Algorithm for individualization of complex treatment of patients with neurocirculatory dystonia at the rehabilitation stage

The dissertation is devoted to the development of an algorithm for individualizing the complex treatment of patients with neurocirculatory dystonia at the rehabilitation stage. The study aims to investigate the clinical-functional state and vegetative homeostasis of this category of patients under sanatorium-resort treatment conditions, as well as to substantiate a basic comprehensive treatment program and the mechanisms of its individual adaptation, taking into account the characteristics of the adaptive capacities of the organism. Particular attention is paid to the development of objective criteria for evaluating the effectiveness of individual treatment programs, based on the integration of nosological and adaptive approaches.

The practical significance of the work is associated with the implementation of the developed programs in the activities of medical-preventive institutions and sanatorium-resort organizations, which makes it possible to optimize the treatment process through the differentiated prescription of therapeutic physical factors, phyto- and pharmacotherapy, and health-improving diets, as well as to objectify the evaluation of treatment results using quantitative comprehensive criteria.

Relevance of the problem

Neurocirculatory dystonia (NCD) currently represents a pressing medical and social problem, due to the wide prevalence of the disease among the young population, the loss of working capacity by patients in the most active creative age, and the possibility of transformation into chronic somatic pathology (hypertensive disease, ischemic heart disease, myocardiodystrophy) (Pokalev G.M., 1994; Strelkova N.I., 1999; Tsaregorodtseva L.V., 2003; Nezhkina N.N., Boshko I.E., 2003; Abbakumov S.A., 1997, 2003; Makolkin V.I., 1995, 2004 et al.).

Despite the many-year history of studying the issue, there is still no unified concept of this problem in the literature: the issues of terminology, etiopathogenesis and classification of NCD are debated, and its place among pathological conditions has not been determined (Vein A.M. et al., 1971, 1993; Pokalev G.M., 1977, 1989; Makolkin V.I., Abbakumov S.A., 1985, 2003; Karapata A.P., 1987; Beevers D.J., 1987; Vinogradov A.F., 1999; Kurochkin A.A., 2003; Neudakhin E.V., 2003 et al.). Despite the absence of the term NCD in the International Classification of Diseases, 10th revision, it is most frequently used by clinicians of various specialties to denote dysregulatory disorders of the cardiovascular system, and for this reason it is used in the present work.

The diagnosis of NCD is associated with certain difficulties, which is explained on the one hand by the polymorphism of clinical manifestations, and on the other hand by the absence of a morphological substrate and generally accepted diagnostic criteria of the disease (Vein A.M. et al., 1981; Strelkova N.I., 1999; Abbakumov S.A., 1997, 2003; Makolkin V.I., 1995, 2004; et al.). In this regard, there is a growing interest in the use of examination methods that allow identifying and assessing functional changes in the organism in this category of patients (Khanina S.B., 1987; Korochkin V.L., 1989; Baranov M.V., 1993; Bova A.A., 1997; Sashina E.L., 2004).

The heterogeneity of the clinical picture of NCD requires an individual differentiated approach in prescribing complex treatment (Pokalev G.M. et al., 1985; Abbakumov S.A., 2003; Makolkin V.I., 2004; Strelkova N.I., Bobrovnitsky I.P., 2006). To date, this problem has not been definitively resolved. At the same time, it has been established that the success of treatment largely depends on the correct assessment of the adaptive capacities of the organism and their targeted and adequate stimulation (Strelkova N.I., 2002; Razumov A.N., 2003; Sokolov A.V., 2004).

Thus, the search for ways to diagnose functional changes in the organism of patients with NCD and the development of methods for their adequate correction is relevant.

Aim of the study:

Improvement of the immediate results of treatment of patients with NCD at the rehabilitation stage through the substantiation, development and application of individual comprehensive treatment programs.

Objectives of the study:

1. To study the clinical-functional state and vegetative homeostasis in patients with NCD at the rehabilitation stage.

2. To develop and implement a basic comprehensive treatment program for patients with NCD, meeting modern principles of treatment and including an optimal combination of corrective methods.

3. To develop an algorithm for individual adaptation of the basic comprehensive treatment program, taking into account the characteristics of the clinical-functional state and vegetative status of patients with NCD.

4. To evaluate the effectiveness of the application of individual comprehensive treatment programs at the rehabilitation stage.

Scientific novelty of the study:

For the first time at the rehabilitation stage, a comprehensive examination of patients with NCD was carried out, including, along with nosological diagnosis, an assessment of the adaptive capacities of the organism, allowing the identification of individual characteristics of the functional state of a particular patient. Based on the obtained results of the examination, individual comprehensive treatment programs for patients with NCD were developed and implemented. Comprehensive objective criteria for evaluating the effectiveness of individual treatment programs were developed and applied, based on the principle of integration of nosological and adaptive approaches in the evaluation of treatment results.

Practical significance of the study:

The application of the developed comprehensive individual treatment programs in patients with NCD allows:

• Optimization of the treatment process through the targeted application of therapeutic physical factors, phyto- and pharmacotherapy, health-improving diets;

• Implementation of a differentiated approach to the prescription of treatment, taking into account the identified features of the clinical-functional state and vegetative status;

• Objectification of the evaluation of the results of the conducted treatment on the basis of quantitative comprehensive criteria that take into account the dynamics of subjective sensations of the patient, clinical-instrumental data and indicators of the adaptive capacities of the organism before and after treatment.

Statements submitted for defense:

A comprehensive examination of patients with NCD at the rehabilitation stage allows identifying a number of individual functional features caused by the state of adaptive and physical capacities of the organism, vegetative homeostasis, and the psycho-emotional sphere.

The identified individual functional features of the organism in patients with NCD are advisable to use as reference signs when prescribing individual comprehensive treatment programs.

Analysis of the dynamics of the state of adaptive capacities of the organism, along with taking into account changes in clinical and instrumental-laboratory indicators before and after treatment, allows an objective evaluation of the effectiveness of individual treatment programs in patients with NCD.

Implementation of the study results:

The results of the study are used in the practical activities of the clinical sanatorium "Priokskiye Dali" of LLC "Mostransgaz", MU "Lukhovitskaya CRH", MUZ "Ozyorskaya CRH", the polyclinic of CJSC "PRO-SAM" of the city of Ryazan, the polyclinic of GUZ ROKB, and at the Department of Restorative Medicine and Balneology of SEI HPE "Ryazan State Medical University named after Academician I.P. Pavlov of Roszdrav".

Publications: 13 printed works have been published on the topic of the dissertation.

Approbation of the work:

The main results of the work were reported at:

• The 6th International Conference "Modern Technologies of Restorative Medicine", Sochi, 2003.

• The All-Russian Forum "Zdravnitsa-2003", Sochi, 2003.

• The 7th International Conference "Modern Technologies of Restorative Medicine", Sochi, 2004.

• The International Congress "Restorative Medicine and Rehabilitation - 2005", Moscow, 2005.

• The 8th International Conference "Modern Technologies of Restorative Medicine", Sochi, 2005.

• The Scientific-Practical Conference "Current Issues of the Formation and Development of Medical Care in Departmental Medical Institutions of OJSC "Gazprom", Moscow, 2005.

• The Inter-Departmental Meeting of SEI HPE "RyazGMU of Roszdrav", 2006.