Структурно-функциональные изменения сердечно-сосудистой системы у машинистов локомотивного депо с АГ и эффективность восстановительной программы на поликлиническом этапе реабилитации

The study is devoted to the investigation of structural and functional changes in the cardiovascular system in locomotive depot drivers suffering from arterial hypertension, as well as to the evaluation of the effectiveness of a restorative programme of psychophysiological adaptation applied at the outpatient stage of rehabilitation. The work combines epidemiological, clinical-instrumental and psychophysiological approaches: cardiovascular risk factors, the character of left ventricular myocardial remodelling, the elastic properties of the common carotid and femoral arteries, the state of autonomic regulation of cardiac rhythm, and the psycho-emotional status of railway transport workers are analysed. The professional activity of locomotive drivers is considered with regard to the exposure to a complex of adverse occupational factors, including intense psycho-emotional stress and round-the-clock work schedules.

Within the framework of the dissertation, the dynamics of the functional reserves of the cardiovascular system, autonomic balance, and psychological adaptation in drivers with arterial hypertension resulting from the application of the developed restorative programme are evaluated. The data obtained are compared with a control group and discussed from the standpoint of prevention of cardiovascular complications, preservation of occupational fitness, and working longevity of locomotive depot employees.

Arterial hypertension is currently the most widespread cardiovascular disease among working-age individuals, both in our country and abroad [12,143,149]. The presence of arterial hypertension is associated with a significant increase in the risk of cardiovascular complications and mortality [53,118,153]. Analysis of the prevalence of arterial hypertension among railway transport workers has shown that among drivers and assistant drivers of locomotive depots, the condition occurs 1.5 times more frequently at the age of 35–49 than among persons not involved in train traffic control. Among them, a high level of morbidity with temporary loss of working capacity is observed, along with a growing number of cases of occupational unfitness and primary disability due to diseases of the circulatory system [122]. Attention to this occupational category is also explained by the fact that the professional training of drivers and their assistants involves considerable expenditure and therefore imposes increased requirements on the preservation of their health, occupational fitness, and the need for working longevity [43].

The work of a locomotive driver is associated with exposure to a complex of adverse occupational factors, the leading one being intense and prolonged psycho-emotional stress combined with frequent acute stressful situations and the need to perform work on a round-the-clock basis, which leads to external and internal desynchronization of circadian rhythms, changes in higher nervous activity, and a decrease in the functional reserves of the circulatory system [112,130]. According to modern concepts, systemic dysregulatory dysfunction and maladaptation play a decisive role in the formation of arterial hypertension, promoting the development of left ventricular hypertrophy, which is an unfavourable prognostic sign [119,149,202].

The search for new medical technologies to increase the effectiveness of treatment of arterial hypertension at the outpatient stage, aimed at enhancing nonspecific adaptation mechanisms, the functional reserves of the cardiovascular system, and psychocorrection, contributing to improved control of arterial hypertension and the prevention of its complications, remains relevant.

The scarcity of data on the relationship between the state of the autonomic and cardiovascular systems and the psycho-emotional status of drivers with arterial hypertension, as well as the absence of data on the use of a restorative programme of psychophysiological adaptation at the outpatient stage, provided the rationale for our study.

Objective of the study:

To determine the structural and functional changes in the cardiovascular system in locomotive drivers with arterial hypertension and to demonstrate the effectiveness of a restorative programme at the outpatient stage of rehabilitation.

Tasks of the study:

1. To determine the character of left ventricular myocardial remodelling and the elastic properties of the common carotid and femoral arteries in patients with arterial hypertension.

2. To identify cardiovascular risk factors and the frequency of arterial hypertension among locomotive depot drivers.

3. To study heart rate variability, the functional reserves of the cardiovascular system, and the psycho-emotional status of drivers with arterial hypertension, as well as the dynamics of these indicators resulting from the application of the restorative programme at the outpatient stage of rehabilitation.

4. To evaluate the impact of the restorative programme on autonomic regulation, the functional reserves of the cardiovascular system, psychological adaptation, and quality of life in locomotive drivers with arterial hypertension.

Scientific novelty

Based on the results of a single-stage prospective study, the health status and epidemiological aspects of arterial hypertension have been examined, and a high frequency of cardiovascular risk factors has been established in depot drivers.

A comprehensive study of the cardiovascular system, autonomic and psycho-emotional status in drivers with arterial hypertension has established an interrelation between autonomic disturbances and changes in psycho-emotional status.

The predominance of the concentric type of left ventricular remodelling has been revealed, with its frequency increasing alongside the duration of the disease.

Changes in vascular hemodynamics are characterized by reduced elasticity and increased stiffness of the common carotid and femoral arteries. It has been determined that increased stiffness of the main arteries may be regarded as an integral indicator of endothelial dysfunction.

The effectiveness of the developed restorative programme of psychophysiological correction has been proven, with reductions in anxiety and improvements in the functional reserves of the cardiovascular system demonstrated in drivers with arterial hypertension.

Scientific and practical significance of the work

The necessity of a comprehensive examination of drivers with arterial hypertension has been shown, including the study of the elastic properties of the main arteries for the assessment of target organs and of the overall functional state for the detection and correction of autonomic and psycho-emotional disturbances.

The expediency of including the developed restorative programme in the combined therapy of arterial hypertension has been established, as it increases the effectiveness of treatment and reduces the risk of cardiovascular complications and economic losses.

On the basis of the study materials, a health database of depot drivers has been created, used for monitoring functional and current psycho-emotional state and for evaluating the effectiveness of treatment.

Statements submitted for defence

1. Changes in intracardiac and vascular hemodynamics in depot drivers with arterial hypertension are characterized by left ventricular remodelling, predominantly of the concentric type, reduced elasticity and increased stiffness of the common carotid and femoral arteries, the latter being regarded as an integral indicator of endothelial dysfunction.

2. Investigation of the functional state and psychological profile of drivers with arterial hypertension has revealed decreased heart rate variability, reduced reserve capacity of the cardiovascular system and psychological adaptation: increased anxiety, reduced stress resistance and emotional stability compared with controls. An interrelation between autonomic disturbances and changes in psycho-emotional status has been established.

3. The application of the restorative programme at the outpatient stage of rehabilitation contributes to the restoration of autonomic balance, the mobilization of the functional reserves of the cardiovascular system and psychological defence mechanisms, and the improvement of the course of the disease and quality of life of drivers with arterial hypertension.

Approval of the work

The materials of the study were presented at the 8th All-Russian Congress "Non-Invasive Electrocardiology in Clinical Medicine," Moscow, 2007; the interregional scientific and practical conference "Current Problems of Internal Medicine: Traditional Psychosomatic Approaches," Chelyabinsk, 2007; the Republican Conference of Scientists of Bashkortostan: "Scientific Breakthrough-2007," Ufa, 2007; the XIV scientific and practical conference with international participation "Current Issues of Cardiology" with the III International Symposium on Echocardiography and Vascular Ultrasound, Tyumen, 2007; the II Congress of the Society of Heart Failure Specialists "Heart Failure 2007," Moscow, 2007; and the Republican Conference "Medical Science-2008," Ufa, 2008.

The dissertation was approved at an extended meeting of the Cardiology Problem Commission of the State Educational Institution of Higher Professional Education "Bashkir State Medical University of the Federal Agency for Health Care and Social Development" on 18 January 2008.

Implementation of results into practice

The main results of the studies have been implemented in the practical work of Polyclinics No. 1 and No. 2 of the Non-State Healthcare Institution "Divisional Hospital at Ufa Station" of OAO "RZD," Polyclinics No. 1 and No. 2 of City Clinical Hospital No. 13, in the work of the Laboratory of Psychophysiological Support of the Locomotive Depot at Dema Station, and are used in the educational process of the Department of Hospital Therapy No. 1 of the State Educational Institution of Higher Professional Education "Bashkir State Medical University of the Federal Agency for Health Care and Social Development.