- О проекте
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- Партнерские программы
- Международные услуги
Тимченко Наталья Федоровна,
Львовский Национальный медицинский университет им. Д. Галицкого, Украина
Участник первенства: Национальное первенство по научной аналитике - "Украина";
Открытое Европейско-Азиатское первенство по научной аналитике;
В 81,28±4,66% боль в Человека с локализацией в области грудины слева (81,88 ± 2,41%) и давящим характером (63,82 ± 4,58%) целесообразно расценивать, как самую первую жалобу пациента и симптом для врача, а также как информационное сообщение организма о начале развития ОИМ (I.21), на что пациент должен отреагировать немедленным обращением за медицинской помощью, а врач ответить своевременными и качественными лечебно-диагностическими мероприятиями.
Ключевые слова: Острый инфаркт миокарда, пациент, боль, эпидемиологическая характеристика.
In 81,28±4,66% pain is localized in the left area of the sternum (81,88±2,41%) and it has pressing nature (63,82±4,58%), it is advisable to regard as the first complaint of patients and the symptom for doctor and as informational message of the organism about the beginning of the development of acute myocardial infarction (I.21), the patient must immediately react on this and appeal for medical aid and doctor must response timely and high quality treatment and diagnostic measures.
Keywords: Acute myocardial infarction, patient, pain, epidemiological characteristic.
Introduction. Since time immemorial, pain in the organism of Human is analyzed as severe and fatal companion of Human, though the axiom of this is the statement of the ancient Greeks that “pain - is a health watchdog“. Indeed, despite the fact that the pain almost always is painful and inhibits Human, reduces working capacity, deprives sleep,pain is necessary and to certain limits is useful .
In the context of mentioned above it is appropriate to emphasize that Human may not always understand when the pain is faithful and vigilant guard of his/her body, because pain teaches Human to be circumspect, forces to protect own body, warns about danger and notifies about disease . The pain of Human is unchangeable friend and tested helper of doctor, because in many cases actually pain allows doctor to assess the degree and nature of the violation of organism integrity .
Nowadays, the undeniable scientific fact that occurrence of acute myocardial infarction (AMI) (І.21) (the extreme degree already existing in Human is chemic heart disease), begins in most cases with the feeling of retrosternal pain – the most important of feeling in the organism and special significance of signal that nature invented during evolution to timely and properly inform the organism of Human about the threat of danger  and actually to encourage Human in such condition to timely ask doctor for help.
Actuality of presence of pain during AMI (І.21) is explained by the fact that in Ukraine each year 50 thousand cases of myocardial infarction are registered. At the same time the mortality statistics of this disease remains constantly high –30% of patients die from AMI (І.21), while in Western countries - 5%.
All of this in general confirm the importance of this research concerning minimization of pain as the main precursor in the occurrence of AMI (І21) in human in the context of prolongation of duration and quality of biological life at the modern stage of Human development.
Aim of research –the medical and social aspects of human pain in case of occurrence of acute myocardial infarction (І.21) as the basis of duration and quality of biological life at the modern stage of human development.
Materials and methods of research.The scientific work done on theselective statistical aggregate amongn=374 patients with AMI(І21), from the total number of (n=3075) treated in inpatient cardiological departments of Lviv region in 2013, with statistical needn=353, where the reliability coefficient was t>2, that>95% (p<0,05), according to program “The medical and social significance of pain and the main risk factors in the occurrence of acute myocardial infarction” that we processed.
In the process of scientific work we used historical, questionnaire, copying of necessary data from the Medical card of inpatient (acc.f. № 003/о), statistical, mathematical, abstract, graphic and also methods of deductive awareness, structural and logical analysis including systemic principles. The obtained questionnaires data of epidemiological researches summarized and processed by an automated process on the personal computer using the programs „Microsoft Office Excel 2003”.
Results and their discussion. The analysis of obtained results show that 81,28±4,66% (n=304) of patients confirmed that the beginning in the development and diagnosed by doctors AMI (І.21) was pain, while other feelings, such as: 7,49±1,42% (n=28) of respondents noted before fainting state; the feeling of lack of air recorded 5,88±1,25% (n=22) of questioned; the rhythm disorders of cardiovascular cuts - noted 3,21±0,93% (n=12) of surveyed, and discomfort in the stomach area felt 2,14±0,76% (n=8) of interviewed (p<0,05), that confirm data of drawing 1.
Dr. 1. The anamnestic information of patients (%) that signals Human about beginning of Acute Myocardial Infarction(I.21) (n=374, whenр<0,05 )
Including the dominance of pain that has patient with AMI(І.21) as the starting symptom that notifies the possible problems in the heart, theresearch defines its localization that actually approves drawing 2, where there trosternal pain in the left side was typical for 46,01±3,89% (n=140) of patients, while pain in heart area noted 16,45±2,32% of respondents (n=50), in the left half of chest the pain noticed 14,48±2,18% of questioned(n=44) and only 4,94±1,27% interviewed (n=15) said about the pain inside of the chest (p<0,05).18,12±2,44% (n=55) of patients with AMI (І21) complained on radiating pain.
Dr. 2. The localization of pain (%) at the beginning of AMI (І21) among surveyed patients(n=304, whenр<0,05)
It is proved that according to the type of pain at AMI (І.21) (drawing 3) 63,82±4,58% (n =194) of patients had the pressing ache,where as the clutching ache recorded in 14,8±2,2% of patients (n=45); the bursting ache - 8,22±1,64% of questioned (n=25); the dull ache - in6,58±1,47% of respondents (n=20); the burning ache - 3,62±1,09% of surveyed(n=11); the acute/knife-like ache - 2,96±0,98% of patients (n=9) (р<0,05).
Dr. 3. Еру сharacteristics of thepaintype(%), which disturbed patients at the beginning of AMI (І.21) (n=304, whenр<0,05)
The characterological feature of AMI pain (І.21) is it spreading beyond the area of the direct affected heart that received the name in medicine irradiation (from Latinirradio–to highlight with rays). It is substantiated that among patients with the inherent radiating pain (n=55)(see data оf drawing 4),in34,55±7,93% of cases (p<0,05) patients with AMI (І.21) referred to the irradiation of pain in left arm while 23,63±6,54% of patients noted radiating pain in left shoulder. On the spread of pain in the left shoulder blade complained 21,82±6,29% of questioned; in the left half of the neck - 7,27%±3,63% of patients with AMI (І21), while the echo of pain in the left elbow noted 5,45%±3,14% of interviewed, in the epigastric area-5,45%±3,14% respondents, 1,82±1,82% of persons from the total number of researched said about the irradiation of pain in the lower jaw.
Nowadays, the undeniable scientific fact isthatsignificant orientation of biological organisms is based on so called “biological clocks”, withtheirhelpare set and operate in these organisms daily, seasonal or annual rhythms of various physiological processes [7, 8, 9, 10].
Considering the peculiarities of the Human biological clock, includingthecircadian motivation [11, 12, 13]weattempted to characterize the process of fluctuation of activity of AMI pain (І21), synchronized with 24-hour daily cycle.
Dr. 4. The epidemiological description of the irradiationof pain (%), which disturbed patients at the beginning of AMI (І21) (n=55, whenр<0,05)
In connection with this, the obtained results convincingly prove the existing of “hourly characteristic”in the occurrence of pain among patients due to AMI (І.21) (n=304 ), where 40,13±3,63% of surveyed respondents noted cardiological pain during the daytime (1200p.m.-1759p. m.), whereas the emergence of pain in the morning period (from600a.m. till1159a.m.) noted 27,96±3,03% of questioned. It should be mentioned that 16,78±2,35% of interviewed noticed the emergence of pain in the evening period (from600p.m. till1159p.m.),15,13±2,23% of researched personsnoticed the episodes of pain in their own organism at night during the period from 1200a.m.till559a.m.(see data of drawing5).
Dr. 5. The characteristics of the beginningof pain (%), which disturbed patients with AMI (І.21) synchronized with 24-hour daily cycle(n=304, when р<0,05)
The analysis of development of pains that eventually caused AMI(І.21) among patients, in week division confirmed probability of their occurrence in 14,29±2,17% of cases per day and it was connected with the preference on Monday (16,45±2,33%);on Friday (16,12±2,3%);on Tuesday (15,43±2,23%) and on Wednesday (14,80±2,21%),with less number of occurrence of pain episodes on Thursday (13,16±2,08%), on Saturday (13,16±2,08%) and on Sunday(11,18±1,92%), that, in fact, demonstrate the data of drawing6.
Dr. 6. The indexes of the occurrence of pain (%) among patients at the beginning of AMI (І.21) in weekdivision(n=304, when р<0,05)
According to the results of research was conducted the chronobiological distribution of [14,15] the occurrence of pain among the population that preceded the development of AMI(І.21) during one year of observation.
This proved that the highest indicator of pain among patients with AMI (І.21) (see data of drawing7)was in the winter season, where the emergence of pain recorded 31,25±3,20% of questioned from the total number of researched persons (n=304) (December–9,54±1,77%); January–11,51±1,94%; February–10,2±1,83%), while in spring the pain noted 25,33±2,89% of patients(March-9,21±1,74%; April–8,55±1,68%;May–7,57±1,58%).23,03±2,75% of patients with AMI (І.21) noticedthe emergence of pain in autumn (in September 7,89±1,61%; in October - 6,91±1,51% and in November–8,22±1,64%), in summer the pain noted 20,39±2,59% ofsurveyed, namely: in June - 7,57±1,58%; in July – 5,92±1,39%;in August - 6,91±1,51%, that, in fact, shows the seasonal cyclicity ofthe development of AMI (І.21) depending on the annual rhythms of functioning of hemostasis system  in the Humanorganism.
Dr. 7. The statistical characteristics of seasonal cyclicity of pain among patientsat the beginning of AMI (І.21) (n=304, when р<0,05)
It was also researched the question of fixation by the respondents the beginning of the occurrence ofthefirst in life pain of cardial type, that in each particular case for each questioned led to stationary bed by reason of AMI(І21).The results of this confirm that (drawing8)73,68±4,92% of interviewed from the number of patients with AMI(І.21) (n=304, withр<0,05) admitted that the first cardiological pain they felt one year ago;5,59±1,36% - two years ago; 2,63±0,97% - three years ago; 1,32±0,66% - four years ago; 4,93±1,27% - five years ago, while 6,58±1,47% - ten years ago; 1,98±0,81 - fifteen years ago; 2,3±0,87% - twenty years ago, 0,99±0,57%of researched said that pain in the heart area periodically disturbed them more than twenty years.
Dr. 8.The indication of continuance of cardial type pain (%) among patients that led to stationary bed by reason of AMI (I.21) (n=304, when<0,05)
Conclusion.The obtained results convincingly confirm that among81,28±4,66% of patients the initial symptom in the development of AMI (І.21) is pain with localization in the area of leftsternal(81,88±2,41%) of the pressing character (63,82±4,58%) with own “hours of risk”, that occur in day (40,13±3,63% ), and in the morning (27,96±3,03%)periods of time, where in the week division dominate Monday (16,45±2,33%), Tuesday (15,43±2,23%) and Friday(16,12±2,3%) with the maximum in the winter period of the year (31,25±3,20%).
The doctors should regard such epidemiological characteristic of cardiological pain as the important complaint and symptomat the beginning of development of AMI (І21), while the population of Ukraine in general is not psychologically cautious with the appearance of cardiological pain at occurrence of cardiological pain to timely appeal to the doctor that confirm the low level of sanitary and educational work as preventive technology at the primary level of medical providing in the active health care system in the context of prolongation of duration and quality of biological life at the modern stage of Human development.
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