ó㳺í³÷íå îá´ðóíòóâàííÿ ðåàá³ë³òàö³¿ ã³ðíèê³â âóã³ëüíèõ øàõò ç õðîí³÷íèìè ðàäèêóëîïàò³ÿìè

Ïî ïîêàçàòåëÿì òÿæåñòè òðóäà ðèñê ðàçâèòèÿ ÕÏÊÐ ìàêñèìàëüíî ïîâûøåí ó ãîðíîðàáî÷èõ î÷èñòíîãî çàáîÿ è ïðîõîä÷èêîâ, ó ãîðíîðàáî÷èõ ïî ðåìîíòó ãîðíèõ âûðàáîòîê è ïîäçåìíûõ ýëåêòðîñëåñàðåé ïîâûøåí.

Òÿæåñòü òðóäà çàíèìàåò ïåðâîå ìåñòî ñðåäè ôàêòîðîâ, êîòîðûå âëèÿþò íà ðàçâèòèå ÕÏÊÐ ó ãîðíîðàáî÷èõ - ñðåäíÿÿ îöåíêà ïî ïÿòèáàëüíîé øêàëå (4,6 ± 0,1) áàëëà. Ôàêòîðû, êîòîðûå â íàèáîëüøåé ñòåïåíè îïðåäåëÿþò ðèñê ðàçâèòèÿ òÿæåñòè çàáîëåâàíèÿ, òàêîâû: ïðîôåññèÿ, íàêëîíû êîðïóñà íà 60 ãðàäóñîâ çà ñìåíó, ñóììàðíûé âåñ ïåðåìåùàåìûõ ãðóçîâ íà ïðîòÿæåíèè ñìåíû (ò), óäåëüíûé âåñ òÿæåëîãî ôèçè÷åñêîãî òðóäà íà ïðîòÿæåíèè ñìåíû (%) â ñîîòâåòñòâèè ñ ãèãèåíè÷åñêîé êëàññèôèêàöèåé. ×óâñòâèòåëüíîñòü ìîäåëè 70,0% (ÄÈ 54,6% - 83,4%), ñïåöèôè÷íîñòü ìîäåëè 71,2% (ÄÈ 59,6% - 86,7%).

Âåäóùèé ñèíäðîì â êëèíè÷åñêîé êàðòèíå ãîðíîðàáî÷èõ ñ ÕÏÊÐ - áîëåâîé (97,0 ± 2,0) %. Ó 100% ãîðíîðàáî÷èõ ñ ÕÏÊÐ îòìå÷åíî îãðàíè÷åíèå ïîäâèæíîñòè ïîÿñíè÷íîãî îòäåëà è áîëåçíåííîñòü ïðè ýòîì, ÷òî âëèÿåò íà êà÷åñòâî æèçíè. Íà êà÷åñòâî æèçíè ó ãîðíîðàáî÷èõ ñ ÕÏÊÐ âëèÿåò äëèòåëüíîñòü çàáîëåâàíèÿ (ñ óâåëè÷åíèåì äëèòåëüíîñòè íà 1 ãîä ÂØ = 1,25 (ÄÈ 1,04 - 1,50) è èíòåíñèâíîñòü áîëåâîãî ñèíäðîìà (êîððåëÿöèîííàÿ ñâÿçü ñîìàòè÷åñêîãî ñîñòîÿíèÿ r = - 0,4; ïñèõîëîãè÷åñêîãî ñîñòîÿíèÿ r = - 0,3; ñîöèàëüíîãî ôóíêöèîíèðîâàíèÿ r = - 0,35).

Òðåòüÿ ãðóïïà èíâàëèäíîñòè ó ãîðíîðàáî÷èõ ñ ÕÏÊÐ ñîñòàâèëà (96,0 ± 2,8) %, ÷òî óêàçûâàåò íà íåîáõîäèìîñòü ðàçðàáîòêè ïðîãðàìì ðåàáèëèòàöèè è ïðîôèëàêòèêè.

Íàìè ïðîâåäåíà îöåíêà ýôôåêòèâíîñòè íîâîãî ðåàáèëèòàöèîííîãî ëå÷åíèÿ ó 40 ãîðíîðàáî÷èõ ñ ÕÏÊÐ. Ñðåäíèé âîçðàñò ãîðíîðàáî÷èõ (49,0 ± 9,1) ëåò. Êëèíè÷åñêè îöåíèâàëè ýôôåêòèâíîñòü ðåàáèëèòàöèîííîãî ëå÷åíèÿ. Áîëüíûå áûëè ðàçáèòû íà äâå ïîäîáíûå ïî âîçðàñòó è íåâðîëîãè÷åñêèìè êëèíè÷åñêèìè ïðîÿâëåíèÿìè ãðóïïû: â I (îñíîâíóþ) ãðóïïó âîøëè áîëüíûå, êîòîðûå ïîëó÷àëè ÒÊ íà àïïàðàòå «Òðàêîìïüþòåð» â êîìïëåêñå ñ ìàãíèòîòåðàïèåé è èíôðàêðàñíîé ëàçåðíîé òåðàïèåé. Âî II ãðóïïå ïàöèåíòàì íàçíà÷åíû ñòàíäàðòíûå ìåòîäû ýëåêòðîëå÷åíèÿ. Êðîìå òîãî, ãîðíîðàáî÷èå âñåõ ãðóïï ïîëó÷àëè ìåäèêàìåíòîçíîå ëå÷åíèå (íåñòåðîèäíûå ïðîòèâîâîñïàëèòåëüíûå ïðåïàðàòû, ñèìïàòîëèòèêè, âèòàìèíû ãðóïïû Â). Äëèòåëüíîñòü ëå÷åíèÿ îò 10 äî 12 ñåàíñîâ.

 ðåçóëüòàòå ïðîâåäåííîé íàìè ðåàáèëèòàöèè äëèòåëüíîñòü ïðåáûâàíèÿ íà áîëüíè÷íîé êîéêå ó ãîðíîðàáî÷èõ 1-é ãðóïïû áûëà äîñòîâåðíî íèæå íà 2-4 äíÿ.

Ïðè àíàëèçå îòäàëåííûõ ðåçóëüòàòîâ ðåàáèëèòàöèè óñòàíîâëåíî, ÷òî ó ãîðíîðàáî÷èõ 1-é ãðóïïû ðåìèññèÿ ñîñòàâèëà â ñðåäíåì (6,0 ± 2,0) ìåñÿöà, ó ãîðíÿêîâ 2-é ãðóïïû - òîëüêî (1,0 ± 0,5) ìåñÿöà.

Êëþ÷åâûå ñëîâà: ðàäèêóëîïàòèè, ãîðíîðàáî÷èå, âðåäíûå ôàêòîðû, ðåàáèëèòàöèÿ.

Zhdanova G.V.Hygienic basis of rehabilitation of miners of coal mines with chronic radiculopathys. - A manuscript.

Dissertation for the candidate of medical sciences degree in speciality 14.02.01 - Hygiene and occupational pathology. - M. Gorky Donetsk national medical university Ministry of Public Health, Ukraine, Donetsk, 2009.

The dissertation is dedicated of hygenic substantiate to rehabilitation of miners of coal mines with chronic radiculopathys.

The article deals with analysis of peculiarities in morbidity and social importance of professional lumbar-sacral radiculopathy as a leading nosologic entity among coal miners whose work is associated with constant exposure to risk factors. On the establishment of results comparatively estimation of the harmful factors and analysis of the literature the main causes of originating and progress of the lumbar-sacral radiculopathy of the miners: work conditions, work hardness. Efficiency is traction-computer stretch in combination is laser and electromagnetic therapy investigated at treatment lumbar-sacral radiculopathy. The big efficiency represent treatment as compared with ordinary physiotherapy. The conclusion about necessity application is given made of treatment of miners.

Keywords: radiculopathies, miners, harmful factors, rehabilitation.

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