A comprehensive examination and a course of interval hypoxic training were carried out in patients with postmastectomy syndrome in combination with standard therapy and healthy volunteers. The effectiveness and mechanisms of action of IHT in the rehabilitation of patients with postectomy syndrome were analyzed. It has been proven that when combined with IHT and standard therapy, cancer patients experience a reduction in pain, an improvement in the condition of the external respiratory organs, oxygen supply to the body, the coefficient of oxygen utilization by tissues and, as a result, a better supply of tissues and cells with oxygen than when using only standard therapy.
Key words: hypoxic therapy, postmastectomy syndrome, breast cancer, functional respiratory system.
Postmastectomy syndrome is the most common consequence of radical treatment for breast cancer. Accompanied by such manifestations as swelling of the soft tissues on the side of the operation, limitation of the amplitude of active and passive movements of the limb in the shoulder joint, decreased muscle strength, impaired sensitivity, autonomic-trophic disorders of the upper limb, severe pain, impaired psychophysiological status, etc.
Studying the influence of mountain climate on the course of the pathological process is of interest to researchers of various profiles, since in the mountains many diseases have certain developmental features. Important information is that the incidence of malignant tumors decreases as the altitude above sea level increases. (M.K.Kairakbaev 1983 and others)
Rehabilitation of patients with breast cancer in conditions of high-altitude hypoxia had a positive corrective effect on the state of the cardiovascular system and blood system (the number of reticulocytes, erythrocytes increases, the hemoglobin content increases), and the regulation of carbohydrate metabolism improves. (O.P. Kulish, 1989). The hemostimulating effect of high-altitude hypoxia has been proven (M.M. Mirrakhimov, 1970, A.A. Almekerova, 1983).
The basis in the mechanism of action of hypoxic gas mixtures is the enhancement of oxygen transport to tissues, as well as the training of enzymatic processes of biological oxidation and the reproduction of high-energy compounds. Carrying out hypoxic therapy increases the adaptive potential of the body and the effectiveness of treatment. The use of hypoxic therapy in cancer patients is based on leveling oxygenation of normal and tumor tissues.
Disturbances in oxygen metabolism in various organs and tissues of the tumor-bearing organism as the tumor grows malignantly have been noted by a number of authors. (Kavetsky R.E., 2001).
In the literature, unfortunately, there is little information about the peculiarities of the state of the functional respiratory system in postmastectomy syndrome – the most important system of the body, the main task of which is the timely and sufficient supply of the body and all its tissues with oxygen. A functional respiratory system, including the organs of external respiration, blood circulation, respiratory function of the blood, tissue mechanisms that utilize oxygen in the tissues. This system is responsible for providing the most essential element for life and normal tissue function – oxygen (Kolchinskaya A.3. et al., 2003).
After radical treatment of breast cancer, restorative treatment of patients is a complex task. Currently, many methods have been proposed for the treatment of this severe pathology. However, there is clearly not enough correct scientific research into this problem. In addition, the question of the possibility of using hypoxic therapy in this category of patients is not clear, although the significant biological and therapeutic and prophylactic potential of this technology is beyond doubt.
PURPOSE of this report: to present an analysis of the effectiveness and mechanisms of action of IHT in the rehabilitation of patients with postectomy syndrome in comparison with standard therapy.
OBJECT AND METHODS OF RESEARCH: 88 patients with postmastectomy syndrome aged 32–70 years were observed.
In patients with postmastectomy syndrome and healthy volunteers, indicators of the body’s oxygen regimes were determined – minute volume of respiration (minute volume of exhaled air), respiratory rate, tidal volume. The gas composition of inhaled and exhaled alveolar air was determined using a gas analyzer. In addition, heart rate and arterial blood oxygen saturation were determined. The supply of oxygen to the body was characterized – the oxygen regimes of the body: the rate of gradual oxygen delivery and its consumption was determined. Laboratory studies included determination of a general blood test in patients.
A session of interval hypoxic training included short-term inhalation (5 minutes) of a hypoxic mixture with 11-16% oxygen, repeated 4-6 times in one session at normal atmospheric pressure and inhalation of air (5 minutes) with 20.9% O2 (normoxic intervals between hypoxic exposures).
Statistical analysis was carried out using parametric and non-parametric statistics methods and included descriptive statistics, Student’s t test for related samples, Spearman correlation analysis, Pearson test (χ2) for comparing the nature of frequency distributions of certain facts, calculation of correlation ratios, variance and discriminant analyzes.
RESULTS: analysis of the mechanisms of action of normobaric interval hypoxic training in combination with standard therapy showed that it is the same. as in the mountains, the state of all links of the functional respiratory system changes: external respiration and blood circulation increase, they become more economical. The respiratory function of the blood increases, because The hemoglobin content in the blood increases, its oxygen capacity increases, improving the oxygen supply to the body and the general condition of the body.
The MRR in patients with postmastectomy syndrome was 4753.33±487.79 ml/min, RR was 287.53±41.52 ml, 16.53±1.62 respiratory movements per minute were recorded. The oxygen content in the exhaled air was 15.80%±0.88, and the oxygen content in the alveolar air was slightly lower than 15.79%±2.23. These data differed somewhat from the indicators of external respiration of healthy people (Table 1).
Table 1
External respiration parameters of examined patients with postmastectomy syndrome and healthy people
Note: * – p less than 0.05, ** p – less than 0.01
Indicators of external respiration in patients with postmastectomy syndrome are significantly worse than in healthy individuals.
To characterize the respiratory function of the blood, the number of red blood cells, the amount of hemoglobin in the blood, the saturation of arterial blood with oxygen and its content in arterial and venous mixed blood, and the oxygen capacity of the blood were taken into account (Table 2).
Table 2
Indicators of respiratory function of the blood of examined patients with postmastectomy syndrome before treatment and healthy people
Note: * – p less than 0.05, ** p – less than 0.01
It has been established that the use of only a standard treatment complex (drug therapy according to indications and massage) does not have a very pronounced positive effect on the various functional systems of the patient’s body. Pain syndrome decreased by 45%, quality of life according to various indicators increased by 5-8%, however, all these changes were noted only immediately after the end of rehabilitation treatment. The volume of various parts of the upper limb on the side of the operation decreased by an average of 2-3%, stiffness in its joints decreased, hand strength increased by 8.2 ± 0.39 kg, the speed of impulse transmission along the ulnar nerve increased by 1.3 times, the rheological properties of the blood practically did not change, while the parameters of hemostasis slightly improved.
The use of hypoxic training, which is known to have a nonspecific stimulating effect on the body’s reserve capabilities, made it possible to identify some features of this treatment procedure. Firstly, various parameters characterizing the degree of edema and stiffness of the joints of the upper limb on the side of surgery, the linear velocity of blood flow in the main arteries of the upper limb and the speed of impulse conduction along the ulnar nerve in patients with postmastectomy syndrome practically did not differ from the corresponding values of patients in the control group (standard therapy).
Secondly, the strength of the hand of the upper limb on the side of the operation increased very noticeably – by 17.2 ± 0.39 kg, the pain syndrome decreased by 78% and these positive changes gradually decreased, but remained reliable, and were recorded during all periods of observation (up to 12 months after the end of treatment). The quality of life of patients with postmastectomy syndrome also significantly and statistically significantly improved, while for a number of indicators these changes persisted throughout the year of observation.
Thus, our studies of the oxygen regimes of the body in patients with postmastectomy syndrome prove that the use of interval hypoxic training in patients with postmastectomy syndrome causes an improvement in all parts of the functional respiratory system. Thus, the rate of gradual delivery of oxygen to the lungs increases from 1142.27±145.58 ml/min to 1422.87±114.8058 ml/min (p less than 0.05). The intensity of oxygen supply to the lungs, alveoli, and mixed venous blood has increased significantly, which indicates an increase in the rate of oxygen supply to the tissues, i.e. There is an improvement in the arteriovenous difference in oxygen and the coefficient of oxygen utilization by tissues, which occurs in the mechanisms of oxygen metabolism disorders as the tumor grows malignantly.
CONCLUSIONS: the work carried out allows us to conclude that when combining IHT and standard therapy in cancer patients, there is a decrease in pain, an improvement in the condition of the external respiratory organs, oxygen supply to the body, the coefficient of oxygen utilization by tissues and, as a result, a better supply of tissues and cells with oxygen than when using only standard therapy.
Intermittent Hypoxia training in rehabilitation treatment for patients with postmastaktomicheskim syndrome.
A.V. Bratik A., T.N. Tsyganova.
Summary
The complex examination was done and the hypoxic interval training course was applied in combination with standard therapy on the patients with postmastectomy syndrome and on the healthy volunteers. The analysis of effectiveness and mechanisms of Hypoxic Interval training was done at rehabilitation of patients with postectomy syndrome. Was confirmed that the combination of Interval Hypoxic Training and standard therapy method for treating oncological patients allows reducing pain syndrome, improving conditions of external respiration apparatus, oxygen supply of organism, coefficient of tissues’ consumption of oxygen and as a result – better supply of tissues and cells with oxygen then at applying only standard treatment methods.
Keywords: hypoxytherapy, cancer, mammary gland cancer, functional respiratory system
References
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