nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical Universitynefr-6Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSПилотное исследование накожной билатеральной электромиостимуляции нижних конечностей во время гемодиализаA pilot study of intradialytic epicutaneous bilateral electromyostimulation of lower extremitiesВишневскийК. А.VishnevskiiK. A.mercucio_fh@mail.ruРумянцевА. Ш.RumyantsevA. Sh.noemail@neicon.ruКоростелеваН. Ю.KorostelevaN. Yu.noemail@neicon.ruЗемченковА. Ю.ZemchenkovA. Yu.noemail@neicon.ruСмирновА. В.SmirnovA. V.noemail@neicon.ruПервый Санкт-Петербургский государственный медицинский университет им. акад. И.П. ПавловаRussian FederationГородская Мариинская больница, Городской нефрологический центрRussian Federation2014010120141815361Copyright © Вишневский К.А., Румянцев А.Ш., Коростелева Н.Ю., Земченков А.Ю., Смирнов А.В., 20142014Вишневский К.А., Румянцев А.Ш., Коростелева Н.Ю., Земченков А.Ю., Смирнов А.В.Vishnevskii K.A., Rumyantsev A.S., Korosteleva N.Y., Zemchenkov A.Y., Smirnov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/6

ЦЕЛЬ ИССЛЕДОВАНИЯ: оценка эффективности метода накожной билатеральной электромиостимуляции (НБЭМ) нижних конечностей при реабилитации больных, получающих программный гемодиализ. ПАЦИЕНТЫ И МЕТОДЫ. В исследование было включено 24 больных с ХБП Vд стадии. Пациентов распределили на 2 группы: группу НБЭМ (12 человек) и группу контроля (12 человек), сопоставимых по полу, возрасту, длительности заместительной почечной терапии и индексу коморбидности Чарлсона. В группе НБЭМ в течение 1 мес в дополнение к стандартной заместительной и симптоматической терапии проводились процедуры миостимуляции 3 раза в неделю по 30 мин в течение первых 3 ч сеанса гемодиализа. В обеих группах до и после исследования выполняли традиционный спектр клинических и биохимических анализов крови, проводили тест с 6-минутной ходьбой с датчиком сатурации кислорода, сбор данных по опроснику полинейропатии Total Symptom Score (TSS). В течение периода исследования в обеих группах проводился мониторинг нежелательных явлений. РЕЗУЛЬТАТЫ. В группе НБЭМ по сравнению с контролем наблюдалось статистически значимое снижение показателей додиализного уровня азотемии: в группе НБЭМ в сыворотке крови концентрация креатинина снизилась с 0,85±0,21 до 0,80±0,17 ммоль/л (р<0,05), мочевины c 23,5±5,1 до 20,4±3,9 ммоль/л (р<0,05). Другие лабораторные показатели значимо не менялись. Только в группе НБЭМ наблюдалось снижение выраженности болевого синдрома шкалы TSS с 1,8±1,0 до 1,11±0,7 баллов (р<0,05) и результирующего параметра TSS с 3,66±2,3 до 2,22±1,2 баллов (р<0,05). В отличие от контрольной группы, в группе вмешательства показатель пройденного за 6 мин расстояния увеличился c 431±113 до 455±99 м (р<0,05), отмечалось значимое снижение выраженности одышки (с 3,7±1,1 до 2,9±1,4 баллов, р<0,05) и усталости (с 4,3±2,0 до 2,5±1,6 баллов, р<0,05) после теста 6-минутной ходьбой. Значимых нежелательных явлений во время исследования не наблюдалось. ЗАКЛЮЧЕНИЕ. Процедура НБЭМ во время гемодиализа является безопасным вмешательством, позволяющим увеличить эффективность проводимой процедуры в виде снижения базального уровня креатинина и мочевины, снизить выраженность симптомов полинейропатии, а также улучшить показатели физической адаптации пациентов на гемодиализе.

AIM OF RESEARCH: to evaluate the effectiveness of the bilateral epicutaneous electromyostimulation (BEEM) of lower extremities in the rehabilitation of hemodialysis patients. PATIENTS AND METHODS. The study included 24 patients with CKD Vd. Patients were divided on 2 groups: the BEEM group (N=12) and control group (N=12), comparable by sex, age, duration of renal replacement therapy and Charlson comorbidity index. The BEEM group underwent the procedures of muscle stimulation of the lower extremities during hemodialysis sessions for 4 weeks, 3 times per week and 3 BEEM treatments each session for 30 minutes each procedure, while the CG remained on previous dialysis regimen. In both groups before and after the investigations were carried out blood tests, a 6-minute walk test (6MWT) with oxygen saturation sensor and data collection by Total Symptom Score (TSS) polyneuropathy questionnaire. During the study the adverse events was monitored in both groups. RESULTS. Significant decreasing in serum levels of creatinine (from 0,85±0,21 to 0,80±0,17 mmol/l, p < 0.05) and urea (from 23,5±5,1 to 20,4±3,9, p < 0.05) was observed in the BEEM group compared with the control group. Other laboratory parameters were not significantly changed. There was noted a certain decreasing in the TSS pain scale from 1,8±1,0 to 1,11±0,7 points (p < 0.05) and in the resulting TSS from 3,66±2,3 to 2,22±1,2 points (p < 0.05) in BEEM group compared with the control. Unlike the control group, the distance walked in the 6MWT in the BEEM group increased from 431±113 to 455±99 m (p < 0.05) and there was significant reduction of the dyspnea (from 3,7±1,1 to 2,9±1,4 points, p < 0.05) and fatigue (from 4,3±2,0 to 2,5±1.6 points, p < 0.05) after the 6-minute walk test. Significant adverse events during the study were not observed. CONCLUSION: The BEEM procedure during hemodialysis is a safe intervention, what can enhance the efficiency of the procedures in form of lowering baseline creatinine and urea, reduce symptoms of polyneuropathy, and increase the physical adaptation of the hemodialysis patients.

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The authors declare that there are no conflicts of interest present.