Роль функциональной электростимуляции в реабилитации пациентов с диабетическими ангиопатиями нижних конечностей
AbstractThe aim of the study was to evaLuate the possibiLity of the infLuence of functionaL eLectrostimuLation (FES) of the Lower extremities on the main cLinicaL manifestations of diabetic angiopathy of the Lower extremities in patients with type 2 diabetes.
Material and methods. Under supervision in «Main MiLitary CLinicaL HospitaL name of academician N.N. Burdenko» there were 56 patients (27 men and 29 women) aged 45 to 75 years with a diagnosis of diabetes meLLitus type 2 compLicated with diabetic angiopathy of the Lower extremities. Patients incLuded in the study were divided into the main (n=29) and controL groups (n=27) by randomization. Prior to the start of treatment, the mean HbA1c LeveL in the examined patients did not differ and corresponded to 8.3±1.7% in the main and 8.7±1.3% in the controL groups (p=1.0). To assess the degree of functionaL disorders in the form of Leg pain when waLking, a treadmiLL test was conducted according to the Gardner-Skinner ProtocoL. Laser DoppLer fLowmetry (LDF) was carried out to evaLuate microcircuLation before and after the course of treatment. To assess the intensity of pain, a 10-point visuaL anaLogue pain scaLe (VAS) was used.
Patients of both groups studied received basic therapy, incLuding diet, registered in the Russian Federation, antipLateLet, hypoLipidemic drugs and exercise therapy in the form of therapeutic exercises. In addition to the basic treatment, patients of the main group underwent functionaL eLectrostimuLation (FES) of the Lower extremities with a course of 10 procedures.
Results and discussion. After the course of treatment in patients of both groups there was a positive dynamics of the main cLinicaL symptoms of the disease, aLthough the degree of these changes differed significantLy - there was a decrease in the intensity of pain syndrome at rest (on the scaLe of YOUR) in the main group from 7.5 to 4 points, in the controL group from 7.8 to 6.2 points; significantLy decreased or disappeared AnaLysis of the SAN scaLe and SF-36 questionnaire reveaLed unidirectionaL shifts in both groups, but a number of indicators showed a certain advantage of the treatment compLex with the use of FES procedures. It was found that the appointment of FES contributed to the improvement of functionaL parameters of waLking: an increase in the distance passed by patients without pain by 2.3 times and the maximum distance passed by 2.4 times, whiLe in the controL group the changes in these parameters were not so significant. After treatment with LDF data in both groups increased the rate of microcircuLation (PM): in the main group of PM increased by 37%, in the controL group by 31%, the index of microcircuLation efficiency (IEM) increased by 63% onLy in the main group, in the controL group of IEM did not change significantLy. When anaLyzing the state of operation of certain perfusion controL mechanisms by means of waveLet transformation in the group with the use of FES, an increase in the ampLitude of osciLLations in the myogenic by 27-31% and neurogenic by 21-23% frequency ranges was noted, which was accompanied by a decrease in PS (shunting index) by 30%. In the controL group there was a sLight increase in ampLitude onLy in the spectrum of fast (respiratory and cardiac) osciLLations.
Summary. The use of functionaL eLectrostimuLation of the Lower extremities against the background of basic therapy of diabetes meLLitus aLLowed to increase the effectiveness of compLex treatment of diabetic angiopathy of the Lower extremities in patients with type 2 diabetes, to obtain a therapeutic resuLt associated with the reduction of pain, improvement of peripheraL hemodynamics, increased exercise toLerance and a positive impact on the quaLity of Life of patients.
Keywords:functionaL eLectrostimuLation, diabetes meLLitus, Laser DoppLer fLowmetry
Endocrinology: News, Opinions, Training. 2018; 7 (2): 68–70.