mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical Universitymvjr-1167Research ArticleОБЗОРЫREVIEWОб эффективности тренирующих мышечных нагрузок при реабилитации больных, перенесших операцию реваскуляризации миокардаAbout Efficacy of the Training Exercises in Rehabilitation of Patients Unergoing Surgical Miocardial RevascularisationБыковА. Т.BykovA. T.

4 Sedina st., Krasnodar, 350063. Tel. 8-906-180-20-80

МаляренкоТ. Н.MalyarenkoT. N.

4 Sedina st., Krasnodar, 350063. Tel. 8-906-180-20-80

ДюжиковА. А.DyuzhikovA. A.

344083, г. Ростов-на-Дону, ул. Благодатная, 170. Тел. 8-988-532-71-34

170 Blagodatnaya st., Rostov-on-Don, 344083

МаляренкоЮ. Е.MalyarenkoYu. E.Кубанский государственный медицинский университетРоссияKuban State medical UniversityRussian FederationРостовский центр кардиологии и сердечно-сосудистой хирургииРоссияRostov Centre of Cardiology and Cardiovascular SurgeryRussian Federation20123009201203715Copyright © Быков А.Т., Маляренко Т.Н., Дюжиков А.А., Маляренко Ю.Е., 20122012Быков А.Т., Маляренко Т.Н., Дюжиков А.А., Маляренко Ю.Е.Bykov A.T., Malyarenko T.N., Dyuzhikov A.A., Malyarenko Y.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/1167

В связи с существующими, порой значительными, различиями в содержании реабилитационных программ кинезиотерапевтической направленности, используемых после операций реваскуляризации миокарда, предлагается при их составлении руководствоваться едиными принципами оптимизации функционального состояния организма человека, прежде всего, принципом активации кардиопротекторных эффектов. Они замыкаются на медико-биологической и медико-социальной сущности здоровья. Представляется, что такой унифицированный подход будет способствовать повышению эффективности реабилитации на всех её этапах и, в частности, препятствовать формированию рестенозов коронарных артерий.

Analysis of rehabilitation programs with kinesiotherapy components using in various countries for patients undergoing surgical myocardial revascularization revealed often considerable contents differences. Therefore it is proposed to be guided by uniform principles for compose such programs. These principles would have the physiological argumentation and be closed on the medico-biological and medico-social essence of health. It seems that such unitary approach would assist increase of the programs efficacy on all stages of rehabilitation and, first of all, prevent possible forming of coronary arteries restenosis.

операции реваскуляризации миокардапрограммы реабилитациикинезиотерапияsurgery of myocardial revascularisationrehabilitation programs with kinesiotherapyReferencesHall C.M., Brody L.T. Therapeutic exercise. Moving toward function. – Philadelphia - Tokio: Lippincott Williams & Wilkins, 2005. – 2d ed. – 787 p.Hall C.M., Brody L.T. Therapeutic exercise. Moving toward function. – Philadelphia - Tokio: Lippincott Williams & Wilkins, 2005. – 2d ed. – 787 p.Быков А.Т. Восстановительная медицина и экология человека. – М.: «ГЭОТАР-Медиа», 2009. – 688 с.Быков А.Т. Восстановительная медицина и экология человека. – М.: «ГЭОТАР-Медиа», 2009. – 688 с.Hillis L.D., Smith P., Anderson J.L., et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons // J. Am. Coll. Cardiol. – 2011. – Vol. 58. – P. 2584-2614.Hillis L.D., Smith P., Anderson J.L., et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons // J. Am. Coll. Cardiol. – 2011. – Vol. 58. – P. 2584-2614.Hirschhorn A.D., Richards D., Mungovan S.F., et al. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery - a randomised controlled trial // Heart Lung Circ. – 2008. – Vol. 17. – P. 129-138.Hirschhorn A.D., Richards D., Mungovan S.F., et al. Supervised moderate intensity exercise improves distance walked at hospital discharge following coronary artery bypass graft surgery - a randomised controlled trial // Heart Lung Circ. – 2008. – Vol. 17. – P. 129-138.Карпов Ю.А., Аронов Д.М. Кардиологическая реабилитация в России нуждается в коренной реорганизации // Кардиологический Вестник. – 2010. – Т.V (XVII). № 2. – С. 5-13.Карпов Ю.А., Аронов Д.М. Кардиологическая реабилитация в России нуждается в коренной реорганизации // Кардиологический Вестник. – 2010. – Т.V (XVII). № 2. – С. 5-13.Westerdahl E., Lindmark B., Eriksson T., et al. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery // Chest. – 2005. – Vol. 128. – P. 3482-3488.Westerdahl E., Lindmark B., Eriksson T., et al. Deep-breathing exercises reduce atelectasis and improve pulmonary function after coronary artery bypass surgery // Chest. – 2005. – Vol. 128. – P. 3482-3488.Bandy W.D., Sanders B. Therapeutic exercise for physical therapist assistants. – Philadelphia: Lippincott Williams & Wilkins, 2008. – 2nd ed. – 458 p.Bandy W.D., Sanders B. Therapeutic exercise for physical therapist assistants. – Philadelphia: Lippincott Williams & Wilkins, 2008. – 2nd ed. – 458 p.Tsai M.-W., Chie W.-C., Kuo T. B., et al. Effects of Exercise Training on Heart Rate Variability after coronary angioplasty // Physical Therapy. – 2006. – Vol. 86(5). – P. 626 - 635.Tsai M.-W., Chie W.-C., Kuo T. B., et al. Effects of Exercise Training on Heart Rate Variability after coronary angioplasty // Physical Therapy. – 2006. – Vol. 86(5). – P. 626 - 635.De Ferrary G.M., Vanoli E., Schwartz P.J. Vagal activity and ventricular fibrillation // In: Levy M.N., Schwartz P.J., eds. Vagal control of the heart. Experimental basis and clinical implications. – April Armonk, NY: Futura Publishig Co., 1994. – P. 613-636.De Ferrary G.M., Vanoli E., Schwartz P.J. Vagal activity and ventricular fibrillation // In: Levy M.N., Schwartz P.J., eds. Vagal control of the heart. Experimental basis and clinical implications. – April Armonk, NY: Futura Publishig Co., 1994. – P. 613-636.Carvalho M.N., Colaco A.L., Fortes Z.B. Cytokines, endothelial dysfunction, and insulin resistance // Arq. Bras. Endocrinol. Metabol. – 2006. – Vol. 502. – P. 304-312.Carvalho M.N., Colaco A.L., Fortes Z.B. Cytokines, endothelial dysfunction, and insulin resistance // Arq. Bras. Endocrinol. Metabol. – 2006. – Vol. 502. – P. 304-312.Katritsis D.G., Ioannidis J.P. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a metaanalis // Circulation. – 2005. – Vol. 111(2). – P. 2906-2912.Katritsis D.G., Ioannidis J.P. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a metaanalis // Circulation. – 2005. – Vol. 111(2). – P. 2906-2912.Long X., Bratz I.N., Alloosh M. Short-term exercise training prevents micro- and macrovascular disease following coronary stenting // J. of Applied Physiol. – 2010. – Vol. 108(6). – P. 1766-1774.Long X., Bratz I.N., Alloosh M. Short-term exercise training prevents micro- and macrovascular disease following coronary stenting // J. of Applied Physiol. – 2010. – Vol. 108(6). – P. 1766-1774.Becker B.E., Cole A.J. Aquatic rehabilitation // In: Physical medicine & rehabilitation. Principles and practice / J.A.DeLisa (Ed.- in- chief) // Philadelphia: Lippincott Williams & Wilkins, 2005. – Vol. 1. – Part 20. – P.479-492.Becker B.E., Cole A.J. Aquatic rehabilitation // In: Physical medicine & rehabilitation. Principles and practice / J.A.DeLisa (Ed.- in- chief) // Philadelphia: Lippincott Williams & Wilkins, 2005. – Vol. 1. – Part 20. – P.479-492.Schmid J.P., Noveanu M., Morger S., et al. Influence of water immersion , water gymnastics and swimming on cardiac output in patients with heart failure // Heart. – 2007. – Vol. 93. – P. 722-727.Schmid J.P., Noveanu M., Morger S., et al. Influence of water immersion , water gymnastics and swimming on cardiac output in patients with heart failure // Heart. – 2007. – Vol. 93. – P. 722-727.Зубкова С.М. Гидротерапия // В кн.: В.М.Боголюбов (ред). Физиотерапия и курортология. – М.-Пермь: ИПК «Звезда», 2008. – Т. 1. – С. 85–105.Зубкова С.М. Гидротерапия // В кн.: В.М.Боголюбов (ред). Физиотерапия и курортология. – М.-Пермь: ИПК «Звезда», 2008. – Т. 1. – С. 85–105.Климко В.В. Оптимизация этапной медицинской реабилитации больных ишемической болезнью сердца, перенесших коронарное шунтирование. – М, 2009. – 48 с.Климко В.В. Оптимизация этапной медицинской реабилитации больных ишемической болезнью сердца, перенесших коронарное шунтирование. – М, 2009. – 48 с.Gottesman R.F., Grega M.A., Bailey M.M., et al. Delirium after coronary artery bypass graft surgery and late mortality // Ann. Neurol. – 2010. – Vol. 67. – P. 338-344.Gottesman R.F., Grega M.A., Bailey M.M., et al. Delirium after coronary artery bypass graft surgery and late mortality // Ann. Neurol. – 2010. – Vol. 67. – P. 338-344.Martin F. Recognizing depression after a coronary bypass graft // Br. J. Nurs. – 2006. – Vol. 15. – P. 703-706.Martin F. Recognizing depression after a coronary bypass graft // Br. J. Nurs. – 2006. – Vol. 15. – P. 703-706.Tully P.J., Bennetts J.S., Baker R.A., et al. Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgery // Heart & Lung: The Journal of Acute and Critical Care. – 2011. – Vol. 40(1). – P. 4-11.Tully P.J., Bennetts J.S., Baker R.A., et al. Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgery // Heart & Lung: The Journal of Acute and Critical Care. – 2011. – Vol. 40(1). – P. 4-11.Stygall J., Newman S.P., Fitzgerald G., et al. Cognitive change 5 years after coronary artery bypass surgery / // Health Psychol. – 2003. – Vol. 22(6). – P. 579-586.Stygall J., Newman S.P., Fitzgerald G., et al. Cognitive change 5 years after coronary artery bypass surgery / // Health Psychol. – 2003. – Vol. 22(6). – P. 579-586.Lee J.D., Lee S.J., Tsushima W.T., et al. Benefits of off-pump bypass on neurologic and clinical morbidity a prospective randomized trial // Ann. Thorac. Surg. – 2003. – Vol. 76. – P. 18-26.Lee J.D., Lee S.J., Tsushima W.T., et al. Benefits of off-pump bypass on neurologic and clinical morbidity a prospective randomized trial // Ann. Thorac. Surg. – 2003. – Vol. 76. – P. 18-26.Freund H.-J., Jeannerod M., Hallett M., Leiguarda R. Higherorder motor disorders. – N.Y.: Oxford Univ. Press, 2005. – 320 p.Freund H.-J., Jeannerod M., Hallett M., Leiguarda R. Higherorder motor disorders. – N.Y.: Oxford Univ. Press, 2005. – 320 p.Фокин В.Ф., Пономарева Н.В. Энергетическая физиология мозга. Москва: «АНТИДОР», 2003. 288 с.Фокин В.Ф., Пономарева Н.В. Энергетическая физиология мозга. Москва: «АНТИДОР», 2003. 288 с.Zhang F. Exercise preconditioning and brain ischemic tolerance // Neuroscience. – 2011. – Vol. 177. – P. 170-176.Zhang F. Exercise preconditioning and brain ischemic tolerance // Neuroscience. – 2011. – Vol. 177. – P. 170-176.Gertz K. Integrative physiology: physical activity improves long-term stroke outcome via endothelial nitric oxide synthasedependent augmentation of neovascularization and cerebral blood flow // Circulation Research. – 2006. – Vol. 99. – P. 1132-1140.Gertz K. Integrative physiology: physical activity improves long-term stroke outcome via endothelial nitric oxide synthasedependent augmentation of neovascularization and cerebral blood flow // Circulation Research. – 2006. – Vol. 99. – P. 1132-1140.Быков А.Т., Маляренко Т.Н. Кинезиотерапия: психологический аспект реабилитации больных кардиологического профиля при старении // Военная медицина. – 2012. – № 2. С. 12–17.Быков А.Т., Маляренко Т.Н. Кинезиотерапия: психологический аспект реабилитации больных кардиологического профиля при старении // Военная медицина. – 2012. – № 2. С. 12–17.Murphy J.J., Conway B. Get Fit for Your Op // Eur .J. Cardiovasc. Nurs. – March 2007. – Vol. 6(1). – Suppl. – S7-S8.Murphy J.J., Conway B. Get Fit for Your Op // Eur .J. Cardiovasc. Nurs. – March 2007. – Vol. 6(1). – Suppl. – S7-S8.Levine G.M., Bates E.R., Blankenship E.R., et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions // J. Am. Coll. Cardiol. – 2011. – Vol. 58. – P. 44-122.Levine G.M., Bates E.R., Blankenship E.R., et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions // J. Am. Coll. Cardiol. – 2011. – Vol. 58. – P. 44-122.Recommendations of the University of Wisconsin Hospital and Clinics Authority. Exercise and Activity after Heart Surgery. – http://www.uwhealth.org/healthfacts. – 08.08.2011.Recommendations of the University of Wisconsin Hospital and Clinics Authority. Exercise and Activity after Heart Surgery. – http://www.uwhealth.org/healthfacts. – 08.08.2011.James V. Leg exercise after a heart bypass. – http://www.livestrong.com/article /382530. – 2011. May, 26.James V. Leg exercise after a heart bypass. – http://www.livestrong.com/article /382530. – 2011. May, 26.Welch C. Exercise after coronary bypass. – http://www.livestrong.com/article/457534. – 2011. May, 29.Welch C. Exercise after coronary bypass. – http://www.livestrong.com/article/457534. – 2011. May, 29.von der Peijl I.D., Vliet Vlieland Th.P.M., Versteegh M.I.M., et al. Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program / // Ann. Thorac. Surg. – 2004. – Vol. 77. – P.1535-154.von der Peijl I.D., Vliet Vlieland Th.P.M., Versteegh M.I.M., et al. Exercise therapy after coronary artery bypass graft surgery: a randomized comparison of a high and low frequency exercise therapy program / // Ann. Thorac. Surg. – 2004. – Vol. 77. – P.1535-154.Wright D.J., Williams S.G., Rilley R., et al. Is early, low level, short term exercise cardiac rehabilitation following coronary bypass surgery beneficial? // Heart. – 2002. – Vol. 88. – P. 83-84.Wright D.J., Williams S.G., Rilley R., et al. Is early, low level, short term exercise cardiac rehabilitation following coronary bypass surgery beneficial? // Heart. – 2002. – Vol. 88. – P. 83-84.Karoff M., Held K., Bjarnason-Wehrens B. Cardiac rehabilitation in Germany // Europ. J. Cardiovasc. Prevent. & Rehab. – 2007. – Vol. 14(1). – P. 18-27.Karoff M., Held K., Bjarnason-Wehrens B. Cardiac rehabilitation in Germany // Europ. J. Cardiovasc. Prevent. & Rehab. – 2007. – Vol. 14(1). – P. 18-27.Fiorina C., Vizzardi E., Lorusso R., et al. The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation program // Eur. J. Cardiothorac. Surg. – 2007. – Vol. 32. – P. 724-729.Fiorina C., Vizzardi E., Lorusso R., et al. The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation program // Eur. J. Cardiothorac. Surg. – 2007. – Vol. 32. – P. 724-729.Hulzebos E.H., Helders P.J., Favie N.J., et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial // JAMA. – 2006. – Vol. 296. – P. 1851-1857.Hulzebos E.H., Helders P.J., Favie N.J., et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial // JAMA. – 2006. – Vol. 296. – P. 1851-1857.Smith S.C.Jr., Benjamin E.J., Bonow R.O., et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: A Guideline from the American Heart Association and American College of Cardiology Foundation // Circulation. – 2011. – Vol. 124. – P. 2458-2473.Smith S.C.Jr., Benjamin E.J., Bonow R.O., et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: A Guideline from the American Heart Association and American College of Cardiology Foundation // Circulation. – 2011. – Vol. 124. – P. 2458-2473.Goel K., Lennon R.J., Tilbury R.T., et al. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community // Circulation. – 2011. – Vol. 123. – P. 2344-2352.Goel K., Lennon R.J., Tilbury R.T., et al. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community // Circulation. – 2011. – Vol. 123. – P. 2344-2352.Balady G.J., Ades P.A., Bittner V A., et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association // Circulation. – 2011. – Vol. 124. – P. 2951–2960.Balady G.J., Ades P.A., Bittner V A., et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association // Circulation. – 2011. – Vol. 124. – P. 2951–2960.Suaya J. A. Use of cardiac rehabilitation by medicare beneficiaries after myocardial infarction or coronary bypass surgery // Circulation. – 2007. – Vol. 116. – P. 1653-1662.Suaya J. A. Use of cardiac rehabilitation by medicare beneficiaries after myocardial infarction or coronary bypass surgery // Circulation. – 2007. – Vol. 116. – P. 1653-1662.Dendale P., Berger J., Hansen D. Cardiac rehabilitation reduces the rate of major adverse cardiac events after percutaneous coronary intervention // Europ. J. Cardiovasc. Nurse – 2005. – Vol. 4(2). – P. 113-116.Dendale P., Berger J., Hansen D. Cardiac rehabilitation reduces the rate of major adverse cardiac events after percutaneous coronary intervention // Europ. J. Cardiovasc. Nurse – 2005. – Vol. 4(2). – P. 113-116.Bäck M., Wennerblom B., Wittboldt S., Cider Å. Effects of high frequencyexercise in patient after elective percutaneous coronary intervention // Europ. J. Cardiovasc. Nursing. – 2008. – Vol. 7(4). – P. 307-313.Bäck M., Wennerblom B., Wittboldt S., Cider Å. Effects of high frequencyexercise in patient after elective percutaneous coronary intervention // Europ. J. Cardiovasc. Nursing. – 2008. – Vol. 7(4). – P. 307-313.Беляев А.А., Зубков В.И., Портнов В.В. и др. Современные методы реабилитации больных больных ишемической болезнью сердца, перенесших реконструктивные кардиоваскулярные операции // Тематич. сборн.: Долечивание (реабилитация) больных после операций на сердце и магистральных сосудах. – Вып. 1. – М., 2007. – С. 7-8.Беляев А.А., Зубков В.И., Портнов В.В. и др. Современные методы реабилитации больных больных ишемической болезнью сердца, перенесших реконструктивные кардиоваскулярные операции // Тематич. сборн.: Долечивание (реабилитация) больных после операций на сердце и магистральных сосудах. – Вып. 1. – М., 2007. – С. 7-8.Косов В.А., Замотаев Ю.Н. Влияние физических тренировок (механотерапии) на показатели кардиореспираторной системы при реабилитации больных, перенесших чрескожную транслюминальную ангиопластику // Современные подходы к программам восстановительной медицины и реабилитации в ведомственном здравоохранении: Сборник трудов II научно-практической конференции. − Москва: Главн. клин. госпиталь МВД России. – 2005. – С. 54..Косов В.А., Замотаев Ю.Н. Влияние физических тренировок (механотерапии) на показатели кардиореспираторной системы при реабилитации больных, перенесших чрескожную транслюминальную ангиопластику // Современные подходы к программам восстановительной медицины и реабилитации в ведомственном здравоохранении: Сборник трудов II научно-практической конференции. − Москва: Главн. клин. госпиталь МВД России. – 2005. – С. 54..

The authors declare that there are no conflicts of interest present.