medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2017-17-6-10medsovet-2141Research ArticleЦЕРЕБРОВАСКУЛЯРНЫЕ ЗАБОЛЕВАНИЯCEREBROVASCULAR DISEASESВЕДЕНИЕ ПАЦИЕНТОВ, ПЕРЕНЕСШИХ ИШЕМИЧЕСКИЙ ИНСУЛЬТ, С ДВИГАТЕЛЬНЫМИ НАРУШЕНИЯМИMANAGEMENT OF PATIENTS AFTER ISCHEMIC STROKE WITH MOTOR DISTURBANCESПарфеновВ. А.ParfenovV. A.

Доктор медицинских наук,  профессор

MD, Prof.

Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation201709112017017610Copyright © Парфенов В.А., 20172017Парфенов В.А.Parfenov V.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/2141

Ведение пациентов, перенесших ишемический инсульт (ИИ), основывается на профилактике повторного ИИ и других сердечно-сосудистых заболеваний. Необходимо использование лекарственных средств (антитромбоцитарные средства или антикоагулянты, статины, антигипертензивные средства), нелекарственных методов (отказ от курения, злоупотребления алкоголем, рациональное питание, увеличение физической активности), небольшой части пациентов показано хирургическое лечение (каротидная эндартерэктомия). При двигательных нарушениях ведущее  значение имеет лечебная гимнастика, которая направлена на тренировку движений в паретичных конечностях и предотвращение контрактур. В настоящее время не доказана эффективность применения лекарственных средств для улучшения восстановления  двигательных  функций. Обсуждаются возможности Церебролизина и результаты недавно опубликованного исследования ECOMPASS, в котором у 70 пациентов изучалась эффективность Церебролизина (30 мл внутривенно в течение 7–28-го  дней ИИ) в сравнении с плацебо. Отмечены улучшение восстановления двигательных функций в подгруппе пациентов с выраженными двигательными нарушениями, а также улучшение процессов нейропластичности по данным диффузно-тензорной и функциональной магнитнорезонансной томографии при использовании Церебролизина (в сравнении с плацебо). Использование всех эффективных методов при ведении пациентов, перенесших ИИ, позволяет  снизить риск развития повторного  инсульта, улучшить восстановление и качество жизни пациентов.

Management of patients after ischemic stroke is based on the prevention of the repeated ischemic stroke and other cardiovascular diseases.  It’s  necessary to use drugs (antiplatelet  drugs or anticoagulants, statins, antihypertensive drugs), non-drug methods (smoking cessation, alcohol abstinence, rational diet, increase of physical activity), surgical therapy is indicated for a share of patients (carotid endarterectomy). In motor disturbances the remedial gymnastics targeted at training of movements in paretic extremities and prevention of contractures plays the leading role. Currently the effectiveness  of drugs to improve restoration of the motor functions is not proved. Possibilities  of cerebrolysin and results of the recently published study ECOMPASS are discussed, in which effectiveness of cerebrolysin was studied on 70 patients (30 ml intravenously for 7–28 days of IS) versus placebo. Improvement of restoration of the motor functions in a subgroup of patients with pronounced motor disturbances has been observed as well as improvement of neuroplasticity processes by results of the diffuse and tensor and functional magnetic and resonance tomography in use of cerebrolysin (versus placebo). Use of all effective methods in management of patients after ischemic stroke allows reducing the risk of development of repeated stroke, improving the restoration and quality of life of patients.

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