The effect of ozone therapy on microhemodynamics and peripheral blood flow in patients with COVID-associated pneumonia in the early recovery period

Authors:

Konev Sergey Mikhailovich, student, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubezkaya Str., b. 2, Moscow, 119991, Russian Federation; nurse of the department of medical rehabilitation, Clinical hospital N 1, JSC Corprate group Medsi, Otradnoye, 2, b. 1., Krasnogorsk, 143442, Moscow region, Russian Federation; e-mail: koneffseryozha039@gmail.com; https://orcid.org/0000-0001-5907-140X.

Tsvetkova Alyona Vladislavovna, assistant of the Department of Sports Medicine and Medical Rehabilitation I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubezkaya Str., b. 2, Moscow, 119991, Russian Federation; Physiotherapist of the Department of medical rehabilitation, Clinical hospital N 1, JSC Corporate group Medsi, Otradnoye, 2, b. 1., Krasnogorsk, 143442, Moscow region, Russian Federation; e-mail: tv-aa@yandex.ru; https://orcid.org/0000-0002-2698-3514.

Koneva Elizaveta Sergeevna, Grand PhD of Medical Sciences, Associate Professor, Professor of the Department of Sports Medicine and Medical Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubezkaya Str., b. 2, Moscow, 119991, Russian Federation; Chief Specialist in Medical Rehabilitation of JSC Corprate group Medsi, Otradnoye, 2, b. 1., Krasnogorsk, 143442, Moscow region, Russian Federation, e-mail: elizaveta.coneva@yandex.ru; https://orcid.org/0000-0002-9859-194X.

Matsonashvili Teimurazi Rafaelovich, PhD of Medical Sciences, Cardiovascular Surgeon of the Department of Surgical Treatment of Tachyarrhythmias, Federal State Budgetary Institution “National Medical Research Center for Cardiovascular Surgery named after A.N. Bakulev”, Rublevskoe sh., 135, Moscow, 121552, Russian Federation; e-mail: 89265961779@yandex.ru; https://orcid.org/0000-0001-7902-1784.

Lyadov Konstantin Viktorovich, Academician of the Russian Academy of Sciences, Grand PhD of Medical Sciences, Professor, Professor of the Department of sports medicine and medical rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), 8 Trubezkaya Str., b. 2, Moscow, 119991, Russian Federation; e-mail: klyadov@ mail.ru; https://orcid.org/0000-0001-5468-5074.

Zhumanova Ekaterina Nikolaevna, Grand PhD of Medical Sciences, Head of the Gynecology Center, Clinical hospital N 1, JSC Corprate group Medsi, Otradnoye, 2, b. 1., Krasnogorsk, 143442, Moscow region, Russian Federation; e-mail: ekaterinazhumanova@yandex.ru; https://orcid.org/0000-0003-3016-4172.

Sidyakina Irina Vladimirovna, Grand PhD of Medical Sciences, Head of the Neurorehabilitation Center, Clinical hospital N 1, JSC Corprate group Medsi, Otradnoye, 2, b. 1., Krasnogorsk, 143442, Moscow region, Russian Federation; e-mail: sidneuro@mail.ru; https://orcid.org/0000-0002-0998-9252.

Shapovalenko Tatyana Vladimirovna, Grand PhD of Medical Sciences, Chief Doctor of Clinical hospital N 1, JSC Corprate group Medsi, Otradnoye, 2, b. 1., Krasnogorsk, 143442, Moscow region, Russian Federation; e-mail: shapovalenkotv@mail.ru; https://orcid.org/0000-0002-9905-6236.

Korchazhkina Natalia Borisovna, Grand PhD of Medical Sciences, Professor, State Scientific Center of the Russian Federation Federal State Budgetary Scientific Institution “Russian Scientific Center for Surgery named after Academician B.V. Petrovsky”, Abrikosovsky per., 2, bldg. 2, Moscow, 119435, Russian Federation; e-mail: n9857678103@gmail.com, https://orcid.org /0000-0001-6913-8778.

Annotation:

Introduction. For 3 years of the course ofthe pandemic, the global medical community has studied the pathogenetic mechanisms of the development of this infection, described the characteristic clinical manifestations, proposed the main laboratory and instrumental diagnostic methods, and formed recommendations for drug treatment. At the same time, despite effective treatment, most patients note the persistence of complaints and clinical symptoms for a long time after discharge. In this regard, it seems relevant to develop effective methods for the rehabilitation of patients who have undergone COVID-associated pneumonia. A promising method is systemic ozone therapy, which has an immunomodulatory, anti-inflammatory, antiplatelet, virucidal effect.

Aim — to evaluate the effect of systemic ozone therapy on microcirculation and microhemodynamics in a patient with COVID-associated pneumonia in the early recovery period.

Materials and methods. A prospective randomized clinical trial was conducted, including 90 patients aged 33 to 89 years with COVID-associated pneumonia in the early recovery period. Patients were divided into 3 groups, comparable in age, gender and clinical and functional disorders. In group III (N = 34), patients received a standard complex of rehabilitation treatment — exercise therapy, chest massage, physiotherapy procedures (low-frequency magnetotherapy and drug electrophoresis in the projection of the lung fields), in groups I and II, in addition to the basic complex rehabilitation, intravenous infusions of ozonized physiological saline with an output ozone concentration of 2.0 mg/l daily No. 10 and every other day No. 5, respectively. In order to assess the effect of systemic ozone therapy on the peripheral blood flow of patients with COVID-associated pneumonia, the main characteristics of microhemodynamics on the 1st and 10th day of rehabilitation treatment were analyzed.

Results. Evaluation of microcirculation dynamics in group I patients on the 10th day of rehabilitation revealed statistically significant negative dynamics in relation to the average value of the microcirculation index, shunt perfusion, and the standard deviation of the amplitude of blood flow fluctuations. The change in nutritive blood flow and the coefficient of variation was not statistically significant, but there was also a trend towards a decrease in the values of these indicators.
An analysis of changes within each group before and after treatment showed that a 10-day course of ozone therapy significantly worsens microhemodynamics, while a smaller number of ozone therapy procedures, but with a frequency of 1 time in 2 days, significantly improves it. Statistically significant differences were obtained for all characteristics. Taking into account the negative dynamics in the studied group I, a separate analysis was carried out between patients of groups II and III, since in both samples there was a positive therapeutic effect against the background of restorative treatment, it was the significance of the difference between them that determined the effect of ozone therapy on peripheral blood flow.

Discussion. A new coronavirus infection is a complex, multisystem disease characterized by damage to various organs and the development of endothelial dysfunction. In this regard, the development of comprehensive rehabilitation programs is relevant, and laser dopplerometry is one of the important methods for evaluating the effectiveness of treatment.

Summary. Comprehensive rehabilitation of patients with COVID-associated pneumonia in the early recovery period significantly improves nutritional and shunt blood flow. Inclusion in the treatment of systemic ozone therapy performed every other day in the amount of 5 procedures with an ozone concentration at the outlet of the ozonizer of 2.0 mg/ml also increases the values of all the main characteristics of microhemodynamics, including significantly improving the coefficient of variation, in contrast to the standard rehabilitation program.

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