Title : Indicators of vegetative reactivity in early verticalization in patients with ischemic stroke
In economically developed countries of the world, cardiovascular diseases nowadays represent the general factor of mortality. From year to year, in the order of 15 million people, acute cerebrovascular accident (ONMC) is formed. In various countries of the earth, the incidence of stroke ranges from 2.6 to 7.4 cases per 1 thousand inhabitants, while mortality in the acute stage of the disease can reach 20-35%, and at the end of the 1st year from the stage of stroke onset - 47-50% [Koton SS, Schneider AL, Rosamond WD et al. 2014, Carandang R, Seshadri S, Beiser A et al. 2006]. The initial disability of a later survivor of ONMC is 3.4 cases per 10 thousand population and takes priority among many factors of disability: at best, 20% of patients are ready to resume previous labor and social functions; 30% of patients require long-term care [Gusev E.I., Skvortsova V.I., 2001., Sacco RL, Dong C., 2014]. Taking into account the treatment and further rehabilitation and rehabilitation actions of only one patient, the financial costs are noticeable and represent an average of $ 65 thousand per year. USA [Jauch EC, Saver JL, Adams HP et al., 2013]. Ischemic brain damage or brain infarction accounts for over 80% of situations only ONMC, in turn, first of all, the implementation of the assessment of the cause, prevention and therapy, in particular, of this type of stroke, provides interest throughout the planet.
The purpose of the study. To conduct a comparative analysis of the development of the position of the ANS in patients with ischemic stroke.
Materials and methods. The materials of the study are the search results conducted in the PubMed, ISI Web of Science databases. According to a thorough analysis of the data since the preparation of such studies, a conclusion has been made.
Results and their discussions. In the past, stroke began to be considered as a systemic pathological process in the human body, which suspects activity in the pathogenesis of all components of homeostasis. With the explicated heterogeneity and variability of risk circumstances, the formation of ONMC with the development of focal brain damage is created, [Apanel E.N., 2013]. In addition, Professor-neurophysiologist V.N. Kazakov in 2004 recommended the theory of neuroimmunoendocrine stress regulation. In accordance with it, the sanogenetic response of the body to the influence of an irritating factor, in particular an acute stroke, is divided into several stages continuously following each other, clearly predetermined in the period [Kazakov V.N. et al., 2004]. The autonomic nervous system (ANS) is to the greatest extent the main element, the influence of which on stress is now carried out for several seconds. The excitation of the ANS from the moment of vascular lesion is performed immediately and lasts for a long time. In the system of autonomic regulation, with the development of ischemic stroke (AI) and the formation of a lesion of brain tissue, a persistent imbalance is formed, after some time, the endocrine system, which is not immediately responsive, associated with the autonomous system, is involved in the process, the effects of which develop within a few hours, but there are delayed ones, since they are realized at the cellular-metabolic level and at the genome level. Systemic immunological changes occur at later stages of the process, and their consequences are recorded indefinitely [Kazakov V.N. et al., 2004]. Thus, with ONMC, a disorder of autonomic regulation not only occurs in response to cerebral damage, but also becomes an essential link in the pathogenesis in the further course of stroke. In particular, the ANS is the main one in the implementation of regulatory functions, ensuring and supporting all forms of activity of the organism and its adaptation. When there is a threat to the very existence of the organism, including with cerebral ischemia, the involvement of the ANS is clearly noted in the general reactions of the organism as a whole, and its adaptive significance [Son A.S., Solodovnikova Yu.A., 2010]. A significant number of materials from both domestic and foreign colleagues are devoted to the study of the state of the ANS during the acute period of AI, the possibility of its influence on the prognosis of the disease [Laowattana S, Zeger SL, Lima JA et al., 2006]. According to both foreign and domestic literature in the past years, attention to this problem has increased significantly again, [Gonchar I.A., 2011]. And first of all, this is interrelated with the fact that the ANS plays an important role in maintaining the functional parameters of the activity of different body systems within the boundaries of homeostasis, provides vegetative support for mental and physical activity, adaptation to changing conditions caused by AI [Vane A.M., 2005]. In patients with AI, damage to regulation in the work of the ANS is associated with a worse functional consequence and an increased mortality rate [De Raedt S, De Vos A, De Keyser J., 2015]. Nevertheless, at the moment, no specific therapeutic strategies and rehabilitation measures have been developed that could affect the vegetative status in cerebral ischemia, differentiated approaches to the management of stroke patients taking into account the type of vegetative response have not been determined. At the same time, there is no doubt that in the process of post-stroke neuropreservation, the load of patients should depend on the nature of the functioning of the ANS. This task requires serious analysis, including consideration of the features of the AI clinic, taking into account the nature of changes in autonomic regulation systems.
There is no doubt that the clinical demonstration of the development of the work of the ANS in AI is more than different. These transformations are both primary in nature, which is associated with the depletion of the suprasegmental part of the ANS in conditions of excessive stress of the functional system, and secondary in nature as a manifestation of a systemic response to the occurrence of a pathological focus in the brain [Son A.S., Solodovnikova Yu.A., 2010]. In the acute period of the disease, as a result of the redistribution of activity levels of vegetative regulation mechanisms, the predominance of the influence of the suprasegmental apparatus over the segmental level is observed, reflecting the centralization of regulation systems [Samokhvalova E.V. et al., 2004]. Following the literature materials, many authors observe at the same time the advantage of the sympathetic nervous system, namely, since the sympathetic nervous system allows an increase in mismatched detections, especially of the reactive cardiovascular system, and explain this factor as prognostic unfavorable. [. Laowattana S, Zeger SL, Lima JA et al., 2006; Gonchar I.A., 2011; De Raedt S, De Vos A, De Keyser J., 2015].
From the point of view of a number of authors, premature non-manifested arrhythmia is noted in 35-69% of post-stroke patients, despite the fact that most of them disappear by the end of the 1st week from the period of onset of the disease [Gonchar I.A., 2011]. The occurrence of arrhythmias in this case is due to the activation of the sympathetic department of the ANS and depression of the vagal influence. This causes a violation of the regulation of blood pressure at night in patients with AI and allows the formation of a recurrence of vascular curiosity. In addition, the advantage of the sympathetic nervous system is combined with angiospasm, arterial hypertension, hyperglycemia, reduced reaction of internal organs to catecholamines with an increase in their concentration in the blood, sleep disturbance [Gonchar I.A., 2011; De Raedt S, De Vos A, De Keyser J., 2015]. At the same time, in scientific works, a part of the works representing a favorable course of the disease under the influence of the sympathetic nervous system, no other than, needs further consideration.
If we take into account the asymmetry of the division of functions in the cerebral cortex and the topical location of the ischemic center in ONMC, manifestations of autonomic dysfunction can be diverse [Colivicchi F, Bassi A, Santini M et al., 2004; Meyer S, Strittmatter M, Fischer C et al., 2004; Colivicchi F, Bassi A, Santini M et al., 2005, Gonchar I.A., 2011]. When a brain infarction is localized in the right hemisphere, arrhythmias and a feeling of heart failure occur more often, which is explained by the provision of autonomic regulation of the heart rhythm by the right hemisphere of the brain, the occurrence of a predominance of vagal influence with a decrease in vascular tone and activation of the limbic-reticular complex [Gonchar I.A., 2011; De Raedt S, De Vos A, De Keyser J., 2015]. Weakening of autonomic control of cardiac activity is noted with ischemia of the insular zone of the brain of the right hemisphere, which leads to more frequent occurrence of cardiac arrhythmias in the form of ventricular tachycardia [Colivicchi F, Bassi A, Santini M et al., 2004; Meyer S, Strittmatter M, Fischer C et al., 2004; Colivicchi F, Bassi A, Santini M et al., 2005, Gonchar I.A., 2011]. Ischemia of the insular zone is associated with both cardiac arrhythmias and stress hyperglycemia, arterial hypertension, immunosuppression and the subsequent occurrence of infectious complications in brain infarction [De Raedt S, De Vos A, De Keyser J., 2015]. sympathetic influences with an increase in vascular tone and difficulty in venous outflow were detected with damage to the left hemisphere . Several studies have indicated that damage to the left carotid basin is associated with death from cardiac causes in cerebral infarction [Laowattana S, Zeger SL, Lima JA et al., 2006; De Raedt S, De Vos A, De Keyser J., 2015].
Conclusions. In patients with acute and the nature of changes in vegetative activity affects the course and outcome of the disease. Apparently, these changes represent one of the transformative indicators of rehabilitation potential, expressing the ability of the ANS to respond and find the direction of the reaction to a variety of rehabilitation methods, to ensure tolerance to rehabilitation loads and to predict the degree of safety of rehabilitation measures.