Diagnostic technique for disturbed vegetative regulation of heart rhythm in children with gastrooesophageal reflux disease

FIELD: medicine.

SUBSTANCE: intraoesophageal pH monitoring and Holter monitoring are recorded daily. The heart rate variability is estimated in the aggregate with an analysis of a nocturnal heart rate trend. If finding more than 5 episodes of high heart rate dispersion coinciding with reflux episodes, or if a nocturnal structure comprises more than 50% of the episodes, the disturbed vegetative regulation of heart rhythm related to gastrooesophageal reflux disease is diagnosed.

EFFECT: technique enables diagnosing the extra-oesophageal manifestations of gastrooesophageal reflux disease at the early stage of the disease after the subjective manifestations have been observed.

 

The invention relates to medicine, namely to Pediatrics.

Clinic gastroesophageal reflux disease (GERD) is the sum of esophageal and extraesophageal symptoms. Adults to extraesophageal symptoms of GERD include, in particular arrhythmia. In children with GERD arrhythmia detected relatively infrequently, however, there are disorders of autonomic regulation of heart rhythm, which may be associated with the implementation of esophagojejunal reflex during pathological reflux. Without correction of vegetative status cannot complete treatment of GERD in children.

A known method for the diagnosis of autonomic cardiac neuropathy in children with diabetes mellitus [Ivanov D.A., Gosev SF Method for early diagnosis of autonomic cardiac neuropathy in children with diabetes mellitus type I // Patent for the invention №2218864, Moscow, 2003]. During Holter monitoring is temporal and spectral analysis of heart rhythm, as well as trend analysis of heart rate (HR) during a night's sleep. Counts the number of periods of high variance (TTD) heart rate and the percentage of time that the DPP occupy in the structure of sleep a night. However, an increase in periods of high dispersion curves more than 5 episodes or more than 50% of the night's sleep was regarded as expressed vegetative down-regulation de the activity of the heart and an early sign of autonomic cardiac neuropathy. The disadvantage of this method is: use only in children with diabetes and only in the diagnosis of autonomic cardiac neuropathy; the failure time of the DPP with clinical manifestations of the underlying disease.

As the closest analogue (prototype) the selected method for the diagnosis of autonomic disorders in children with gastroesophageal reflux disease [Ivanov I.I., Gosev SF Features of the functioning of the autonomic nervous system in children and adolescents with acidic and alkaline gastroesophageal-reflux // Pediatrics. - 2010. No. 2. - P.17-23], which is associated with carrying out daily monitoring intraesophageal pH and Holter monitoring. It is shown that in children with acidic and alkaline gastroesophageal-reflux (compared to physiological change indicators of temporal and spectral analysis of heart rhythm. According to the simultaneous monitoring of pH and ECG revealed parallelism in the change in the spectral indices of the rhythm and the occurrence of acid reflux. The disadvantage of this method is that for the assessment of autonomic homeokinesis used indicators of temporal and spectral analysis of rhythm, which are calculated automatically by the program, and therefore, the possible error due to the frequent presence of children is of refacto. Also, do not use all the diagnostic possibilities of the method Holter monitoring.

The objective of the invention is to develop a method, which will reveal the instability of heart rhythm associated with impaired autonomic regulation due to GERD.

The problem is solved due to the fact that in the method for the diagnosis of impaired autonomic regulation of heart rhythm in children with gastroesophageal reflux disease, including daily monitoring intraesophageal pH and Holter monitoring with measurement of heart rate variability, has the following differences: advanced analysis of the trend of the heart rate during sleep at night by counting the number of episodes of PPD and their percentage in the structure of sleep a night.

The essence of the proposed method lies in the fact that the increase in the representation of the DPP more than 5 episodes or more than 50% during the night's sleep is a marker of impaired autonomic regulation of heart rhythm. The periods of instability of heart rhythm associated with the presence of pathological gastroesophageal reflux and may be predictors of arrhythmias. Their identification requires dynamic monitoring of the functional state of the cardiovascular system in children with GERD.

Between the combination of the substantial characteristics of the proposed facility and achievable technical result there is a causal relationship, namely, the increase in the representation of the DPP more than 5 episodes or more than 50% during the night indicates the presence of impaired autonomic regulation of heart rhythm in children with GERD.

New features of the claimed method for the diagnosis of impaired autonomic regulation of heart rhythm in children with gastroesophageal reflux disease are:

1) expand diagnostic capabilities Holter monitoring - the use of trend analysis heart rate during sleep at night,

2) identify early signs of instability of heart rhythm in the absence of severe clinical symptoms of cardiovascular system in patients with GERD

3) identification of communication episodes TTD with the presence of pathological gastroesophageal reflux according to the daily pH-metry.

The method is developed based on the analysis of daily monitoring intraesophageal pH and Holter monitoring 69 children with GERD and 48 children with chronic gastroduodenitis. The diagnosis of GERD is exhibited on the basis of the clinical picture and confirmed by instrumental data. The study found that in children with GERD time episodes TTD in total amounted to 304 (240-354) minutes (indicated by the median and the interquartile scale), and in children with chronic gastroduodenitis - 252 (202-294) minutes (the difference statistician who Cesky significant p=0,021). Time TTD from the entire period of sleep was in children with GERD 58,0 (48,0 is 65.5)%, and in children with chronic gastroduodenitis - 46,8 (43,1-50,6)% (difference is statistically significant, p=0.002). Thus, when GERD have more severely impaired autonomic regulation of heart rhythm.

The proposed method for the diagnosis of impaired autonomic regulation of heart rhythm in children with gastroesophageal reflux disease is carried out in the following sequence:

When conducting daily monitoring intraesophageal pH and Holter monitoring conduct simultaneous analysis of reflux episodes and the RPE. Count the number of TTD and interest of their contents in the structure of sleep a night. If you have more than 5 episodes of the DPP or more than 50% of their representation in the structure of sleep talking about the violation of vegetative regulation of heart rhythm. At the same time pathological gastroesophageal reflux and Beijing believe that the instability of the heart rhythm is associated with reflux episodes. Clinical example.

Michael S., age 16. The diagnosis of GERD exhibited a year ago, the gastroenterologist is observed with 8-years of age. The main complaint at the time of the survey is heartburn. Clinical signs of GERD are supported by the data daily pH-metry: sour pathological reflux of 2 degrees. Signs of autonomic dysfunction neveragain, clinically determined atonia. According to kardiointervalografii - vagotonic with Hyper sympathicotonic reactivity. By Holter monitoring heart rate from 50 to 154 per minute during the day and from 53 to 88 per minute at night. Circadian index of 1.41 (within normal limits). Spectral analysis showed that the high-frequency component is only 8,8% of the total spectrum, despite the fact that during the whole day and night was periodically determined aetiology. The low-frequency component amounted to 22.2%, a component of very low frequencies - 68,9%. Index vagosympathetic interaction 2,52, the index of centralization of 0.45. These data suggest the involvement in the regulation of sympathetic autonomic nervous system and confirm the results of the WHALE on the availability of vagotonia with Hyper sympathicotonic reactivity. When analyzing the trend of the heart rate during sleep was determined to be only three periods of high variance, however, their total duration was more than half the night time. Identified violations sleep patterns, which in time are associated with the presence of night time acid reflux (according to the daily pH-metry), subjectively not weary child. In this case, we can conclude that the instability of heart rhythm associated with GERD. A comprehensive therapy and observation.

Thus, the image is eenie allows you to extend the diagnostic capabilities of Holter monitoring in the diagnosis of impaired autonomic regulation of heart rhythm in children with GERD, to establish the existence of unstable heart rhythm and to monitor the functional state of the cardiovascular system in patients.

A method for the diagnosis of impaired autonomic regulation of heart rhythm in children with gastroesophageal reflux disease, including daily monitoring of intraesophageal pH and Holter monitoring, wherein the heart rate variability assessed in conjunction with trend analysis of heart rate during sleep at night and if more than 5 episodes of periods of high variance in heart rate, coinciding with episodes of reflux, or their percentage representation of more than 50% in the structure of sleep at night diagnose violation of vegetative regulation of heart rhythm associated with gastroesophageal reflux disease.



 

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FIELD: biotechnologies.

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9 cl, 6 dwg, 7 ex

FIELD: medicine.

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Moisture sensor // 2497130

FIELD: chemistry.

SUBSTANCE: disclosed is a method of detecting urine, which involves: using a urine sensor having a matrix, the matrix containing a thermochromic substance distributed therein and a temperature varying means, where said temperature varying means is capable of either raising temperature or lowering temperature upon contact with urine so as to cause temperature change in the thermochromic substance, resulting in colour change; contacting the urine with the sensor matrix; and determining presence of urine based on colour change of the thermochromic substance. A sensor for determining presence or absence of urine is also disclosed.

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11 cl, 7 ex, 2 dwg

FIELD: medicine.

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2 ex

FIELD: medicine.

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3 ex

FIELD: medicine.

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3 ex

FIELD: medicine.

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3 tbl, 1 ex

FIELD: medicine.

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FIELD: medicine.

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FIELD: medicine.

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4 tbl

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5 tbl, 4 ex

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3 tbl, 3 ex

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3 tbl, 2 ex

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8 tbl, 2 ex

FIELD: medicine.

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7 tbl, 2 ex

FIELD: medicine.

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1 ex, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to rehabilitation and preventive medicine, cardiology, therapy. It involves drug-induced therapy and a course of cardiorespiratory training with biological feedback (BF) presenting a cardiorhythmography (CRG) and a reference cyclic curve (RCC) to the patient to be matched under continuous visual control. It is followed by active (BF-assisted) and non-active (BF-unassisted) 2-minute tests with the first and last test of each session are non-active (NT). The first NT involves recording reference data of patient's cardiorespiratory system with evaluating the parameters as follows: RCC amplitude, period and continuous component matched with average heart rate on the following active test (AT). The test are automatic, individual for the patient as for the moment of testing with the use of an apparatus for functional psychophysiological correction comprising units described in the patent claim. Each following AT requires forming RCC with the use of average heart rate, amplitude and period on the basis of spectral analysis of CRG and CC of the previous AT. In the beginning of the procedure, the patient is set up to successful completion of the task, 5 s after the beginning of each AT, an audio signal (1 kHz, 300 ms, 30 dB above a threshold of audibility) is supplied. Before the beginning of the course and after each session and the whole course, the patient is tested to determine a level of reactive and personal anxiety and depression by stating the required number of sessions for recovery of cardiorespiratory synchronisation and normal heart rate and blood pressure. Before the first NT and after each AT, capnometry is used to determine the concentration of CO2 in expired air. If observing decrease, respiratory depth is corrected. If maintaining CO2 in expired air after each following AT less than 95% from reference, respiratory depth is corrected during the following AT under control of capnometry to achieve the concentration of not less than 95% from reference. The therapeutic course includes at least 5 sessions, 1 session daily or every second day to recover the respiratory pattern lost due to the disease and the biorhythmological structure of heart rate.

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1 ex, 3 tbl, 3 dwg

FIELD: medicine.

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EFFECT: application of claimed group of inventions will make it possible to increase quality of resulting data of reconstructed image.

34 cl, 10 dwg

FIELD: medicine, cardiology.

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EFFECT: higher accuracy of evaluation.

2 dwg, 1 ex, 2 tbl

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