A method for the treatment of children with primary arterial hypertension

 

(57) Abstract:

The invention relates to medicine, namely to Pediatrics. After a five-day adaptation carry out ultrasonic inhalations of low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana with a low content of boron mineral water at a flow rate of aerosol 5 l/min with a duration of 3 min with subsequent inhalation olive or stone fruit oil. Mos balneotherapy spend the days free from inhalation, boys at a water temperature of 36°With a duration of 5-10 minutes, and the hydrogen sulfide concentration of 50-100 mg/l, the girls 25-50 mg/l, at a rate of 8 balne - and 10 physical therapy. The method provides a pronounced hypotensive effect and increases tolerance to physical load. 3 table.

The invention relates to medicine, namely Pediatrics, and can be used in the treatment of children (boys and girls) aged 12-15 years with primary arterial hypertension syndrome dystonia.

Cardiovascular disease is called the disease of the century because of their wide distribution and social significance. Such pathologies include hypertension in a child who is La successful adaptation in the face, challenging, it correlates with emotional status, anxiety, individual reactions to frustrating, causing tension, personality characteristics, and current mental status.

Due to the fact that in recent years a marked increase in cardiovascular diseases in childhood, including hypertension, it becomes extremely urgent problem of identifying high-risk groups and to study the factors contributing to the development of this disease. The risk factors for hypertension are: personality, changes in lipid metabolism, vascular embryopathy, pathology receptors of the vascular wall and endothelium, features ReninAngiotensin system, nutrition, environmental conditions, etc. extensively studied the role of heredity in the development of primary hypertension (PAG) in children.

Vegetative-dystonic cardiovascular disorders in children occur relatively late, which is associated with the maturation of cardiovascular system, usually on the background of pubertal body changes, combined with other, previously arisen or almost simultaneously with them psicosomatica prevention of cardiovascular disease in children and improving the efficiency of sanatorium rehabilitation and treatment of children with primary hypertension. In this sense the value of new highly effective methods with the use of non-standard combinations, including the use of mineral waters. When developing adaptive compensatory abilities of the body, any mineral water, including arsenic, have complex effects on the body due to its chemical composition.

It is noted that internal use of arsenic-bearing mineral waters contributes to the activation of tissue enzymes liver, while normalizing the lipid metabolism. This schityvaetsya not only the specific properties of these waters, but also non-specific in their action ("Therapeutic use of arsenic waters Chvizhepse with hypertension". Methodical recommendations. - Sochi. - 1979).

It is known that arsenic alters the processes of tissue respiration by continuous excitation" redox processes, thereby increasing the proliferation of regeneration. However, the effect of arsenic-bearing mineral water cannot be fully equated to the properties of arsenic, because the composition of water in addition to arsenic include other components with distinct pharmacological properties: iodine, boron, silicon, foodarama water on the main risk factors of coronary heart disease, as overweight, hypercholesterolemia, triglyceridemia. However, the unique chemical composition and physico-chemical properties of these mineral waters require further in-depth research with a view to their differentiated medicinal use not only in the quality of drinking water, but in physiotherapy practice, in particular for transpulmonary route of administration in the form of an ultrasonic aerosol.

Given that an important place among the actuators of PAG in children is given to violations of the processes of adaptation, justified the development of medical facilities for children with primary arterial hypertension (PAG), including the use of balneotherapy and ultrasonic nebulizers (ULTRASONIC) using low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana with a low content of boron mineral water, providing training, improves metabolic processes, increase efficiency, restorative effect. The presence of this water trace elements - iron, arsenic, fluorine, iodine, etc. identifies the significant corrective role of mineral waters in the state of the cardio-vascular activity, particularly in the processes of excitation nom status, improving the adaptive capacity of the organism.

In the course of research in the development of the method of transpulmonary the way to the introduction of low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana boric mineral water in the body in the form of ultrasound (superfine) aerosol was detected sufficiently high therapeutic effect. It is known that the dispersion of the drug increases the pharmacokinetics, pharmacodynamics, pharmacokinetic aerosol. Among the advantages of such a method of use of mineral waters - small volume flow of mineral water (1 patient up to 10 ml per procedure), which increases the throughput of physiotherapeutic treatments.

In the resort in rehabilitation at PAG in children is important and balneotherapy (mos baths), providing a clear cardiotonic, sedative, antioxidant effect.

There is a method of treatment of children with PAH by applying the total hydrogen sulfide baths with hydrogen sulfide concentration of 50 mg/l, water temperature 36°C With exposure time from 5 min to 10 min at a rate of 8-10 baths every other day ("Methods of treatment of natural and reformed the.).

However, the known method does not give the desired result, is not taken into account the concentration of hydrogen sulfide on the sex of the baby and when using this method, stable hemodynamic does not occur.

The technical result of the invention is to improve therapeutic efficacy and the development of new economically meaningful method of complex treatment of children with primary hypertension by enhancing the adaptive capacity of the organism and its tolerance to physical activity.

The technical result is achieved by the fact that after the five-day adaptation carry out ultrasonic inhalations of low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana with a low content of boron mineral water at a flow rate of aerosol 5 l/min with a duration of 3 min with subsequent inhalation olive or stone fruit oil, and hydrogen sulfide balneotherapy spend the days free from inhalation, boys with hydrogen sulfide concentration of 50-100 mg/l, the girls 25-50 mg/l, at a rate of 8 balneo - and 10 physical therapy.

The method is carried out using a commercially available ultrasonic nebulizer THO the ear from 0 to 20 liters per minute, that allows you to properly dispense the amount entered in the respiratory tract medical substances). Procedure release in a separate room with permanent ventilation by model rules for ultrasonic inhalers. To obtain highly dispersed aerosols using low-mineralized hydrocarbonate chloride-sodium-calcium pliciloricus with a low content of boron mineral water with arsenic content of 1.5 mg/l of boron to 40.4 mg/l, silicon was 37.1 mg/l sodium - 189,1 mg/l, magnesium - 42,4 mg/l, calcium - 448,5 mg/l, iron (ferrous) of 8.4 mg/l, fluorine - up to 1.6 mg/l, chlorine - 66,0 mg/L.

Set the following parameters for the ULTRASONIC inhalations:

The composition of mineral water corresponds bottle manufactured for internal use.

- The flow rate of aerosol 5 l/min

The consumption of mineral water 5 cubic cm

- Duration inhalation aerosol 3 minutes

The course consists of 10 sessions over a day.

During the procedure, ULTRASONIC inhalations rhythm, frequency and depth of inhalation, normal, and must comply with the conditions in the measurement of basal metabolic rate. Rapid and irregular breathing can cause hyperbolising aerosol mineral water can be observed phenomena of irritation of respiratory tract, so after inhalation of mineral water immediately perform a 3-minute inhalation olive or stone fruit oil.

The total hydrogen sulfide baths appointed with a 7-day stay of the child in the clinic when the water temperature is 36°, length of 4-10 min (increasing vacation each subsequent procedure for 1 minute) in a day with ULTRASONIC inhalations with mineral water boys when hydrogen sulfide concentration of 50-100 mg/l, the girls 25-50 mg/l of hydrogen sulfide at the rate of 8 baths (table 1).

Example 1. Patient Peter K., age 14 were treated at the pediatric clinic Nicker from 01.05. - 26.05.2001, with a diagnosis of Primary hypertension. Chronic compensated tonsillitis. Child from 3 pregnancies occurring on the background of acute respiratory viral infections, anemia, and threats of termination in the second half, when birth weight 3500,0. The neonatal period without features. Psychophysical development according to age. Up to 2 years almost was not sick, then frequent acute respiratory infections 4-5 times, angina - annually. In 3.5 years on the background of follicular angina underwent infectious-toxic cardiopathy. Up to 10 years, 1-2 times per year, exacerbation of chronic tonsillitis. The burdened heredity: Boite headaches, the dizziness. Identified raising HELL to 150/90 mm RT.article at the age of 13. When the examination at children's hospital excluded symptomatic hypertension. Planned treatment was not conducted.

Upon admission to the hospital center complained of headaches, fatigue, "stabbing" pain in the heart, dizziness.

Objective: height 176 cm, weight 62,7 kg Skin and visible mucous clean, pale pink color. Subcutaneous fat moderately developed, muscle tone satisfactory. Tonsil gipertrofirovannyy to II degree, loose, no raids. Peripheral lymph nodes are not palpable. Respiratory, digestive and musculoskeletal systems without pathology. Borders of relative heart dullness within normal limits. Apical impulse - Y m/p, the tones are muffled, rhythmic accent of II tone of the aorta, short systolic murmur at the apex. Pulse 80 beats./min AD (right hand) 150/90 mm RT.art., AD (left hand) 140/80 mm RT.article.

The results of the survey before the treatment: the Blood - HB 150 g/l, L -5,7×10/l, e/3 p/3/64 l/27 m/3, ESR - 4 mm/h

Clinical analysis of urine within normal limits.

Biochemical blood test: weight peptides - 0,31462,28 nmol/ml

The results of the ECG: rhythm 65 min, RR-0,91", PQ-0,16", QRS-0,06", QT-0,35". Sinus rhythm. Vertical axis. Signs of left ventricular hypertrophy.

Ultrasound examination of the kidneys: secretory-excretory function of the kidneys is not broken.

The results of Bicycle ergometry: source - HR 78 beats./min, AD - 140/80 mm RT.art., at 3 minutes 1 load - HR 119 beats./min, BP is 150/90 mm RT.art., at the 3 minute mark II load - HR 129 beats./min, AD - 165/100 mm RT.art., at the 3 minute mark III load - HR -162 beats./min, AD - 180/100mm RT.article During the recovery period (4 minutes) - HR 97 beats./min, BP - 140/90 mm RT.art., index DP (GARDEN×HR/100), at the height of the load - 291,6. Physical capacity is 600 kg·m/min. during Bicycle ergometry, with the second load 3 minutes began to complain of shortness of breath, headache, fatigue. Clinorotation - giperkatolichesky option. After examination on day 6 after adaptation to a child receiving treatment by the proposed method (table 1): Ultrasonic inhalations of low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana with a low content of boron mineral water at a flow rate of aerosol 5 l/min with a duration of 3 minutes through the day No. 10 with subsequent inhalation olive oil ur water 36°C lasting from 4 to 10 minutes (exposure time of each of the following procedure increases by 1 minute) No. 8, which released in the days free from the BONDAGE of inhalation. In addition, in the days free from bathing the child received physical therapy, dosed walking, using sports games.

After 4 treatments, the child disappeared complaints of fatigue, and headaches. HELL decreased to 130/80 mm RT.article When receiving hydrotherapy pathological reactions were noted. After taking 5-6 treatments headaches disappeared, HELL dropped to 120/80 mm RT.article Child General medical complex on the proposed method moved well. During exercise had no complaints. During treatment stabilized blood pressure within 120/80 mm RT. article Clinical analysis of blood, urine, ECG after treatment is within normal limits. Improved lipid oxidation and antioxidant protection: the number of diene conjugates decreased by 64.7%, malonic dialdehyde erythrocyte - by 11.4%, while decreased catalase serum that is explained by the initial stress of the antioxidant defense system and its depletion by inactivation of the increased amount of hydrogen peroxide in the blood. After the load. Improved portability of muscular work, resulting in increased power and work performed.

Survey data after treatment:

The purpose: the initial 72 HR beats./min, BP 120/80 mm RT.art., at 3 minutes 1 load - HR 100 beats./min, AD - 140/80 mm RT.art., at the 3 minute mark II load - HR 120 beats./min, AD - 150/80 mm RT.art., at the 3 minute mark III load - HR - 143 beats./min, HELL -160/90 mm RT.art., at the 3 minute mark IV load - HR - 166 beats./min, AD - 170/90 mm RT.article During the recovery period (4 minutes) - HR - 83 beats./min, BP - 120/80 mm RT.art., index DP - 282,2 (at the height of the load), physical capacity 750 kg·m/min. Clinorotation sample - normostenichesky option. The treatment results in marked positive dynamics of clinical data: there are no complaints, heart sounds become zvuchanie, BP 120/80 mm RT.article The child was discharged with significant improvement. Evaluation of the effectiveness of treatment are shown in table 2.

Example 2. Patient Irina P., 14 years of age, was treated at the children's hospital center may 2 - may 26, 2001 with a diagnosis of Primary hypertension. Mitral valve prolapse with regurgitation 1 tbsp. S-shaped scoliosis of Art. II

The girl from the second pregnancy, against anemia, II term labor with mass 3400,0. Before the year Perenyi infection. March 1999 first appeared pain in the heart, palpitations, increased blood pressure to 140/90 mm RT.article In recent years, there has been a tendency to increase the blood pressure to 150-160/90 mm RT.art., HR 100-120 beats./min, ECG - prolonged A-V conduction. False angina with excitement and running. Upon admission to the clinic centre complained of headache, dizziness, fatigue, anxiety, irritability, "stabbing" pain in the heart area.

Data of objective examination: the correct shape, skin and visible mucous clean, pale pink color. Subcutaneous fat moderately developed. The asymmetry of the shoulders, shoulder blades. Tonsil loose, gipertrofirovannyy to the I-II Art. no raids. The lymph nodes are not palpable. Borders of relative heart dullness within the age norm. Apical impulse in The m/reverie. Muffled heart sounds, rhythmic, at the top and so Botkin systolic murmur of moderate intensity, outside of the heart is not carried out. Pulse 78 beats./min AD (right hand) - 140/80 mm RT.art., AD (left hand) - 130/80 mm RT.article With the respiratory, digestive, excretory system revealed no pathology. Mensis with 12 years of continuous, slightly painful, load and with poor 4-5 days.

Clinical analysis of urine within normal limits.

ECG - sinus arrhythmia. The normal position of the axis. Violation of intraventricular conduction.

Ultrasound of the kidney - without a pathology.

Biochemical blood test: weight peptides - 0,290 srvc. units, catalase serum - 35.9 µkat/l ceruloplasmin - 0,218 g/l, diene conjugates - to 3.73 Rel. units, malonic dialdehyde - 53,35 nmol/ml

Examined by an endocrinologist: Diffuse hyperplasia of the thyroid gland 1 tbsp.

The results of Bicycle ergometry: HR - 88 beats./min, BP - 130/80 mm RT.art., at 3 minutes 1 load - HR 107 beats./min, BP 140/90 beats./min, at 3 minutes II load - HR 133 beats./min, BP 150/90 mm RT.art., at the 3 minute mark III load - HR 160 beats./min, BP 170/90 mm RT.article During the recovery period (4 minutes) - HR 98 beats./min, BP 140/90 mm RT.article Index DP (GARDEN×HR/100) at the height of the load - 272. The physical capacity of 450 kg·m/min (achieved a 75 watt). During Bicycle ergometry 3 load began to complain of shortness of breath, fatigue, dizziness. Clinorotation sample - giperkatolichesky option.

The girl assigned to the treatment by the proposed method (table 1):

- adaptation 5 days

- ULTRASONIC inhalations of low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana with a low content of boron mineral water for 3 minutes through the day No. 10, followed by inhalation of stone fruit oil (for removing the phenomena of irritation of respiratory tract).

- General mos bath with a concentration of hydrogen sulfide 50 mg/l (introductory bath - 25 mg/l of sulfide) in the days free from inhalation, No. 8 when the water temperature is 36°, length from 4 to 10 min (increasing vacation next bath for 1 minute).

The first procedure of the ULTRASONIC inhalations and shared baths, moved well. After 4-5 treatments disappeared complained of headache, dizziness, fatigue. Improved emotional tone. BP - 120/80 mm RT.article General medical complex moved well. Discharged with significant improvement, which resulted in the disappearance of pain in the heart, headaches disappeared, improved mood, increased efficiency, HELL decreased to - 110-120/70-80 mm RT.article The positive dynamics in peripheral blood: HB - 140 g/l, L-4,8×10 9/l, e/3, P/2,/54, L/35, M/6, erythrocyte sedimentation rate 5 mm/h On the ECG is normal. Clinorotation sample - normostenichesky option.

Veloergometer the La to 285,6. Improved work performed, tolerance to physical load was 86,5%.

After treatment, the positive trend noted in the antioxidant defense system in the blood and lipid peroxidation in the form of lower levels of diene conjugates and malonic dialdehyde as in the stroma of erythrocytes and lipid. Evaluation of the effectiveness of treatment are shown in table 3.

A comprehensive evaluation of effectiveness was based on counting the number of signs (indicators) with favorable dynamics. When this is installed the following categories of assessments: a significant improvement - 11 signs with positive dynamics, improved - 6-10 signs of a slight improvement - 1-5 signs of deterioration - adverse changes.

To evaluate the effectiveness of the proposed method of treatment comparative characteristics of the 2 groups of patients.

I group of 30 children (boys and girls) aged 12-15 years with primary arterial hypertension were treated by hydrogen sulfide balneotherapy in the form of hydrogen sulfide total baths with hydrogen sulfide concentration of 50 mg/l No. 8 in a day when the water temperature is 36°With a duration of 5-10 min on a background of treatment Fizkultury the th (boys and girls) aged 12-15 years with primary arterial hypertension were treated by the proposed method according to the scheme of leave procedures (table 1).

The treatment in both groups contributed to the favorable changes in subjective status. After treatment by the proposed method subjective complaints was stopped in both boys and girls, while in the treatment method prototype the number of complaints significantly reduced.

The formation of the PAG in children depends on the type of hemodynamics, i.e., the coordinated relationship between cardiac output and peripheral resistance to blood flow. In the group of children treated in the prototype, therapeutic effect identified in the hyperkinetic type of blood circulation by reducing stroke volume. In the group of children treated by the proposed method, accurate shifts marked with hyperkinetic type of circulatory and eugenetics and marked activation of the antioxidant defense system of blood and positive changes in the system of lipid peroxidation in the lower DK and MDA both in the stroma of erythrocytes and lipid.

Thus, the pronounced hypotensive effect, increased tolerance to physical load and consequently the improvement of the General condition and clinical pokazatel.

Evaluation of the treatment effectiveness of the proposed method in example 1 are presented in table 2.

Evaluation of the treatment effectiveness of the proposed method in example 2 are shown in table 3.

Thus, the proposed method of treatment can improve therapeutic efficacy of sanatorium-resort treatment of children with primary hypertension on 11,10% by increasing the adaptive capacities of the organism and its tolerance to physical activity.

Literature

1. Belokon N. A., Koberger M. B. heart Disease and blood vessels in children. - Moscow. - Medicine. - 1987. - T. 2. - S. 136-190.

2. Karachevtseva T. C. Therapy of various diseases in childhood. - Moscow. - Medicine. - 1988. - C. 802.

3. Ulaschyk B. C. New methods and techniques of physical therapy. - Minsk. - Belarus. - 1996.

4. Aleksandrov, A. A. Prevention of cardiovascular disease with childhood - a new approach in preventive cardiology. - Cardiology. - 1987. - №9.

5. Bogolyubov C. M., Ponomarenko, N. General physiotherapy. - Moscow. - Saint-Petersburg. - 1997.

6. Therapeutic use of arsenic waters e evaluation criteria the chemical composition of mineral waters. - M, Centrometric. - 1982: GOST 13273-88. Drinking mineral water and curative - table.

8. Garkavi L. H., Cucina E. B. and other Adaptive response and resistance of organism. - Rostov-on-don. - 1990. - c.222.

9. Garkavi L. H., Cucina E. B. and other Signal indicators anti-stress reactions and stress in children. - Pediatrics. - 1996. No. 5. - S. 107-109.

A method for the treatment of children with primary hypertension by common hydrogen sulfide baths, over-against the background of physical therapy, dosed walking, using sports games through the day at a water temperature of 36°With a duration of 5-10 min, characterized in that after the five-day adaptation carry out ultrasonic inhalations of low-mineralized hydrocarbonate chloride-sodium-calcium placebomarijuana with a low content of boron mineral water at a flow rate of aerosol 5 l/min with a duration of 3 min with subsequent inhalation olive or stone fruit oil, and mos balneotherapy spend days free from inhalation boys when hydrogen sulfide concentration of 50-100 mg/l, the girls 25-50 mg/l, at a rate of 8 balneo - and 10 physical therapy.



 

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