДРОМЕ ИНГИБИТОРАМИ ГЛИКОПРОТЕИНОВЫХ IIb/IIIa-РЕЦЕПТОРОВ ТРОМБОЦИТОВ

Д.В. Преображенский , Д.В. Фитцер . . . . . . . . . . . . . . . . .3

PREVENTION AND TREATMENT OF THROMBOTIC COMPLICATIONS OF PERCUTANEOUS INTERVENTIONS AND ACUTE CORONARY SYNDROME USING INHIBITORS OF GLYCOPROTEIN IIb/IIIa-RECEPTOR OF PLATELET

D.V. Preobrazhenskiy , D.V. Fettser . . . . . . . . . . . . . . . 3

ОРИГИНАЛЬНЫЕ СТАТЬИ

МЕДИКАМЕНТОЗНАЯ ТЕРАПИЯ АМБУЛАТОРНЫХ ПАЦИЕНТОВ СТАРШЕГО ВОЗРАСТА С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Е.А. Темникова. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

БИОЛОГИЧЕСКИЕ РИТМЫ И ВОЗРАСТ

Е.Д. Голованова, Г.Н. Федоров, В.Н. Григорьева, С.М. Баженов, Н.Н. Силаева, Т.В. Осипова . . . . . . . . . . . 16

НЕОТЛОЖНАЯ МЕДИЦИНСКАЯ ПОМОЩЬ ПОЖИЛЫМ ПАЦИЕНТАМ С ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ ПРИ ИБС НА ГОСПИТАЛЬНОМ ЭТАПЕ

В.Г. Епифанов, В.Т. Долгих, В.Н. Лукач. . . . . . . . . . . . . . 21

ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ И ОЖИРЕНИЕ У ПАЦИЕНТОВ СТАРЧЕСКОГО ВОЗРАСТА: ДИАГНОСТИЧЕСКИЕ ПРОБЛЕМЫ

Л.И. Малинова, Т.С. Силина, С.С. Шувалов, Т. П. Денисова . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

МАРКЕРЫ ДИСФУНКЦИИ МИОКАРДА В ОЦЕНКЕ ТЯЖЕСТИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У БОЛЬНЫХ С АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙ ПОЖИЛОГО ВОЗРАСТА

Н.В. Медведев, Н.К. Горшунова . . . . . . . . . . . . . . . . . . . . 31

КАРДИОРЕНАЛЬНЫЙ СИНДРОМ И АНЕМИЯ У БОЛЬНЫХ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ

НЕДОСТАТОЧНОСТЬЮ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА ГОРОДСКОГО ВРАЧЕБНОГО УЧАСТКА

А.Г. Утева, Л.Т. Пименов. . . . . . . . . . . . . . . . . . . . . . . . . . 36

ORIGINAL ARTICLES

OUT-PATIENT DRUG THERAPY

OF ELDERLY PATIENTS WITH CHRONIC

HEART FAILURE

Ye.A. Temnikova . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

BIOLOGICAL RHYTHMS AND AGE

Ye.D. Golovanova, G.N. Fedorov, V.N. Grigoryeva,

S.M. Bazhenov, N.N. Silayeva, T.V. Osipova. . . . . . . . . 16

EMERGENCY MEDICAL CARE TO ELDERLY PATIENTS WITH ATRIAL FIBRILLATION IN CORONARY ARTERY DISEASE AT THE PRE-HOSPITAL STAGE

V.G. Yepifanov, V.T. Dolgikh, V.N. Lukach . . . . . . . . . 21

CHRONIC HEART FAILURE AND OBESITY IN ELDERLY PATIENTS:

DIAGNOSTIC ISSUES

L.I. Malinova, T.S. Silina, S.S. Shuvalov,

T.P. Denisova. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

MARKERS OF MYOCARDIAL DYSFUNCTION

IN THE ASSESSMENT OF THE SEVERITY CHRONIC HEART FAILURE IN ELDERLY PATIENTS

WITH ARTERIAL HYPERTENSION

N.V. Medvedev, N.K. Gorshunova . . . . . . . . . . . . . . . . 31

CARDIORENAL SYNDROME

AND ANEMIA IN ELDERLY PATIENTS

WITH CHRONIC HEART FAILURE

IN URBAN MEDICAL DISTRICT

A.G. Uteva, L.T. Pimenov . . . . . . . . . . . . . . . . . . . . . . 36

АМЛОДИПИН В ЛЕЧЕНИИ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ У ЖЕНЩИН В ПОСТМЕНОПАУЗЕ

В.М. Царева, Н.Ю. Хозяинова, Ю.В. Курбасова, А.Н. Агафонов, Н.В. Романченко. . . . . . . . . . . . . . . . . . . .40

КЛИНИКО-ЭКОНОМИЧЕСКИЙ АНАЛИЗ СТАЦИОНАРНОГО ЛЕЧЕНИЯ ИНГИБИТОРАМИ АПФ ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙ

С.В. Шиганов, В.В. Баев, П.А. Воробьев. . . . . . . . . . . . . .45

СОЦИАЛЬНАЯ МЕДИЦИНА И ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ

ПОСТАРЕНИЕ НАСЕЛЕНИЯ И ПРОГРАММЫ МОДЕРНИЗАЦИИ ЗДРАВООХРАНЕНИЯ

И.А. Гехт, Г.Б. Артемьева. . . . . . . . . . . . . . . . . . . . . . . . . .51

СУБЪЕКТИВНОЕ КАЧЕСТВО ЖИЗНИ ПОЖИЛЫХ ЛЮДЕЙ ФЕДЕРАЛЬНОГО ГЕРОНТОЛОГИЧЕСКОГО ЦЕНТРА «ПЕРЕДЕЛКИНО», МОСКВА И ВОРОНЕЖСКОГО ОБЛАСТНОГО ГЕРОНТОЛОГИЧЕСКОГО ЦЕНТРА

И.В. Сакоренко, Н.В. Клевцова, Г.Л. Зуйков, В.А. Костенко, Т.И. Грекова, О.Е. Синицына,

В.И. Донцов . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53

ТЕЗИСЫ К XVI МЕЖДУНАРОДНОЙ НАУЧНОПРАКТИЧЕСКОЙ КОНФЕРЕНЦИИ «ПОЖИЛОЙ БОЛЬНОЙ. КАЧЕСТВО ЖИЗНИ»

(Продолжение). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59

SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121

AMLODIPINE IN THE TREATMENT OF HYPERTENSION IN POSTMENOPAUSAL WOMEN

V.M. Tsareva, N.Yu. Khozyainova, Yu.V. Kurbasova,

A.N. Agafonov, N.V. Romanchenko . . . . . . . . . . . . . . . 40

CLINICAL AND ECONOMIC ANALYSIS OF TREATING PATIENTS WITH HYPERTENSION USING ACE INHIBITORS

S.V. Shiganov, V.V. Bayev, P.A. Vorobyev . . . . . . . . . . 45

SOCIAL MEDICINE

AND PUBLIC HEALTH

AGING OF THE POPULATION AND HEALTH CARE MODERNIZATION PROGRAM

I.A. Gekht, G.B. Artemyeva . . . . . . . . . . . . . . . . . . . . . 51

SUBJECTIVE QUALITY OF LIFE

IN ELDERLY PATIENTS OF THE FEDERAL GERONTOLOGY CENTER «PEREDELKINO», MOSCOW, AND VORONEZH REGIONAL GERONTOLOGY CENTER

I.V. Sakorenko, N.V. Klevtsova, G.L. Zuykov, V.A. Kostenko, T.I. Grekova, O.E. Sinitsyna,

V.I. Dontsov . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

ABSTRACTS OF THE XVI INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE «THE ELDERLY PATIENT.

QUALITY OF LIFE» . . . . . . . . . . . . . . . . . . . . . . . . . 59

SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121