PASSIVE VERTICALIZATION IN PATIENTS WITH SYMPTOMATIC PRECEREBRAL STENOSЕS IN ACUTE STROKE

stenoses of precerebral arteries, to determine predictors of the complications of verticalization in order to perform a more differentiated approach to the implementation of the protocol to ensure the safety of the process.

 Design and methods. The study included 50 patients with hemispheric ischemic stroke. Group 1 (n = 30) included patients without hemodynamically signiicant stenoses of the brachiocephalic arteries (BCA), group 2 (n = 20) included patients with hemodynamically signiicant stenoses of the BCA. Verticalization was carried out on a tilt-table «Vario-Line» («Beka») on the 1, 2, 3, 4, 5 and 14 day from the onset of the disease.

 Results. In group 2 an earlier decline in the rate of cerebral blood low (CBF), as well as the re-reduction rate of the CBF during the session of verticalization were detected. During the interruption between the sessions, indicators of autoregulation recovered more slowly in patients from group 2. Moreover, the cerebral autoregulation indicators were decreased during the course of verticalization, by 14 day only a quarter of these patients had a ratio of 10 % overshoot.

Conclusions. Patients with hemodynamically signiicant stenoses of symptomatic BCA need to use a special regimen of verticalization that would appear «gentle» in order to prevent the complications of verticalization. Assessment of cerebral blood low autoregulation by the overshoot factor can help to identify patients with the increased risk of complications.

1. Скворцова В.И., Шамалов Н.А., Бодыхов М.К. Лечение ишемического инсульта // Трудный пациент. — 2007. — Т. 7. — С. 11–14. / Skvortsova V.I., Shamalov N.A., Bodykhov M.K. Treatment of ischemic stroke // Difficult Patient [Trudnyiy Patsient]. — 2007. — Vol. 7. — P. 11–14 [Russian].

2. Moris A.D., Grosset D.G., Squire I.B., Lees K.R., Bone I., Reid J.L. The experience of an acute stroke unit: implications for multicentre acute stroke trials // J. Neurol. Neurosurg. Psych. — 1993. — Vol. 56, № 4. — P. 352–355.

3. Diserens K., Michel P., Bogousslavsky J. Early mobilisation after stroke: review of the literature // J. Cerebrovasc. Dis. — 2006. — Vol. 22, № 2–3. — P. 183–190.

4. Guidelines for Management of Ischaemic Stroke and Transient Ischaemic Attack. The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee 2008 // Cerebrovasc. Dis. — 2008. — Vol. 25, № 5. — Р. 457–507.

5. Langhorne P., Stott D.J., Robertson L. et al. Medical complications after stroke: a multicenter study // J. Stroke. — 2000. — Vol. 31, № 6. — P. 1223–1229.

6. Silvestrini M., Cupini L.M., Placidi F., Diomedi M., Bernardi G. Bilateral hemispheric activation in the early recovery of motor function after stroke // Stroke. — 1998. — Vol. 29, № 7. — Р. 1305–1310.

7. Кадыков А.С., Черникова Л.А., Шахпаронова Н.В. Реабилитация неврологических больных. — М.: МЕД Прессинформ, 2009. — С. 54–56. / Kadykov A.S., Chernikova L.A., Shahparonova N.V. Rehabilitation of neurological patients. — Moscow: MED Pressinform, 2009. — P. 54–56 [Russian].

8. Иванова Г.Е. Комплексная дифференцированная физическая реабилитация больных с мозговым инсультом: Дисс. … д-ра мед. наук. — Москва, 2003. — 409 c. / Ivanov G.E. Integrated differentiated physical rehabilitation of patients with cerebral stroke: the Thesis for the degree of Doctor of Medicine. — Moscow,2003. — 409 p. [Russian].

9. Bernhardt J., Dewey H., Thrift A., Collier J., Donnan G. A very early rehabilitation trial for stroke (AVERT) phase 2 safety and feasibility // Stroke. — 2008. — Vol. 39, № 2. — P. 390–396.

10. Canadian best practice recommendations for stroke care: summary // Can. Med. Assoc. J. — 2008. — Vol. 179, № 2, 17. — P. 1–25.

11. Sundseth A., Thommessen B., Ronning O.M. Outcome after mobilization within 24 hours of acute stroke. A randomized controlled trial // J. Stroke. — 2012. — Vol. 43, № 9. — P. 2389–2394.

12. Schwarz S., Georgiadis D., Aschoff A., Schwab S. Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke // Stroke. — 2002. — Vol. 33, № 2. — P. 497–501.

13. Wojner-Alexandrov A., Garami Z., Сhernyshev O., lexandrov A. Heads down: lat positioning improves blood low velocity in acute ischemic stroke // Neurology. — 2005. — Vol. 64, № 8. — P. 1354–1367.

14. Исаева Т.В., Лядов К.В., Шаповаленко Т.В., Сидякина И.В., Макарова М.Р. Особенности реабилитации пациентов с кардиоэмболическим инсультом на фоне хронической сердечной недостаточности // Физиотерапия, бальнеология и реабилитация. — 2011. — № 6. — С. 10–15. / Isayeva T.V., Lyadov K.V., Shapovalenko T.V., Sidyakina I.V., Makarova M.R. Features of rehabilitation of patients with cardioembolic stroke with chronic heart failure // Physiotherapy, Balneology and Rehabilitation [Fizioterapiya, Balneologiya i Reabilitatsiya]. — 2011. — № 6. — P. 10–15 [Russian].

15. Циммерман М., Ениг В., Вутке В. и др. Физиология человека. В 3 томах. — Т. 2. — Пер. с англ. / Под ред. Шмидта Р. и Тевса Т. — 3-е изд. — М.: Мир, 2005. — 314 с. / Zimmerman M., Jenig V., Vutke W. et al. Human Physiology. — Vol. 2. / Ed. by Schmidt R. and Tews T. — Moscow: Mir, 2005. — 314 p. [Russian].

16. Гудкова В.В., Стаховская Л.В., Кирильченко Т.Д. и др. Ранняя реабилитация после перенесенного инсульта // Consilium medicum. — 2005. — T. 7. — С. 8–12. / Gudkov V.V., Stakhovskaya L.V., Kirilchenko T.D. et al. Early rehabilitation after stroke // Consilium medicum. — 2005. — Vol. 7. — P. 8–12 [Russian].

17. Малярова Е.Ю., Лелюк В.Г., Скворцова В.И. Изменения церебрального кровотока в процессе пассивной вертикализации больных в остром периоде инсульта: пилотное исследование. Нарушения мозгового кровообращения: диагностика, профилактика, лечение // Материалы НПК Реал Тайм. — 2010. — С. 97–98. / Malyarova E.J., Lelyuk V.G., Skvortsova V.I. Changes in cerebral blood low during passive tilting of patients with acute stroke: a pilot study. Cerebrovascular accident: diagnosis, prevention, treatment // Materials Real Time SPC. — 2010. — P. 97–98 [Russian].

18. Лукьянов А.Л., Шамалов Н.А., Иванова Г.Е., Скворцова В.И. Вертикализация больных в остром периоде церебрального инсульта // Журн. неврологии и психиатрии. — 2010. — Т. 4, № 2. — С. 29–35. / Lukianov A.L., Shamalov N.A., Ivanova G.E., Skvortsova V.I. Passive tilting in patients in the acute period of cerebral stroke // J. Neurol. Psychiatry. — 2010. — Vol. 4, № 2. — P. 29–35 [Russian].