Petrov Ye. Ye., Burmak Yu. G., Treumova S. I., Ivanitskaya T. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Estimation of peculiarities of bronchial patency’s changes in the patients with chronic cor pulmonale (CCP) of broncho-pulmonary genesis depending on the intensity of hemodynamic disorders in conditions of comorbidity with hypertensive disease (HD) has been carried out. Indices of bronchial patency in 160 patients with chronic obstructive pulmonary disease and CCP (female-62, male-98, mean age – 55,6±2,2), among whom 96 (female-38, male-58) had its combination with HD of the II stage, 2 degree of arterial hypertension, were examined. Then the patients were subdivided depending on the presence and expressiveness of systemic hemodynamics’ disorders. There were two main groups – patients with comorbid pathology- without signs of systemic hemodynamics’ disorders (the compensation stage, group “1m”, 32 patients (33,3%) and “2m” group – with the presence of circulatory insufficiency – 64 patients (66,7%) (the decompensation stage). The comparative groups include patients with CCP of broncho-pulmonary genesis without HD (patients – 64, female-24, male-40), among whom 32 (50,0%) were without signs of systemic hemodynamics’ disorders – the compensation stage (group “1с”), 32 (50,0%) – with presence of the II stage of circulatory insufficiency – the decompensation stage (group “2с”). All the groups were of the same sex, age and duration of disease’s course. The carrying out treatment of both CCP of broncho-pulmonary genesis and HD met the requirements of the protocol. It has been established that patients both of the main groups and the comparative groups had significantly lower indices of vital capacity (VC) and significant patency’ decreasing of proximal and distal bronchi in comparison with healthy individuals. Besides, the changes were visible distinctly even in patients during the compensation stage of CCP (the group 1с). The analysis of bronchial patency’ indices in patients of the 1m and 1с groups has presented a significant decrease of almost all indices of external respiration function (ERF) in the patients with presence of comorbid HD. Noting the presence of the significantly low VC (1,14 times; р<0,001), we can’t help directing at a possible participation of the left ventricular dysfunction in the arterial hypertension in its formation. The following indices were significantly decreased in patients of the 1m group in comparison with the 1с group: forced expiratory volume per 1 second (FEV1) (1,10 times, р<0,001) and indices, reflecting patency in proximal parts of bronchi – peak expiratory flow rate (PEFR) (1,53 times, р<0,001), forced expiratory flow 25% (FEF 25), 50% (FEF50) forced vital capacity (1,14 times, р<0,001 and 1,08 times, р<0,05, accordingly). Besides indices of distal bronchial patency didn’t have significant differences. The most significant changes of ERF were diagnosed in patients with comorbid pathology in presence of circulatory insufficiency (2m group); in comparison with patients of the 2с group were noted maximal decrease of the following indices: VC (1,3 times; р<0,001), FEV1 (1,31 times, р<0,001) and indices of proximal bronchial patency – PEFR (1,32 times, р<0,001), FEF 25 (1,20 times, р<0,001). Taking into account the fact of maximal changes in structure of external respiration’s indices in comorbid patients with CCP during decompensation stage, it is impossible to doubt the contribution of the ventricular dysfunction (which leads indirectly to an increase of bronchial resistance) in their formation. At the same time the significant differences in indices of distal bronchial patency haven’t been revealed. Conclusions 1. The presence of disorders of proximal and distal bronchial patency is noted in the patients with CCP of broncopulmonary genesis; intensity of the changes has a tendency to an increase as development of CCP decompensation. 2. Patients with CCP of broncho-pulmonary genesis and comorbid HD have the most intensive changes of bronchial patency’s disorders. Besides, the maximal changes of patency mainly in proximal parts of bronchi are noted in patients with CCP during the decompensation stage.

chronic cor pulmonale, hypertensive disease, comorbidity, external respiration function

1. Mostovoy YuM. Khronichne obstruktyvne zakhvoryuvannya lehen. Klyuchovi pytannya. Ukr. med. chasopys. 2016 Serp 25;4(114):63-5. [in Ukrainian].
2. Konoplʹova LF, Rudenko YuV. Khronichne leheneve sertse. U kn.: Amosova KM. (red.). Vnutrishnya medytsyna: Kyyiv: Medytsyna. 2009;2:15878. [in Ukrainian].
3. Fabbri LM, Beghe B, Agusti A. Cardiovascular mechanisms of death in severe COPD exacerbation: time to think and act beyond guidelines. Thorax. 2011;66:745-7.
4. Pavlov P, Ivanov Y, Glogovska P, Popova T, Borisova E, Nozharov V. Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease. Eur Respir J. 2012 Sep 1;40(56):986.
5. Berezin AYe. Khronicheskaya obstruktivnaya bolezn legkikh i kardiovaskulyarnyy risk. Ukr. med. chasopys. 2009;2(70):62-9. [in Russian].
6. Caughey GE, Ramsay EN, Vitry AI, Gilbert AL, Luszcz MA, Ryan P, et al. Comorbid chronic diseases, discordant impact on mortality in older people: a 14-year longitudinal population study. J Epidemiol Community Health. 2010 Dec;64(12):1036-42.
7. Chandy D, Aronow WS, Banach M. Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease. Itepr. Blood Press. Control. 2013;6:101-9.
8. Rabe KF, Hurd S. Global Initiative for Chronic Obstructive Lung Disease: Gold executive summary. Am. J. Respir. Crit. Med. 2007;176(6):532-55.
9. Young RP, Hopkins R, Eaton TE. Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes. Eur. Respir. J. 2007 Oct;30(4):616-22.
10. Kirillov MM. Vliyaniye medikamentoznoy terapii bronkhialnoy astmy na sistemu mikrotsirkulyatsii i gemostaz. Pul’monologiya. 2002;12(2):1721. [in Russian].
11. Lizohub VH, Voloshyna OO. Zminy ekhokardiohrafichnykh parametriv u khvorykh na bronkhialnu astmu, poyednanu z arterialnoyu hipertenziyeyu. Likarska sprava. 2007;8:20-30. [in Ukrainian].
12. Khronichne obstruktyvne zakhvoryuvannya leheni. Adaptovana klinichna nastanova, zasnovana na dokazakh: Nakaz MOZ Ukrayiny vid 27 chervnya 2013 № 555 [Internet]. Dostupno: http://mtd.dec.gov.ua/images/dodatki/2013_555_HOZL/2013_555_hozl_kn.pdf [in Ukrainian].
13. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report. COLD Executive Summary. Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-82.
14. Gavrisyuk VK. Khronicheskoye legochnoye serdtse: mekhanizmy patogeneza i printsipy terapii. Ukrainskiy pulmonologicheskiy zhurnal. 2007;1:9-10. [in Russian].
15. Nastanova ta klinichnyy protokol nadannya medychnoyi dopomohy «Arterialna hipertenziya». K.; 2012. 107 s. [in Ukrainian].
16. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur. Heart J. 2013;34:2159-219.
17. Gavrisyuk VK, Yachnik AI. Voprosy prakticheskogo primeneniya klassifikatsii nedostatochnosti krovoobrashcheniya pri zabolevanii legkikh. Ukrayinsʹkyy kardiolohichnyy zhurnal. 2005;1:9-13. [in Russian].
18. Treumova CI. Ekhokardiohrafichni pokaznyky systolichnoyi i diastolichnoyi funktsiyi livoho shlunochka u khvorykh na khronichne leheneve sertse v stadiyi dekompensatsiyi. Liky. 2006;5-6:96-9. [in Ukrainian].
19. Kirillov AM. Patsiyenty s sochetaniyem ishemicheskoy bolezni serdtsa i khronicheskoy obstruktivnoy bolezni legkikh: klinicheskiye proyavleniya i kharakternyye osobennosti pokazateley funktsional’nykh metodov issledovaniya. Sovremennyye problemy nauki i obrazovaniya. 2015;1. Dostupno: http://www.science-education.ru/ru/article/view?id=21183 [in Russian].
20. Treumova SI. Systolichna i diastolichna funktsiya miokarda pravoho shlunochka v stadiyi dekompensatsiyi. Problemy ekolohiyi ta medytsyny. 2006;1-2:35-6. [in Ukrainian].
21. Pustovalova IA. Kharakter izmeneniy ventilyatsionnoy funktsii legkikh pri sochetanii khronicheskoy obstruktivnoy bolezni legkikh i arterialnoy gipertenzii. Vestnik Yuzhno-Ural’skogo gosudarstvennogo universiteta. Seriya «Obrazovaniye, zdravookhraneniye, fizicheskaya kultura». 2014;14(3):76-7. [in Russian].

«Bulletin of problems biology and medicine» Issue 1 Part 1 (148), 2019 year, 148-152 pages, index UDK 616.233+616.24-005:616.12-008.331.1

10.29254/2077-4214-2019-1-1-148-148-152