RU2241469C2 - Method for treating children with primary arterial hypertension - Google Patents

Abstract

FIELD: medicine, pediatrics.

SUBSTANCE: after a 5-d-long adaptation one should carry out ultrasound inhalations with low-mineralized hydrocarbonate chloride-sodium-calcium-carbonate-arsenous mineral water at low boron content at aerosol flow rate being 5 l/min at 3-min-long duration followed by inhalation with either olive or kernel oil. Hydrogen sulfide balneotherapy should be carried out during inhalation-free days in boys at water temperature being 36 C at 5-10 min duration and hydrogen sulfide concentration being 50-100 mg/l, in girls - 25-50 mg/l, 8 balneo- and 10 physioprocedures/course. The method provides pronounced hypotensive effect.

EFFECT: increased tolerance to physical loading.

2 ex, 3 tbl

Description

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 with vegetovascular dystonia syndrome.

Cardiovascular diseases are called diseases of the century due to their wide distribution and social significance. This pathology includes hypertension in childhood. Since the level of blood pressure reflects the overall degree of mobilization of the body necessary for successful adaptation in conditions requiring stress, it correlates with emotional status, anxiety, an individual type of reaction to frustrating, stressful situations, personality traits, and current mental state.

Due to the fact that in recent years there has been an increase in cardiovascular diseases in childhood, including hypertension, the problem of identifying high-risk groups and studying factors contributing to the development of this disease becomes extremely urgent. The risk factors for the development of hypertension are usually attributed to: personality type, changes in lipid metabolism, vascular membranopathy, pathology of the receptors of the vascular wall and endothelium, functional features of the reninangiotensin system, nature of nutrition, environmental conditions, etc. The role of heredity in the development of primary arterial hypertension is actively studied ( PAG) in children.

Vegetative-dystonic cardiovascular disorders in children occur relatively late, which is associated with the maturation of the cardiovascular system, usually against the background of puberty restructuring of the body, combined with other psychosomatic disorders that occurred earlier or almost simultaneously with them.

One of the urgent problems of modern medicine is the development of methods for the prevention of cardiovascular pathology in children and increasing the effectiveness of sanatorium-resort healing and treatment of children with primary arterial hypertension. At the same time, new highly effective methods using non-standard combinations, including the use of mineral waters, are gaining importance. When developing adaptive compensatory capabilities of the body, any mineral water, including arsenic, has a complex effect on the body due to its chemical composition.

It was noted that the internal use of arsenic-containing mineral waters contributes to the activation of tissue liver enzymes, while normalizing lipid metabolism. This takes into account not only the specific properties of these waters, but also their nonspecific effect ("Therapeutic use of carbonic arsenic water Chvizhepsa with hypertension". - Methodological recommendations. - Sochi. - 1979).

It is known that arsenic alters the processes of tissue respiration through continuous “excitation” of redox processes, thereby enhancing the proliferation of regeneration. Nevertheless, the action of arsenic-containing mineral water cannot be fully equated with the properties of arsenic, since in addition to arsenic, the water also contains other components with pronounced pharmacological properties: iodine, boron, silicon, fluorine, magnesium, iron, etc., which have a complex effect on the body . The positive effect of arsenic-containing waters on such risk factors for coronary heart disease as overweight, hypercholesterolemia, triglyceridemia has been proven. However, the unique chemical composition and physicochemical properties of these mineral waters require further more in-depth scientific research with a view to their differentiated medicinal use not only in the drinking regimen, but also in physiotherapeutic practice, in particular for the transpulmonary route of administration in the form of an ultrasonic aerosol.

Given that an important place among the triggering mechanisms of PAG in children is given to violations of adaptation processes, the development of treatment complexes for children with primary arterial hypertension (PAG), including the use of balneotherapy and ultrasonic inhalation (US) using low-mineralized sodium chloride-calcium carbonate arsenic, is justified low boron content of mineral water, providing training, improving metabolic processes, increasing efficiency, restorative action. The presence of trace elements in this water - iron, arsenic, fluorine, iodine, etc. determines the significant corrective role of mineral waters in the state of cardiovascular activity, especially in the processes of excitation and contraction of the heart muscle, increasing its resistance to oxygen starvation, in the hemostatic system, the immune system status, improving the adaptive capabilities of the body.

In the course of the studies, when developing the method of the transpulmonary route of administration of weakly mineralized bicarbonate chloride-sodium-calcium-arsenic-boric mineral water into the body in the form of ultrasonic (highly dispersed) aerosol, a rather high therapeutic effect was revealed. It is known that the dispersion of the drug enhances the pharmacokinetics, pharmacodynamics, pharmacological activity of the aerosol. Among the advantages of this method of using mineral waters is the low consumption of the volume of mineral water (per 1 patient up to 10 ml per procedure), which increases the throughput of the physiotherapy room.

In the resort, in the system of rehabilitation measures for children with PAG, balneotherapy (hydrogen sulfide baths), which has a clear cardiotonic, sedative, antioxidant effect, also occupies an important place.

There is a method of treating children with PAG by using common hydrogen sulfide baths at a concentration of hydrogen sulfide 50 mg / l, water temperature 36 ° C with an exposure of 5 minutes to 10 minutes for a course of 8-10 baths every other day ("Methods of treatment with natural and reformed physical factors of children with primary arterial hypertension. "- Guidelines. - Sochi. - 1991).

However, the known method does not give the desired result, the concentration of hydrogen sulfide from the sex of the child is not taken into account, and when using this method, stable normalization of hemodynamics does not occur.

The technical result of the invention is to increase therapeutic efficacy and develop a new economically significant method for the complex treatment of children with primary arterial hypertension by increasing the adaptive capacity of the body and its tolerance to physical activity.

The technical result is achieved by the fact that after a five-day adaptation, ultrasonic inhalations are carried out with weakly mineralized bicarbonate chloride-sodium-calcium carbonate-arsenic with a low content of boron mineral water at an aerosol flow rate of 5 l / min for 3 minutes followed by inhalation with olive or stone seed oil, and hydrogen sulfide in a balneotherapy days free from inhalation, for boys at a concentration of hydrogen sulfide of 50-100 mg / l, for girls - 25-50 mg / l, for a course of 8 balneotherapy and 10 physiotherapy.

The method is carried out using a commercially available ultrasonic inhaler THOMEX L-2 (drop spectrum 0.5-8 microns, fogging efficiency 2.5 ml / min, the ability to adjust the air flow from 0 to 20 liters per minute, which allows you to correctly dose the amount introduced into respiratory tract of a therapeutic substance). Procedures are released in a separate room with a permanent supply and exhaust ventilation according to the standard rules for ultrasonic inhalers. To obtain highly dispersed aerosols, low-mineralized bicarbonate chloride-sodium-calcium carbonate-arsenic minerals with a low content of boron are used with mineral water with arsenic content of 1.5 mg / l, boron - 40.4 mg / l, silicon - 37.1 mg / l, sodium - 189.1 mg / l, magnesium - 42.4 mg / l, calcium - 448.5 mg / l, iron (sour) - 8.4 mg / l, fluorine - up to 1.6 mg / l, chlorine - 66 , 0 mg / l.

Set the following parameters for ultrasound inhalation:

- The composition of the mineral water corresponds to that produced for domestic use.

- Aerosol flow rate of 5 l / min.

- Consumption of mineral water 5 cubic meters. cm.

- Duration of inhalation of aerosol 3 min.

- The course consists of 10 procedures dispensed every other day.

During the ultrasound inhalation procedure, the rhythm, frequency and depth of inhalation are normal and should be consistent with the conditions when measuring basal metabolic rate. Forced and intermittent breathing can cause hyperventilation and undesirable orthostatic reactions or provoke cardiac arrhythmia. When inhaling a finely dispersed aerosol of mineral water, irritation of the mucous membrane of the respiratory tract can be observed, therefore, after inhalation of mineral water, a 3-minute inhalation with olive or stone oil is immediately carried out.

General hydrogen sulfide baths are prescribed from the 7th day of the child’s stay in the clinic at a water temperature of 36 ° C, lasting 4-10 minutes (increasing the vacation of each subsequent procedure by 1 minute) every other day with ultrasound inhalation of mineral water for boys at a concentration of hydrogen sulfide 50-100 mg / l, for girls - 25-50 mg / l of hydrogen sulfide, in the course of 8 baths (table 1).

Example 1. Patient Peter K., 14 years old, was treated at the Children's Clinic of the SRRC since 01.05. - May 26, 2001 with a diagnosis of Primary arterial hypertension. Chronic compensated tonsillitis. A child from 3 pregnancies, proceeding against the background of acute respiratory viral infection, anemia and the threat of interruption in the second half, at birth, body weight 3500.0. The neonatal period without features. Psychophysical development according to age. Until 2 years, practically did not get sick, then - frequent acute respiratory infections up to 4-5 times, tonsillitis - annually. At 3.5 years old, he suffered from infectious toxic cardiopathy against the background of follicular tonsillitis. Up to 10 years, 1-2 times a year, exacerbation of chronic tonsillitis. Heredity is burdened: grandmother (on the maternal side) coronary heart disease (CHD), hypertension. From the age of 12, headaches and dizziness began to bother. An increase in blood pressure to 150/90 mm Hg was detected. at the age of 13 years. When examined in a children's clinical hospital, symptomatic hypertension is excluded. Routine treatment was not carried out.

Upon admission to the clinic, the center complained of headaches, fatigue, stitching pains in the heart, dizziness.

Objectively: Height 176 cm, weight 62.7 kg. The skin and visible mucous membranes are clean, pale pink. Subcutaneous fat is moderately developed, muscle tone is satisfactory. Tonsils are hypertrophied to the II degree, friable, no raids. Peripheral lymph nodes are not palpable. Respiratory, digestive and musculoskeletal systems without pathology. The limits of relative cardiac dullness are within normal limits. The apical impulse is Y m / r, tones are muffled, rhythmic, II tone accent on the aorta, short systolic murmur at the apex. Pulse 80 beats / min. HELL (right hand) 150/90 mm Hg, HELL (left hand) 140/80 mm Hg

The results of the examination before treatment: Blood - HB 150 g / l, L -5.7 × 10 / l, e / 3 p / 3 s / 64 l / 27 m / 3, ESR - 4 mm / h.

Clinical analysis of urine is within normal limits.

Biochemical analysis of blood: medium-molecular peptides - 0.314 cu, serum catalase 55.6 μkat / l, ceruloplasmin - 0.213 mg / l, diene conjugates - 4.08 cu, malondialdehyde 62.28 nmol / ml.

ECG results: rhythm 65 per minute, RR-0.91 ", PQ-0.16", QRS-0.06 ", QT-0.35". Sinus rhythm. The vertical position of the axis. Signs of left ventricular hypertrophy.

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

Bicycle ergometry results: initial - heart rate 78 beats / min, blood pressure - 140/80 mm Hg, 3 minutes 1 load - heart rate 119 beats / min, blood pressure - 150/90 mm Hg, 3 minutes II load - heart rate 129 beats / min, BP - 165/100 mm Hg, 3 minutes III load - heart rate -162 beats / min, BP - 180/100 mm Hg During the recovery period (4 minutes) - heart rate of 97 beats / min, blood pressure - 140/90 mm Hg, index DP (GARDEN × HR / 100), at a load height of 291.6. Physical performance - 600 kg · m / min. In the process of bicycle ergometry, from the II load of 3 minutes there were complaints of shortness of breath, headache, fatigue. Clinoortoproba is a hyperdiastolic variant. After the examination, on the 6th day after adaptation, the child is prescribed a course of treatment according to the proposed method (Table 1): Ultrasonic inhalations of weakly mineralized bicarbonate chloride-sodium-calcium-arsenic with low boron content of mineral water at an aerosol flow rate of 5 l / min for 3 minutes every other day No. 10 followed by inhalation with olive oil in combination with hydrogen sulfide baths with a concentration of hydrogen sulfide 100 mg / l (inlet bath 50 mg / l) at a water temperature of 36 ° C, lasting from 4 to 1 0 minutes (the exposure of each subsequent procedure increases by 1 minute) No. 8, which are released on days free of ultrasound inhalation. In addition, on days free of baths, the child received exercise therapy, dosed walking using sports and recreational games.

After 4 procedures, the child's complaints of fatigue and headaches disappeared. Blood pressure decreased to 130/80 mm Hg. When taking balneotherapy, a pathological reaction was not noted. After taking 5-6 procedures, headaches disappeared, blood pressure decreased to 120/80 mm Hg. The child’s general medical complex according to the proposed method was well tolerated. During exercise, no complaints. During treatment, blood pressure stabilized within 120/80 mm RT. ct Clinical analysis of blood, urine, ECG after treatment is within normal limits. The indicators of lipid oxidation and antioxidant protection improved: the number of diene conjugates decreased by 64.7%, malondialdehyde of erythrocytes - by 11.4%, while a decrease in serum catalase was noted, which is explained by the initial overstrain of the antioxidant defense system and its depletion during inactivation of an increased amount hydrogen peroxide in the blood. After the treatment, there were positive changes in the reaction of the cardiovascular system to physical activity. The tolerance of muscle work has improved, resulting in an increase in the power of the work performed.

Examination data after treatment:

Bicycle ergometry: initial - heart rate 72 beats / min, blood pressure 120/80 mm Hg, 3 minutes 1 load - heart rate 100 beats / min, blood pressure 140/80 mm Hg, 3 minutes II load - heart rate of 120 beats / min, blood pressure - 150/80 mm Hg, at 3 minutes of III load - heart rate - 143 beats / min, blood pressure of -160/90 mm Hg, at 3 minutes of IV load - Heart rate - 166 beats / min, blood pressure - 170/90 mm Hg During the recovery period (4 minutes) - heart rate - 83 beats / min, blood pressure - 120/80 mm Hg, DP index - 282.2 (at load height), physical performance - 750 kg · m / min. Clinoorthostatic test - normotonic option. As a result of treatment, a positive dynamics of clinical data was noted: complaints disappeared, heart sounds became louder, blood pressure was 120/80 mm Hg. The child was discharged with significant improvement. Evaluation of the effectiveness of the treatment are shown in table 2.

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

A girl from II pregnancy, against the background of anemia, II urgent delivery with a mass of 3400.0. I suffered rickets up to a year, thymus hyperplasia was noted. From an early age, frequent acute respiratory viral infections. Since March 1999, pain in the heart, palpitations, and increased blood pressure to 140/90 mm Hg first appeared. In recent years, there has been a tendency to increase blood pressure to 150-160 / 90 mmHg, heart rate of 100-120 beats / min, on the ECG - lengthening of A-V conductivity. Cardialgia with excitement and running. Upon admission to the clinic center, complaints of headache, dizziness, fatigue, anxiety, irritability, stitching pains in the heart.

Objective examination data: the physique is correct, the skin and visible mucous membranes are clean, pale pink. Subcutaneous fat is moderately developed. Asymmetry of the shoulders and shoulder blades. Tonsils loose, hypertrophied to I-II art. no raids. Lymph nodes are not palpable. The boundaries of relative cardiac dullness within the age norm. The apical impulse in At m / rib. Heart sounds are muffled, rhythmic, moderate systolic murmur is heard at the top and top of Botkin, and is not performed outside the heart. Pulse 78 beats / min. HELL (right hand) - 140/80 mm Hg, HELL (left hand) - 130/80 mm Hg On the part of the respiratory system, digestion, excretory system, pathology was not detected. Mensis from 12 years old, continuous, slightly painful, mild for 4-5 days.

Examination data before treatment.

Complete blood count: HB - 139 g / l, Er - 4.15 × 10 12 / l, CP - 0.99, L-4.2 × 10 9 / l, P / 2, C / 43, E / 0 , L / 44, M / 11, ESR 8 mm / hour.

Clinical analysis of urine is within normal limits.

ECG - sinus arrhythmia. Normal axis position. Violation of intraventricular conduction.

Ultrasound of the kidneys - without pathology.

Biochemical analysis of blood: medium molecular peptides - 0.290 conv. units, serum catalase - 35.9 μkat / l, ceruloplasmin - 0.218 g / l, diene conjugates - 3.73 rel. units, malondialdehyde - 53.35 nmol / ml.

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

Bicycle ergometry results: heart rate - 88 beats / min, blood pressure - 130/80 mm Hg, 3 minutes 1 load - heart rate 107 beats / min, blood pressure 140/90 beats / min, 3 minutes II load - Heart rate 133 beats / min, BP 150/90 mm Hg, at 3 minutes of III load - heart rate 160 beats / min, BP 170/90 mm Hg During the recovery period (4 minutes) - heart rate of 98 bpm, blood pressure 140/90 mm Hg Index DP (CAD × HR / 100) at a load height of 272. Physical performance 450 kg · m / min (achieved power 75 W). In the process of bicycle ergometry at 3 load there were complaints of shortness of breath, fatigue, dizziness. Clinoorthostatic test - hyperdiastolic variant.

The girl was prescribed treatment according to the proposed method (table 1):

- adaptation of 5 days

- diet, table 15

- climatotherapy according to regimen 1-II

- LFK, cardiovascular group on the river II

- Ultrasound inhalation of low-mineralized bicarbonate chloride-sodium-calcium-arsenic carbonate with a low content of boron with mineral water for 3 minutes every other day No. 10, followed by inhalation with stone oil (to relieve irritation of the respiratory tract mucosa).

- General hydrogen sulfide baths with a concentration of hydrogen sulfide 50 mg / l (inlet bath - 25 mg / l hydrogen sulfide) on days free of inhalation, No. 8 at a water temperature of 36 ° C, lasting from 4 to 10 minutes (increasing the vacation of each next bath by 1 minute).

The first procedures of ultrasonic inhalation and shared baths were well tolerated. After 4-5 procedures, complaints of headache, dizziness, fatigue disappeared. Improved emotional tone. HELL - 120/80 mm Hg The general medical complex was well tolerated. It was discharged with significant improvement, which was expressed in the disappearance of pain in the heart, headaches disappeared, mood improved, performance increased, blood pressure decreased to - 110-120 / 70-80 mm Hg. Positive dynamics of peripheral blood was noted: HB - 140 g / l, L-4.8 × 10 9 / l, E / 3, P / 2, C / 54, L / 35, M / 6, ESR 5 mm / h. On the ECG - a normal variant. Clinoorthostatic test - normotonic option.

Bicycle ergometry: the achieved power during treatment is 100 W (600 kg · m / min), an increase in the double indicator to 285.6 is noted. The performance indicators improved, exercise tolerance was 86.5%.

After treatment, positive dynamics were noted in the system of antioxidant protection of blood and lipid peroxidation in the form of a decrease in the level of diene conjugates and malondialdehydes both in the stroma of red blood cells and lipids. Assessment of the effectiveness of the treatment are shown in table 3.

A comprehensive assessment of the effectiveness was carried out on the basis of counting the number of signs (indicators) with favorable dynamics. At the same time, the following categories of assessments were established: significant improvement - 11 signs with positive dynamics, improvement - 6-10 signs, slight improvement - 1-5 signs, deterioration - adverse changes.

To evaluate the effectiveness of the proposed method of treatment, a comparative characteristic was performed in 2 groups of patients.

Group I - 30 children (boys and girls) aged 12-15 years with primary arterial hypertension were treated with hydrogen sulfide balneotherapy in the form of hydrogen sulfide common baths at a concentration of hydrogen sulfide 50 mg / L No. 8 every other day at a water temperature of 36 ° C for 5- 10 minutes on the background of physiotherapy exercises, dosed walking using sports and recreational games (prototype).

Group II - 30 children (boys and girls) aged 12-15 years with primary arterial hypertension received treatment according to the proposed method according to the procedure of vacation procedures (table 1).

The treatment in both groups contributed to favorable changes in subjective status. After treatment with the proposed method, subjective complaints were completely stopped both from boys and girls, while during treatment by the prototype method the number of complaints only significantly decreased.

The formation of PAG in children depends on the type of hemodynamics, i.e. from a coordinated relationship between cardiac output and peripheral blood flow resistance. In the group of children who received treatment according to the prototype, the therapeutic effect was revealed with a hyperkinetic type of blood circulation due to a decrease in stroke volume. In the group of children treated according to the proposed method, significant changes were noted both with the hyperkinetic type of blood circulation and with eukinetic, as well as the activation of the antioxidant blood protection system and positive changes in the lipid peroxidation system in the form of a decrease in the level of DC and MDA as in the stroma red blood cells and lipids.

Thus, a pronounced hypotensive effect, an increase in exercise tolerance and, as a result, an improvement in the general condition and clinical indicators during treatment by the proposed method was noted in 83.3% of cases, while treatment by the prototype method in 72.2% of cases.

Assessing the effectiveness of the treatment according to the proposed method according to example 1 is presented in table 2.

Assessing the effectiveness of the treatment according to the proposed method according to example 2 are shown in table 3.

Thus, the proposed method of treatment allows to increase the therapeutic effectiveness of the spa treatment of children with primary arterial hypertension by 11.10% by increasing the adaptive capabilities of the body and its tolerance to physical activity.

Literature

1. Belokon N.A., Kuberger M.B. Diseases of the heart and blood vessels in children. - Moscow. - The medicine. - 1987. - T.2. - S.136-190.

2. Karachevtseva T.V. Balneotherapy of various diseases in childhood. - Moscow. - The medicine. - 1988 .-- S.802.

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

4. Alexandrov A.A. Prevention of cardiovascular disease since childhood is a new approach to preventive cardiology. - Cardiology. - 1987. - No. 9.

5. Bogolyubov V. M., Ponomarenko G. N. General physiotherapy. - Moscow. - St. Petersburg. - 1997.

6. Therapeutic use of carbonic arsenic water Chvizhepsa with hypertension. Guidelines. - Sochi. - 1979.

7. Ivanov V.V. The main criteria for assessing the chemical composition of mineral waters. - M., Centrsovetkurort. - 1982: GOST 13273-88. Mineral water for drinking and healing - canteens.

8. Garkavi L.Kh., Kvakina E.B. and others. Adaptation reactions and body resistance. - Rostov-on-Don. - 1990. - p. 222.

9. Garkavi L.Kh., Kvakina E.B. et al. Signal indicators of antistress reactions and stress in children. - Pediatrics. - 1996. - No. 5. - p. 107-109.

Claims (1)

A method of treating children with primary arterial hypertension by means of common hydrogen sulfide baths, released on the background of physiotherapy exercises, dosed walking using sports and recreational games every other day at a water temperature of 36 ° C for 5-10 minutes, characterized in that ultrasonic inhalations are performed after five days of adaptation slightly mineralized hydrocarbonate chloride-sodium-calcium carbonate-arsenic with a low content of boron mineral water at an aerosol flow rate of 5 l / min Stew 3 min followed by inhalation or olive kernel oil, and hydrosulphuric balneotherapy performed during inhalation boys free of hydrogen sulfide at a concentration of 50-100 mg / l, girls - 25-50 mg / L at rate of 8 and 10 balneo- fizioprotsedur.