APPLICATION
OF HBO IN COMPLEX TREATING OF MITRAL CARDIAC
DEFECTS
WITH SHARP TRANSGRESSIONS OF BLOOD CIRCULATION
Practical recommendations.
Contemporary medicine has
achieved significant successes in treating of rheumatism. Yet, rheumatic
cardiac defects and mitral valve, in particular, still remain to be a problem
of therapeuts, pediaters and surgeons. Broad experience in treating of
rheumatic diseases of heart usually permits to determine and begin treating in
time.
Nevertheless a large group
of sicks with rheumatic state of neglection of cardiovascular system still
exists. These often have defect of squeezing of myocard together with delays
of greater and lesser blood circulation, resulting in transgressions of
functioning of lung, liver, cerebrum, kidney. Treating of such sicks is a
complicated problem because the disease weakly responds to the customary
methods (cardiac glycolis, urinal, inhibitors of aldosteron, etc.), and
operation is a rescue one.
The risk tremendously
improves if two or more valves are to be renovated. Sometimes it is difficult
to determine whether the patient is of IV or V (when operation is forbidden)
level of disease. These sicks have practically no chances to be healed.
The way to decompensate
defective blood circulation and improve myocard is the application of
oxygenotherapy. This is approved both theoretically and practically. Really,
oxygenotherapy, which can reduce the hypoxia, exists in myocard and many other
organs. Because of hypertension in lung, hypoxia becomes a complicated problem
and realizes through the improvement of oxygental shortage, lactacidemy,
vascular hypoxemia, etc. The re-distribution of oxygen in tissue causes the
production of new compounds in some organs, and these compounds themselves
strengthen the complications of blood circulation.
The application of
oxygenotherapy repairs normal functioning of organs and stimulates medicinal
therapy. Calculations are representing the limitations of ordinary
oxygenotherapy and the application of HBO-therapy becomes more reasonable.
The value of cardiac
outlet for sicks with mitral defect reduces up to 3-3,5 l/min.; the use of
oxygen remains or even improves a little. According to Fick equation:
Q = A/a*(A-bpO2),
where: Q is the value of
blood circulation; a - solvability of O2 in blood. Change of concentration of
oxygen in blood should be of 7 -
8 volume percents. The outlet of a healthy man is 5,0l/min.; sequentially the
change of concentration should be of 4,6%. Thus for the sicks of IV-V degree
the improvement would be of 2,4 - 3,4% that is the result of improvement of
utilization of oxygen by tissue caused by lessening of speed of blood for sick.
This is a specific compensation of hypoxia; but it can't compensate the
transgression of circulation of blood completely; thus the hypoxia appears
anyway. On the other hand aerial pressure can't improve the concentration of
oxygen in blood by 3-3,5% and thus completely diminish the hypoxia the
extreme improvement of the concentration of oxygen in blood can reach 1,9%.
Only the inhalation of oxygen with one additional atmosphere can give us
required result. These are the theoretical predictions for the application of
HBO for invalids of blood circulation.
Selection of pressure of
oxygen and scheme of treating.
Generally, the optimal
oxygenation - is a such one, that provides the required concentration of
oxygen in blood without intoxication of body with oxygen.
The determination of the
optimal oxygenation is done directly or by method of solving of sign,
according the mentioned above Fick equation and nomogram; this constant would
really equate the searched value. For hard sicks it can achieve the value of
3AT and even more; but in practice it would be less a little because the
troubling and headaches can arrive. Practically approved figure is of
2,5AT for HBO of hard sicks.
In general the exposition
would be of 1-1,5 hours; saturation of oxygen - 1,7-2,5AT. If advanced
calculations cannot be done, the saturation of oxygen would be 1,7-2,0AT. The
amount of procedures in course is 10-14; sometimes a repetitive course is
probable in 1-2 weeks after the
first one.
Anyhow the first procedure
would be an examining one with the exposition of no more than 30 minutes. No
special medicinal preparation would be done before it; the results represent
the availability of patient for HBO-therapy.
If a patient feels fear,
discomfort, pain the pressure would be reduced by 0,3-0,4AT.
Electrocardiogram; some
assessments of functioning of lung; its dynamic roentgenoscopy would be used
for the control of the efficiency of HBO-therapy course. Oxygental
intoxication; lessening of lung volume, worthening of pleural permeability,
lowering of transparency of lung would cause immediate stopping of HBO. But
practically intoxication is impossible.
The estimates for the efficiency
of treating.
The result of application can be
represented in control figures or according the self sensation of patient.
Subjective bettering is realized in normalization of sleeping and appetite,
lessening of aggressiveness. Respiration becomes still; pulse normalizes;
liver lessens; the relative amount of urine improves. The cardiac blood
tension improves and vascular one - lessens. This allows us to predict the
bettering of squeezing of myocard. Also
the peripheral blood circulation comparatively reduces; the concentration of
lactic acid and the relation lactate/piruvate also lessens.
The volume of lung grows;
the pleural conductivity improves.
Almost all patients
(excluding the most hard sicks) are feeling the bettering after HBO.
The absolute contraindications
for the application of HBO are:
1. Epilepsy;
2. Caverns in lung;
3. Otorhinolaryngologic diseases
(otitis, eustahitis, gaymoritis, fronitis, etc.);
4. Claustrophobia.
The conditional contraindications
for the application of HBO are:
1. Active rheumatism;
2. Acute infections;
3. Lung hypertension of
III degree; 4. Improved sensitivity to oxygen.
The use of HBO-therapy
with proposed constants causes observable bettering of state of cardiac sicks
without additional complications. Especially this is of use if the medicinal
therapy has no success.
Practical recommendations are prepared with participation
of:
professor
S.Efruni,
doctor
V.Rodionov,
professor
I.Zamotaev,
doctor
Yu.Bukaev,
doctor
N.Vasilyeva.