Vasilenko I A, Kotov S V, Isakova E V, Mosalskaya D V
Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2021;121(3. Vyp. 2):53-59. doi: 10.17116/jnevro202112103253.
To assess the possibility of using the integral indicators of thrombodynamics to improve the safety of rehabilitation measures in patients in the recovery period of stroke.
A prospective study included 52 patients in the recovery period of stroke. To compare the effect of the intensity of physical activity on the change in the integral indicators of thrombodynamics in accordance with the objectives of the study, the patients were randomized into two groups. In the first group, patients received treatment, including physiotherapy, stabilometric trainings, neuropsychological tasks. Patients of the second group received complex treatment, including more intense physical activity with the use of cyclic exercises, biomechanotherapy. To assess the state of hemostasis, an integral thrombodynamics test was used, and the numerical parameters of the spatial dynamics of the growth of a fibrin clot were calculated.
The state of compensated hypercoagulability was revealed in the majority of patients before the start of medical rehabilitation, despite taking antithrombotic therapy, which was evidence of the ineffectiveness of the therapy. At the same time, it was noted that it was its action, probably during the ongoing program of physical rehabilitation, that ensured the stability of the integral indicators of thrombodynamics and the absence of clinically significant unwanted thromboembolic complications. As a result of the analysis of the data in dynamics before and after treatment, a direct relationship was traced between the intensity of physical activity and the tendency to disturb the hemostatic balance.
The intensity of physical activity during treatment undoubtedly influenced the state of hemostasis. The expediency of monitoring the dynamics of coagulation activity in patients in the recovery period of stroke has been demonstrated.
评估使用血栓动力学积分指标改善脑卒中恢复期患者康复措施安全性的可能性。
一项前瞻性研究纳入了52例脑卒中恢复期患者。为根据研究目的比较体力活动强度对血栓动力学积分指标变化的影响，将患者随机分为两组。第一组患者接受包括物理治疗、平衡功能训练、神经心理任务在内的治疗。第二组患者接受综合治疗，包括使用循环运动、生物力学疗法进行更剧烈的体力活动。为评估止血状态，采用了血栓动力学积分测试，并计算了纤维蛋白凝块生长空间动力学的数值参数。
尽管接受了抗血栓治疗，但在医学康复开始前，大多数患者仍表现出代偿性高凝状态，这证明了治疗的无效性。同时，注意到可能正是在正在进行的物理康复计划期间，其作用确保了血栓动力学积分指标的稳定性以及临床上无显著的不良血栓栓塞并发症。通过对治疗前后动态数据的分析，发现体力活动强度与止血平衡紊乱倾向之间存在直接关系。
治疗期间的体力活动强度无疑影响了止血状态。已证明对脑卒中恢复期患者的凝血活性动态进行监测是合理的。
