Clinical material contains the results of observations of 488 patients with coronary artery disease (CAD) after surgical myocardial revascularization (SMR), which were located at the department of cardiorehabilitation of the medical-health complex "Byla Akacia" (Odesa), Sanatorium Karpaty (Mukachevo), sanatorium "Mirgorod" (Mirgorod), in the majority - male and working age. To evaluate the status of patients and comparative assessment of treatment outcomes of patients with CAD after SMR used generally recognized methods of research. The scientific novelty of the results of the study is that, as a result of the conducted research, it was found that in the Odessa region the prevalence and incidence of circulatory system diseases increased during 2010 - 2016, the share of circulatory system diseases in the structure of total mortality played a leading role , the number of stenting of the coronary arteries increased 4 times, the number of surgical interventions - 6 times with the presence of postoperative mortality (5,6%). In patients with coronary heart disease after surgical myocardial revascularization, the number of comorbidities ranged from 2 to 5 at the same time. For the first time, it was found that the introduction of mineral water "Polyana cupel" normalized glucose levels in animals with experimental alloxan diabetes, which became the basis for its use in patients with insulin resistance and diabetes mellitus.
Further development was obtained that in patients with CAD after SMR there were disturbances of the cardiovascular system and neuro-psychological condition more pronounced compared with comparison groups. It has been shown for the first time that the use of hydro-kinesiotherapy and traditional kinesitherapy in patients with coronary heart disease after surgical myocardial revascularization at the spa rehabilitation stage improved their clinical condition, disease course and exercise tolerance. It was first proved that the use of differentiated programs increased the efficiency of SR of patients with CAD after SMR with different concomitant diseases: improved their clinical and psycho-emotional state and increased the level of integral main compared with comparison groups (p <0.01). It was first determined that early (after 7-10 days) SR of patients with CAD after aortic coronary artery bypass surgery (ACABS) using an individual program directly and within 2 months after rehabilitation treatment improved their clinical condition and tolerance level of physical progression of the disease (there were no mortality, restenosis of the coronary arteries, 2 times less worsened the condition compared with the comparison group). For the first time it was proved that within 12 months the results of SR of these patients were achieved with the use of differentiated programs developed: improvement of their quality of life on the part of: physical, psychological and emotional state, increase of adherence to treatment, an increase in the integral index of health status by 17,3%, 20,3% and 11,5% in patients with concomitant arterial hypertension, diabetes mellitus and osteoarthritis, respectively, more significantly the condition compared with the comparison group (p <0,05). For the first time the conceptual model of medical care for patients with CAD after SMR and ACABS. Specified indications and contraindications for the purpose of the developed programs of rehabilitation treatment. Recommendations on the formation of lifestyle motivation in patients taking into account the main risk factors for the progression of the disease, its complications and increasing adherence to treatment are developed.
