Introduction
Chapter 1. Theoretical part
1 Definition
2 Classification
3 Etiology
4 Pathogenesis
5 Risk factors
6 Clinic
7 Diagnostics
8 Treatment
9 Prevention
Chapter 2. Practical part
2.1 Studying risk factors in patients
2.2 Methods for diagnosing patients with hypertension
3 Analysis and evaluation of the results of the study of patients with hypertension
2.4 The role of the paramedic in organizing and conducting diagnostic, therapeutic and preventive measures to combat hypertension
Conclusion
Introduction
Relevance. Considering the problem hypertension, we are faced with a paradox: with a significant prevalence of this pathology, public awareness of it is very low. According to statistics, only 37.1% of men know that they have hypertension, about 21.6% of them are treated, and only 5.7% are treated effectively. About 59% of women know that they have a disease, 45.7% of them are treated, and only 17.5% are treated effectively.
Currently, arterial hypertension is considered to be a multifactorial disease, in the development of which are important as hereditary predisposition, and the factors environment, bad habits. Like no other disease, hypertension is a lifestyle disease. Clinical studies indicate the possibility of improving the life prognosis and quality of life of patients with adequate antihypertensive therapy, which is carried out differentially depending on the state of the target organs, concomitant pathology and other features of the patient.
Our country has a positive experience in conducting preventive programs. Yes, in former USSR the "All-Union cooperative program for the prevention of arterial hypertension" was carried out. As a result of their implementation in the groups of program participants, there was a decrease in overall mortality by 17% and 21%, respectively, the frequency of cerebral stroke by 50% and 38%, and mortality from cardiovascular diseases by 41%. Participation in educational program forms a correct idea of the disease, risk factors for its occurrence and conditions for a progressive course, which allows the patient to more clearly follow a set of recommendations for a long time, forms an active life position the patients themselves and their loved ones in the further process of recovery.
Object Area-Therapy
The object of the study is hypertension
The subject of the study is Hypertension: an analysis of the prevalence, the role of a paramedic in the organization and implementation of diagnostic, therapeutic and preventive measures.
Purpose of the study: To study the role of a paramedic in the organization and implementation of diagnostic, therapeutic and preventive measures to combat hypertension.
Research objectives:
To reveal the concept and causes of the development of hypertension.
Learn the classification and clinical picture manifestations of hypertension.
Discuss factors in the development of hypertension.
4. Conduct a study aimed at studying risk factors in outpatient patients.
Process and analyze the results of the study.
6. Select methods for organizing and conducting diagnostic, therapeutic and preventive measures to combat hypertension.
Analyze the results of the study and formulate conclusions.
Research methods:
1. Theoretical (study of literary sources)
Empirical (questionnaire)
Chapter 1. Theoretical part
1 Definition
Hypertension (Greek hyper- + tonos tension; synonym: essential arterial hypertension, primary arterial hypertension) - a common disease unclear etiology, the main manifestations of which are high blood pressure in frequent combination with regional, mainly cerebral, disorders of vascular tone; staging in the development of symptoms; pronounced dependence of the flow on functional state nervous mechanisms of regulation blood pressure in the absence of a visible causal relationship of the disease with primary organic damage to any organs or systems. The latter circumstance distinguishes hypertension from symptomatic, or secondary, arterial hypertension.
The prevalence of hypertension in developed countries high, and it is higher among residents of large cities than among the rural population. With age, the frequency of hypertension increases, and in people over 40 years of age it reaches 20-25% in these countries with a relatively even distribution among men and women (according to some reports, hypertension is more common in women).
In general, ideas about the etiology of hypertension are in the nature of hypotheses, therefore, the affiliation of hypertension to diseases of unknown etiology remains reasonable.
In the pathogenesis of hypertension, the leading is the violation of higher nervous activity, initially arising under the influence of external stimuli and subsequently leading to persistent excitation of the autonomic pressor centers, which causes an increase in blood pressure.
2 Classification
Over the entire period of studying the disease, more than one classification of hypertension has been developed: according to the appearance of the patient, the reasons for the increase in pressure, etiology, the level of pressure and its stability, the degree of organ damage, the nature of the course. Some of them have lost their relevance, others continue to be used by physicians today, most often this is a classification by degree and stage.
There is no single systematization, but most often doctors use the classification that was recommended by WHO and the International Society for Hypertension (ISH) in 1999. According to WHO, hypertension is classified primarily by the degree of increase in blood pressure, which are divided into three:
1.The first degree - mild (borderline hypertension) - is characterized by pressure from 140/90 to 159/99 mm Hg. pillar. 2.In the second degree of hypertension - moderate - arterial hypertension is in the range from 160/100 to 179/109 mm Hg. pillar. .In the third degree - severe - the pressure is 180/110 mm Hg. pillar and above. You can find classifiers in which 4 degrees of hypertension are distinguished. In this case, the third form is characterized by pressure from 180/110 to 209/119 mm Hg. column, and the fourth - very heavy - from 210/110 mm Hg. pillar and above. The degree (mild, moderate, severe) indicates only the level of pressure, but not the severity of the course and the patient's condition. In addition, physicians distinguish three stages of hypertension, which characterize the degree of organ damage. Classification by stages: stage. The increase in pressure is insignificant and unstable, the work of the cardiovascular system is not disturbed. Complaints in patients, as a rule, are absent. stage. Arterial pressure increased. There is an increase in the left ventricle. Usually there are no other changes, but local or generalized vasoconstriction of the retina of the eye may be noted. stage. There are signs of organ damage: · heart failure, myocardial infarction, angina pectoris; · chronic kidney failure;
· stroke, hypertensive encephalopathy, transient disorders blood circulation of the brain; · from the side of the fundus: hemorrhages, exudates, edema optic nerve;
· lesions of peripheral arteries, aortic aneurysm. When classifying hypertension, options for increasing pressure are also taken into account. There are the following forms: · systolic - increased only top pressure, lower - less than 90 mm Hg. pillar; · diastolic - increased lower pressure, upper - from 140 mm Hg. pillar and below; · systolic-diastolic; · labile - pressure rises by a short time and normalizes itself, without drugs. 3 Etiology The main cause of hypertension is repeated, as a rule, prolonged psycho-emotional stress. The stress reaction has a pronounced negative emotional character. Risk factors for hypertension are divided into manageable and unmanageable. Controlled risk factors include: smoking, alcohol consumption, stress, atherosclerosis, diabetes mellitus, excessive salt intake, physical inactivity, obesity. The main factors involved in the development of hypertension are: An excess of Na+ causes (among other things) several effects: Increased transport of fluid into cells and their swelling. Swelling of the cells of the walls of blood vessels leads to their thickening, narrowing of their lumen, increased rigidity of the vessels and a decrease in their ability to vasodilate. Disorders of the functions of membrane receptors that perceive neurotransmitters and other biologically active substances that regulate blood pressure. This creates a condition for the dominance of the effects of hypertensive factors. Disturbances in the expression of genes that control the synthesis of vasodilator agents (nitric oxide, prostacyclin) by endothelial cells. Studies have shown that salt intake in excess of the physiological norm leads to an increase in blood pressure. It has been scientifically proven that regular consumption of more than 5 g of salt with food daily contributes to the occurrence of hypertension, especially if a person is predisposed to it. Excess salt in the body often leads to spasm of the arteries, fluid retention in the body and, as a result, to the development of hypertension. environmental factors. Factors such as noise, pollution and water hardness are considered risk factors for hypertension. Highest value have occupational hazards (for example, constant noise, the need to strain attention); living conditions (including utilities); intoxication (especially alcohol, nicotine, drugs); brain injuries (bruises, concussions, electrical trauma, etc.). individual characteristics of the body. Hereditary burden of hypertension is one of the most powerful risk factors for the development of this disease. There is a fairly close relationship between blood pressure levels in first-degree relatives (parents, brothers, sisters). The risk increases even more if two or more relatives had high blood pressure. Beginning with adolescence, average level blood pressure is higher in men than in women. Sex differences in blood pressure peak at young and middle age (35-55 years). In later life, these differences smooth out, and sometimes women may have a higher average level of pressure than men. This is due to the higher premature mortality of middle-aged men with high blood pressure, as well as the changes that occur in the body of women after menopause. High blood pressure most often develops in people over 35 years of age, and the older the person, the higher the numbers of his blood pressure. In men aged 20-29 years, hypertension occurs in 9.4% of cases, and in 40-49 years old - already in 35% of cases. When they reach the age of 60-69, this figure rises to 50%. It should be noted that under the age of 40, men suffer from hypertension much more often than women, and then the ratio changes in the opposite direction. Currently, hypertension has become much younger and increased blood pressure is increasingly being detected in young people and people of mature age. The risk of developing hypertension increases in women during menopause. This is due to violation hormonal balance in the body during this period and exacerbation of nervous and emotional reactions. According to studies, hypertension develops in 60% of cases in women precisely in menopause. In the remaining 40%, during menopause, blood pressure is also steadily elevated, but these changes disappear as soon as the difficult time for women is left behind. Stress is the body's response to a strong influence of factors external environment. There is data showing that different kinds acute stress increase blood pressure. It is not known, however, whether long-term stress leads to a long-term increase in blood pressure, independent of other factors such as diet or socioeconomic factors. In general, there is not enough data to say with certainty about the causal relationship between stress and blood pressure or to calculate the quantitative contribution of this factor to the development of the disease. It is difficult to find another such habit, about the dangers of which so much has been said and written. The fact that smoking can cause the development of many diseases has become so obvious that even a special term has appeared - “diseases associated with smoking”. The cardiovascular system also suffers from nicotine. Diabetes is a reliable and significant risk factor for the development of atherosclerosis, hypertension and coronary heart disease. Diabetes mellitus leads to profound metabolic disorders, increased levels of cholesterol and lipoproteins in the blood, and a decrease in the level of protective lipoprotein blood factors. Atherosclerosis is the main cause of various lesions of cardio-vascular system. It is based on deposits in the walls of the arteries of fatty masses and the development connective tissue with subsequent thickening and deformation of the arterial wall. Ultimately, these changes lead to a narrowing of the lumen of the arteries and a decrease in the elasticity of their walls, which makes it difficult for blood to flow. Mankind has long known about the beneficial effects of muscle activity on the state of the body. During physical exertion, sharp increase energy consumption, it stimulates the activity of the cardiovascular system, trains the heart and blood vessels. Muscle load contributes to the mechanical massage of the walls of blood vessels, which has a beneficial effect on blood circulation. Thanks to physical exercises, the heart works more fully, blood vessels become more elastic, and the level of cholesterol in the blood decreases. All this inhibits the development of atherosclerotic changes in the body. Regular physical exercise on fresh air, adequate to achieve an average level of fitness, are quite effective tool prevention and treatment of arterial hypertension. Research data suggest that a 10 kg weight gain is accompanied by an increase in systolic pressure by 2-3 mm Hg. and an increase in diastolic pressure by 1-3 mm Hg. This is not surprising, since obesity is often associated with other factors listed - an abundance of animal fats in the body (which causes atherosclerosis), the use of salty foods, and low physical activity. In addition, with excess weight, the human body needs more oxygen. And oxygen, as you know, is carried by the blood, so an additional burden falls on the cardiovascular system, which often leads to hypertension. IN scientific research established bad influence alcohol on the level of pressure, and this effect did not depend on obesity, smoking, physical activity, sex and age. It is estimated that the use of 20-30 ml. pure ethanol are accompanied by an increase in systolic pressure by about 1 mm Hg. and diastolic pressure by 0.5 mmHg. In addition, there is an addiction, which is very difficult to fight. Alcohol abuse can lead to the development of heart failure, hypertension, acute disorder cerebral circulation. 4 Pathogenesis A number of factors are involved in the mechanism of development of hypertension: · nervous; · reflex; · hormonal; · renal; · hereditary. It is believed that psycho-emotional overstrain ( nerve factor) leads to depletion of centers vascular regulation with involvement in pathogenetic mechanism reflex and humoral factors. Among the reflex factors, one should take into account the possible shutdown of depressor effects carotid sinus and aortic arch, as well as activation of the sympathetic nervous system. Among hormonal factors the strengthening of the pressor influences of the pituitary-diencephalic region (hyperplasia of the cells of the posterior and anterior lobes of the pituitary gland), excessive release of catecholamines (hyperplasia of the adrenal medulla) and activation of the reningipertensive system as a result of increasing ischemia of the kidneys (hyperplasia and hypergranularity of cells of the juxtaglomerular apparatus, atrophy of the interstitial cells of the medulla of the kidneys) are important . The renal factor in the pathogenesis of hypertension is given exceptional importance, since the excretion of sodium and water by the kidneys, the secretion of renin, kinins and prostaglandins by them is one of the main mechanisms for regulating blood pressure. In the circulatory system, the kidney plays the role of a kind of regulator that determines the value of systolic blood pressure and ensures its long-term stabilization at a certain level (barostatic function of the kidney) by the feedback mechanism. Feedback in this system is carried out by the nervous and endocrine mechanisms of blood pressure regulation: the autonomic nervous system with baro- and chemoreceptors and centers of vascular regulation in the brainstem, the renin-angiotensin system, neuroendocrine system(vasopressin, oxytocin), corticosteroids, natriuretic hormone and atrial natriuretic factor. In this regard, a prerequisite for the development of chronic arterial hypertension is a shift in the dependence curve excretory function kidneys from the value of systolic blood pressure towards its higher values. This phenomenon is called “kidney switching”, which is accompanied by contraction of the afferent arterioles, inhibition of the countercurrent-multiplier system of the kidneys, and increased water reabsorption in the distal tubules. Depending on the activity of the pressor systems of the kidneys, they speak of vasoconstrictor hypertension with high activity renin in the blood plasma (the tendency to spasms of arterioles is pronounced) or hypervolemic hypertension with low renin activity (an increase in the mass of circulating blood). The level of arterial pressure is determined by the activity of not only pressor, but also depressor systems, including the kinin and prostaglandin systems of the kidneys, which are involved in the excretion of sodium and water. The role of hereditary factors in the pathogenesis of hypertension is confirmed by the results of a number of experimental studies. It has been shown, for example, that the excretory and endocrine functions of the kidneys, which regulate the level of arterial pressure, can be genetically determined. In the experiment, animal lines with "spontaneous" arterial hypertension, which is based on defects in excretory and other kidney functions, were obtained. The “membrane theory” is also convincing in this respect. primary hypertension, according to which the primary link in the genesis of essential hypertension is a genetic defect cell membranes in relation to the regulation of the distribution of intracellular calcium, which leads to a change in the contractile properties of vascular smooth muscles, an increase in the release of mediators nerve endings, increased activity of the peripheral part of the sympathetic nervous system and, finally, to the reduction of arterioles, which results in arterial hypertension and the inclusion of the renal factor (“kidney switch”). Naturally, the hereditary pathology of cell membranes does not remove the role stressful situations, psycho-emotional stress in the development of hypertension. Membrane pathology of cells can only be a background against which other factors act favorably (Scheme XIX). It is important to emphasize the fact that the renal factor often closes the "vicious circle" of the pathogenesis of hypertension, since developing arteriolosclerosis and subsequent renal ischemia include the renin-angiotensin-aldosterone system. 1.5 Risk factors The main cause of hypertension is repeated, as a rule, prolonged psycho-emotional stress. Stress - the reaction has a pronounced negative emotional character. Risk factors for hypertension are divided into manageable and unmanageable. Uncontrolled risk factors include: heredity, gender, age, menopause in women, environmental factors. Controlled risk factors include: smoking, alcohol consumption, stress, atherosclerosis, diabetes mellitus, excessive salt intake, physical inactivity, obesity. Too much Na+ in food. Excess salt in the body often leads to spasm of the arteries, fluid retention in the body and, as a result, to the development of hypertension. environmental factors. Factors such as noise, pollution and water hardness are considered risk factors for hypertension. Occupational hazards are of the greatest importance (constant noise, the need for tension of attention); living conditions (including utilities); intoxication (especially alcohol, nicotine, drugs); brain injuries (bruises, concussions, electrical trauma, etc.). Hereditary burden of hypertension is one of the most powerful risk factors for the development of this disease. The risk increases even more if two or more relatives had high blood pressure. High blood pressure most often develops in people over 35 years of age, and the older the person, the higher the numbers of his blood pressure. Currently, hypertension has become much younger and increased blood pressure is increasingly being detected in young people and people of mature age. Stress is the body's response to environmental factors. There is evidence that various types of acute stress increase blood pressure. Diabetes mellitus is a reliable and significant risk factor for the development of hypertension and leads to profound metabolic disorders, increased levels of cholesterol and lipoproteins in the blood, and a decrease in the level of protective lipoprotein blood factors. Atherosclerosis is the main cause of various lesions of the cardiovascular system. It is based on deposits in the walls of the arteries of fatty masses and the development of connective tissue, followed by thickening and deformation of the walls of the arteries. Ultimately, these changes lead to a narrowing of the lumen of the arteries and a decrease in the elasticity of their walls, which makes it difficult for blood to flow. Obesity. Research data indicate that weight gain by 10 kg is accompanied by an increase in systolic pressure by 2-3 mm. rt. Art. and an increase in diastolic pressure by 1-3 mm. rt. Art. Alcohol. It is estimated that the use of 20-30 ml. pure ethanol are accompanied by an increase in systolic pressure of about 1 mm. rt. Art. and diastolic pressure by 0.5 mm. rt. Art. Thus, acting simultaneously and for a long time, the factors described above lead to the development of hypertension (and other diseases). The impact of these factors on a person already suffering from hypertension contributes to the aggravation of the development of the disease and increases the risk of developing various complications. 1.6 Clinic Clinic of hypertension in early stages development of the disease is not clearly expressed, therefore, there are certain difficulties in differentiating this disease from neurocirculatory dystonia. The borderline is considered to be systolic blood pressure of 140-159 mm Hg. Art. and diastolic - 90-94 mm Hg. Art. Patients complain about headache a certain localization (often in the temples, neck), accompanied by nausea, flashing before the eyes, dizziness. Symptoms worsen during a sharp rise in blood pressure (hypertensive crisis). Objectively, a deviation of the left borders of absolute and relative cardiac dullness to the left, an increase in blood pressure above the corresponding physiological (age, gender, etc.) norm, an increase (during a crisis) in the pulse rate and, accordingly, the heart rate, and often arrhythmia, accent II tone above the aorta, an increase in the diameter of the aorta. ECG shows signs of left ventricular hypertrophy. At x-ray examination <#"justify">In accordance with the recommendations of the WHO Expert Committee, there are 3 stages of hypertension. stage (mild) - periodic increase blood pressure (diastolic pressure - more than 95 mm Hg) with possible normalization of hypertension without drug treatment. During a crisis, patients complain of headache, dizziness, sensation of noise in the head. The crisis may be resolved by copious urination. Objectively, only narrowing of arterioles, dilatation of veins and hemorrhages in the fundus without other organ pathology can be detected. Hypertrophy of the myocardium of the left ventricle no. stage ( moderate) - stable increase in blood pressure (diastolic pressure - from 105 to 114 mm Hg). The crisis develops against the background of high blood pressure, after the resolution of the crisis, the pressure does not normalize. Changes in the fundus are determined, signs of left ventricular myocardial hypertrophy, the degree of which can be indirectly assessed by X-ray and echocardiographic studies. Currently, an objective assessment of the thickness of the ventricular wall is possible using echocardiography. stage (severe) - a stable increase in blood pressure (diastolic pressure is more than 115 mm Hg). The crisis also develops against the background of high blood pressure, which does not normalize after the resolution of the crisis. Changes in the fundus compared with stage II are more pronounced, arterio- and arteriolosclerosis develops, cardiosclerosis joins left ventricular hypertrophy. There are secondary changes in other internal organs. Taking into account the predominance of a specific mechanism for increasing blood pressure, the following forms of hypertension are conditionally distinguished: hyperadrenergic, hyporeinic and hyperreninous. The first form is manifested by pronounced autonomic disorders during a hypertensive crisis - a feeling of anxiety, flushing of the face, chills, tachycardia; the second - swelling of the face and (or) hands with periodic oliguria; the third - high diastolic pressure with severe increasing angiopathy. The latter form is rapidly progressive. The first and second forms most often cause hypertensive crises for I-II and II-III stages of the disease, respectively. A hypertensive crisis is considered as an exacerbation of hypertension. Three types of crisis are distinguished depending on the state of central hemodynamics at the stage of its development: hyperkinetic (with an increase in the minute volume of blood or cardiac index), eukinetic (with the preservation of normal values of the minute volume of blood or cardiac index) and hypokinetic (with a decrease in the minute volume of blood or cardiac index). index). Complications of hypertension: heart failure, ischemic disease heart, cerebrovascular accidents, up to ischemic or hemorrhagic stroke, chronic renal failure, etc. Acute heart failure, cerebrovascular accidents most often complicate hypertension during the development of a hypertensive crisis. Diagnosis is based on anamnestic and clinical data, the results of dynamic measurement of blood pressure, determination of the boundaries of the heart and the thickness (mass) of the wall of the left ventricle, examination of the vessels of the fundus, blood and urine ( general analysis). To determine the specific mechanism of arterial hypertension, it is advisable to study the humoral factors of pressure regulation. Differential diagnosis. It is necessary to differentiate hypertension from symptomatic arterial hypertension, which is one of the syndromes in other diseases (kidney disease, skull trauma, endocrine diseases and etc.). 7 Diagnostics Diagnosis of hypertension (AH) and examination of patients with arterial hypertension (AH) is carried out in strict sequence, meeting certain tasks: Determination of the stability of the increase in blood pressure (BP) and its degree. Exclusion of the secondary nature of hypertension or identification of its form. Identification of the presence of other risk factors, CVD and clinical conditions, which can affect the prognosis and treatment, as well as the assignment of the patient to a particular risk group. Determining the presence of POM and assessing their severity. Determination of blood pressure stability and its degree At the initial examination of the patient, the pressure on both hands should be measured. In the future, measurements are taken on the arm where blood pressure is higher. In patients over 65 years of age, patients with diabetes and receiving antihypertensive therapy, measure blood pressure while standing after 2 minutes. It is advisable to measure the pressure on the legs, especially in patients younger than 30 years. To diagnose the disease, at least two measurements must be taken with an interval of at least a week. Ambulatory blood pressure monitoring (ABPM) SMAD provides important information on the state of the mechanisms of cardiovascular regulation, in particular, it reveals such phenomena as diurnal variability in blood pressure, nocturnal hypotension and hypertension, blood pressure dynamics over time, and the uniformity of the hypotensive effect of drugs. At the same time, the data of 24-hour blood pressure measurements have a greater prognostic value than one-time measurements. The recommended ABPM program involves recording blood pressure at intervals of 15 minutes during wakefulness and 30 minutes during sleep. Approximate normal blood pressure values for the period of wakefulness are 135/85 mm Hg. Art., night sleep - 120/70 mm Hg. Art. with the degree of decrease at night 10-20%. The absence of a nocturnal decrease in blood pressure or the presence of an excessive decrease in blood pressure should attract the attention of a doctor, because. such conditions increase the risk of organ damage. Possessing unconditional information, the SMAD method is not generally accepted today, mainly because of its high cost. After the identification of stable hypertension, the patient should be examined to rule out symptomatic hypertension. The survey includes 2 stages. The first stage is mandatory studies that are carried out for each patient when AH is detected. This stage includes the assessment of POM, the diagnosis of concomitant clinical conditions that affect the risk of cardiovascular complications, and routine methods for excluding secondary hypertension. Collection of anamnesis. Laboratory and instrumental studies: general urine analysis; determination of blood levels of hemoglobin, hematocrit, potassium, calcium, glucose, creatinine; determination of the blood lipid spectrum, including the level HDL cholesterol, LDL and triglycerides (TG): electrocardiogram (ECG); chest x-ray; examination of the fundus; ultrasound examination (ultrasound) of the abdominal organs. If at this stage of the examination the doctor has no reason to suspect the secondary nature of hypertension and the available data are sufficient to clearly determine the patient's risk group and, accordingly, treatment tactics, then the examination can be completed. The second stage involves studies to clarify the form of symptomatic hypertension, additional examination methods for assessing POM, and identifying additional risk factors. Special examinations to detect secondary hypertension. Additional studies to evaluate concomitant risk factors and POM. They are performed in cases where they can affect the tactics of managing a patient, i.e. their results may lead to a change in the level of risk. So, for example, echocardiography, as the most exact method detection of LVH, if it is not detected by ECG, and its diagnosis will affect the definition of the risk group and, accordingly, the decision on the appointment of therapy. Examples of diagnostic conclusions: Hypertension (or arterial hypertension) 3 degrees, 2 stages. Dyslipidemia. Left ventricular hypertrophy. Risk 3. Hypertension 2 degrees, 3 stages. ischemic heart disease. Angina pectoris, 11 functional class. Risk 4. Hypertension stage 2. aortic atherosclerosis, carotid arteries. Risk 3. Hypertension 1 degree, 3 stages. vascular atherosclerosis lower extremities. Intermittent lameness. Risk 4. Hypertension 1st degree, 1st stage. diabetes mellitus, type 2, medium degree severity, stage of compensation. Risk 3. 8 Treatment The mode of work and rest is important, moderate physical exercise, proper nutrition with limited consumption table salt, animal fats, refined carbohydrates. It is recommended to refrain from taking alcoholic beverages. Treatment is complex, taking into account the stages, clinical manifestations and complications of the disease. Use antihypertensive, sedative, diuretic and other drugs. Antihypertensive drugs used to treat hypertension can be conditionally divided into the following groups: · drugs that affect the activity of the sympathetic-adrenal system - clonidine (clofelin, hemiton), reserpine (rausedil), raunatin (rauvazan), methyldopa (dopegyt, aldomet), guanethidine (isobarine, ismelin, octadine); · beta-adrenergic receptor blockers (alprenolol, atenolol, acebutalol, trazikor, visken, anaprilin, timolol, etc.); · alpha-adrenergic receptor blockers (labetolol, prazosin, etc.); · arteriolar vasodilators (apressin, hyperstat, minoxidil); · arteriolar and venous dilators (sodium vitroprusside); · ganglion blockers (pentamine, benzohexonium, arfonad); · calcium antagonists (nifedipine, corinfar, verapamil, isoptin, diltiazem); · drugs that affect water and electrolyte balance(hypothiazide, cyclomethiazide, oxodoline, furosemide, veroshpiron, triamterene, amiloride); · drugs that affect the activity of the renin-angiotensin system (captopril, enalapril); · serotonin antagonists (ketanserin). Given the large selection antihypertensive drugs, it is advisable to determine a specific mechanism for increasing blood pressure in a patient. In case of stage I hypertension, course treatment is aimed at normalizing and stabilizing normalized pressure. use sedatives(bromides, valerian, etc.), reserpine and reserpine-like drugs. The dose is selected individually. The drugs are given mainly at night. In crises with a hyperkinetic type of blood circulation, beta-adrenergic receptor blockers are prescribed (anaprilin, inderal, obzidan, trazikor, etc.). In stage II-III, continuous treatment with constant reception antihypertensive drugs, ensuring the maintenance of blood pressure as close as possible to the physiological level. Simultaneously combine several drugs with different mechanisms of action; include saluretics (hypothiazide, dichlothiazide, cyclomethiazide). Also used in combination dosage forms containing saluretics (Adelfan-Ezidrex, Sinepres, etc.). At hyperkinetic type blood circulation in therapy include blockers of beta-adrenergic receptors. The use of peripheral vasodilators has been shown. good effect achieved by taking gemiton, clonidine, dopegyt (methyldopa). In elderly people with antihypertensive therapy it is necessary to take into account the compensatory value of arterial hypertension due to the atherosclerotic process developing in them. You should not strive to ensure that blood pressure reaches the norm, it should exceed it. In a hypertensive crisis, more decisive action is required. However, it must be remembered that a sharp decline arterial pressure during the relief of a crisis, in fact, is a catastrophe for the relationship between the mechanisms of pressure regulation that has developed in a certain way in the patient. During a crisis, the dose of drugs used is increased and drugs with a different mechanism of action are additionally prescribed. IN emergency cases, with extremely high blood pressure, intravenous administration is indicated medicines(dibazole, pentamin, etc.) Inpatient treatment is indicated for patients with high diastolic pressure (more than 115 mm Hg), with severe hypertensive crisis and complications. Treatment of complications is carried out in accordance with general principles treatment of the syndromes giving clinic of complications. Patients are prescribed exercise therapy, electrosleep, in the first stage of the disease - physiotherapeutic methods. In stages 1 and 2, treatment is shown in local sanatoriums. 1.9 Prevention The following facts testify to the role of nervous mechanisms in the origin of hypertension: in the vast majority of cases, patients can establish in the past, before the onset of the disease, the presence of strong nervous "shakes", frequent unrest, mental trauma. Experience shows that hypertension is much more common in people who are subject to repeated and prolonged nervous strain. Thus, the huge role of disorders of the neuropsychic sphere in the development of hypertension is indisputable. Of course, personality traits and the reaction of the nervous system to external influences matter. Heredity also plays a role in the occurrence of the disease. Under certain conditions, malnutrition can also contribute to the development of hypertension; gender, age matters. Thus, women during menopause (at 40-50 years old) suffer from hypertension more often than men of the same age. Elevations in blood pressure can occur in women during pregnancy, which can lead to serious complications during childbirth. Therefore, in this case therapeutic measures should be aimed at eliminating toxicosis. Atherosclerosis can contribute to the development of hypertension cerebral vessels, especially if it affects certain departments that are in charge of the regulation of vascular tone. The disruption of the kidneys is very important. Reducing the blood supply to the kidneys causes the production of a special substance - renin, which increases blood pressure. But the kidneys also have a so-called renoprival function, which consists in the fact that the medulla of the kidneys produces a substance that destroys compounds in the blood that increase blood pressure (pressor amines). If, for some reason, this so-called antihypertensive function of the kidneys is impaired, then blood pressure rising and stubbornly holding on high level despite comprehensive treatment modern means. In such cases, it is believed that the development of persistent hypertension is a consequence of a violation of the renoprival function of the kidneys. Prevention of hypertension requires special attention to nutrition. Recommended to avoid overuse meat and fats. The diet should be moderately high-calorie, with a restriction of protein, fat and cholesterol. This helps prevent the development of hypertension and atherosclerosis. Overweight people should periodically resort to unloading diets. Known limitation in the diet should correspond to labor activity. In addition, significant malnutrition contributes to the development of hypertension, causing a change in the reactivity of the higher parts of the central nervous system. Correct Mode nutrition without the formation of excess weight should be sufficient to prevent functional disorders higher nervous system. Systematic weight control is the best guarantee of a proper diet. A person suffering from hypertension should be moderate in fluid intake. Normal daily requirement 1-1.5 liters of all water taken per day in the form of liquids is satisfied in water, including liquid meals at dinner. About 1 liter of liquid, in addition, a person receives from the water that is part of the products. In the absence of heart failure, the patient can afford to take fluids in the range of 2-2.5 liters (preferably no more than 1-1.2 liters). It is necessary to distribute the drink evenly - you can not drink a lot at once. The fact is that the liquid is quickly absorbed from the intestines, flooding the blood, increasing its volume, which increases the load on the heart. It must move a larger than usual mass of blood until the excess fluid is removed through the kidneys, lungs, and skin. Overfatigue of a diseased heart causes a tendency to edema, and an excess of fluid aggravates it all the more. The use of pickles should be excluded, table salt should be limited to 5 g per day. Excessive salt intake leads to water-salt metabolism that contributes to hypertension. Alcoholic drinks, smoking also accelerate the development of the disease, so they should be strictly prohibited for patients with hypertension. Nicotine is a poison for blood vessels and nerves. The appropriate distribution of hours of work and rest is of great importance. long and hard work, reading, mental fatigue, especially in persons predisposed to hypertension, contributes to its occurrence and development. Particular attention should be paid physical culture. It is a kind of protective measure that trains the neurovascular apparatus of hypertensive patients, reduces the phenomena associated with disorders of the nervous system - headache, dizziness, noise and heaviness in the head, insomnia, general weakness. Exercises should be simple, rhythmic, performed at a calm pace. A particularly important role is played by regular morning hygienic gymnastics and constant walking, especially before going to bed, lasting at least an hour. Very useful hours spent in nature, outside the city, in the country. It must be remembered, however, that summer residents should alternate hours of hard work with hours of relaxed, simple movement. Try to avoid prolonged loads in a bent state, try not to garden, but rather spend outdoor activities in the country<#"justify">Chapter I Conclusions Hypertension deserves the most serious attention, especially because it leads to strong decline, and sometimes to the loss of mental and physical performance in adulthood, when a person can bring maximum benefit society. In addition, hypertension is one of the main obstacles to healthy longevity. The following facts testify to the role of nervous mechanisms in the origin of hypertension: in the vast majority of cases, patients can establish in the past, before the onset of the disease, the presence of strong nervous stress, frequent unrest, mental trauma. Experience shows that hypertension is much more common in people who are subject to repeated and prolonged nervous strain. Thus, the huge role of disorders of the neuropsychic sphere in the development of hypertension is indisputable. Of course, personality traits and the reaction of the nervous system to external influences matter. Early detection of psychopathological disorders, their timely correction -important factors defining success rehabilitation measures in patients with hypertension. In hypertensive patients with cardialgia, psychopathological symptoms are also more pronounced, mainly in the form of hypochondriacal, anxious and hysterical syndrome. In persons with professional arterial hypertension and patients with hypertension most often reveal the following character traits: hyperthymia, sthenicity, demonstrativeness, psychasthenicity and less often introversion, cycloidism and rigidity. Heredity also plays a role in the occurrence of the disease. Under certain conditions, malnutrition can also contribute to the development of hypertension; gender, age matters. Elevations in blood pressure can occur in women during pregnancy, which can lead to serious complications during childbirth. Atherosclerosis of the cerebral vessels can contribute to the development of hypertension, especially if it affects certain departments that are in charge of the regulation of vascular tone. Thus, these factors must be taken into account when constructing individual plan primary prevention hypertension and rehabilitation of patients. Chapter 2. Practical part 1 Study of risk factors in patients Having studied the literature on this topic, I decided to find out if visitors to the city's polyclinic have risk factors. I did a survey. The study involved 30 people of different ages. Participants were asked to answer the following questions: .Your age? How do you rate your health level? What, in your opinion, is the cause of the development of diseases of the cardiovascular system? Do any of your relatives have heart disease? Do you smoke? Is your life stressful? Do you tend to be overweight? Do you do physical exercises? Do you know your normal blood pressure numbers? Summing up the results of the survey, we can conclude that many people do not comply with the simplest norms. healthy lifestyle life. Some become victims of inactivity (physical inactivity), others overeat with the almost inevitable development of obesity, vascular sclerosis in these cases, and some have heart disease, others do not know how to relax, be distracted from industrial and domestic worries, are always restless, nervous, suffer from insomnia which ultimately leads to numerous diseases of the cardiovascular system. Almost all respondents (91%) smoke, which actively shortens their lives. Thus, the residents of the city have all the risk factors for cardiovascular diseases: smoking, overweight, physical inactivity, stress, hereditary factor, lack of awareness of their pressure. This suggests that the medical assistants of the city pay little attention to primary prevention, they need to take this problem more seriously, because today the incidence of hypertension in people is very high. 2 Methods for diagnosing patients with hypertension In order to solve the problems formulated in the work, a survey was conducted of patients of both sexes aged from 25 to 75 years. The study involved 30 people who were divided into two groups: group 1 - control, which included 15 healthy subjects: 6 women and 9 men (mean age - 51.5 years). The group of healthy subjects included people who did not have chronic and acute somatic diseases and diseases of the nervous system, mental health and consented to participate in the study. group 2 - the main one, which included 15 patients with hypertension: 6 women and 9 men (mean age - 48.9 years). In all patients, hypertension proceeded with crises. Among men, 2 were diagnosed with stage I hypertension, 2 with stage II hypertension, and 5 with stage III hypertension. Among women, stage I hypertension was present in 2, one had stage II hypertension, and 3 had stage III hypertension. All patients underwent a comprehensive clinical examination. The layout of the experiment is shown in Table 1. Table 1 Scheme of constructing an experiment in a group of patients with hypertension Research methods Age Group of patients Healthy Typological questionnaire G.Yu. Eysenka 25-751515 Cattell's sixteen-factor personality questionnaire 25-751515 Diagnosis of the level of personal frustration (Boyko) 25-751515 Emotional burnout (Boyko) 25-751515 Social maladjustment Leary 25-751515 Statistical methods zM were used for statistical processing of the study results. 3 Analysis and evaluation of the results of the study of patients with hypertension Clinical Methods The studies included general clinical, cardiological and neurological examinations. The data of the anamnesis, heredity, transferred earlier and accompanying illnesses, frequency of nervous stress, bad habits, pregnancy, adherence to the treatment of hypertension and control of blood pressure. The study of the state of the cardiovascular system included the control of blood pressure. Psychological research included: Identification of extraversion-introversion, assessment of emotional stability-instability (neuroticism); Assessment of individual psychological characteristics of a person; Identification of the level of personal frustration and the level of manifestation emotional burnout; Study of the mechanisms of social maladaptation. The most important component of hypertension are emotional disorders. In our work, we assessed the personality traits of patients with hypertension using the following components: extraversion-introversion (Eysenck's Questionnaire), individual psychological characteristics of the personality (Kettel's Questionnaire), identifying the level of personal frustration and the level of manifestation of emotional burnout (Boiko's Methods), studying the mechanisms of social maladjustment (Leary method). Typological questionnaire G.Yu. Eysenck (EPI Questionnaire). The EPI questionnaire contains 57 questions, 24 of which are aimed at identifying extraversion-introversion, 24 others - at assessing emotional stability-instability (neuroticism), the remaining 9 form a control group of questions designed to assess the sincerity of the subject, his attitude to the examination and the reliability of the results. Cattell's sixteen-factor personality questionnaire. The Cattell Questionnaire is one of the most common questionnaire methods for assessing the individual psychological characteristics of a person both abroad and in our country. It was developed under the direction of R.B. Kettel and is intended for writing a wide range of individual-personal relationships. Diagnosis of the level of personal frustration (Boyko). The technique is aimed at a person's emotionally negative experience of any failure, failure, loss, collapse of hopes, accompanied by a sense of hopelessness, the futility of the efforts made. Emotional burnout (Boyko). Measurement of the level of manifestation of emotional burnout - a psychological defense mechanism in the form of a complete or partial exclusion of emotions in response to selected psychotraumatic effects. Leary's social maladaptation. The technique was created by T. Leary, G. Leforge, R. Sazek in 1954 and is designed to study the subject's ideas about himself and the ideal "I", as well as to study relationships in small groups. With the help of this technique, the predominant type of attitude towards people in self-esteem and mutual evaluation is revealed. At the first stage, the subjects of the control and main groups underwent a clinical study. An important stage of our study was the study of anamnesis, which allows us to assess the role of factors that take the most significant part in the formation of hypertension. The following indicators of anamnesis were taken into account: heredity, previous and concomitant diseases, the frequency of nervous stress, bad habits, pregnancy, adherence to the treatment of hypertension and control of blood pressure. The study of the state of the cardiovascular system included the control of blood pressure. According to the results of the data collection of anamnesis, the following indicators were identified: table 2 Comparative analysis of anamnestic data of healthy and hypertensive patients Groups Heredity Past, concomitant diseases Nervous stress Bad habits Pregnancy Adherence to treatment of the disease Control of blood pressure levels 2%960.3%1280.4%853.6%213.4%1067%15100% Comparison of the anamnestic data of the subjects of the main and control groups established a significantly higher degree of stress load. With statistical significance of differences (p<0,05) в группе гипертонических больных она составляла 80,4%, т. е. достоверно выше, чем у здоровых 46,9%. В 53,6% в основной группе, т. е. меньше, чем у здоровых 60,3% (p<0,05) был установлен факт вредных привычек. При исследовании наследственной предрасположенности было показано ее достоверное преобладание в группе больных гипертонической болезни (40,2%) по сравнению с соответствующими показателями у здоровых (наследственная предрасположенность 26,8%) (p<0,05). When patients with hypertension were admitted to the emergency room of the hospital, the following indicators of blood pressure and the corresponding severity of the disease were noted in patients. Table 3 Clinical assessment of disease severity Severity of the disease Percentage Hypertensive disease 1 st.27.8 Hypertensive disease 2 st. Table 4 Concomitant psychovegetative symptoms Psycho-vegetative symptoms Percent Asthenia 26.8 Headaches 80.4 Psycho-emotional stress 53.6 Low mood 67 Depression 33.5 At the second stage, the subjects of the control and main groups underwent a psychological study. Analyzing the results obtained, we came to the conclusion that in patients with hypertension, the level of social maladaptation is higher than in healthy subjects. Thus, according to the study, we came to the conclusion that in order to normalize the psychological status of hypertensive patients, it is necessary to carry out psycho-correctional work among hypertensive patients. 2.4 The role of the paramedic in organizing and conducting diagnostic, therapeutic and preventive measures to combat hypertension Prevention of hypertension, which is a chronic progressive vascular pathology, is not an easy task. Given its widespread prevalence, a special role in working with patients belongs to paramedical workers, in particular paramedics. The most important prerequisite for effective treatment is thoughtful individual work with patients. First of all, it is necessary to instill in the patient the need for systematic (and not only with an increase in blood pressure) taking medications for many years, and also, most importantly, a decisive improvement in their lifestyle, i.e., eliminating, if possible, risk factors for arterial hypertension. Prevention of hypertension is aimed at early detection of the disease by measuring blood pressure in people over 30-35 years of age during periodic medical examinations conducted at enterprises and institutions. People who have an increase in blood pressure should be taken under dispensary observation. The paramedic working at the paramedical station monitors the blood pressure of these people, actively visits them, monitors the action of antihypertensive drugs. Prevention of hypertension is of paramount importance in solving the problem of longevity, in maintaining mental and physical performance in adulthood. Thus, it is known that the presence of arterial hypertension shortens life expectancy by an average of 10 years (in the group of people older than 45 years). Such a frequent complication of hypertension, such as a hypertensive crisis, causes a rather high mortality rate, a high percentage of temporary disability and disability. Huge labor losses are also caused by another complication - myocardial infarction. It is practically important that the prevention of hypertension and the prevention of coronary artery disease largely coincide. The most promising is the identification of individuals with risk factors, i.e. those people in whom the development of hypertension is more likely (hereditary burden, abuse of table salt, animal fats, liquid and alcoholic beverages, improper work and rest, endocrine changes, intake oral contraceptives). Primary prevention of hypertension should begin in childhood. It is necessary to organize a medical examination in children's institutions, schools, universities with regular measurement of blood pressure in children and young people 2-3 times a year. This should be given special attention at the FAP, in the pre-medical reception rooms of outpatient clinics, etc. Primary prevention measures should take into account all risk factors. A rational muscular load is necessary already in childhood, unreasonable exemptions from physical education at school must be excluded, overfeeding of children and adolescents is unacceptable, especially salt-eating (increased consumption of table salt). If moderate hypertension does not cause pain, then only a wellness regimen should be recommended. These persons are contraindicated for work at night, as well as work associated with sharp nervous overload, tilting the head and torso, lifting weights. It is not recommended to sharply tilt the head, the body to a patient with hypertension, as this increases the pressure in the cerebral vessels; the head should be kept as straight as possible or slightly pulled back. Overtime work is unacceptable, it is necessary to limit the impact of industrial and domestic noise wherever possible. It is contraindicated for many hours sitting at the TV, especially for elderly obese persons after eating. Recall that it causes thrombosis of small veins of the legs. It is necessary to combat hypokinesia. Food that can increase vascular tone and irritate the nervous system (rich meat soups, fried meat, strong coffee, alcoholic beverages, spicy and spicy dishes) should be excluded from the diet. The fight against obesity is of great importance. Persons with overweight are recommended to periodically resort to unloading diets. Systematic control of body weight is a necessary prerequisite for a proper diet. Persons with borderline hypertension should be under medical supervision. Their dispensary is obligatory. Exercise training is recommended. If within 6-12 months their blood pressure steadily normalizes or remains in the border zone, then the observation is continued for another year. When complaints (headache, insomnia, etc.) appear in risk groups, drug treatment is started, usually 6-blockers and sedatives are prescribed. However, the paramedic must instill in every patient with hypertension that without the elimination of risk factors, drug treatment will give an incomplete and short-lived effect. It is in the patients' misunderstanding of this circumstance, as well as in the irregularity of taking antihypertensive drugs, that the reasons for the relatively high incidence of hypertension and its complications, including those with a fatal outcome (strokes, myocardial infarctions), lie. The experience of some foreign countries shows that persistent work with patients, individually selected and regular antihypertensive therapy can reduce the incidence of myocardial infarction and hemorrhagic strokes in the population by 20-30%. Therefore, the paramedic should carry out preventive work with persons disposed to hypertension in order to reduce the risk of morbidity. Although with persons with hypertension, prevention is also necessary. Disease is easier to prevent than to cure! And the paramedic plays a huge role in this. Chapter II Conclusions On the basis of an empirical experiment, it can be concluded that hypertension has a great influence on the personality and largely determines the behavior of the subject. The emotional sphere of hypertensive patients is characterized by high personal and reactive anxiety, emotional tension, low mood, irritability, the presence of depressive states, including masked ones. Patients with hypertension are characterized by a higher level of accentuation in general and especially of emotive, anxious, pedantic, cyclothymic and distimic types. Patients with hypertension had a higher level of alexithymia, which acts as an important pathogenetic factor in the formation of psychosomatic pathology. Features of adaptation in psychosomatic disorders are difficult due to the active use of non-adaptive psychological defense mechanisms such as denial, repression, hypercompensation and compensation, which do not contribute to the awareness of the presence and complexity of the disease, which leads to chronicity of the disease, as well as disharmonic personality development. Thus, the residents of the city have all the risk factors for cardiovascular diseases: smoking, overweight, physical inactivity, stress, hereditary factor, lack of awareness of their pressure. This suggests that the medical assistants of the city pay little attention to primary prevention, they need to take this problem more seriously, because today the incidence of hypertension in people is very high. Conclusion Measures to prevent hypertension are the subject of intensive and in-depth research. Hypertension, as observations have shown, is one of the most common cardiovascular diseases in many countries. Patients with hypertension are more prone to atherosclerosis, especially the arteries of the brain, heart, kidneys. All this indicates the need for systematic measures of personal and social prevention of this disease, its timely treatment. Epidemiological studies have shown that in a third of patients, hypertension is latent. Hypertensive disease deserves the most serious attention, especially because it leads to a strong decrease, and sometimes to a loss of mental and physical performance in adulthood, when a person can bring maximum benefit to society. In addition, hypertension is one of the main obstacles to healthy longevity. First of all, it is worth thinking about hypertension for everyone whose blood pressure is within the high or borderline norm. Everyone needs to have information about cases of hypertension in the family. A person who may develop arterial hypertension, as a preventive measure, needs to reconsider his usual way of life and make the necessary amendments to it. This concerns an increase in physical activity, regular outdoor activities are necessary, especially those that, in addition to the nervous system, also strengthen the heart muscle: these are running, walking, swimming, skiing. Nutrition should be complete and varied, include both vegetables and fruits, as well as cereals, lean meats, and fish. Eliminate large amounts of salt. You should also not get involved in alcoholic beverages and tobacco products. A healthy lifestyle, a calm and benevolent atmosphere in the family and at work, regular preventive examinations by a cardiologist - that's all the prevention of hypertension and cardiovascular diseases. In this work, I have: .The literature on this topic was studied and analyzed, where I found out: risk factors for hypertension, the role of a paramedic in the primary prevention of arterial hypertension. .A study aimed at studying the risk factors for cardiovascular diseases of the city residents was carried out. .A memo for patients on the primary prevention of arterial hypertension has been developed. (Annex 1) Having solved the tasks I have listed above, I can say that the goal of the thesis has been achieved, I have studied the role of the paramedic in the primary prevention of hypertension. List of used literature 1.Ababkov V.A. The problem of scientific character in psychotherapy. - St. Petersburg: Piter, 2014. - 560 p. 2.Alexander F. Psychosomatic medicine. - M.: UNITI, 2012. - 435 p. .Ananiev VA. Introduction to health psychology. - St. Petersburg: Piter, 2015. - 560 p. .Bagmet A.D. Vascular remodeling and apoptosis in normal and pathological conditions // Kardiologiya. -2012. - No. 3. - S. 83-86. .Balluzek M.F., Shpilkina N.A. Myocardial remodeling in patients with arterial hypertension with varying degrees of severity. Regional blood circulation and microcirculation. - 2013. - V. 2, No. 10. - S. 50-53. 6.Bolotovsky G.V., Mutafyan O.A. Hypertonic disease. - M: Omega, 2014. 7.Burduli N. M., Gatagonova T. M.,. Burnatseva I. B., Ktsoeva S. A., Gadzhinova L. B. Hypertension. - M: Phoenix, 2012. 8.Burlachuk L.F., Morozov S.M. Dictionary-reference book on psychological diagnostics. - St. Petersburg: Piter, 2015. - 530 p. 9.Vasilyeva L.P. Hypertension / L.P. Vasilyeva. - St. Petersburg. : Ves, 2009. - 160 p. 10.Volkov V.S., Tsikulin A.E. Treatment and rehabilitation of patients with hypertension in a polyclinic. - M.: Medicine, 1989. - 256 p. 11.Gindikin V.Ya., Semke V.Ya. Somatics and psyche. - M.: Enlightenment, 2004. - 385 p. .Hypertension under control - M.: MedExpertPress, 2005. - 144 p. 13.Efremushkin G.G. Syndromes in cardiology. - Barnaul: ASMU, 2014. 14.Zateyshchikova A.A., Zateyshchikov D.A. Endothelial regulation of vascular tone: research methods and clinical significance // Cardiology. - 2008. - No. 9. - S. 68-80. 15.Izard K.E. Psychology of emotions. - St. Petersburg: Peter, 2006. - 455 p. .Isurina G.L. Group methods of psychotherapy and psychocorrection. In the book: M.M. Kabanova et al. Methods of psychological diagnosis and correction in the clinic. - M.: Education, 2013. - p. 231-254. .Kabanov M.M., Lichko A.E., Smirnov V.M. Methods of psychological diagnostics and correction in the clinic. - M.: VLADOS, 2005. - 385 p. .Karvasarsky B.D. Medical psychology.- M.: Medicine, 2006. - 565 p. .Clinical psychology. Ed. B.D. Karvasarsky. - St. Petersburg: Peter, 2007. - 960 p. .Kolotilshchikova E.A., Mizinova E.B., Chekhlaty E.I. Coping behavior in patients with neurosis and its dynamics in the process of short-term interpersonal group psychotherapy // Bulletin of psychotherapy. 2014. - No. 12. - S. 9-23. .Lankin V.Z., Tikhaze A.K., Belenkov Yu.N. Free radical processes in diseases of the cardiovascular system // Cardiology. - 2010. - No. 7. - S. 48-61. 22.Latoguz I.K. Internal diseases.- Kharkov, 2014. 23.Maksimuk A. M. Handbook of hypertension Minimum price. -M.: Phoenix, 2013. -250 p. 24.Small medical encyclopedia: In 6 volumes. USSR Academy of Medical Sciences. Ch. ed. V. I. POKROVSKY. - M. Soviet encyclopedia. - T. 1 A - Infant, 2012, 560 p. 25.Malysheva I. S. Hypertension.- M: Vector, 2008. 26.Malysheva I.S. Hypertension. Home encyclopedia. - M.: Vector, 2014. -208 p. 27.Mukhina S.A., Tarnovskaya I.I. Theoretical Foundations of Nursing / Study Guide in 2 parts. Part II. - M.: Rodnik, 2008. - 208 p. 28.Myasnikov A. L. Hypertension and atherosclerosis. - M: Medicine, 2015. .Perfilieva G.M. Nursing process. // Nurse. - 2009. No. 3 - S. 33. 30.Saikov D.V., Serafimovich E.N. Pressure. From high to normal. Hypertension therapy + treatment program. - M.: Trioleta, 2012. - 212 p. 31.Nursing / Edited by A. F. Krasnov. - S.: GP "Perspektiva", 2008. - 368s. 32.Smolyansky: B.L., Liflyandsky V.G. Hypertension - the choice of diet - M .: Publishing House "Neva", 2013. - 225 p. 33.Health promotion and disease prevention. Basic terms and concepts / Ed. A.I. Vyalkova, R.G. Oganov. - M.: Higher School, 2011. - 285 p. 34.Chazova I.E., Dmitriev V.V., Tolpygina S.N. Structural and functional changes in the myocardium in arterial hypertension and their prognostic value // Synopsismedicinalic. - 2013. - No. 1. - S. 10-17. 35.Shulutko B.I., Perov YL. Arterial hypertension. - St. Petersburg: Peter, 1992 - 304 p. Annex 1 Memo "Prevention of hypertension"
MINISTRY OF HEALTH OF THE CHELYABINSK REGION
STATE BUDGET PROFESSIONAL EDUCATIONAL INSTITUTION
"SATKINSKY MEDICAL COLLEGE"
Research
ISCHEMIC HEART DISEASE
| Specialty: 31. 02. 01. Medical business |
| Full-time form of education |
| Student: Valieva Zarina Dinarikovna |
| Group 53 - f |
| Head: Vasilyeva Asya Toirovna |
| 20 17 y |
| Comptroller |
| ______________________________________________ |
| «____» _________________________________ 2017 |
Satka 20__
| INTRODUCTION………………………………………………………….… | |
| HEARTS | |
| Classification and clinical picture of manifestation ischemic heart disease……………………………………………….. | |
| 1.2 Factors in the development of coronary heart disease………………... | |
| 1.3 Diagnosis of coronary heart disease……………………… | |
| 1.4 Treatment of coronary heart disease……………………………… | |
| 1.5 Preventive measures for coronary heart disease……………………………………………………………………….… | |
| CHAPTER 2 THE ROLE OF THE HELP IN PREVENTION ISCHEMIC HEART DISEASE | |
| 2.1 Analysis of statistical data on incidence coronary heart disease according to the report of the Central District Hospital of the city of Satka in the dynamics of 3 years…………………………………….. | |
| 2.2 Analysis of the survey among 5th year students in the specialty "General Medicine" GBPOU "Satka Medical College"……….. | |
| 2.3 Development of measures for the prevention of ischemic heart diseases………………………………………………………..…..… | |
| CONCLUSION……………………………………………….…….. | |
| LIST OF ABBREVIATIONS………………………………………... | |
| LIST OF USED SOURCES……………. | |
INTRODUCTION
In the second half of the 20th century, non-communicable diseases, primarily diseases of the cardiovascular system, which are currently the leading cause of morbidity, disability and mortality in the adult population, began to pose a major threat to public health and a public health problem. There was a "rejuvenation" of these diseases. They began to spread among the population of developing countries.
In Russia, these diseases are the main cause of death and morbidity among the population. If in 1939 they accounted for only 11% in the overall structure of causes of death, then in 1980 they accounted for over 50%.
Of great importance are the issues of prevention of cardiovascular pathology, focused on the formation of a healthy lifestyle of the population. Morbidity and mortality from CVD can be reduced by improving treatment methods in combination with preventive measures. A huge role in the prevention of these diseases is played by nursing staff.
The non-decreasing increase in the incidence and mortality of the population from cardiovascular diseases (CVD) is one of the most important factors in the formation of a difficult demographic situation in the country, from which society suffers significant human losses and economic damage.
According to the WHO, cardiovascular diseases account for 49% of all deaths in the European Region. For Russia, the pathology of the cardiovascular system is an extremely urgent problem, since it determines more than half of the cases of disability and mortality in the adult population. The mortality rate of the able - bodied population from cardiovascular diseases in Russia currently exceeds that in the European Union by 4.5 times .
The relevance of research on coronary heart disease (CHD) is determined by the high level of its prevalence, mortality, temporary disability and disability, as a result of which society suffers large economic losses.
The weak effectiveness of preventive work carried out in the 90s and the first decade of the 21st century is determined by several positions:
- insufficient attention to prevention in territorial health programs, low budget financing of preventive programs;
- lack of an organizational structure of the preventive service;
– poor interrelationship in the work of centers for medical prevention and treatment-and-prophylactic institutions (HCF);
- the practical absence of preventive work in health facilities;
- low training of doctors and paramedical personnel on prevention issues, as well as low awareness and lack of motivation of the population to maintain their health.
Medical examinations reveal only 8-10% of a specific pathology; poor sanitary and educational work does not lead to a change in people's behavior. At the same time, medical visits specially allocated for prevention are poorly used. One of the important factors hindering preventive work at the present time is the lack of economic incentives for this work.
The results of experimental preventive programs carried out in Russia have proved the possibility of successfully reducing morbidity, mortality and disability from CVD.
Purpose of the study: Studying the role of a paramedic in the prevention of coronary heart disease.
Research objectives:
1 Conduct a theoretical review of the literature on the development of coronary heart disease.
2 Conduct an analysis of the number of cases of coronary heart disease in the Satka district based on the report of the Central District Hospital of the city of Satka for the period 2014-2016.
3 Conduct a survey among 5th year students in the specialty "General Medicine" GBPOU "Satka Medical College".
4 Develop measures to prevent coronary heart disease.
5 Develop a booklet on the prevention of coronary heart disease.
Object of study: Cardiac ischemia.
Subject of study: The role of the paramedic in the prevention of coronary heart disease.
Research methods:
– analysis of literary sources;
– statistical data processing.
Hypothesis: The competence of the paramedic in the prevention of coronary heart disease helps to reduce the incidence.
Practical significance of the study: The research materials can be used in the preparation and conduct of classes in the study of coronary artery disease (for specialties 31.02.01 "Medicine", 34.02.01 "Nursing"). A booklet that deals with issues of preventing the development of coronary artery disease will help students in studying PM.04 Preventive activities.
Scope and structure of work: The final qualifying work consists of 49 pages of printed text, and includes an introduction, two chapters, 6 figures, a conclusion, 29 references.
CHAPTER 1 FEATURES OF ISCHEMIC DISEASE
HEARTS
Ischemic heart disease is a pathological condition characterized by an absolute or relative impairment of myocardial blood supply due to damage to the coronary arteries.
1.1 Classification and clinical presentation of manifestation
ischemic heart disease
There are numerous options for the clinical manifestations of this disease: sudden cardiac death (SCD), angina pectoris, painless myocardial ischemia (MIM), myocardial infarction (MI), postinfarction cardiosclerosis. There is no generally accepted clinical classification of IHD. This is due to rapidly changing ideas about the mechanisms of development of coronary insufficiency, with the presence of a common morphological substrate for various forms of coronary artery disease and the possibility of a rapid and often unpredictable transition from one clinical form of this disease to another, the existence of several forms of coronary artery disease in one patient (postinfarction cardiosclerosis, angina pectoris, painless ischemia myocardium). The most widespread in our country is the classification of the All-Russian Scientific Center of the USSR Academy of Medical Sciences (1984), developed on the basis of the recommendations of WHO experts (1979).
Clinical classification of coronary heart disease (1984):
1. Sudden coronary death;
2. Angina pectoris;
2.1. Angina pectoris:
2.1.1. First-time angina pectoris;
2.1.2. Stable angina (indicating the functional class from I to IV);
2.1.3. Progressive angina (unstable);
2.2. Spontaneous (special, variant, vasospastic) angina;
3. Myocardial infarction:
3.1. Large focal (transmural);
3.2. Small focal;
4. Postinfarction cardiosclerosis;
5. (indicating the form and stage);
6. Violations of the heart rhythm (indicating the form).
Later, another form of coronary artery disease was added to this classification - “painless myocardial ischemia” (BIM). The last two forms of coronary artery disease in this classification (heart failure, cardiac arrhythmias) are considered as independent variants of the course of the disease and are diagnosed in the absence of other clinical manifestations of coronary artery disease (angina pectoris, myocardial infarction, postinfarction cardiosclerosis) in patients.
Sudden coronary death
Sudden coronary death is sudden, unexpected death due to the cessation of the functioning of the heart (sudden cardiac arrest).
Etiology
The cause of sudden coronary death is one violation of the contractility of the heart due to any lesion. In most cases, sudden coronary death develops as a result of an abnormal heart rhythm called an arrhythmia. The most common life-threatening arrhythmia is ventricular fibrillation, which is an irregular, disorganized series of impulses originating from the ventricles (lower chambers of the heart).
Clinical manifestations
With ventricular fibrillation, loss of consciousness occurs due to almost absent heart contractions. Before cardiovascular death, pain in the region of the heart sharply increases, many patients have time to complain about it and experience strong fear, as happens with myocardial infarction. Psychomotor agitation is possible, the patient grabs the region of the heart, breathes noisily and often, catches air with his mouth, sweating and reddening of the face are possible.
Nine out of ten cases of sudden coronary death occur outside the home, often against the background of a strong emotional experience, physical overload, but it happens that the patient dies from acute coronary pathology in his sleep.
With ventricular fibrillation and cardiac arrest against the background of an attack, severe weakness appears, dizziness begins, the patient loses consciousness and falls, breathing becomes noisy, convulsions are possible due to deep hypoxia of the brain tissue.
On examination, pallor of the skin is noted, the pupils dilate and stop responding to light, it is impossible to listen to heart sounds due to their absence, and the pulse on large vessels is also not determined. In a matter of minutes, clinical death occurs with all the signs characteristic of it. Since the heart does not contract, the blood supply to all internal organs is disrupted, therefore, within a few minutes after loss of consciousness and asystole, breathing stops. Acute circulatory failure leads to the fact that the patient does not feel the pulse on the femoral and carotid arteries, there is convulsive agonal breathing. Respiratory activity soon stops. Therefore, with symptoms that indicate acute circulatory failure, it is necessary to immediately carry out resuscitation.
In a hospital setting, when conducting an ECG, doctors can identify precursors of ventricular fibrillation - group ventricular extrasystoles, expansion of the QRS complex on the cardiogram. In more rare cases, circulatory failure and sudden death occurs after a slowing of the heart rate with a parallel rhythm disturbance (bradyarrhythmia).
Ischemic heart disease: angina pectoris, myocardial infarction
Ischemic heart disease is a group of diseases that are based on a mismatch between myocardial oxygen demand and its delivery through the coronary vessels.
Etiology
Atherosclerosis of the coronary vessels.
Clinical manifestations
IHD can manifest itself in the form of angina pectoris, myocardial infarction, cardiosclerosis.
Angina pectoris (angina pectoris). Its main symptom is pain in the heart, localized behind the sternum, having a pressing, compressive character, radiating to the left shoulder, arm, shoulder blade, half of the neck. Most often, it occurs in response to physical activity and stops at rest. The duration of the pain attack is from 2 to 15 minutes. The pain is quickly relieved by taking nitroglycerin. During severe attacks of angina pectoris, there may be a sharp weakness, sweating, pallor of the skin.
There are four functional classes of angina pectoris:
1 patient tolerates physical activity well, angina pectoris attacks are rare, occur only during very intense exercise - the first class (latent angina pectoris);
2 is characterized by a slight limitation of physical activity, attacks occur when walking on a flat area at a distance of more than 500 m, when climbing stairs more than one floor; the likelihood of seizures increases in cold windy weather, when walking against the wind - the second class;
3 pronounced limitation of normal physical activity, pain attacks occur when walking on a flat area at a distance of 100-500 m, when climbing one floor - the third class;
4 an attack of pain occurs even with minor physical exertion, when walking on a flat place at a distance of less than 100 m, the occurrence of angina attacks at rest is characteristic - the fourth class.
Myocardial infarction is a disease characterized by the formation of an area of ischemic necrosis in the myocardium due to impaired blood circulation in the coronary vessels. Most often, myocardial infarction develops in men after 40 years.
Myocardial infarction is usually observed in patients who have suffered from angina pectoris for some time. The main symptom of the disease is pain behind the sternum and in the region of the heart with the same irradiation as in angina pectoris. The pain is tearing, more intense and longer than with angina pectoris. It lasts more than 1 hour, sometimes up to several days, does not disappear after taking nitroglycerin. With myocardial infarction, pain is often accompanied by fear of death. This pathology can be complicated by rupture of the heart muscle, cardiac aneurysm, cardiogenic shock, and the occurrence of cardiac arrhythmias.
With the development of cardiogenic shock, the following signs are noted: pallor of the skin, cold sweat, acrocyanosis, agitation, alternating with apathy, a sharp decrease in blood pressure, a thready pulse, a decrease in diuresis (oliguria, anuria).
Postinfarction cardiosclerosis
Postinfarction (postnecrotic) cardiosclerosis is myocardial damage caused by the replacement of dead myocardial fibers with connective tissue, which leads to disruption of the functioning of the heart muscle.
Etiology
The cause of this type of cardiosclerosis is myocardial infarction, but this is not the only factor that can provoke the development of the disease. The risk group includes patients with cardiovascular pathologies, inflammatory processes of the myocardium, and vascular injuries.
Classification
Allocate disseminated (i.e., small-focal) and large-focal post-infarction cardiosclerosis.
Clinical manifestations
This disease is notable for the fact that it often develops asymptomatically. This is especially true of the focal form and a moderate degree of diffuse cardiosclerosis. Doctors usually associate the diagnosis of cardiosclerosis with a heart rhythm disorder or pain syndrome. Sometimes arrhythmias of varying degrees are the first signs of the developing process of sclerosis. With diffuse cardiosclerosis, they may be accompanied by symptoms of heart failure and impaired contraction of the heart muscle. The larger the area of tissue damage, the stronger the manifestations of heart failure and rhythm disturbances.
Symptoms of cardiosclerosis:
1 increased heart rate, pain in the region of the heart;
2 the occurrence of difficulty breathing (shortness of breath);
3 pulmonary edema (acute form of left ventricular failure);
4 heart rhythm is heard intermittently (atrial fibrillation, blockade, etc.);
5 signs of congestive heart failure (swelling of the extremities, accumulation of fluid in the abdominal, pleural cavities, liver enlargement, etc.).
All the main symptoms of this disease develop progressively, since cardiosclerosis itself tends to progress as muscle tissue is replaced by scars.
Chronic heart failure
Chronic heart failure (CHF) is a pathological condition in which the cardiovascular system is unable to provide organs and tissues with sufficient blood volume for normal functioning.
Etiology
The development of pathology can provoke heart defects, hypertension, myocarditis, cardiosclerosis (atherosclerotic, post-infarction), pulmonary diseases that occur with hypertension of the pulmonary circulation (obstructive bronchitis, pulmonary emphysema), chronic intoxication, endocrine diseases (obesity, thyrotoxicosis).
Classification of chronic heart failure (according to Strazhesko-Vasilenko):
1 initial is manifested by shortness of breath, palpitations, fatigue only during physical exertion - the first stage;
2 signs of circulatory insufficiency at rest are moderately expressed, with physical activity they are pronounced, there are minor hemodynamic disturbances in the systemic or pulmonary circulation - stage 2A;
3 marked signs of heart failure at rest, severe hemodynamic disturbances in the systemic and pulmonary circulation - stage 2B;
4 there are pronounced disturbances of hemodynamics, metabolism, irreversible changes in organs and tissues - the third stage.
Clinical manifestations
Shortness of breath initially occurs only during physical exertion, then at rest. Periodically occurring severe shortness of breath is called cardiac asthma. As a rule, the patient takes a forced position. Acrocyanosis is noted - cyanosis in areas of the body remote from the heart (lips, fingers and toes, ears, nose tip).
Edema is observed. Initially, the accumulation of fluid in the body is manifested by an increase in the patient's body weight and a decrease in diuresis (hidden edema). With the accumulation of a large volume of fluid, visible edema is detected. Initially, they are observed at the end of the day on the feet, in the ankle joint, on the legs, and disappear after a night's rest. Then the edema becomes permanent, their area gradually increases. The accumulation of fluid in the serous cavities (ascites, hydrothorax, hydropericardium) joins the edema.
Patients complain of a feeling of heaviness in the right hypochondrium due to congestion in the liver, palpitations and interruptions in the work of the heart, dry or with expectoration of mucous sputum cough, sometimes hemoptysis. Also, increased fatigue, weakness, decreased ability to work, sleep disturbances are noted.
Heart rhythm disorders
Cardiac arrhythmias are a group of heart diseases that are characterized by impaired impulse formation or conduction in the heart, or a combination of the two.
Etiology
Functional changes in a healthy heart (psychogenic disorders) occur against the background of neurosis, cortico-visceral changes with reflex influences from other organs - viscerocardial reflexes.
Organic heart disease - all occurrences of coronary artery disease, heart defects, myocarditis, myocardiopathies.
Toxic damage to the myocardium, most often with an overdose of drugs.
With pathology of the endocrine glands (thyrotoxicosis, hypothyroidism, pheochromocytoma).
Electrolyte shifts, metabolic disorders of potassium and magnesium, including hypokalemia when taking cardiac glycosides, saluretics and other drugs.
Traumatic damage to the heart.
Age-related changes weakening of nerve influences on the heart, decreased automatism of the sinus node, increased sensitivity to catecholamines.
All of the above causes contribute to the formation of ectopic foci.
Classification
All rhythm and conduction disorders are classified as follows:
- Disturbances in the rhythm of the heart.
- Violations of conduction in the heart.
In the first case, as a rule, there is an acceleration of the heart rate or an irregular contraction of the heart muscle. In the second, the presence of blockades of varying degrees with or without a slowing of the rhythm is noted.
In general, the first group includes a violation of the formation and conduction of impulses:
In the sinus node, manifested by sinus tachycardia, sinus bradycardia and sinus tachyarrhythmia or bradyarrhythmia.
In the atrial tissue, manifested by atrial extrasystole and paroxysmal atrial tachycardia,
According to the atrioventricular connection, manifested by atrioventricular extrasystole and paroxysmal tachycardia,
Through the fibers of the ventricles of the heart, manifested by ventricular extrasystole and paroxysmal ventricular tachycardia.
In the sinus node and in the tissue of the atria or ventricles, manifested by flutter and flicker (fibrillation) of the atria and ventricles.
The second group of conduction disorders includes blocks (blockades) in the path of impulses, manifested by sinoatrial blockade, intra-atrial blockade, atrioventricular blockade of 1, 2 and 3 degrees and blockade of the bundle of His bundle.
Clinical picture
Symptoms of arrhythmia may not be felt at all by a person and are detected only during a routine examination. Most often, patients complain of such conditions:
- a feeling of interruptions in the rhythm, "shocks" or "blows" in the chest;
- blockades are characterized by "fading" or a feeling of "stopping" the heart;
- the patient's behavior changes: he suddenly freezes, "listens" to the work of the heart, becomes hyper suspicious, worried about the fear of death.
1.2 Factors in the development of coronary heart disease
The main task of preventing the development of coronary heart disease is the elimination or maximum reduction in the magnitude of those risk factors for which this is possible. To do this, even before the onset of the first symptoms, it is necessary to adhere to recommendations for lifestyle modification.
Risk factors for coronary heart disease circumstances, the presence of which predisposes to the development of coronary artery disease. These factors are in many ways similar to risk factors for atherosclerosis, since the main link in the pathogenesis of coronary heart disease is atherosclerosis of the coronary arteries. Conventionally, they can be divided into two large groups: changeable and unchangeable risk factors for coronary artery disease.
Modifiable risk factors for coronary heart disease include:
- arterial hypertension (i.e. high blood pressure),
- diabetes,
- smoking,
- high blood cholesterol, etc.,
- overweight and the nature of the distribution of fat in the body,
- sedentary lifestyle (hypodynamia),
- malnutrition.
Unchangeable risk factors for coronary artery disease include:
– age (over 50-60 years old),
- male gender,
- burdened heredity, that is, cases of coronary artery disease in close relatives,
- The risk of coronary artery disease in women will increase with prolonged use of hormonal contraceptives.
The most dangerous in terms of the possible development of coronary heart disease are arterial hypertension, diabetes, smoking and obesity. According to the literature, the risk of coronary artery disease with elevated cholesterol levels increases by 2.2-5.5 times, with hypertension - by 1.5-6 times. Smoking greatly affects the possibility of developing coronary artery disease, according to some reports, it increases the risk of developing coronary artery disease by 1.5-6.5 times.
A noticeable influence on the risk of developing coronary artery disease is exerted by such, at first glance, factors that are not related to the blood supply to the heart, such as frequent stressful situations, mental overstrain, and mental overwork. However, most often it is not the stresses themselves that are “to blame”, but their influence on the characteristics of a person’s personality. In medicine, two behavioral types of people are distinguished, they are usually called type A and type B. Type A includes people with an excitable nervous system, most often of a choleric temperament. A distinctive feature of this type is the desire to compete with everyone and win at all costs. Such a person is prone to overestimated ambitions, vain, constantly dissatisfied with what has been achieved, is in eternal tension. Cardiologists say that it is this type of personality that is least able to adapt to a stressful situation, and people of this type of coronary artery disease develop much more often (at a young age - 6.5 times) than people of the so-called type B, balanced, phlegmatic, benevolent. The likelihood of developing coronary heart disease and other cardiovascular diseases increases synergistically with an increase in the number and "power" of these factors.
For men, the critical mark is the 55th anniversary, for women 65 years.
It is known that the atherosclerotic process begins in childhood. Research results confirm that atherosclerosis progresses with age. Already at the age of 35, coronary heart disease is one of the 10 leading causes of death in the US; 1 in 5 people in the US have a heart attack before the age of 60. At the age of 55-64 years, the cause of death of men in 10% of cases is coronary heart disease. The prevalence of stroke is even more related to age. With each decade after reaching the age of 55, the number of strokes doubles; however, about 29% of stroke sufferers are under 65 years of age.
Observations show that the degree of risk increases with age, even if other risk factors remain in the "normal" range. However, it is clear that a significant increase in the risk of coronary heart disease and stroke with age is associated with those risk factors that can be influenced. For example, a 55-year-old man with a high complex level of risk factors for developing coronary heart disease has a 55% chance of clinical manifestation of the disease within 6 years, while for a man of the same age, but with a low complex level of risk, it will be only 4% .
Modification of the main risk factors at any age reduces the likelihood of the spread of diseases and mortality due to initial or recurrent cardiovascular diseases. Recently, much attention has been paid to the impact on risk factors in childhood in order to minimize the early development of atherosclerosis, as well as to reduce the "transition" of risk factors with age.
Among the many provisions regarding coronary artery disease, one is beyond doubt - the predominance of male patients among patients.
In one of the large studies at the age of 30-39 years, atherosclerosis of the coronary arteries was detected in 5% of men and 0.5% of women, at the age of 40-49 years, the frequency of atherosclerosis in men is three times higher than in women, at the age of 50-59 years in men twice as much, after 70 years the frequency of atherosclerosis and coronary artery disease is the same in both sexes. In women, the number of diseases slowly increases between the ages of 40 and 70 years. In menstruating women, IHD is rare, and usually in the presence of risk factors - smoking, arterial hypertension, diabetes mellitus, hypercholestremia, and diseases of the genital area.
Sex differences are especially pronounced at a young age, and over the years they begin to decrease, and in old age both sexes suffer from coronary artery disease equally often. In women under 40 years of age, suffering from pain in the region of the heart, severe atherosclerosis is extremely rare. At the age of 41-60 years, atherosclerotic changes in women are almost 3 times less common than in men. There is no doubt that normal ovarian function "protects" women from atherosclerosis. With age, manifestations of atherosclerosis gradually and steadily increase.
Genetic factors
The importance of genetic factors in the development of coronary heart disease is well known: people whose parents or other family members have symptomatic coronary heart disease are at increased risk of developing the disease. The associated increase in relative risk is highly variable and can be up to 5 times higher than in individuals whose parents and close relatives did not suffer from cardiovascular disease. The excess risk is especially high if the development of coronary heart disease in parents or other family members occurred before the age of 55. Hereditary factors contribute to the development of dyslipidemia, hypertension, diabetes mellitus, obesity, and possibly certain behaviors that lead to the development of heart disease.
Irrational nutrition
Most of the risk factors for developing coronary artery disease are related to lifestyle, one of the important components of which is nutrition. Due to the need for daily food intake and the huge role of this process in the life of our body, it is important to know and follow the optimal diet. It has long been noted that a high-calorie diet with a high content of animal fats in the diet is the most important risk factor for atherosclerosis. So, with chronic consumption of foods high in saturated fatty acids and cholesterol (mainly animal fat), an excess amount of cholesterol accumulates in hepatocytes and, according to the principle of negative feedback, the synthesis of specific LDL receptors decreases in the cell and, accordingly, the uptake and absorption by hepatocytes decreases. atherogenic LDL circulating in the blood. This type of nutrition contributes to the development of obesity, disorders of carbohydrate and lipid metabolism, which underlie the formation of atherosclerosis.
Dyslipidemia
Elevated cholesterol levels and changes in blood lipid composition. Thus, an increase in cholesterol levels by 1.0% (at a rate of 5.0 mmol / l and below) increases the risk of developing a heart attack by 2%.
Numerous epidemiological studies have shown that plasma levels of total cholesterol (CHC), low-density lipoprotein cholesterol have a positive relationship with the risk of coronary heart disease, while this relationship is negative with high-density lipoprotein cholesterol. Due to this connection, LDL-C is called "bad cholesterol" and HDL-C is called "good cholesterol". The significance of hypertriglyceridemia as an independent risk factor has not been conclusively established, although its combination with low HDL-C is considered to contribute to the development of coronary artery disease.
To determine the risk of developing coronary artery disease and other diseases associated with atherosclerosis, and the choice of treatment tactics, it is sufficient to measure the concentration of total cholesterol, HDL cholesterol and triglycerides in the blood plasma. The accuracy of predicting the risk of developing coronary artery disease increases markedly if the level of HDL cholesterol in the blood plasma is taken into account. An exhaustive characterization of lipid metabolism disorders is a prerequisite for effective prevention of cardiovascular diseases, which essentially determine the prognosis of life, working capacity and physical activity in the everyday life of most elderly people in all economically developed countries.
Arterial hypertension
Arterial hypertension - when blood pressure exceeds 140/90 mm Hg Art.
The importance of high blood pressure (BP) as a risk factor for the development of coronary artery disease and heart failure has been proven by numerous studies. Its significance increases even more if we take into account that 20-30% of middle-aged people in Ukraine suffer from arterial hypertension (AH), while 30-40% of them do not know about their disease, and those who do are treated irregularly and poorly. control BP. It is very easy to identify this risk factor, and many studies, including those conducted in Russia, have convincingly proved that through the active detection and regular treatment of hypertension, it is possible to reduce mortality by approximately 42-50%, and by 15% from coronary artery disease.
The need for medical treatment of patients with blood pressure above 180/105 mm Hg. Art. is not in much doubt. As for cases of "mild" hypertension (140-180/90-105 mmHg), the decision to prescribe long-term drug therapy may not be easy. In such cases, as in the treatment of dyslipidemia, one can proceed from an assessment of the overall risk: the higher the risk of developing coronary artery disease, the lower the numbers of elevated blood pressure should begin drug treatment. At the same time, non-drug measures aimed at modifying lifestyle remain an important aspect of hypertension control.
Also, increased systolic pressure is the cause of left ventricular myocardial hypertrophy, which, according to ECG data, increases the development of atherosclerosis of the coronary arteries by 2-3 times.
Diabetes
Diabetes mellitus or impaired glucose tolerance, when fasting blood glucose is equal to or greater than 6.1 mmol / l.
Both types of diabetes markedly increase the risk of coronary artery disease and peripheral vascular disease, more so in women than in men. The increased risk (2-3 times) is associated both with diabetes itself and with a greater prevalence of other risk factors in these people (dyslipidemia, hypertension, BMI). An increased prevalence of risk factors occurs already in carbohydrate intolerance, as detected by carbohydrate loading. The “insulin resistance syndrome” or “metabolic syndrome” is being carefully studied: a combination of impaired carbohydrate tolerance with dyslipidemia, hypertension and obesity, in which the risk of developing coronary artery disease is high. To reduce the risk of developing vascular complications in diabetic patients, normalization of carbohydrate metabolism and correction of other risk factors are necessary. Persons with stable type I and type II diabetes are shown physical activity that improves functional ability.
Hemostatic factors
A number of epidemiological studies have shown that certain factors involved in the blood coagulation process increase the risk of developing coronary artery disease. These include elevated plasma levels of fibrinogen and coagulation factor VII, increased platelet aggregation, reduced fibrinolytic activity, but so far they are not commonly used to determine the risk of developing coronary artery disease. In order to prevent them, drugs that affect platelet aggregation are widely used, most often aspirin at a dose of 75 to 325 mg / day. The effectiveness of aspirin has been convincingly proven in studies on the secondary prevention of coronary artery disease. With regard to primary prevention, aspirin, in the absence of contraindications, is advisable to use only in people with a high risk of developing coronary artery disease.
Overweight (obesity)
Obesity is one of the most significant and, at the same time, the most easily modifiable risk factors for atherosclerosis and coronary artery disease. At present, convincing evidence has been obtained that obesity is not only an independent risk factor (RF) for cardiovascular diseases, but also one of the links - possibly a trigger for other RFs, such as hypertension, HLP, insulin resistance, and diabetes mellitus. Thus, a number of studies have revealed a direct relationship between mortality from cardiovascular diseases and body weight.
More dangerous is the so-called abdominal obesity (male type), when fat is deposited on the abdomen. Body mass index is often used to determine the degree of obesity.
Low physical activity
In persons with low physical activity, IHD develops 1.5-2.4 (on average 1.9) times more often than in persons leading a physically active lifestyle. When choosing a program of physical exercises, it is necessary to take into account 4 points: the type of physical exercises, their frequency, duration and intensity. For the prevention of coronary artery disease and health promotion, physical exercises are most suitable, which involve regular rhythmic contractions of large muscle groups, brisk walking, jogging, cycling, swimming, skiing, etc. You need to do 4-5 times a week for 30-40 minutes, including a warm-up and cool-down period. When determining the intensity of physical exercise that is acceptable for a particular patient, the maximum heart rate (HR) after exercise should be equal to the difference between the number 220 and the patient's age in years. For people with a sedentary lifestyle without symptoms of coronary artery disease, it is recommended to choose such an intensity of exercise at which the heart rate is 60-75% of the maximum. Recommendations for individuals with coronary artery disease should be based on clinical examination and exercise test results.
Quitting smoking has been proven to be much more effective than many medications. Conversely, smoking increases the risk of developing atherosclerosis and increases the risk of sudden death by several times.
The association of smoking with the development of CHD and other noncommunicable diseases is well known. Smoking affects both the development of atherosclerosis and the processes of thrombosis. Cigarette smoke contains over 4,000 chemical compounds. Of these, nicotine and carbon monoxide are the main elements that have a negative effect on the activity of the cardiovascular system.
Direct and indirect synergistic effects of nicotine and carbon monoxide on the progression and severity of atherosclerosis:
- lowers plasma high-density lipoprotein cholesterol levels;
- increases the adhesion of platelets and the tendency to thrombosis.
Alcohol consumption
The relationship between alcohol consumption and mortality from coronary artery disease is as follows: non-drinkers and heavy drinkers have a higher risk of death than moderate drinkers (up to 30 g per day in terms of pure ethanol). Despite the fact that moderate doses of alcohol reduce the risk of CHD, other health effects of alcohol (increased blood pressure, risk of sudden death, effects on psychosocial status) do not allow alcohol to be recommended for the prevention of CHD.
Arterial pressure
If it is within the normal range, it is necessary to check it twice a year. If blood pressure is elevated, measures should be taken on the advice of a doctor. Very often long-term use of drugs that reduce blood pressure is required. The target pressure level is less than 140/90 mm. rt. St in people without comorbidities, and less than 130/90 in people with diabetes or kidney disease.
Cholesterol level
The annual examination should include a blood test for cholesterol. If it is elevated, it is necessary to start treatment on the recommendation of a doctor.
Blood sugar. It is especially necessary to control blood sugar levels in the presence of diabetes or a tendency to it; in such cases, constant monitoring by an endocrinologist is necessary.
1.3 Diagnosis of coronary heart disease
Diagnosis of coronary heart disease is primarily based on the patient's subjective feelings during an attack. Since in the pathogenesis of anginal syndrome, in addition to myocardial ischemia, sympathicotonia occupies a significant place, angina pectoris in patients with IHD is accompanied by an increase in heart rate and an increase in blood pressure.
Myocardial ischemia can lead to dysfunction of the papillary muscles and, as a result, to mitral regurgitation, as well as to violations of local contractility of the left ventricle, which are sometimes detected by palpation of the apex beat. It happens that ischemia sometimes reduces the distensibility of the left ventricle, it becomes rigid, which is expressed by the appearance during the atrial systole of the IV tone and gallop rhythm.
Angina usually resolves within 1-2 minutes after the cessation of the load that caused it, or within 3-5 minutes with sublingual nitroglycerin. This response helps differentiate myocardial ischemia from many other causes of chest discomfort.
Diagnosis of myocardial infarction is based on the clinical picture, ECG changes, and transient hyperenzymemia. Other studies are used to clarify complications, and in doubtful cases for the purpose of differential diagnosis, given the high frequency of atypical and asymptomatic forms.
Laboratory research methods
Laboratory research methods occupy one of the central places in the early diagnosis of coronary artery disease. Great importance is attached to the study of lipid metabolism and the blood coagulation system, the violation of which underlies the atherosclerotic process, and consequently, coronary artery disease. However, only an integrated approach to assessing the results of studies of both metabolic and functional nature makes it possible to more reliably diagnose the initial forms of this pathology.
Lipid metabolism studies
Among the biochemical indicators reflecting the state of lipid metabolism in normal conditions and in various pathological processes, in particular in atherosclerosis and coronary artery disease, the level of total cholesterol plays an important role; low density lipoproteins, or β-lipoproteins; very low density lipoproteins, or pre-β-lipoproteins; high density lipoproteins, or α-lipoproteins; triacylglycerols (TG) blood.
For widespread use, it is more accessible to assess the level of lipoproteins by their content of cholesterol (CS), respectively, LDL-C (β-CS), VLDL-C (pre-β-CS), HDL-C (α-CS). According to these indicators, it is possible to identify dyslipoproteinemia and hyperlipoproteinemia, to establish their types, to determine the coefficient of atherogenicity.
As you know, hypercholesterolemia belongs to the group of major risk factors for coronary artery disease. A high level of cholesterol in the blood serves to some extent as a diagnostic test. However, at present, more and more importance is attached not to its absolute content, but to dyslipoproteinemias, i.e. violation of the normal ratio between atherogenic and non-atherogenic lipid fractions due to an increase in the former or a decrease in the latter.
Based on various options and combinations of lipid metabolism indicators, it was proposed to distinguish five types of hyperlipoproteinemia:
I - hyperchylomicronemia (chylomicrons are mainly droplets of triacylglycerols suspended in blood serum);
IIA, hyper-β-lipoproteinemia;
IIB - hyper-β-lipoproteinemia in combination with hyperpre-β-lipoproteinemia;
III - dis-β-lipoproteinemia (a peculiar fraction of floating β-lipoproteins);
IV - hyperpre-β-lipoproteinemia;
V - hyperpre-β-lipoproteinemia with hyperchylomicronemia.
In addition, each type of hyperlipoproteinemia has characteristic combinations of the main features with other indicators of lipid metabolism. So, in all types, except for IV, there is an increased level of total cholesterol and in all, except for IIA, an increased level of TG.
It is believed that the risk of developing coronary artery disease is the greater, the higher the atherogenicity. According to available information, a very high risk of developing coronary artery disease in people with types IIA, IIB, III, relatively high - with type IV, is not precisely defined in people with type V and is absent with type I hyperlipoproteinemia.
Blood clotting studies
According to modern concepts, along with changes in lipid metabolism, disorders of the blood coagulation system play a significant role in the pathogenesis of coronary artery disease. It has been proven that in patients with atherosclerosis and coronary artery disease, its coagulating properties increase. Therefore, the characteristic changes in the indicators that determine the state of hemostasis can serve as one of the additional diagnostic signs of coronary artery disease.
A thromboelastogram (TEG) and a coagulogram can be used to study the blood coagulation system. However, when conducting mass studies, a quick and fairly objective general assessment of the state of hemocoagulation is possible only using the method of thromboelastography. It can be used instead of such biochemical studies as determining the time of blood clotting and plasma recalcification, prothrombin content, plasma tolerance to heparin, blood clot reaction, etc.
As is known, the principle of the thromboelastography method is to graphically record changes in blood viscosity during coagulation from a liquid state to fibrinolysis of the formed clot. According to various TEG parameters, one can judge the transition of prothrombin to thrombin, the rate of fibrin formation, the clot formation time indicator, its elasticity, etc.
To characterize blood coagulation, it is necessary to take into account the following indicators of thromboelastogram:
P - reaction time, characterizes the speed of the first and second phases of blood coagulation (the formation of thromboplastin and the conversion of prothrombin to thrombin);
K - the time of clot formation, determines the rate of loss of fibrin filaments;
Р+К – coagulation constant, reflects the total duration of blood coagulation;
Р/К – thromboelastographic constant of prothrombin use, reflects the use of prothrombin by thromboplastin in the formation of thrombin;
Ma and E - maximum dynamic (transverse) constants, correspond to the third phase of blood coagulation;
t - specific coagulation constant, corresponds to the period from the end of visible coagulation to the beginning of clot retraction;
C - constant syneresis, reflects the time from the beginning of fibrin formation to its completion, compaction and contraction.
T - constant of total blood coagulation, shows the degree of intensity of clot formation, as well as the retraction time;
Angle α is an angular constant, depends on the value of P, K, t, C, Ma. The faster fibrin is formed, the greater the angle α.;
The importance of detecting disorders of lipid metabolism and blood coagulation in people at risk for coronary artery disease is of particular importance not only for its early diagnosis, but also for targeted preventive measures.
At the end of the 1st - beginning of the 2nd day of myocardial infarction, moderate neutrophilic leukocytosis develops with a moderate shift of the formula to the left, which reaches a maximum on average on the third day and then gradually decreases to normal. At the same time, when leukocytosis begins to decrease, the ESR increases, which also usually does not reach significant numbers. Thus, during the acute period, there is a crossover of the curves of leukocytosis and ESR. In addition, in the first few days of the disease in the blood, the activity of some tissue enzymes increases.
Instrumental research methods
Electrocardiography is one of the most important methods, especially if the ECG is taken during a painful episode, which is rarely possible, mainly during inpatient treatment of the patient. During myocardial ischemia, there may be ST-segment and T-wave changes. Acute ischemia usually results in transient horizontal and downward-sloping ST-segment depression and T-wave flattening or inversion. Sometimes there is ST-segment elevation, indicating more severe transmural myocardial ischemia, similar to that observed in the early stages of acute myocardial infarction. After relief of symptoms, all ST segment deviations quickly normalize. Signs of a previous myocardial infarction (abnormal Q waves) also indicate the presence of coronary disease.
Test with physical activity
A resting ECG in a patient who has not had a myocardial infarction can usually be normal. During the test on a stationary bicycle, when the load is constantly increasing, the patient's heart rate and ECG are recorded and pressure is monitored at regular intervals. The test is continued until an angina attack occurs, signs of myocardial ischemia appear on the ECG, the target heart rate is reached, or fatigue develops, making it impossible to continue the load. The test is considered positive for coronary artery disease if there is typical patient discomfort in the chest or ECG changes characteristic of ischemia (horizontal or oblique ST segment depression of 1 mm) are noted. When the test is carried out under the control of other (in addition to ECG) research methods, echocardiographic control takes into account violations of myocardial contractility in two or more segments, and when myocardial scintigraphy with thallium-201 takes into account local defects in myocardial perfusion, as well as impaired perfusion in comparison with initial state. The information content of the test is reduced when taking certain drugs. For example, β-blockers or some calcium antagonists (which slow the heart rate) can make it impossible to achieve the target heart rate.
Pharmacological stress tests
People who are unable to exercise (for example, with severe arthritis) are shown pharmacological exercise tests using dobutamine, which increases myocardial oxygen demand by accelerating heart rate and increasing contractility, or dipyridamole, which causes coronary vasodilation, which increases blood flow in areas of the myocardium, supplied by intact coronary arteries. Since the arteries in ischemic areas are already maximally dilated, a steal syndrome occurs when blood flows from the affected areas to healthy ones, myocardial ischemia develops, which can be documented using ECG, echocardiography, or myocardial radionuclide studies.
Coronary angiography is rarely necessary to confirm the diagnosis, but it can establish the extent and severity of atherosclerotic changes, which is necessary if surgical treatment is discussed. This is the most effective way to detect coronary artery stenoses, in which atherosclerotic plaques are visualized radiographically. In the process of this study, you can also determine the volume of the left ventricle, violations of contractile function - general and regional. The procedure is associated with some risk, therefore it is not indicated for severe left ventricular failure, people over 70 years old, with significant obesity, as well as severe concomitant (for example, oncological) diseases.
Daily monitoring ECG subject to the use of sensitive equipment that detects ST segment displacement, it can play a significant role in diagnosis, as well as in assessing the severity of painless ischemia and treatment results.
1.4 Treatment of coronary heart disease
Its goal is to improve the patient's quality of life by reducing the frequency of angina attacks, preventing acute myocardial infarction and improving survival. The modern strategy for the treatment of myocardial ischemia is to restore the balance between myocardial oxygen demand and its delivery to it.
Non-pharmacological treatment of coronary heart disease
– Reducing excess body weight (up to optimal for the patient).
– Reduction of dyslipidemia (diet low in cholesterol and fat, drug correction).
– Sufficient physical activity in the absence of contraindications.
– Control of blood pressure (restriction of salt, alcohol, drug correction).
– Control of blood glucose levels (diet, weight loss, drug correction).
- To give up smoking .
Medical treatment
Patients with chronic ischemic heart disease, manifested by pain, arrhythmias, heart failure, are treated with antianginal, antiarrhythmic and other drugs in order to achieve the disappearance of existing symptoms or their significant reduction in the shortest possible period. In other words, at first, these are purely symptomatic goals. The tasks of the strategic plan are solved within the framework of the secondary prevention program. This is the prevention of premature death, inhibition of progression and achievement of partial regression of atherosclerosis of the coronary arteries, prevention of clinical complications and exacerbations of the disease.
It is necessary to avoid the influence of factors provoking angina attacks. The optimal regimen is that the patient avoids stress that provokes angina pectoris. It is important to explain to him that only under such a regimen, load tolerance can increase. Sometimes this can be achieved without drug treatment.
Surgical method of treatment
Percutaneous transluminal coronary angioplasty is performed under x-ray control. A catheter with a balloon at the end is inserted through a peripheral artery (usually the femoral or brachial) and passed to the stenotic segment of the coronary artery. The balloon at the end of the catheter is inflated under high pressure, the stenosis expands and coronary perfusion increases, after which the catheter is removed. Coronary artery bypass grafting (CABG) involves the reconstruction of the coronary arteries using native bypass grafts. After CABG, angina disappears in the vast majority of patients and exercise capacity usually improves.
1.5 Preventive measures for coronary heart disease
Diseases can be prevented by following the recommendations of your doctor for treatment, changing your lifestyle and following simple rules.
- You need to stop smoking.
– You should limit the intake of table salt to 6 g per day. Do not keep the salt shaker on the table, try to cook food without salt, eat fresh vegetables and fruits, refuse canned or salty-tasting foods.
- Normalize body weight. Each extra kilogram is accompanied by an increase in blood pressure by 2 mm Hg. Art. It is important to normalize body weight, as judged by the value of the body mass index, which should be less than 25. Body mass index is determined by the formula: body weight (kg) divided by height, expressed in meters and squared (m 2 ).
– Reduce your intake of fatty and sugary foods (cookies, sweets, chocolate, ice cream). The calorie content of the daily diet should correspond to the energy costs of the body. The average energy requirement of women is 1500-1800 kcal per day, men - 1800 - 2100 kcal per day. Products should be steamed, boiled or baked. When cooking, you need to use vegetable fats (olive, sunflower, corn oil).
- Exercise daily for at least 30 minutes. You need to exercise regularly. The level of physical activity will be determined by the doctor.
- It is necessary to control the level of blood pressure. Get your blood pressure to be normal - less than 140/90 mmHg.
– Be sure to limit the use of alcohol or refuse to take it. The dose of alcohol safe for the cardiovascular system in terms of pure ethyl alcohol is less than 30 g for men per day (50-60 ml of vodka, 200-250 ml of dry wine or 500 - 600 ml of beer) and 15 g for women (25-30 ml of vodka, 100-125 ml of dry wine or 250-300 ml of beer).
– Periodically check the level of cholesterol (lipids) in the blood. The desired concentration of total cholesterol is less than 200 mg/dL (5 mmol/L).
– Check your blood glucose (blood sugar) levels periodically. Fasting glucose in the morning should be less than 100 mg/dL (5.5 mmol/L).
Conclusion:
Risk factors for coronary heart disease circumstances, the presence of which predisposes to the development of coronary artery disease. These factors are in many ways similar to risk factors for atherosclerosis, since the main link in the pathogenesis of coronary heart disease is atherosclerosis of the coronary arteries. Conventionally, they can be divided into two large groups: modifiable and non-modifiable risk factors for coronary artery disease.
2 THE ROLE OF THE HELP IN PREVENTION
ISCHEMIC HEART DISEASE
2.1 Analysis of statistical data onincidence
ischemic heart diseaseaccording toreport of the Central
district hospital of the city of Satka in dynamics 3 years
Coronary heart disease incidence statistics according to the report
Central district hospital of the city of Satka in the dynamics of 3 years
Figure - 1. Analysis of the number of treated patients with coronary heart disease for three years (%)
- in 2015, 1730 people, which amounted to 28.5%.
– in 2016, 2691 people, which is 44.3% (see Figure 1).
table 2
Statistics of coronary heart disease for three years
| Total cases | Total cases | Total cases | ||||||
| Cardiac ischemia | ||||||||
| angina pectoris | ||||||||
| Acute myocardial infarction | ||||||||
| Chronic heart failure | ||||||||
| Postinfarction cardiosclerosis | ||||||||
| Rhythm disturbance | ||||||||
| Sudden coronary death | ||||||||
Figure - 2. Analysis of coronary heart disease for three years (in%)
For three years, among IHD diseases, most patients were treated with a diagnosis of angina pectoris 46.6%, in second place with a diagnosis of rhythm disturbance 24.90%, in third place with postinfarction cardiosclerosis 16.8% (see Figure 2).
Table 3
Incidence rate by gender
A study was conducted on the number of diseases depending on gender, in 2014, the percentage of incidence of males exceeds females by 10.6%; in 2015, the incidence rate of males exceeds females by 14%; in 2016, the incidence rate of males exceeds females by 15% (see Figure 3).
Figure - 3. Share ratio for 2014, 2015, 2016 between men and women (in %)
An analysis was made of the age category susceptible to coronary artery disease among men and women for three years (Table 4).
Table 4
Characteristics of the contingent of patients with coronary heart disease by age and gender for three years
| Age (years) | |||||
| 60 and older | |||||
Figure - 4. Age of men susceptible to coronary heart disease (in %)
Thus, we see that the peak of coronary artery disease in men occurs between the ages of 50 and 59 (see Figure 4).
Figure - 5. Age of women prone to coronary heart disease (in%)
Thus, we see that the peak of coronary artery disease in women occurs at the age of 60 and older (see Figure 5).
Conclusion:
After analyzing the statistical data on the reports of the Central District Hospital of the city of Satka in the dynamics of 3 years, we can conclude that
that every year the number of people suffering from coronary artery disease is steadily increasing. Men get sick more often than women; the frequency of coronary artery disease increases sharply with age.
2.2 Analysis of the survey among students 5specialty course
"medical work"GBPOU "Satka Medical College"
5 questions were developed:
1 What is the primary prevention of coronary artery disease.
2 What is secondary prevention of coronary artery disease.
3 What is related to tertiary prevention of coronary artery disease.
4 List the factors in the development of IHD.
Figure - 6. The number of students who answered correctly in 53 paramedical groups (in %)
1 To the question: What is primary prevention of coronary heart disease?
100% answered the question correctly.
2 To the question: What is secondary prevention of coronary heart disease?
98% are aware of the secondary prevention of coronary heart disease.
3 To the question: What is tertiary prevention of coronary heart disease?
89% answered the question correctly.
4 To the question: List the factors for the development of coronary heart disease?
91% listed in full all the factors for the development of coronary artery disease and 9% partially.
Conclusion: Analysis of the survey among 5th year students in the specialty "General Medicine" on the prevention of coronary heart disease showed a high level of knowledge.
2.3 Development of measures forpreventionischemic
heart diseases
Measures for the prevention of coronary artery disease:
– a paramedic should conduct individual in-depth preventive counseling of persons with high and very high total cardiovascular risk in order to correct risk factors, both in terms of accessibility and referrals of paramedics;
– organizes and conducts dispensary observation of patients with high cardiovascular risk in accordance with the orders of the Ministry of Health of Russia dated February 3, 2015 No. 36an “On approval of the procedure for conducting medical examinations for certain groups of the adult population”.
– organizes and conducts health schools for patients with risk factors for coronary heart disease with the participation of attending physicians and a medical psychologist, if necessary, other specialists (cardiologist, nutritionist, etc.);
– together with local general practitioners, on a regular basis, work is carried out to raise the level of awareness of the population,
serviced by a medical institution, and his motivation to maintain and promote health, a healthy lifestyle. Management of behavioral risk factors should begin as early as possible (from childhood and adolescence) and continue throughout life, especially in a group of people at high risk of developing coronary heart disease.
Studies show that patients consider doctors and paramedics a reliable source of information about health and want to receive qualified help from them in giving up bad habits and stereotypes of behavior. That is why preventive counseling for patients with coronary heart disease and a high risk of its development should become an integral part of all the daily work of paramedics in primary health care.
CONCLUSION
Having studied the theoretical issues of coronary heart disease, we can conclude that the main task of preventing the development of coronary heart disease is to eliminate or minimize the magnitude of those risk factors for which this is possible. To do this, even before the onset of the first symptoms, it is necessary to adhere to recommendations for lifestyle modification.
Risk factors for coronary heart disease circumstances, the presence of which predisposes to the development of coronary artery disease. These factors are in many ways similar to risk factors for atherosclerosis, since the main link in the pathogenesis of coronary heart disease is atherosclerosis of the coronary arteries. Conventionally, they can be divided into two large groups: modifiable and unmodifiable risk factors for coronary artery disease.
The analysis of statistical data was carried out according to the data of the Satka Central District Hospital of the city of Satka in the dynamics of 3 years.
For three years, 6073 patients with coronary heart disease were treated, including:
– in 2014, 1652 people, which amounted to 27.2%;
– in 2015, 1,730 people, which accounted for 28.5%;
- in 2016, 2691 people, which is 44.3%.
During this period, there is an increase in the incidence of coronary heart disease. From 2014 to 2015, treated patients with coronary heart disease increased by 1.3%, from 2015 to 2016 increased by 15.8%.
This is due to the wide prevalence of risk factors for the development of pathology, which include hypertension, smoking, alcohol abuse, obesity, diabetes mellitus, hereditary predisposition, sedentary lifestyle, constant stress and overwork.
For three years, among the diseases of coronary artery disease, most patients were treated with a diagnosis of angina pectoris 46.6%, in second place with a diagnosis of arrhythmias 24.90%, in third place with postinfarction cardiosclerosis 16.8%.
A study was conducted on the number of diseases depending on gender, in 2014, the percentage of incidence of males exceeds females by 10.6%; in 2015, the incidence rate of males exceeds females by 14%; in 2016, the incidence rate of males exceeds females by 15%.
For three years, coronary artery disease among males amounted to 3449 people, and among females 2624.
According to the results of the study, it can be concluded that over the three years of coronary heart disease, men were 13.6% more susceptible than women.
An analysis was made of the age category of those susceptible to coronary artery disease among men and women for three years, the peak of coronary artery disease in men is between the ages of 50 and 59 years, and in women it is at the age of 60 and older.
In order to identify the competence of the paramedic in the prevention of coronary heart disease, a survey was conducted of 5th year students in the specialty "General Medicine" of the Satka Medical College in the amount of 23 people.
The survey analysis showed a high level of knowledge. Only 2 people did not cope with the issue of tertiary prevention of coronary heart disease. And two people partially listed risk factors for coronary artery disease.
Our hypothesis: Competence of a paramedic in the prevention of coronary heart disease contributes to a decrease in morbidity.
As a result of the study, it was confirmed, since it is prevention that is one of the priority tasks of healthcare.
LIST OF ABBREVIATIONS
CVD- cardiovascular diseases
ischemic heart disease- cardiac ischemia
MUZ– municipal health care institution
CRH– central district hospital
health care facility- medical and preventive institution
VSS- sudden cardiac death
BIM- painless myocardial ischemia
THEM- myocardial infarction
PEAKS- postinfarction cardiosclerosis
CHF- chronic heart failure
VKNTs AMS USSR– All-Union Cardiology Research Center of the Academy of Medical Sciences Union of Soviet Socialist Republics
WHO– World Health Organization
ECG– electrocardiogram
HELL- arterial pressure
AG- arterial hypertension
USA- USA
LDL- low density lipoproteins
HDL- high density lipoproteins
XC– cholesterol
BMI- body mass index
FR- risk factors
GLP- left atrial hypertrophy
heart rate- heart rate
TG– triacylglycerol
TEG– thromboelastogram
ESR- erythrocyte sedimentation rate
ACE- angiotensin converting enzyme
US- aortocoronary bypass surgery
GP– general practitioner
exercise therapy- Healing Fitness
PHC– primary health care
LIST OF SOURCES USED
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2. Babushkina, G. V. Coronary heart disease / G. V. Babushkina, A. V. Kartelishev. - M.: Technique, 2013. - 492 p.
3. Boitsov, S.A. Organization of medical examinations and preventive medical examinations of the adult population: guidelines / S.A. Boitsov. – M.: Medicine, 2013. – 387 p.
4. Bochkov, N. P. Reference book of a general practitioner / N. P. Bochkov, V. A. Nasonova. – M.: EKSMO-Press, 2013. – 928 p.
5. Boshkov, A. B. General data on the diagnosis of coronary heart disease / A. B. Boshkov. – M.: EKSMO-Press, 2014. – 119 p.
6. Vinogradova, T. S. Instrumental methods for studying the cardiovascular system / T. S. Vinogradova. – M.: Medicine, 2015. – 180 p.
7. Gasilin, V. S. Polyclinic stage of rehabilitation of patients with myocardial infarction / V. S. Gasilin, N. M. Kulikova. - M.: Medicine, 2013. - 174 p.
8. Gritsyuk, A. I. Emergency conditions in the clinic of internal diseases / A. I. Gritsyuk. - Kyiv: Health, 2013. - 129 p.
9. Denisova, I. N. Diagnosis in cardiovascular diseases: formulation, classification: practice. guide / ed. I. N. Denisova. - M.: GEOTAR-Media, 2013. - 96 p.
10. Ivashkin, V. T. Propaedeutics of internal diseases, cardiology: textbook / V. T. Ivashkin, O. M. Drapkina. - M.: GEOTAR-Media, 2014. - 272 p.
11. Ilyinsky, B.V. IHD and heredity / B.V. Ilyinsky. - M.: Medicine, 2015. - 176 p.
12. Klimova, A.N. Epidemiology and risk factors for IHD / A.N. Klimov. - St. Petersburg: Fortuna, 2013. - 440 p.
13. Kokurina, E. V. Prevention of coronary heart disease: a modern view on the problem / E. V. Kokurina // 6 months. - 2013. - No. 3. – C. 81 – 86.
14. Komarov, F. I. Diagnosis and treatment of internal diseases / F. I. Komarov. - M.: Medicine, 2013. - 384 p.
15. Kosarev, V. V. Clinical pharmacology of drugs used in cardiovascular diseases: textbook / V. V. Kosarev, S. A. Babanov. - Samara.: Etching, 2014. - 139 p.
16. Makarova, I. N. Rehabilitation in diseases of the cardiovascular system / I. N. Makarova. - M.: GEOTAR-Media, 2012. - 304 p.
17. Molchanov, N.S. Prevention of heart disease / N.S. Molchanov. - M.: Knowledge, 2015. - 295 p.
18. Oganov, R. G. Prevention of IHD / R. G. Oganov. – M.: Medicine, 2016. – 347 p.
19. Oganov, R. G. Preventive cardiology: successes, failures, prospects / R. G. Oganov. – M.: Medicine, 2011. – 180 p.
20. Okorokov, A. N. Treatment of diseases of internal organs / A. N. Okorokov. – M.: Medicine, 2014. – 276 p.
21. Ruda, M. Ya. Myocardial infarction / M. Ya. Ruda. – M.: Medicine, 2013. – 347 p.
22. Syrkin, A. L. Myocardial infarction / A. L. Syrkin. - M.: Medicine, 2014. - 556 p.
23. Shevchenko, N. M. Cardiology / N. M. Shevchenko. – M.: Medicine, 2011. – 318 p.
24. Shishkin, A. N. Internal diseases. Recognition, semiotics, diagnostics / A. V. Shishkin. - St. Petersburg: Lan, 2013. - 384 p.
25. Human hygiene and ecology [Electronic resource] / Arkhangelsky, Vladimir Ivanovich. – M.: GEOTAR-Media, 2014. – http://www.medcollegelib.ru/book/ISBN9785970430996.html
26. Order of the Ministry of Health of the Russian Federation dated 03.02.2015 No. 36an “On approval of the procedure for medical examination of certain groups of the adult population”.
– http://www.tfoms.yar.ru/news/index.php?news=732
27. Carrying out preventive measures [Electronic resource]: textbook. allowance / S. I. Dvoinikov [and others]; ed. S. I. Dvoynikova. - M: GEOTAR-Media, 2016.
– http://www.studentlibrary.ru/book/ISBN9785970437537.html.
Coronary artery disease (CHD) Ischemia is an insufficient supply of blood to an organ, which is caused by narrowing or complete closure of the lumen in the artery. Ischemic heart disease is a group of cardiovascular diseases, which are based on impaired blood circulation in the arteries that supply blood to the heart muscle (myocardium). These arteries are called coronary arteries, hence another name for ischemic disease - coronary heart disease. IHD is one of the private variants of atherosclerosis that affects the coronary artery. This is where another name for coronary heart disease comes from - coronary sclerosis.
Coronary heart disease (CHD) is a pathological condition characterized by an absolute or relative impairment of myocardial blood supply due to damage to the coronary arteries of the heart. IHD is a very common disease, one of the main causes of death, as well as temporary and permanent disability in the developed countries of the world. In this regard, the problem of IHD occupies one of the leading places among the most important medical problems of the 20th century.
REASONS FOR THE DEVELOPMENT OF CHD life. If they are prevented in time, the disease may not develop.
Conducted a survey on the basis of KGBUZ "KGP 2" To study preventive work, I compiled a questionnaire, including the following questions: 1. Age, gender 2. Heredity 3. Smoking 4. Stress 5. Nutrition 6. Weight, height 7. Physical activity 8. Arterial pressure 9. Total cholesterol 10. Do you know what is coronary artery disease, angina pectoris.
Prevention of coronary artery disease It is necessary to stop smoking. We move more. Keeping track of weight Proper nutrition Annual leave is necessary to strengthen and restore health. Observe the daily routine, go to bed at the same time. Sleep duration 7-8 hours. Do not engage in physical or mental work before bedtime. It is advisable to take a walk before going to bed.
NUTRITION PRINCIPLES Food should be varied, balanced in calories and nutrients, contain a limited amount of cholesterol. salt - no more than 5 g per day (1 teaspoon without top) If blood pressure rises, it is necessary to limit salt intake - no more than 5 g per day (1 teaspoon without top). Avoid alcoholic drinks.
NUTRITIONAL PRINCIPLES It is necessary to limit: By-products (liver, kidneys, brains, caviar) Egg yolk (no more than 1 per week) Fatty beef, lamb, pork Fatty poultry (goose, duck, chicken) Pure animal fats Palm and coconut oils Fatty dairy products (cream, kefir, cheeses, etc.) Mayonnaise and sauces based on it High-fat sweets Salt Alcohol
NUTRITIONAL PRINCIPLES Add to diet: Vegetables, fruits, berries, lettuce and onions, parsley, dill, spinach, celery, garlic Lean meat and poultry (preferably white meat) Egg white Vegetable oils Marine fish and seafood (BUT NOT shrimp) Soft margarines (no more than a tablespoon per day) Reduced fat dairy products (0.5%-1%) Cereals, bran, wholemeal bread Walnuts (under calorie control) Legumes, soy Green tea
| Discipline: | Medicine |
| Type of work: | graduate work |
| Language: | Russian |
| Date added: | 31.08.2008 |
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| The concept of anemia as an infectious disease, the causes of its occurrence in childhood, the types and degree of danger to the life and health of the child. Analysis of the number of anemias in children of primary and secondary school age, the role of a paramedic in their prevention. | |
STATE EDUCATIONAL INSTITUTION
SECONDARY VOCATIONAL EDUCATION
KASIMOV MEDICAL SCHOOL
SPECIALTY 060101 "MEDICAL BUSINESS"
FINAL QUALIFICATION WORK ON THE TOPIC:
"The role of the paramedic in the prevention of anemia in children of primary and secondary school age".
Performed:
group student 5f2
Konkina Svetlana
Sergeevna
Kasimov 2008
- INTRODUCTION 3
- CHAPTER 1. ANEMIA. 3
- 1.1. Iron deficiency anemia 3
- 1.1.1. Etiology 3
- 1.1.2. Pathogenesis 3
- 1.1.3. Clinic 3
- 1.1.4. Treatment 3
- 1.2. B 12 -deficiency anemia 3
- 1.2.1. Etiology 3
- 1.2.2. Clinic 3
- 1.2.3. Pathogenesis 3
- 1.2.4. Treatment 3
- CHAPTER 2. Analysis of the number of anemia in children of primary and secondary school age. 3
- CHAPTER 3
- 3.1. Prevention and dispensary observation for iron deficiency anemia 3
- 3.2. Dispensary observation of B12-deficiency anemia 3
- CONCLUSION 3
- USED LITERATURE 3
Many anemias in children, despite the increased interest in them by diatricians, are still not well recognized, and pathogenetic methods of their treatment are poorly introduced into wide clinical practice. Meanwhile, the study of this pathology is of great practical importance. Some forms of anemia pose an immediate threat to life or are inevitably associated with defending children in physical and sometimes mental development. Over the past 10 years in the field of hematology in connection with the introduction of biochemical, immunological, cytological, molecular genetic and physiological methods of research, great progress has been made. Thanks to the creation of a method for cloning hematopoietic cells in the spleen of irradiated mice, chromosome analysis, and bone marrow transplantation, the role of stem cells as a fundamental unit of hematopoiesis has been proven. A major achievement is the fact of establishing a primary lesion of stem cells in aplastic anemia. It has been proven that the cause of hemolytic disease of the newborn can be not only group or Rh incompatibility of the blood of mother and child, but also incompatibility for other erythrocyte antigens. The number of carriers of hemoglobin anomalies and hereditary deficiency of glucose-6-phosphate dehydrogenase in the world is huge. Mutant variants of this enzyme have been identified. Among the Russian population, there are such hereditary anomalies as heterozygous?-thalassemia, hemolytic anemia caused by unstable hemoglobins, deficiencies of G-6-PD enzymes, pyruvate kinase, hexokinase, adenylate kinase, methemoglobinrectase in erythrocytes, etc. new data on the structure of the erythrocyte membrane, their enzymes, the role of membrane lipids and proteins in changing the shape of erythrocytes, mechanisms for eliminating defective erythrocytes. In connection with the foregoing, this topic seems to be very relevant.
Goal of the work- study of the frequency of occurrence of anemia in children and the development of preventive measures to prevent them.
Work tasks:
Consider the theoretical foundations of this topic,
· To study the educational and methodical literature concerning both the diseases themselves and their prevention.
Analyze the incidence of anemia.
· Develop preventive measures for these diseases.
Object of study: children with iron deficiency anemia and B 12 deficiency anemia.
This work consists of three parts. The first part outlines the theoretical foundations for the occurrence of the course and complications of these anemias. The second part analyzes the incidence and the dynamics of its development over the past three years. The third part provides recommendations for the prevention of these diseases.
When writing this work, legal documents in the field of health care, educational and methodological literature were used.
CHAPTER 1. ANEMIA.In childhood, all variants of anemia can occur or manifest, however, anemia associated with a deficiency of substances necessary for normal hematopoiesis, primarily iron, predominates (up to 90%). At the same time, individual clinical forms of anemia usually develop as a result of various influences and have a complex pathogenesis. In our country, anemia occurs on average in 40% of children under 3 years old, in 1/3 - at puberty, much less often - in other age periods.
This is due to the high intensity of growth of a child in the first years of life and a teenager, accompanied by a proportional increase in the number of formed elements and blood volume and high activity of erythropoiesis.
The entire bone marrow of the child is involved in the process of hematopoiesis, the body constantly requires a large amount of iron, high-grade protein, trace elements, and vitamins.
In this regard, even small violations of feeding, infectious effects, the use of drugs that depress the function of the bone marrow easily lead to anemia in children, especially in the second half of life, when neonatal iron stores are depleted.
Long-term sideration causes deep tissue and organ changes, the development of hypoxia and disorders of cellular metabolism.
In the presence of anemia, the growth of the child slows down, its harmonious development is disturbed, intercurrent diseases are more often observed, foci of chronic infection are formed, and the course of other pathological processes is aggravated.
1.1. Iron-deficiency anemia1.1.1. EtiologyThe cause of iron deficiency is its imbalance in the direction of the predominance of iron expenditure over intake, observed in various physiological conditions or diseases.
Increased consumption of iron, causing the development of hyposiderosis, is most often associated with blood loss or with its increased use in certain physiological conditions (pregnancy, a period of rapid growth). In adults, iron deficiency develops, as a rule, due to blood loss. Most often, constant small blood loss and chronic occult bleeding (5-10 ml / day) lead to a negative iron balance. Sometimes iron deficiency can develop after a single massive loss of blood that exceeds the iron stores in the body, as well as due to repeated significant bleeding, after which the iron stores do not have time to recover.
Various types of blood loss, leading to the development of posthemorrhagic iron deficiency anemia, are distributed in frequency as follows: uterine bleeding is in the first place, then bleeding from the digestive canal. Rarely, siderhoea can develop after repeated nasal, pulmonary, renal, traumatic bleeding, bleeding after tooth extraction, and other types of blood loss. In some cases, iron deficiency, especially in women, can be caused by frequent blood donations from donors, therapeutic bloodletting for hypertension and erythremia.
There are iron deficiency anemias that develop as a result of bleeding into closed cavities with no subsequent iron recycling (hemosiderosis of the lungs, ectopic endometriosis, glomic tumors).
According to statistics, 20-30% of women of childbearing age have a latent iron deficiency, 8-10% have iron deficiency anemia. The main cause of hyposiderosis in women, in addition to pregnancy, is abnormal menstruation and uterine bleeding. Polymenorrhea can be the cause of a decrease in iron stores in the body and the development of latent iron deficiency, and then iron deficiency anemia. Uterine bleeding to the greatest extent increase the volume of blood loss in women and contribute to the occurrence of iron deficiency. There is an opinion that uterine fibroids, even in the absence of menstrual bleeding, can lead to the development of iron deficiency. But more often the cause of anemia in fibroids is increased blood loss.
The second place in frequency among the factors causing the development of posthemorrhagic iron deficiency anemia is occupied by blood loss from the digestive canal, which is often hidden and difficult to diagnose. In men, this is generally the main cause of sideritis. Such blood loss may be due to diseases of the digestive system and diseases of other organs.
Iron imbalances can accompany repeated acute erosive or hemorrhagic esophagitis and gastritis, peptic ulcer of the stomach and duodenum with repeated bleeding, chronic infectious and inflammatory diseases of the alimentary canal. With giant giertrophic gastritis (Menetrier's disease) and polyposis gastritis, the mucous membrane is easily vulnerable and often bleeds. A common cause of latent blood loss that is difficult to diagnose is a hernia of the alimentary opening of the diaphragm, varicose veins of the esophagus and rectum with portal hypertension, hemorrhoids, diverticula of the esophagus, stomach, intestines, Meckel duct, tumors. Pulmonary bleeding is a rare cause of iron deficiency. Bleeding from the kidneys and urinary tract can sometimes lead to the development of iron deficiency. Very often accompanied by hematuria giᴨȇrnefroma.
In some cases, blood loss of various localization, which is the cause of iron deficiency anemia, is associated with hematological diseases (coagulopathy, thrombocytosis and thrombocytopathy), as well as vascular damage in vasculitis, collagenoses, Rendu-Weber-Osler disease, hematomas.
Sometimes iron deficiency anemia due to blood loss develops in newborns and infants. Children are much more sensitive to blood loss than adults. In newborns, blood loss may be due to bleeding observed during placenta previa, its damage during cesarean section. Other hard-to-diagnose causes of blood loss in the neonatal period and infancy: bleeding from the alimentary canal in infectious diseases of the intestines, intussusception, from Meckel's diverticulum. (C) Information published on the website
Much less often, iron deficiency can occur when it is insufficiently supplied to the body.
Iron deficiency of alimentary origin can develop in children and adults with insufficient content in the diet, which is observed with chronic malnutrition and starvation, with limited nutrition for therapeutic purposes, with monotonous food with a predominant content of fats and sugars. In children, there may be insufficient intake of iron from the mother's body as a result of iron deficiency anemia during pregnancy, premature birth, with multiple pregnancies and prematurity, premature tying of the umbilical cord until the pulsation stops.
For a long time, the absence of hydrochloric acid in gastric juice was considered the main reason for the development of iron deficiency. Accordingly, gastrogenic or achlorhydric iron deficiency anemia was isolated. At present, it has been established that achilia can only have an additional significance in the violation of iron absorption in conditions of an increased need for it by the body. Atrophic gastritis with achilia occurs due to iron deficiency due to a decrease in enzyme activity and cellular respiration in the gastric mucosa.
Inflammatory, cicatricial or atrophic processes in the small intestine, resection of the small intestine can lead to impaired absorption of iron.
There are a number of physiological conditions in which the need for iron increases dramatically.
These include pregnancy and lactation, as well as periods of increased growth in children. During pregnancy, iron consumption rises sharply to meet the needs of the fetus and placenta, blood loss during childbirth and lactation.
The balance of iron in this period is on the verge of deficiency, and various factors that reduce the intake or increase the consumption of iron can lead to the development of iron deficiency anemia.
There are two periods in a child's life when there is an increased need for iron.
The first period is the first - the second year of life, when the child is growing rapidly.
The second period is the period of puberty, when the body develops rapidly again, girls have an additional consumption of iron due to menstrual bleeding.
Iron deficiency anemia sometimes, especially in infancy and old age, develops with infectious and inflammatory diseases, burns, tumors, due to a violation of iron metabolism while maintaining its total amount.
1.1.2. PathogenesisIron deficiency anemia is associated with the physiological role of iron in the body and its participation in the processes of tissue respiration. It is part of the heme - a compound capable of reversibly binding oxygen. Heme is the prosthetic part of the hemoglobin and myoglobin molecule, which binds oxygen, which is necessary for contractile processes in muscles. In addition, heme is an integral part of tissue oxidative enzymes - cytochromes, catalase and ᴨȇroxidase. In the deposition of iron in the body, ferritin and hemosiderin are of primary importance. Transport of iron in the body is carried out by the protein transferrin (siderophilin).
The body can regulate the intake of iron from food only to a small extent and does not control its consumption. With a negative balance of iron metabolism, iron is first consumed from the depot (latent iron deficiency), then tissue iron deficiency occurs, manifested by a violation of enzymatic activity and respiratory function in tissues, and iron deficiency anemia develops only later.
1.1.3. ClinicIron deficiency states depend on the degree of iron deficiency and the rate of its development and include signs of anemia and tissue iron deficiency (siderosis). The phenomena of tissue iron deficiency are absent only in some iron deficiency anemias caused by a violation of iron utilization, when the depots are filled with iron. So, iron deficiency anemia in its course goes through two periods: the period of latent iron deficiency and the period of overt anemia caused by iron deficiency. In the period of latent iron deficiency, many subjective complaints and clinical signs appear that are characteristic of iron deficiency anemia, only less pronounced. Patients report general weakness, malaise, decreased performance. Already in this period, a perversion of taste, dryness and tingling of the tongue, a violation of swallowing with a sensation of a foreign body in the throat (Plummer-Vinson syndrome), palpitations, and shortness of breath can be observed.
An objective examination of patients reveals "small symptoms of iron deficiency": atrophy of the papillae of the tongue, cheilitis ("jam"), dry skin and hair, brittle nails, burning and itching of the vulva. All these signs of violation of the trophism of epithelial tissues are associated with tissue sideration and hypoxia.
Hidden iron deficiency may be the only sign of iron deficiency. Such cases include mild sideritis, developing over a long period of time in women of mature age due to repeated pregnancies, childbirth and abortions, in women - donors, in people of both sexes in a period of increased growth.
In most patients with continued iron deficiency, after the exhaustion of its tissue reserves, iron deficiency anemia develops, which is a sign of severe iron deficiency in the body.
Changes in the function of various organs and systems in iron deficiency anemia are not so much a consequence of anemia, but of tissue iron deficiency. The proof of this is the discrepancy between the severity of the clinical manifestations of the disease and the degree of anemia and their appearance already in the stage of latent iron deficiency.
Patients with iron deficiency anemia note general weakness, fatigue, difficulty concentrating, and sometimes drowsiness. Headache appears after fatigue, dizziness. With severe anemia, fainting is possible. These complaints, as a rule, do not depend on the degree of anemia, but on the duration of the disease and the age of the patients.
Iron deficiency anemia is characterized by changes in the skin, nails, and hair. The skin is usually pale, sometimes with a slight greenish tint (chlorosis) and with an easy blush of the cheeks, it becomes dry, flabby, flaky, cracks easily. Hair loses its luster, becomes gray, thinner, breaks easily, thins and turns gray early. Nail changes are significant: they become thin, matte, flatten, easily exfoliate and break, striation appears. With pronounced changes, the nails acquire a concave, spoon-shaped shape (koilonychia).
In patients with iron deficiency anemia, muscle weakness occurs, which is not observed in other types of anemia. It is attributed to the manifestations of tissue siderome. Atrophic changes occur in the mucous membranes of the digestive canal, respiratory organs, and genital organs. Damage to the mucous membrane of the digestive canal is a typical sign of iron deficiency conditions. In this regard, a misconception has arisen that the primary link in the pathogenesis of iron deficiency anemia is the defeat of the stomach with the subsequent development of iron deficiency.
In most patients with iron deficiency anemia, the appetite decreases. There is a need for sour, spicy, salty foods. In more severe cases, there are perversions of smell, taste (pica chlorotica): eating chalk, lime, raw cereals, pogophagy (an attraction to eating ice). Signs of tissue sideration quickly disappear after taking iron supplements.
In 25% of cases, glossitis and changes in the oral cavity are observed. In patients, taste sensations decrease, tingling, burning and a feeling of fullness in the tongue, especially its tip, appear. On examination, atrophic changes in the mucous membrane of the tongue are found, sometimes cracks at the tip and along the edges, in more severe cases, areas of redness of irregular shape ("geographic tongue") and aphthous changes. The atrophic process also captures the mucous membrane of the lips and oral cavity. There are cracks in the lips and seizures in the corners of the mouth (cheilosis), changes in tooth enamel.
It is characterized by sidereal dysphagia syndrome (Plummer-Vinson syndrome), which is manifested by difficulty in swallowing dry and dense food, a feeling of nausea and a feeling of having a foreign body in the throat. Some patients due to these manifestations take only liquid food. There are signs of a change in the function of the stomach: belching, feeling of heaviness in the abdomen after eating, nausea. They are due to the presence of atrophic gastritis and achylia, which are determined by morphological (gastrobiopsy of the mucous membrane) and functional (gastric secretion) studies. This disease occurs as a result of sideritis, and then progresses to the development of atrophic forms.
In patients with iron deficiency anemia, shortness of breath, palpitations, chest pain, and swelling are constantly observed. The expansion of the boundaries of cardiac dullness to the left, anemic systolic murmur at the apex and pulmonary artery, "top noise" at the jugular vein, tachycardia and hypotension are determined. The ECG shows changes that indicate the phase of repolarization. Iron deficiency anemia in severe cases in elderly patients can cause cardiovascular insufficiency.
A manifestation of iron deficiency is sometimes fever, the temperature usually does not exceed 37.5 ° C and disappears after iron treatment. Iron deficiency anemia has a chronic course with periodic exacerbations and remissions. In the absence of proper pathogenetic therapy, remissions are incomplete and are accompanied by permanent tissue iron deficiency.
1.1.4. TreatmentIt includes the elimination of the causes that caused the disease, the organization of the correct daily routine and a rational balanced diet, the normalization of the secretion of the gastrointestinal tract, as well as the medicinal replenishment of the existing iron deficiency and the use of agents that contribute to its elimination. The mode is active, with sufficient exposure to fresh air. Young children are prescribed massage and gymnastics, older children - moderate sports, with the aim of improving the absorption of food products, stimulating metabolic processes.
The diet is shown depending on the severity of anemia: with mild and moderate anemia and satisfactory appetite - a varied, age-appropriate diet with the inclusion in the diet of foods rich in iron, protein, vitamins, microelements. In the first half of the year - an earlier introduction of grated apple, vegetable puree, egg yolk, oatmeal and buckwheat porridge, in the second - meat souffle, puree from ᴨȇcheni. You can use homogenized canned vegetables (puree) by adding meat products. In severe anemia, usually accompanied by anorexia and dystrophy, the threshold of food tolerance is first determined by prescribing gradually increasing amounts of breast milk or mixtures. Insufficient volume is replenished with juices, vegetable broths, in older children - with mineral water. Upon reaching the proper daily volume of food, its qualitative composition is gradually changed, enriching it with the substances necessary for hematopoiesis. Limit cereal products and cow's milk, since when they are consumed, insoluble phytates and iron phosphates are formed.
Pathogenetic therapy is carried out with iron drugs (ferroceron, resoferon, conferon, aktiferrin, ferroplex, orferon) and vitamins. Iron is most often prescribed orally in the form of ferrous salts, mainly ferrous sulfate, which is absorbed and absorbed most completely. Ferric chloride, lactate, ascorbate, gluconate and iron saccharate are also used. Medicines are made from iron salts in combination with organic substances (amino acids, malic, succinic, ascorbic, citric acids, sodium dioctylsulfosuccinate, etc.), which, in the acidic environment of the stomach, contribute to the formation of easily soluble complex iron compounds - chelates and its more complete absorption . It is recommended to take iron between meals or 1 hour before meals, as some food ingredients may form insoluble compounds with it. Fill preparations with fruit and vegetable juices, citrus juices are especially useful. For young children, the average therapeutic dose is prescribed at the rate of 4-6 mg of elemental iron per 1 kg of weight per day in 3 divided doses. Most of the preparations contain 20% elemental iron, in connection with this, the calculated dose is usually increased by 5 times. The individual dose per course of treatment is calculated in milligrams using the following formula:
Fe\u003d P x (78 - 0.35 xHb),
where P - body weight, kg; Hb - the actual level of hemoglobin in a child, g / l. The course of treatment is usually long, the full dose is prescribed until a stable normal hemoglobin content is reached, and over the next 2 to 4 months (up to 6 months in case of severe anemia of full-term and up to 2 years of life in preterm infants) a prophylactic dose is given (1/2 of the therapeutic dose 1 time per day). day) to accumulate iron in the depot and prevent recurrence of the disease. With poor iron tolerance, treatment begins with small doses, gradually increasing them, changing drugs. The effectiveness of treatment is determined by the increase in hemoglobin by (10 g / l, or 4-6 units per week), a decrease in microcytosis, a reticulocyte crisis on days 7-10 of iron supplementation, an increase in serum iron to 17 μmol / l or more , and the transferrin saturation coefficient - up to 30%. Parenteral iron preparations are prescribed with caution in severe anemia, intolerance to iron preparations when taken orally, peptic ulcer, malabsorption, lack of effect from enteral use, since children may develop hemosiderosis. The course dose is calculated according to the following formulas:
Fe(mg) \u003d (body weight (kg) x) / 20
ANDwhetherFe(mg) \u003d Px (78 - 0.35Hb),
where Fe (µg/l) is the iron content in the patient's serum; Hb - hemoglobin level of reference blood. The maximum daily single dose of parenteral iron preparations for body weight up to 5 kg is 0.5 ml, up to 10 kg - 1 ml, after 1 year - 2 ml, for adults - 4 ml. Iron sucrose is most often used, treatment with ferbitol (iron sorbitol), fercoven (2% iron sucrose with cobalt gluconate in carbohydrate solution) is effective. Iron preparations are administered orally simultaneously with digestive enzymes in order to normalize the acidity of the internal environment and stabilize it. For better assimilation and absorption, hydrochloric acid with ᴨȇpsin pancreatin with calcium, festal is prescribed. In addition, large doses of ascorbic acid and other vitamins in the age dosage inside are shown. Transfusion of whole blood and erythrocyte mass is performed only for vital indications (hemoglobin content below 60 g/l), since it creates the illusion of recovery only for a short time. Recently, it has been shown that blood transfusions suppress the activity of hemoglobin synthesis in normoblasts, and in some cases even cause a reduction in erythropoiesis.
1.2. B 12 deficiency anemiaFor the first time, this kind of deficient anemia was described by Addison in 1849, and then in 1872 by Birmer, who called it "progressive critical" (fatal, malignant) anemia. The causes that cause the development of anemia of this type can be divided into two groups:
insufficient intake of vitamin B 12 in the body with food
Violation of the absorption of vitamin B 12 in the body
Megaloblastic anemia occurs when there is insufficient intake of vitamins B12 and / or folic acid. Deficiency of these vitamins leads to a disruption in the synthesis of DNA and RNA in cells, which causes impaired maturation and hemoglobin saturation of erythrocytes. Large cells - megaloblasts - appear in the bone marrow, and large erythrocytes (megalocytes and macrocytes) appear in the rhyme blood. The process of blood destruction prevails over hematopoiesis. Defective erythrocytes are less stable than normal ones and die faster.
1.2.2. ClinicIn the bone marrow, more or less megaloblasts with a diameter of more than (15 microns), as well as megalocaryocytes, are found. Megaloblasts are characterized by desynchronization of the maturation of the nucleus and cytoplasm. The rapid formation of hemoglobin (already in megaloblasts) is combined with a slow differentiation of the nucleus. These changes in erythron cells are combined with impaired differentiation of other myeloid cells: megakaryoblasts, myelocytes, metamyelocytes, stab and segmented leukocytes are also enlarged in size, their nuclei have a more delicate chromatin structure than normal. In the rhyme blood, the number of red blood cells is significantly reduced, sometimes to 0.7 - 0.8 x 10 12 / l. They are large - up to 10 - 12 microns, often oval in shape, without central enlightenment. As a rule, megaloblasts meet. In many erythrocytes, remnants of the nuclear substance (Jolly bodies) and nucleolemms (Cabot rings) are found. Anisocytosis (macro- and megalocytes predominate), poikilocytosis, polychromatophilia, and basophilic puncture of the erythrocyte cytoplasm are characteristic. Erythrocytes are oversaturated with hemoglobin. The color index is usually more than 1.1 - 1.3. However, the total content of hemoglobin in the blood is significantly reduced due to a significant decrease in the number of red blood cells. The number of reticulocytes is usually reduced, less often - normal. As a rule, leukemia (due to neutrophils) is observed, combined with the presence of polysegmented giant neutrophils, as well as thrombocytosis. In connection with the increased hemolysis of erythrocytes (mainly in the bone marrow), bilirubinemia develops. In 12 - deficiency anemia is usually accompanied by other signs of beriberi: changes in the gastrointestinal tract due to the violation of division (in this case, signs of atypical mitosis are revealed) and maturation of cells (the presence of megalocytes), especially in the mucous membrane. There is glossitis, the formation of a "polished" tongue (due to atrophy of its papillae); stomatitis; gastroenterocolitis, which aggravates the course of anemia due to impaired absorption of vitamin B 12; a neurological syndrome that develops as a result of changes in neurons. These deviations are mainly the result of a violation of the metabolism of higher fatty acids. The latter is due to the fact that another metabolically active form of vitamin B12 - 5 - deoxyadenosylcobalamin (in addition to methylcobalamin) regulates the synthesis of fatty acids, catalyzing the formation of succinic acid from methylmalonic acid. Deficiency of 5-deoxyadenosylcobalamin causes a violation of myelin formation, has a direct damaging effect on the neurons of the brain and spinal cord (especially its posterior and lateral columns), which is manifested by mental disorders (delusions, hallucinations), signs of funicular myelosis (staggering gait, paresthesia, pain, limb numbness, etc. ).
This type of megaloblastic anemia is a violation of the formation of compounds involved in the biosynthesis of DNA, in particular thymidine phosphate, uridine phosphate, orotic acid. As a result, the structure of DNA and the information contained in it on the synthesis of polypeptides are violated, which leads to the transformation of the normoblastic type of erythropoiesis into megaloblastic. The manifestations of these anemias are for the most part the same as in vitamin B12 - deficiency anemia.
The development of megaloblastic anemia is possible not only due to a deficiency of vitamin B 12 and (or) folic acid, but also as a result of a violation of the synthesis of purine or pyrimidine bases necessary for the synthesis of nucleic acids. The cause of these anemias is usually an inherited (usually recessive) disorder of the activity of enzymes necessary for the synthesis of folic, orotic, adenylic, guanylic, and possibly some other acids.
1.2.3. PathogenesisA lack of vitamin B 12 in the body of any origin causes a violation of the synthesis of nucleic acids in erythrokaryocytes, as well as the metabolism of fatty acids in them and cells of other tissues. Vitamin B 12 has two coenzyme forms: methylcobalamin and 5 - deoxyadenosylcobalamin. Methylcobalamin is involved in ensuring normal, erythroblastic, hematopoiesis. Tetrahydrofolic acid, formed with the participation of methylcobalamin, is necessary for the synthesis of 5, 10 - methyltetrahydrofolic acid (a coenzymatic form of folic acid), which is involved in the formation of thymidine phosphate. The latter is included in the DNA of erythrokaryocytes and other rapidly dividing cells. The lack of thymidine phosphate, combined with a violation of the inclusion of uridine and orotic acid in DNA, causes a violation of the synthesis and structure of DNA, which leads to a breakdown in the processes of division and maturation of erythrocytes. They increase in size (megaloblasts and megalocytes), and therefore resemble erythrokaryocytes and megalocytes in the embryo. However, this similarity is only superficial. The erythrocytes of the embryo fully provide the oxygen transport function. Erythrocytes, on the other hand, formed in conditions of vitamin B 12 deficiency, are the result of pathological megaloblastic erythropoiesis. They are characterized by low mitotic activity and low resistance, short life span. Most of them (up to 50%, normally about 20%) are destroyed in the bone marrow. In this regard, the number of erythrocytes in the rhyme blood also significantly decreases.
1.2.4. TreatmentA complex of therapeutic measures for B 12 - deficiency anemia should be carried out taking into account the etiology, severity of anemia and the presence of neurological disorders. When treating, you should focus on the following provisions:
An indispensable condition for the treatment of B 12 - deficiency anemia with helminthic invasion is deworming (to expel a wide tapeworm, fenasal is prescribed according to a certain scheme or male fern extract).
In case of organic bowel diseases and diarrhea, enzyme preparations (panzinorm, festal, pancreatin) should be used, as well as fixing agents (calcium carbonate in combination with dermatol).
Normalization of the intestinal flora is achieved by taking enzyme preparations (panzinorm, festal, pancreatin), as well as by choosing a diet that helps to eliminate the syndromes of putrefactive or fermentative dyspsia.
· A balanced diet with a sufficient content of vitamins, protein, an unconditional prohibition of alcohol is an indispensable condition for the treatment of B 12 and folic deficiency anemia.
Pathogenetic therapy is carried out using parenteral administration of vitamin B12 (cyanocobalamin), as well as normalization of altered central hemodynamic parameters and neutralization of antibodies to gastromucoprotein ("intrinsic factor") or gastromucoprotein + vitamin B12 complex (corticosteroid therapy).
Blood transfusions are carried out only with a significant decrease in hemoglobin and the manifestation of symptoms of a coma. It is recommended to enter erythrocyte mass in 250 - 300 ml (5 - 6 transfusions).
CHAPTER 2. Analysis of the number of anemia in children of primary and secondary school age.In the period from 2005 to 2007, 53 cases of anemia were registered in children of primary and secondary school age in the city of Kasimov and the Kasimov district.
Table 1
Statistical data on the incidence of anemia in Kasimov and Kasimov district among children for 2005-2007
Diagram 1
table 2
The ratio of the incidence of iron deficiency B12-deficiency anemia among children in 2005-2007.
Diagram 2
The ratio of the incidence of iron deficiency and B 12 deficiency anemia among children in 2005-2007.
From this material it is clearly seen that the incidence of anemia in children of primary and secondary school age is growing every year. This is due to the lack of awareness of parents about the proper rational nutrition of the child and their late treatment in medical institutions, as well as unfavorable conditions of both the environment and the social environment. The data also show that despite the increase in the incidence of iron deficiency anemia, the incidence rate is higher than that of B 12 deficiency anemia, this is due to the environmental characteristics of the area in which the population lives.
CHAPTER 3 3.1. Prevention and dispensary observation for iron deficiency anemiaPrimary prevention consists in the use of products containing a lot of iron (meat, ᴨȇchen, cheeses, cottage cheese, buckwheat and wheat groats, wheat bran, soybeans, egg yolk, dried apricots, prunes, dried rose hips). It is carried out among people at risk (for example, those who have had oᴨȇrations on the gastrointestinal tract, with malabsorption syndrome, regular donors, pregnant women, women with polymenorrhea).
Secondary prevention indicated after completion of a course of treatment for iron deficiency anemia. After the normalization of the Hb content (especially with poor tolerance of iron preparations), the therapeutic dose is reduced to prophylactic (30-60 mg of ionized ferrous iron per day). With continued loss of iron (for example, heavy menstruation, constant donation of erythrocytes), prophylactic administration of iron preparations is carried out for 6 months or more after the normalization of the level of Hb in the blood. Monitoring of the Hb content in the blood is carried out monthly for 6 months after the normalization of the Hb level and serum iron concentration. Then control tests are carried out once a year (in the absence of clinical signs of anemia).
Prevention of iron deficiency anemia comes down to good nutrition with the consumption of animal proteins, meat, fish, control of possible diseases, which is mentioned above. An indicator of the well-being of the state is the cause of iron deficiency anemia: for the rich, it is post-hemorrhagic in nature, and for the poor, it is alimentary.
3.2. Dispensary observation of B 12 deficiency anemiaDispensary supervision - lifelong. Supportive therapy (prevention of relapses) is carried out under the control of the level of Hb and the content of erythrocytes, for this purpose cyanocobalamin is used in courses of 25 injections 1 time per year (during remission) throughout life. Once every six months, an endoscopic examination of the stomach with a biopsy is required to exclude stomach cancer.
An important role in the prevention of anemia is played by proper rational nutrition of the child. The paramedic should explain to the parents of the child what foods should be given to him at his age, that the composition of the products must include iron, since a lack of iron leads to the development of anemia. The paramedic should conduct sanitary and educational work on the prevention of anemia. If anemia is suspected, the paramedic should refer the child to a ᴨȇdiatrist so that he can begin timely treatment of anemia. So, in addition to sanitary and educational work, early diagnosis of the disease plays a huge role.
CONCLUSIONAnemia (anemia) - a decrease in the number of red blood cells and (or) a decrease in hemoglobin content per unit volume of blood. Anemia can be both an independent disease and a syndrome that accompanies the course of another pathological process.
With anemia, not only quantitative, but also qualitative changes in erythrocytes are observed: their size (anisocytosis), shape (poikilocytosis), color (hypo- and hyrchromia, polychromatophilia).
The classification of anemia is difficult. It is based on the distribution of anemia into three groups according to the causes and mechanisms of the development of the disease: anemia due to blood loss (posthemorrhagic anemia); anemia due to violations of the formation of hemoglobin or hematopoietic processes; anemia caused by increased breakdown of red blood cells in the body (hemolytic).
From the statistical data it is clearly seen that the incidence of anemia in children of primary and secondary school age is growing every year. This is due to the lack of awareness of parents about the proper rational nutrition of the child and their late treatment in medical institutions, as well as unfavorable conditions of both the environment and the social environment. The data also show that despite the increase in the incidence of iron deficiency anemia, the incidence rate is higher than that of B 12 deficiency anemia, this is due to the environmental characteristics of the area in which the population lives.
The role of the paramedic is to carry out sanitary and educational work on the prevention of anemia in children. If anemia is suspected, the paramedic should refer the child to a ᴨȇdiatrist so that he can begin timely treatment of anemia. So, in addition to sanitary and educational work, early diagnosis of the disease plays a huge role.
REFERENCES1. Anemia in children: diagnosis and treatment. A practical guide for doctors / Ed. A. G. Rumyantseva, Yu. N. Tokareva. M: MAKS-Press, 2000.
2. Volkova S. Anemia and other blood diseases. Prevention and methods of treatment. Publisher: Tsentrpoligraf. 2005 - 162 p.
3. Gogin E. Patient management protocol. "Iron-deficiency anemia". Publisher: Newdiamed. 2005 - 76 p.
4. Ivanov V. Iron deficiency anemia in pregnancy. Tutorial. Ed. N-L. 2002 - 16 p.
5. Kazyukova T.V., Kalashnikova G.V., Fallukh A. et al. New possibilities of ferrotherapy for iron deficiency anemia// Clinical pharmacology and therapy. 2000. No. 9 (2). pp. 88-92.
6. Kalinicheva V. N. Anemia in children. M.: Medicine, 1983.
7. Kalmanova V.P. Indicators of erythropoietic activity and iron metabolism in hemolytic disease of the fetus and newborn and intrauterine transfusions of erythrocytes: Dis ... cand. honey. Sciences. M., 2000.
8. Korovina N. A., Zaplatnikov A. L., Zakharova I. N. Iron deficiency anemia in children. M., 1999.
9. Miroshnikova K. Anemia. Treatment with folk remedies. Publisher: FEIX. 2007 - 256 p.
10. Mikhailova G. Diseases of children from 7 to 17 years old. Gastritis, anemia, influenza, appendicitis, vegetovascular dystonia, neurosis, etc. Ed.: VES. 2005 - 128 p.
11. Ellard K. Anemia. Causes and treatment. Publisher: Norint. 2002 - 64 p.
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Chapter 14
Chapter 14
14.1. RISK FACTORS
The problem of studying the risk factors for the occurrence of diseases, the development of effective measures for their prevention should become priorities in the activities of the health care system and society as a whole.
In the formation of diseases, a large role belongs to the risk factors of lifestyle and habitat. An analysis of data on risk factors for the population shows that among people aged 25 to 65 years, the following risk factors are most common:
Smoking;
Unbalanced diet;
Elevated levels of cholesterol in the blood (hypercholesterolemia);
Excess consumption of table salt;
low physical activity;
Excess body weight;
alcohol abuse;
High blood pressure;
Diabetes;
Psychological factors.
Smoking
Smoking is a risk factor contributing primarily to the occurrence of cardiovascular and oncological diseases. It is now generally recognized that the eradication of smoking is one of the most effective measures to improve the health of the population. Many countries (USA, Finland, Iceland, Northern Ireland, Canada and others) launched a national anti-smoking campaign, which led to a significant reduction in the number of smokers and improved public health.
In one of the studies conducted in the USA, it was shown that the number of cases of cardiovascular diseases in people aged 45-54 years when smoking up to 20 cigarettes per day, compared with non-smokers, increases 1.5 times, and when smoking more than 20 cigarettes - 2 times. Similar data were obtained in the analysis of mortality. Thus, compared with non-smokers, people who smoke more than 20 cigarettes a day have a more than 2-fold higher risk of death from all causes.
In recent years, the number of women and girls who smoke has noticeably increased. At the same time, smoking is more harmful for women than for men for a number of reasons. Being, like in men, a risk factor for the development of cardiovascular, oncological and other diseases, smoking puts before them a number of purely female problems. Thus, the risk of cardiovascular disease is especially high in women who smoke and take contraceptives. Smoking adversely affects pregnancy:
In women who smoke during pregnancy, fetal growth slows down, and the birth weight of the child is on average 200 g less than in children of non-smoking women;
Smoking during pregnancy increases the risk of congenital diseases in children and the risk of perinatal mortality;
Maternal smoking has a negative effect on the fetus, accelerating the number of heartbeats and slowing down breathing;
Women who smoke are more likely to have spontaneous abortions and premature births.
Thus, the fight against smoking, as the prevention of many diseases, should be given an important place. Careful scientific analysis shows that in the fight against cardiovascular diseases alone, 50% of success can be attributed to a decrease in the number of smokers in the population.
Unbalanced diet
Proper, balanced nutrition is the basis for the prevention of many diseases. Basic principles of rational nutrition:
Energy balance of the diet (correspondence of energy consumption to energy consumption);
The balance of the diet for the main components (proteins, fats, carbohydrates, trace elements, vitamins);
Compliance with the diet.
Overnutrition is especially dangerous for the spread of many socially significant chronic diseases. It contributes to the occurrence of diseases of the cardiovascular system, gastrointestinal tract, bronchopulmonary system, diseases of the endocrine system and metabolic disorders, musculoskeletal system, malignant neoplasms, etc. Conversely, there is evidence that an increase in the consumption of vegetables and fiber, as well as Reducing fat intake helps prevent certain types of cancer. Excessive nutrition additionally leads to the emergence of such risk factors as high cholesterol in the blood (hypercholesterolemia), overweight, excessive consumption of table salt.
Elevated levels of cholesterol in the blood (hypercholesterolemia)
Cholesterol belongs to the group of fats, it is necessary for the normal functioning of the body, but its high level in the blood contributes to the development of atherosclerosis. The level of cholesterol in the blood depends mainly on the composition of food, although the genetically determined ability of the body to synthesize cholesterol also has an undoubted influence. There is usually a clear relationship between saturated fat intake and blood cholesterol levels. Changing the diet is accompanied by a change in the level of cholesterol in the blood. In economically developed countries, more than 15% of the population has elevated blood lipids, and in some countries this figure is twice as high. There is now a large amount of undeniable evidence of the relationship between elevated blood cholesterol levels and the risk of developing cardiovascular diseases.
Excess consumption of table salt
Excess consumption of table salt can cause arterial hypertension. In people who consume at least 5-6 g of salt per day, there is an increase in blood pressure with age. At present, in many countries, people consume salt in quantities that far exceed their physiological needs. Limiting the intake of salt is accompanied by a decrease in blood pressure. Thus, for the primary prevention of hypertension, it is necessary to limit the content in the diet
salt intake up to 5 g per day, while increasing the proportion of foods rich in potassium (tomatoes, bananas, grapefruits, oranges, potatoes and others), which reduce the effect of salt in increasing blood pressure.
Low physical activity
In economically developed countries, every second adult leads a sedentary lifestyle, and every day their number is growing, especially for older people. This lifestyle leads to obesity, metabolic disorders, which, in turn, leads to an increase in the number of socially significant diseases. The influence of physical activity on the frequency and outcome of cardiovascular diseases has been scientifically proven. Physical activity has an inhibitory effect on the development of atherosclerosis.
Lack of physical activity combined with an unhealthy diet can lead to overweight. According to special studies, from 10 to 30% of the population of economically developed countries aged 25-65 are obese. Excessive fat deposition leads to the development of risk factors for cardiac diseases - high blood pressure, lipid metabolism disorders, insulin-dependent diabetes, etc. risk of developing gallstone disease, gout. Obesity is now becoming an epidemic in both developed and developing countries.
Reducing excess body weight and maintaining it at a normal level is a rather difficult task, but quite solvable. Control over the amount, composition of food and physical activity contributes to a decrease in body weight. Maintaining a normal body weight is ensured by a balance of incoming and utilized calories. Exercising helps burn calories. It is recommended to reduce body weight gradually, avoiding exotic diets, as they usually bring only temporary success. Nutrition should be balanced, food - low-calorie. However, in general, food should be varied, familiar and affordable, and eating should be enjoyable.
Alcohol abuse
It is one of the most pressing health problems in most countries of the world. Alcohol abuse can cause the following serious problems for the drinker:
Weakening of self-control as a result of acute alcohol intoxication, leading to violation of law and order, accidents, etc.;
Poisoning by alcohol and its surrogates;
The appearance of serious consequences of prolonged alcohol consumption (risk of a number of socially significant diseases, mental decline, premature death).
In Russia, more than 25 thousand people die every year from alcohol poisoning. Acute and chronic diseases caused by excessive alcohol consumption are widely described. In many countries, mortality from cirrhosis of the liver has increased in recent decades, there is convincing evidence of the effect of alcohol on high blood pressure. This defect is the main cause of death from accidents and injuries. Alcohol abuse also causes social problems, including crime, violence, family disruption, academic delays, work problems, suicide, and more. The problems associated with alcohol abuse affect not only the drinkers themselves, but also their families, those around them, and society.
Special studies show that the economic damage caused by alcohol-related problems ranges from 0.5 to 3.0% of the gross national product.
High blood pressure
Approximately one in five people living in economically developed countries has high blood pressure, but most hypertensive patients do not control their condition. Doctors of the American Heart Association call hypertension "the silent and mysterious killer." The danger of arterial hypertension is that this disease in many patients is asymptomatic, and they feel like healthy people. In medicine, there is even such a thing as the “law of halves”. It means that of all people with hypertension, ½ is unaware of their condition, and of those who do, only ½ is being treated, and of those who are being treated, only ½ is being treated effectively.
A prolonged increase in blood pressure has a negative effect on many organs and systems of the human body, but the heart, brain, kidneys, and eyes suffer the most. Arterial hypertension is one of the main risk factors for coronary heart disease, it increases the risk of death from diseases caused by atherosclerosis. Prevention and treatment of hypertension should be the main part of a set of measures aimed at combating risk factors for cardiovascular diseases (smoking, hypercholesterolemia, physical inactivity, overweight, etc.).
Diabetes
This serious disease is, in turn, a powerful risk factor for cardiovascular disease and other serious diseases that lead to disability. Hereditary predisposition plays an important role in the development of diabetes, so people who have diabetes in the family should regularly check their blood sugar levels. Patients with diabetes should try to get rid of other risk factors for non-communicable diseases, such as overweight, physical inactivity, which will contribute to a milder course of the disease. At the same time, smoking cessation, normalization of blood pressure, and rational nutrition become especially important. Proper and timely treatment of the underlying disease will prevent the development of other concomitant diseases. In most countries of the world there are special programs aimed at combating this serious disease.
Psychological factors
Recently, there has been an increasing role of psychological factors in the development of cardiovascular and other diseases. The role of stress, fatigue at work, feelings of fear, hostility, social insecurity in the development of cardiovascular diseases has been proven.
Each of these factors in itself has a significant impact on the development and outcome of many diseases, and their combined effect, all the more, greatly increases the risk of developing pathology. To prevent this, it is necessary to develop and implement a set of state measures to prevent diseases, reduce, and where possible, and eliminate the risk factors that contribute to their occurrence.
The fundamentals of the legislation of the Russian Federation on the protection of the health of citizens establishes the priority of preventive measures in strengthening and protecting the health of the population. Prevention of diseases is the main principle of domestic health care.
14.2. TYPES OF PREVENTIVE MEASURES
The set of preventive measures implemented through the health care system is called medical prevention. Medical prevention in relation to the population is individual, group and population (mass). Individual prevention- this is the implementation of preventive measures with individual individuals. group- with groups of people with similar symptoms and risk factors. population covers large groups of the population (population) or the population as a whole.
In addition, a distinction is made between primary, secondary and tertiary prevention or rehabilitation.
Primary prevention is a complex of medical and non-medical measures aimed at preventing the occurrence of certain deviations in the state of health and diseases.
Primary prevention includes the following set of measures:
Measures to reduce the impact of harmful environmental factors on the human body (improving the quality of atmospheric air, drinking water, soil, the structure and quality of nutrition, working conditions, living and resting, reducing the level of psychosocial stress and other factors that adversely affect the quality of life);
Measures to promote a healthy lifestyle;
Measures to prevent occupationally caused diseases and injuries, accidents, and deaths in working age;
Carrying out immunoprophylaxis among various groups of the population.
Secondary prevention It is a complex of medical, social, sanitary-hygienic, psychological and other measures aimed at the early detection of diseases, as well as the prevention of their exacerbations, complications and chronicity.
Secondary prevention includes:
Targeted sanitary and hygienic education of patients and their families in knowledge and skills related to a specific disease (organization of health schools for patients suffering from bronchial asthma, diabetes mellitus, hypertension, etc.);
Conducting medical examinations in order to detect diseases in the early stages of development;
Conducting courses of preventive (anti-relapse) treatment.
Tertiary prevention or rehabilitation is a complex of medical, psychological, pedagogical, social measures aimed at eliminating or compensating for life limitations, lost functions, with the aim of restoring the patient's social and professional status as fully as possible. This is achieved by developing a network of centers for restorative medicine and rehabilitation, as well as sanatorium-resort institutions.
One of the most important components of primary prevention is formation of a healthy lifestyle(healthy lifestyle), which includes favorable conditions for human life, the level of his culture and hygiene skills, allowing to maintain and strengthen health, maintain an optimal quality of life.
An important role in the formation of a healthy lifestyle belongs to its promotion, the purpose of which is the formation of hygienic behavior of the population, based on scientifically based sanitary and hygienic standards aimed at maintaining and strengthening health, ensuring a high level of working capacity, and achieving active longevity.
The most important areas of healthy lifestyle promotion should be considered:
Propaganda of factors contributing to the preservation of health: personal hygiene, hygiene of work, rest, nutrition, physical education, hygiene of sexual life, medical and social activity, environmental hygiene, etc.;
Promotion of measures to prevent risk factors that adversely affect health: excessive food intake with insufficient physical activity, alcohol abuse, drug use, tobacco smoking, adherence to certain ethnic rituals and habits, etc.
Various forms of propaganda are used to promote healthy lifestyles (Figure 14.1).
Rice. 14.1. Health promotion forms
The primary divisions of the healthy lifestyle formation service include departments (rooms) of prevention. They are organized as part of territorial polyclinics, polyclinic departments of central district (city) hospitals, dispensaries. By decision of the health management body, similar units may be created in other medical institutions.
Organizational and methodological management of the activities of departments (offices) of prevention is carried out Regional Center for Medical Prevention.
The department (office) of medical prevention is headed by a doctor (paramedic) who has appropriate training in the field of medical prevention.
The main tasks of the department (office) of prevention:
Ensuring the interaction of the medical institution with the regional center of medical prevention;
Organizational and methodological support for the activities of medical workers of a medical institution to identify risk factors, correct lifestyle,
promotion of medical and hygienic knowledge, a healthy lifestyle;