Научные источники и работы

COVID-19 реабилитация. СХУ и фиброз легких

Перспективные реабилитационные технологии подразумевают не только реабилитацию в классическом понимании, но и профилактику осложнений. Пневмония Covid-19 существенно отличается от наиболее распространенных случаев пневмонии бактериальной этиологии, которые поддаются лечению антибиотиками. Пневмония, вызванная Covid-19,  является вирусной и может быть особенно тяжелой. Такая пневмония имеет тенденцию поражать все легкие, а не только их отдельные части, заболевание протекает тяжело и долго (от 14 дней до месяца) и сильно выматывает резервы адаптации, приводя к последующим  отсроченным полиорганным патологиям, которые без должной реабилитации имеют тенденцию к манифестации и хронизации.

Последствиями Covid-19 многообразны, но наиболее часто выделяют:

  • Хроническая Обструктивная Болезнь Легких (ХОБЛ) и астма – заболевания дыхательной системы, кардинально меняющие жизненную активность, работоспособность, качество и срок жизни. При ХОБЛ страдают как дыхательные пути, так и ткань самого лёгкого — лёгочная паренхима. Начинается заболевание в мелких дыхательных путях с закупорки их слизью, сопровождающейся воспалением с формированием перибронхиального фиброза (уплотнение соединительной ткани) и облитерации (зарастание полости). Эти процесс при пневмонии, ассоциированной с COVID-19 развиваются достаточно стремительно, а уже при уже сформировавшейся патологии бронхитический компонент включает:
  • гиперплазию слизистых желёз (избыточное новообразование клеток);
  • слизистое воспаление и отёк;
  • бронхоспазм и закупорку дыхательных путей секретом, что приводит к сужению дыхательных путей и увеличению их сопротивления.

Эмфизематозный компонент приводит к разрушению конечных отделов дыхательных путей — альвеолярных стенок и поддерживающих структур с образованием значительно расширенных воздушных пространств. Отсутствие тканевого каркаса дыхательных путей приводит к их сужению вследствие тенденции к динамическому спадению во время выдоха, что становится причиной экспираторного коллапса бронхов. Именно поэтому реабилитацию ХОБЛ и БА необходимо начинать как можно раньше  еще до наступления стадии манифестации фиброзов.

  • Другим – часто встречающимся осложнением является Синдром хронического утомления и переутомления (СХУ), характеризующийся низкой активностью индивида, снижением иммунитета, повышенной метеозависимостью, что существенно снижает жизненный тонус и работоспособность, а также повышает заболеваемость простудными, инфекционными и вирусными заболеваниями, приводит к формированию новых и обострению имевшихся хронических заболеваний. Если утомление можно рассматривать как физиологическое состояние, то переутомление следует рассматривать как пограничное, предпатологическое, поэтому профилактические и восстановительные мероприятия обязательны, иначе переутомление может привести, а часто и приводит, к дисфункции центральной нервной системы с рассогласованием эмоционально-вегетативной регуляции, иначе говоря, к неврозу с нарушениями функций внутренних органов.

Переутомление – комплекс функциональных нарушений в организме, обусловленных чрезмерным утомлением или длительным накоплением утомления, при этом могут отмечаться начальные симптомы нарушения регуляторных систем организма. Субъективные проявления сопровождаются ощущением усталости, невозможностью выполнения прежних нагрузок, нарушением сна (сонливость, бессонница), сонливостью во время работы, беспричинной тревогой, раздражительностью или депрессией.

Осложняет ситуацию тот факт, что большинство осложнений имеют отложенный (от полугода до двух лет) характер и нозологически заранее не очевидны. Особенно настораживает тот факт, что люди, переболевшие коронавирусом  в легкой форме, подвержены осложнениям в более тяжелой форме.

Во избежание пополнения «армии» людей с ограниченной работоспособностью за счет граждан перенесших коронавирус, необходимо разрабатывать и внедрять универсальные и достоверно эффективные методики санаторной и амбулаторной реабилитации после перенесенного коронавируса Sars-CoV-2 с целью профилактики отложенных полиорганных осложнений. Такие полинозологические программы могут быть разработаны в самые сжатые сроки, поскольку научные предпосылки и модели новых технологий уже существуют и уже могут стать основой для создания высокоэффективных немедикаментозных программ с использованием бальнеологических и иных природных лечебных факторов. И это тот случай, можно сделать универсальные программы, которые могут исполняться в санаториях любого профиля и табеля оснащения. Более того, универсальность программ заключается и в возможности их эффективного применения в случаях мутаций вируса и появления новых штаммов. Ниже я привожу краткое описание таких перспективных технологий:

Терапия экзогенным оксидом азота (NO-терапия) – метод лечебного применения экзогенного газообразного оксида азота. Молекула оксида азота является короткоживущим соединением (срок жизни молекулы составляет примерно 10 секунд) В организме человека оксид азота синтезируется в резкльтате расщепления L-аргинина ферментом NO-синтазой (NOS) в эндотелиальных  нервных клетках, в макрофагах.

Используемый в данном методе экзогенный  газообразный оксид азота получают плазмохимическим способом из кислорода и азота атмосферного воздуха в соответствии с оборатимой  химической реакцией N2 +O2 = 2NO.

Газообразный оксид азота, воздействуя на патологически измененные участки кожных покровов пациента, вызывает гибель микроорганизмов, активацию протеолитических ферментов макрофагов, усиливает синтез в макрофагах и моноцитах эндогенного NO, тем самым повыышает их микробную биоцидность. В результате воздействия экзогенного газообразного оксида азота происходит стимуляция микроциркуляторного кровобращения и системы капиллярного кровотока в области трофических нарушений. Под воздействием экзогенного газообразного оксида азота увеличивается количество синтезируемого в эндотелиальных клетках NO, являющегося вазодилататором и антиагрегантом тромбоцитов и эритроцитов и ингибитором тромбообразования. Усиливающийся синтез NO  в клетках нервной системы выступает в качестве медиатора межнейронных коммуникаций, синаптической пластичности и памяти, а также медиатора, обуславливающего релаксацию гладкомышечных клеток.

Вдыхание азота приводит к снижению тонуса гладкой мускулатуры бронхов, активации клеточного фагоцитоза и иммунитета, вызывает активацию апоптоза аномальных стареющих клеток мерцательного эпителия и торможение активности ферментов антиокисдантной системы перекисного окисления липидов (ПОЛ).

Таким образом, метод обладает иммуностимулирующим, репаративно-регенеративным и противовоспалительным лечебными эффектами. Механизмы воздействия и биологическое значение молекулы оксида требуют дополнительного изучения.

Как известно, сейчас еще нет подтвержденного эффективного лекарства от коронавируса. Для профилактических мероприятий в нашей стране, как известно, требуется вакцина, разработанная в ФГБУ «Национальный исследовательский центр эпидемиологии и микробиологии имени почетного академика Н.Ф. Гамалеи» Министерства здравоохранения Российской Федерации под руководством академика А.Л. Гинцбурга. Между тем, эффективное средство борьбы с этой страшной инфекцией, возможно, уже найдено — это молекулярный водород и соединения водорода,  в частности — сероводород.

Доказано, что, хотя в высоких концентрациях сероводород является ядом, но в низких концентрациях он оказывает защитный эффект при самых разных заболеваниях. Так, этот газ широко используется в санаториях в сероводородных ваннах для лечения множества болезней.

Исследованиями Михаила Евгеньева, доктора биологических наук — заведующего Лабораторией молекулярных механизмов биологической адаптации Института молекулярной биологии РАН им. Энгельгардта — было доказано, что использование сероводорода облегчает протекание болезни и помогает справиться с воспалением лёгких, которое часто является следствием заражения данным вирусом. Должен отметить, что инъекции источника сероводорода (тиосульфата натрия) давно применяются в медицине.

Тиосульфат натрия является «медленным» и совершенно безопасным, давно одобренным Минздравом донором сероводорода. На исходной (первой) стадии инфекции сероводород должен проявлять свой противовирусный потенциал для предотвращения размножения коронавируса.

На более поздних стадиях, когда развивается пневмония, ежедневные ингаляции тиосульфата натрия должны предотвращать воспаление легких, что уже было показано на лабораторных животных. Кроме того, предварительная и последующая обработка (ингаляция   тиосульфата натрия) должна снижать степень повреждения легких, часто вызываемых применением ИВЛ.

Отмечу, что данная методика (использование тиосульфата натрия) — это «забытое старое». Ещё в 90-х годах в ряде госпиталей Министерства Обороны СССР (Ереван, Ленинград) тиосульфат успешно применяли против острых форм воспаления лёгких разной этиологии.

Недавние исследования  доктора Сергея Оникиенко свидетельствуют о том, что ингаляции тиосульфата препятствуют развитию «цитокиновой бури» (цитокины – это биологически активные белки, производимые в основном иммунными клетками), способствуют разрешению коронавирусной пневмонии и блокируют репликацию вируса в клетках-мишенях.

Комбинированная технология тиосульфата натрия и «горячих» гелий-кислородных дыхательных смесей могут применяться в том числе и в СКО.

В аптеках продаются небулайзеры (устройства для ингаляции) и стерильный 30-процентный раствор тиосульфата натрия. Его разводят до концентрации 5-10% и используют в объеме 2-3 мл два раза в сутки.

Комбинированная технология, основанная на ингаляции тиосульфата натрия и «горячих» гелий-кислородных дыхательных смесей при тяжелых формах коронавирусной пневмонии, может предотвратить перевод больных на искусственную вентиляцию легких и сохранить им жизнь. Так в Республиканской больнице г. Сыктывкар (Коми) под руководством Оникиенко этот метод был применен на 50 больных, которых планировали перевести на ИВЛ, и после использования этого метода перевели лишь одного человека.

Предлагаемая Сергеем Оникиенко технология  предотвращает перевод больного на ИВЛ. Нельзя сравнивать вероятность перевода на ИВЛ с ее эффективностью. Врачи делают все, чтобы она была эффективной. Вместе с тем, необходимо проведение расширенных клинических испытаний предлагаемой методики у пациентов с различной степенью тяжести коронавирусной пневмонии в различных стадиях патологического процесса.

Физические методы лечения, применяемые в санаториях и на курортах, могут использовать  технологии баланса  тормозных и активирующих процессов в коре головного мозга (методы курортной и спа (аэро-, гелио-, талассо-) терапии), коррекции  астено-невротического и иммунодепрессивного синдромов (гидротерапия — ароматические, контрастные ванны, души, купирования воспаления — противовоспалительные  методы (низкоинтенсивная УВЧ-терапия, высокочастотная магнитотерапия).

            В связи с появлением пандемии Covid-19 актуальным вопросом является восстановление и укрепление иммунитета человека.

Научные исследования, проведенные в Япония, Корея, США доказали преимущества природного астаксантина, которые проявляются:

— возможностью ускоренного иммунного ответа,

— укреплением и уравновешиванием способности иммунной системы защищать организм,

— ростом производства антител,

— защитой иммунных клеток от окислительного стресса,

— мощными противовоспалительными свойствами.

Возвращаясь к водороду Водород (Н2), еще раз отметим, что применение молекулярного водорода является одним из самых перспективных направлений профилактической, адаптационной и восстановительной медицины. Будучи самой маленькой молекулой во вселенной, водород в отношении человеческого организма рассматривается в качестве средства комплексного воздействия на различные звенья патогенеза, обусловленные острой и хронической кислородной недостаточностью), способного достаточно быстро, эффективно и безопасно связывать активные формы кислорода, нормируя окислительно–восстановительный баланс клеточных структур, препятствуя  окислительному стрессу, который,  как известно, является триггером большинства патологических процессов в организме. В данном случае своей мишенью водород выбирает структуры с нарушенным Redox потенциалом в то время, как клетки со сбалансированным окислительно-восстановительным потенциалом (благополучные клетки) остаются без воздействия. Побочным продуктом антирадикального воздействия водорода является вода, также необходимая в клеточной и околоклеточной средах.

Молекулярный водород обладает антиокислительным, противовоспалительным и антиапоптозным действием,  таким образом, являясь активатором клеточного восстановления.

Водород отличается своей высокой степенью проникновения в клетки человеческого организма, может в течение короткого времени диффундировать по всему телу, проникая в клеточную мембрану и в митохондрии, независимо от движения крови по кровеносной системе. Благодаря этому, молекулярный водород эффективно снижает количество вредных свободных радикалов внутри клеток не только тела, но и мозга, защищая их от разрушения, что является важнейшим преимуществом, когда речь идет, например, о нейродегенеративных заболеваниях (болезнь Альцгеймера или болезнь Паркинсона). Научные модели показывают, что водород может быть крайне эффективным при патологиях бронхо-легочной системы и, в первую очередь, при астме и пневмониях, что представляет особый интерес в нынешних условиях.

Согласно исследованиям самой влиятельной международной организации Molecular Hydrogen Institute, которая занимается вопросами терапевтических свойств водорода, более 30% населения Японии и более 20% населения Южной Кореи регулярно употребляют водородную воду как в упаковке, так и воду обогащенную водородом домашними генераторами водородной воды и портативными водородными генераторами. Именно благодаря этим странам и группе ученых из Японии, Кореи, Китая и началось триумфальное шествие и распространение водородной воды и водородотерапии по всему миру.

Водородная терапия в настоящий момент стремительно развивается и даже становится модным мировым трендом оздоровления. Россия в этой области, наконец, появились собственные наработки и скоро начнётся производство компонентов и собственных установок для обогащения питьевой воды газообразным водородом.

Еще одним заслуживающим внимания и проверенным временем универсальным средством реабилитации является разработанное в 2003 году в РНЦ ВМиК бальнеологическое средство для принятия ванн «Биолонг».

Использование препаратов для ванн «Biolong» на основе антигипоксанта и антиоксиданта – Митофен, может стать средством выбора при болезнях органов дыхания, заболеваниях опорно-двигательного аппарата, кожи, хронического утомления и переутомления, дезадаптивных реакций организма человека на стресс. Действующим веществом препаратов для ванн «Biolong» является Митофен – синтетический аналог Убихинона. В основе антигипоксической эффективности Митофена лежит его способность шунтировать I-й и II-й комплексы дыхательной цепи митохондрий, ингибированные вследствие гипоксии. При явлениях кислородной недостаточности любого генеза препарат снижает потребность тканей в кислороде, способствует более полному его усвоению. Препарат обладает выраженной антигипоксической активностью практически при всех видах гипоксии, имеющей место при заболеваниях, в патогенезе которых лежит хроническая кислородная недостаточность, при тяжелых травмах и кровопотерях, после сложных хирургических вмешательств, анемиях. Антиоксидантные свойства «Biolong» проявляет за счет полигидрофениленовой структуры основного ядра Митофена, когда гидроксильные группы полигидрохинона легко отдают свой атом водорода, а тот, в свою очередь, может взаимодействовать с активным радикалом с образованием пироксидов. Препарат способствует повышению энергообеспечения живых клеток за счет более выгодного использования О2 в дыхательной цепи, а также нейтрализует окислители, которые образуются при острой кислородной недостаточности в тканях организма. Кроме того, антиоксидантная активность «Biolong» обладает эффектом пролонгированного действия. Антигипоксическое и антиоксидантное действие препаратов для ванн «Biolong» доказаны научно. Препараты «Biolong» в санаторно-курортной практике, лечебных и оздоровительных учреждениях применяется уже более 15 лет. Хорошая переносимость, практически отсутствие противопоказаний, универсальность,  служат основанием для широкого использования в реабилитации после COVID-19 и профилактике его полиорганных осложнений.

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  782. With adoption, the Indiana Court of Appeals was created as well as the treatment of selecting justices on the courts was readjusted. The development of industry to fulfill war demands aided end the Great Clinical depression. French-Canadian fur traders quickly got here, bringing coverings, jewelry, devices, bourbon as well as tools to trade for skins with the Native Americans. Split right into small groups, the Paleo-Indians were nomads that pursued large video game such as mastodons. They produced stone tools made out of chert by breaking, knapping and flaking.

    A location like a huge bite in the center of the north limit was reserved to the Miami, called the Huge Miami Get, which was the biggest Indian appointment ever before to exist in Indiana. Indianapolis was picked to be the website of the new state funding in 1820 due to its central position within the state and also presumed good water transportation. However the owners were let down to discover the White River was too sandy for navigating. The federal government became developed in the Marion County Courthouse as the second state resources building.
    Globe War I
    On June 10, 1816, delegates put together at Corydon to create the constitution, which was completed in 19 days. Jonathan Jennings was chosen the fledgling state’s first guv in August 1816. President James Madison approved Indiana’s admission into the union as the 19th state on December 11, 1816. Different indigenous peoples inhabited what would become Indiana for thousands of years, a few of whom the united state government expelled in between 1800 as well as 1836. Indiana got its name due to the fact that the state was greatly had by native tribes even after it was given statehood.

    Denied excuse, in 1927 Stephenson provided the Indianapolis Times listings of people the Klan had paid. Throughout the war, Clark took care of to cut off British troops, who were attacking the eastern homesteaders from the west. His success is frequently credited for transforming the program of the American Revolutionary War. At the end of the battle, via the Treaty of Paris, the British crown delivered their claims to the land south of the Wonderful Lakes to the freshly created USA, including Native American lands.

    Sediments birthed by the ice sheets were deposited as till when the glaciers advanced into Indiana and as outwash sand and also gravel when the ice melted. Thick buildups of till and outwash loaded the bedrock valleys (figs. 2 and also 3) and covered the bedrock hills of north Indiana to produce the flat to gently rolling landscape idea of by many as monotonous. Cold air passing over the warmer lake water in fall and also winter months generates hefty precipitation, as well as wintertime snowfall particularly is numerous times more than in various other components of the state.

    They started carrying out lynchings against thought bad guys, leading the state to attempt to crack down on their techniques. By the turn of the 20th century, they had actually come to be so notorious that anti-lynching regulations were passed and also in one occurrence the guv called out the militia to shield a detainee. When the white caps turned up to lynch him, the militia opened up fire, eliminating one and also wounding eleven.
    News Release: Justice And Health Occasion
    Military troops, triumphes were almost uniformly split between the two celebrations. Regardless Of the Indigenous American victories, most of the native populace was ultimately gotten rid of from Indiana, a process that proceeded after the region obtained statehood. The initial territorial capital was established at Vincennes, where it stayed from 1800 to 1813, when territorial officials moved the seat of government to Corydon.

    In this field, the nighttime skies of northwestern Indiana are lit up by its steel heating systems, as well as during the daytime sticking around clouds of industrial smoke frequently shadow such cities as Gary as well as Hammond.

    Different native peoples occupied what would certainly become Indiana for hundreds of years, several of whom the united state federal government expelled between 1800 and also 1836. Indiana obtained its name due to the fact that the state was mainly had by native people even after it was given statehood. Indiana has great winters as well as warm summertimes, attributes of moist continental climate.
    Populace Development
    But the Virginia colony said that it was the rightful proprietor of the land since it fell within its geographical borders. The united state Supreme Court refuted the land company’s right to the insurance claim in 1798. Ohio river is the largest tributary of Mississippi river that flows via lots of American states. Other essential rivers in the state are Kankakee River, Fall Creek, Galena River, White River, Wabash River, and also Tippecanoe River.

    A significant and also growing Hispanic populace lives largely in the cities of central and also northern Indiana. In the early 21st century Asians remained to comprise a little portion of the population, however their numbers were boosting rapidly. Indiana public schools have gone through a number of changes throughout Indiana’s history. Modern, public college requirements, have actually been carried out all throughout the state.
    Indiana Areas And Also Statistical Locations
    Highlighted are the regions of Sout