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».
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