RU2350307C2 - Method of treatment of children with primary arterial hypertensia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely pediatrics and can be used at treatment of children with a primary arterial hypertensia. After five-day adaptation ultrasonic inhalations are spent using a in day brackish hydrocarbonate-chloride-sodium-boric mineral water at a flow rate of an aerosol 5 l/min. Durations of 3 minutes with the subsequent carrying out of inhalation peach or another stone oil in a combination to psychotherapy as a biological feedback it (IS barefooted) in day. In days free from inhalations also it is barefooted spend the general hydrosulphuric baths at temperature of water 36 deg. With duration from 5 till 10 minutes which release to boys at concentration of hydrogen sulphide in water of the first bath - 50 mg/l subsequent - 100 mg/l, and to girls with concentration of hydrogen sulphide in water of the first bath - 25 mg/l subsequent - 50 mg/l, in a day. On a course on 8 fizio - and balneological treatment.

EFFECT: method provides restoration of cardiogemodynamics and tolerance rising to exercise stresses, activates system of antioxidatic protection of blood.

3 tbl, 2 ex

Description

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

Primary arterial hypertension (PAG) in children and adolescents is a common disease of the cardiovascular system, which is subsequently a risk factor in adults with respect to the development of atherosclerosis, coronary heart disease, cerebral complications, heart failure. The sources of hypertension in adults should be sought in childhood and adolescence, when neurogenic and humoral mechanisms of regulation of the cardiovascular system and blood pressure are formed.

The pathogenetic mechanisms of arterial hypertension have been studied in detail by H. Markov and his collaborators for several years. In their opinion, PAG in children and adolescents is essentially a regulatory disease. This is manifested by a violation of the activity and interaction between neurohumoral systems of blood pressure regulation, as well as structural changes in blood vessels, membrane and other disorders of their cells that develop as hypertension progresses, on the one hand, and blood pressure growth, on the other. Under appropriate conditions, all this leads to the formation of mutually reinforcing interactions, which ultimately determines the predominance of pressor mechanisms and the development of arterial hypertension.

A special place in PAG is occupied by changes in transmembrane fluxes of ions, such as sodium, potassium, and especially calcium, in relation to which an increased permeability of the cell membrane surface has been established. Both that and another leads to an increased level of intracellular ionized calcium, the activity of the contractile apparatus of the muscle cells of blood vessels and the heart.

A study of central and peripheral hemodynamics revealed that the most characteristic for PAG in children and adolescents at the initial stage of the disease is the hyperkinetic type of circulation.

In the pathogenesis of the early stage of PAG with a hyperkinetic type of circulation, activation of the sympathoadrenal system plays a key role.

An important place among the triggers of the disease is occupied by violations of adaptation processes. Children with PAG are distinguished by peculiarities of responding to stressful situations, which is manifested in the development of persistent emotional stress, which significantly reduces the adaptive capabilities of the body.

For children suffering from PAG, especially PAGE IA stage, it is enough to exclude stress factors, change the environment so that blood pressure normalizes. Therefore, the use of psychotherapeutic techniques will allow an older child and adolescent to withstand the effects of stress.

In this sense, the biological feedback method (BFB) has proven itself well. Its essence is to teach the patient how to manage the physiological functions of his own body under the control of the instrument and software of the biofeedback system. This method is based on the universally recognized concept of homeostasis, according to which all physiological systems of the body tend to return to a state of stable equilibrium as soon as the factor that removes them from this state ceases to act. Important physiological systems involved in the regulation of homeostasis are respiratory and cardiovascular. The activity of the cardiovascular system is autonomous, and the respiratory system is subject to arbitrary control.

The advantages of these developments are that they use a highly effective, non-drug, absolutely harmless method of diagnosis and rehabilitation treatment. Moreover, in each case, individual characteristics and personalities are taken into account, the load for training is dosed and its implementation is effectively monitored.

Biofeedback is available to patients of all ages, from the youngest children to the very elderly. The gaming capabilities of computer biofeedback turn treatment sessions into an exciting lesson. The emotional interest of patients, “visible” control, improvement of the condition halves (or more) the rehabilitation time, allows halving the drug load, includes the reserves of the human body and improves self-regulation mechanisms.

For a healthy person, the BOS method ensures the perfect work of all body systems and protects them from illness. The patient is given a tool for disclosing and using the body’s reserves for therapeutic purposes.

An alarming situation has developed. According to the information at our disposal, up to 35% of children 6-7 years of age have psychophysiological abnormalities, and by the time they graduate, the percentage of such abnormalities reaches 75-98%. This is directly related to the sharp increase in psychophysiological stresses acting on the growing child’s body both in the family and at school, it requires effective psychological and medical measures aimed at correcting the psychophysiological deviations of schoolchildren, expanding their ability to withstand the consequences of school and everyday stressful situations , the ability to develop skills of biological and social adaptation to various life situations. In this sense, the biofeedback method (BFB) or BFB correction is well established as a method that makes it possible to successfully solve these problems.

Psychotherapy, or psychological correction, is aimed at eliminating neuropsychiatric manifestations. It includes the methods of mental (biological feedback method) and muscle (maximum relaxation of peripheral skeletal muscle) relaxation. The use of psychorelaxation therapy, especially respiratory relaxation training and the biofeedback method in patients with PAG, leads to a significant decrease in OPS and blood pressure, as well as a not so significant increase in blood pressure in response to stressful effects under the influence of psychophysiological self-regulation.

In the resort, in the system of rehabilitation measures for PAG in children, balneotherapy, which has a cardiotonic and sedative effect, occupies an important place. In recent years, the development of methods of spa treatment using the resort's mineral waters in various combinations has been of great interest.

Of the unique mineral waters of the Sochi deposits, low-saline hydrocarbonate-chloride-sodium boron water (Lazarevskaya) is used for therapeutic purposes.

The method of transpulmonary introduction of mineral waters into the body in the form of ultrasonic inhalations that we developed has a significant therapeutic effect in combination with hydrogen sulfide balneotherapy and physiotherapy.

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 preformed physical factors of children with primary arterial hypertension ", - Methodological recommendations. - Sochi. - 1991).

However, the known method does not give the desired result; the concentration of hydrogen sulfide from the child’s gender is not taken into account, there is no persistent cardiohemodynamics, adaptation to the load of growing power is not perfect.

The technical result of the invention is to increase therapeutic efficacy, restore cardiodynamics, increase exercise tolerance.

The technical result is achieved by the fact that after a five-day adaptation, ultrasonic inhalations are carried out every other day with weakly mineralized hydrocarbonate-chloride-sodium-boron mineral water at an aerosol flow rate of 5 l / min. 3 minutes followed by inhalation with peach or other bone oil in combination with biofeedback psychotherapy (BFB) every other day, in combination with general hydrogen sulfide baths, which are released for boys at a concentration of 50 mg / l of hydrogen sulfide in the first bath water, subsequent 100 mg / l, and for girls with a concentration of hydrogen sulfide in the water of the first bath 25 mg / l, subsequent 50 mg / l, every other day, on days free of inhalation and BOS, for a course of 8 physiotherapy and balneotherapy.

Table 1.
Scheme vacation procedures for the proposed method Days healed. No. p / p Total hydrogen sulfide baths (mg / l). Water temperature 36 ° C Ultrasonic inhalations 5 l / min time - 3 min Biofeedback Boys (mg / L // min) Girls (mg / l // min) 1-5 Adaptation + + 6 - - + + 7 50/5 25/5 - - 8 - - + + 9 100/6 50/6 - - 10 - - + + eleven 100/7 50/7 - - 12 - - + + 13 100/8 50/8 - - fourteen - - + + fifteen 100/9 50/9 - - 16 - - + + 17 100/10 50/10 - - eighteen - - + + 19 100/10 50/10 - - twenty - - - - 21 100/10 50/10 - - 22 - - - - 23 - - - - Total Number 8 Number 8 Number 8 Number 8

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 the respiratory tract of the therapeutic substance. The procedures are released in a separate room with a constant supply and exhaust ventilation according to standard rules for ultrasonic inhalers. To obtain highly dispersed aerosols, low-minerals are used Call bicarbonate - sodium chloride-boric mineral water: silicic acid with a content of 13.4 mg / dm ^3, boric acid, 150.8 mg / dm ^3, iron 3.0 mg / dm ³ ( "Lazarevskaya")..

Set the following parameters for ultrasound inhalation:

- aerosol flow rate of 5 l / min;

- mineral water consumption of 5 cc;

- the duration of inhalation of an aerosol of 3 minutes;

The course consists of 10 procedures dispensed every other day.

During the procedure of ultrasound inhalation, the rhythm, frequency and depth of breathing are normal and should correspond to the conditions when measuring basal metabolic rate. Upon inhalation of a highly dispersed aerosol of mineral water, irritation of the mucous membrane of the respiratory tract can be observed, therefore, after inhalation with mineral water, a 3-minute inhalation is immediately carried out with olive or other stone oil.

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 from 5 to 10 minutes (increasing the vacation of each subsequent procedure by 1 minute) at a concentration of hydrogen sulfide in water for boys of the first bath 50 mg / l, the following 100 mg / l, and for girls with a concentration of hydrogen sulfide in the water of the first bath 25 mg / l, the next 50 mg / l, every other day, on days free of inhalation and BF, for a course of 8 physiotherapy and balneotherapy.

Psychotherapy or the method of biological feedback (BFB) is carried out from the apparatus manufactured by JSC Biosvyaz, St. Petersburg. Classes are held individually. Before starting classes, a conversation is held with the patient to eliminate psychological contact and increase motivation for treatment: they explain the purpose of the classes, the essence of the methodology and the principle of the device. Procedures are released in a sitting position with a frequency of 3 times a week (general course of 8 procedures). The duration of each lesson is 30-45 minutes (of which 10-15 minutes before training, patients are questioned about their well-being, the success of the technique, then 20-25 minutes are the training itself and the remaining time is its discussion.

Example 1. Patient Kishko Igor, 15 years old, was treated at the Yunost sanatorium from 2.03.06 g. To 03.27.06.06 with a diagnosis of vegetative-vascular dystonia of the hypertonic type. JEWP. Obesity II degree.

A boy from the 3rd pregnancy, 2 urgent births with a weight of 4 kg. Asphyxia in childbirth, moderate. At the age of 3 months was examined by a neurologist, diagnosis: perinatal encephalopathy, hydrocephalic syndrome. Moved rickets. A history of frequent SARS, bronchitis. At the age of 11, he had viral hepatitis. At 13 years old, examined by a neurologist, diagnosis: post-traumatic encephalopathy, intracranial hypertension, nocturnal enuresis. From the 5th grade, headaches began to disturb, 2 times were fainting. In IV-02, he was hospitalized: dispancreatism. Nephropathy of the first degree, juvenile hypertension (fluctuations in blood pressure 140-150 / 70-80 mm Hg). In 2001, he was operated on for an inguinal hernia.

On admission, he complained of headaches, weakness, fatigue, pain in the heart, dizziness.

Objectively: the condition is satisfactory. Proper physique, increased nutrition. The skin is clean, normal color. Respiratory, digestive and musculoskeletal systems without pathology. Heart - tones are muffled, short systolic murmur at the apex, V-point. HELL 140/80 mm Hg Pulse 80 beats / min. The liver is not enlarged. Urination is not impaired.

The results of the examination before treatment are as follows.

In general, a blood and urine test is without pathology.

On the ECG - heart rate of 66 beats / min (from 03.25.06). Sinus rhythm. Normal position of the electrical axis of the heart. Sinus bradycardia.

Biochemical analysis of blood: medium molecular weight peptides 0.240 cu, serum catalase 35.2 μkat / l, ceruloplasmin 0.280 mg / l, diene conjugates of blood plasma lipids 3.50 rel. Units, malonic dialydehyde of red blood cells 26.9 nmol / ml.

Bicycle ergometry results: initial - heart rate 82 beats / min, blood pressure 125/80 mm Hg, 3 minutes 1 load - heart rate 105 beats / min, blood pressure 140/100 mm Hg, 3 minutes II load - heart rate 120 beats / min, BP 150/100 mm Hg, at 3 minutes of III load - heart rate 125 beats / min, BP 160/100 mm Hg, at 3 minutes of IV load - heart rate 130 beats / min, BP - 170/100 mm Hg During the recovery period of 4 minutes - heart rate 86 beats / min, blood pressure 130/80 mm Hg, index DP (GARDEN * heart rate / 100) 216. Physical performance 700 kg m / min. In the process of bicycle ergometry from the III load of the 3rd minute there were complaints of shortness of breath, headache, fatigue.

After adaptation, the child is prescribed a course of treatment according to the proposed method (table 1): ultrasonic inhalation of low-mineralized hydrocarbonate-chloride-sodium-boron mineral water (Lazarevskaya) at an aerosol flow rate of 5 l / min, lasting 3 minutes, followed by inhalation with peach oil, through day, No. 8 in combination with biofeedback psychotherapy (BFB), on the same day, for a course of 8 procedures and hydrogen sulfide baths with a concentration of hydrogen sulfide for boys (table 1: first bath 50 mg / l, followed by 100 mg / l at a water temperature of 36 ° C, lasting from 5 to 10 minutes (the exposure of each subsequent procedure increases by 1 minute) for a course of No. 8 baths, which were released on days free from ultrasound inhalation and biofeedback.

After the 4th procedure, the child stopped complaining of headaches, pains in the heart, fatigue. After the 6th procedure, blood pressure decreased to 120/80 mm Hg. The treatment complex according to the proposed method was well tolerated. During exercise, no complaints. During treatment, blood pressure stabilized to 110-120 / 70-80 mm Hg. Improved lipid peroxidation and antioxidant protection. Positive shifts have come in the reaction of the cardiovascular system to physical activity, the power of the work done has increased, and tolerance to physical activity has increased.

Examination data after treatment:

Bicycle ergometry: initial - heart rate 80 beats / min, blood pressure 110/80 mm Hg, 3 minutes I load - heart rate 105 beats / min, blood pressure 125/80 mm Hg, 3 minutes II load - heart rate 130 beats / min, BP 130/90 mm Hg, at 3 minutes of III load - heart rate 135 beats / min, BP 140/90 mm Hg, at 3 minutes of IV load - heart rate 140 beats / min. HELL 150 mm Hg, 3 minutes V load - heart rate 160 beats / min, HELL 165/80 mm Hg During the recovery period at 4 minutes - heart rate of 90 beats / min, blood pressure 125/80 mm Hg, index DP 253. Physical performance 850 kg m / min.

As a result of the treatment, a positive dynamics of the clinical data was noted: no complaints were made, it became more active, heart sounds became louder, blood pressure was 115-120 / 70-80 mm Hg. The child was discharged with significant improvement.

Example 2. Zhikvarentsova Katya, 14 years old, was admitted to the sanatorium on 2.03.06. She was on 03/27/06 with a diagnosis of VVD. Juvenile hypertension 1 tbsp. Obesity 1-2 tbsp.

A girl from her first pregnancy (dropsy, fetal hypoxia), an urgent birth with a body weight of 3700 g, 52 cm. She grew and developed by age. She was ill with ARI, chickenpox, measles, rubella, and scarlet fever.

In 2001, she suffered a head injury, concussion. After inpatient treatment, the condition improved. In 2002, inpatient treatment was repeated. In 2003, she had a urinary tract infection.

From the anamnesis: since 2002 I began to complain of headaches, paroxysmal pains, nausea, dizziness. Examination revealed hypertension. Fluctuations in blood pressure 140/90 to 160 / 100-110 mm Hg Repeatedly treated in hospitals.

On admission: blood sugar - 4.9 mmol / L.

General blood test dated March 5, 2003: Hb 145 g / l, L 6.0 * 10.9 / l, E 7%, C 63%, L 23%, M 4%, ESR 6 mm / hour.

Urinalysis - without pathology. Urinalysis according to Nechiporenko - without pathology.

Objectively: satisfactory condition, clean skin, normal color. The subcutaneous fat layer is sufficiently developed. Regional lymph nodes are not enlarged. In the lungs - vesicular breathing. Heart sounds are arrhythmic, somewhat muffled, short systolic murmur at the apex. The abdomen is soft, painless.

On the ECG from 03/10/06 - heart rate of 72 beats / min. Sinus rhythm, unstable. Normal position of the electrical axis of the heart.

Consultation with an optometrist. At the fundus, the veins are dilated, full-blooded. Diagnosis: angiopathy of the retinal vessels.

Biochemical analysis of blood: medium molecular weight peptides 0.270 conventional units, serum catalase 35.9 μkat / l, 52.56 nmol / ml.

Bicycle ergometry results: initial heart rate 86 beats / min, blood pressure 130/80 mm Hg, 3 minutes of 1 load - heart rate 115 beats / min, blood pressure 140/80 beats / min, 3 minutes of the second load - heart rate 122 beats / min, BP 140/70 mm Hg, at 3 minutes of III load - heart rate 143 beats / min, BP 150/70 mm Hg 3 minutes IV load - heart rate 158 beats / min, blood pressure 160/80. During the recovery period (4 minutes) - heart rate of 97 beats / min, blood pressure 130/70 mm Hg Index DP (GARDEN × HR / 100) at a load height of 253. Physical performance 600 kg m / min (achieved power 100 W). In the process of bicycle ergometry at 2 load, shortness of breath, fatigue appeared, at the end of the IV load - dizziness.

Clinoorthostatic test - hyperdiastolic variant.

After adaptation and examination on day 6, the girl was prescribed a course of treatment according to the proposed method (table 1): ultrasonic inhalation of weakly mineralized hydrocarbonate-chloride-sodium-boron mineral water (Lazarevskaya) at an aerosol flow rate of 5 l / min, lasting 3 minutes subsequent inhalation with peach oil, every other day, No. 8 in combination with biofeedback psychotherapy (BFB), on the same day, for a course of 8 procedures and hydrogen sulfide baths with a concentration of hydrogen sulfide for girls, the first bath 25 mg / l, subsequent 50 mg / l at a water temperature of 36 ° C, lasting from 5 to 10 minutes (the exposure of each subsequent procedure increases by 1 minute) for the course No. 8 baths, which were released on days free from ultrasound inhalation and Biofeedback.

After 4-5 procedures, the girl stopped complaining of headache, dizziness, fatigue, palpitations. Improved emotional tone. HELL decreased to 120/80 mm RT. Art. The general medical complex of the proposed method was well tolerated. During treatment, blood pressure stabilized to 110-120 / 80 mm. Hg, peripheral blood indices improved 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. On the ECG, after treatment, the normal option. Positive shifts have come in the reaction of the cardiovascular system to physical activity.

Bicycle ergometry after treatment: initial - heart rate of 80 beats / min, blood pressure 110/70 mm Hg, 3 minutes of 1 load - heart rate 109 beats / min, blood pressure 120/80 mm Hg, 3 minutes 2 loads - Heart rate 125 beats / min, blood pressure 130/80 mm Hg, 3 minutes 3 loads - heart rate 139 beats / min, blood pressure 130/80 mm Hg, 3 minutes - heart rate 160 beats, BP 140 / 80 mm Hg, 3 minutes 4 loads - heart rate 169 beats / min, BP 140/80 mm Hg, index DT 237. Physical performance 750 kg x. m / min (achieved power 125 W).

Clinoorthostatic test - normotonic option. As a result of treatment, a positive dynamics of clinical data was noted: complaints disappeared, mood improved, performance increased, blood pressure decreased to 110-120 / 70-80 mm Hg, heart sounds became louder. The girl was discharged with significant improvement.

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 assessment categories were established: significant improvement of 11 signs with positive dynamics, improvement of 6-10 signs, slight improvement of 1-5 signs, worsening - adverse changes.

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

1 group of 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 min on the background of physiotherapy exercises, dosed walking using sports and recreational games (prototype).

II group of 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 by 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 96% of cases, while treatment by the prototype method in 92% 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.

table 2
Assessing the effectiveness of the treatment according to the proposed method according to the example The name of indicators before treatment after treatment score effect. Headache + - + Pain in the heart + - + Dizziness + - + Body weight (kg) 62.5 67.8 - Heart rate (bpm) 80 75 + Systolic blood pressure (mmHg) 140 120 + Diastolic blood pressure (mmHg) 90 80 + The average dynamic blood pressure (mmHg) 106.6 93.3 + Double product under load 216 253 - Physical Performance (kg m / min) 650 850 + Impact volume (ml) 78,2 71,4 + Peripheral resistivity 22.7 22.2 -

Table 3
Assessing the effectiveness of the treatment according to the proposed method in example 2 The name of indicators before treatment after treatment score effect. Headache + - + Pain in the heart + - + Heartbeat + - + Body weight (kg) 55,4 57.5 + Heart rate (bpm) 92 80 + Dizziness + - + Systolic blood pressure (mmHg) 140 120 + Diastolic blood pressure (mmHg) 90 80 + The average dynamic blood pressure (mmHg) 103.3 90 + Double product under load 253 237 + Physical Performance (kg m / min) 600 750 + Impact volume (ml) 68,2 61.3 + Peripheral resistivity 21.8 21.3 -

Thus, the proposed method of treatment allows to increase the therapeutic effectiveness of the spa treatment of children with primary arterial hypertension by 96% by increasing the adaptive capacity of the body and its tolerance to physical activity.

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 a duration of 5 to 10 minutes, characterized in that after a five-day adaptation is carried out every other day ultrasonic inhalations of low-mineralized hydrocarbonate-chloride-sodium-boron mineral water at an aerosol flow rate of 5 l / min, duration 3 minutes, followed by halations with peach or other bone oil in combination with biofeedback psychotherapy (BFB) every other day, in combination with common hydrogen sulfide baths, which are released to boys at a concentration of hydrogen sulfide in the water of the first bath - 50 mg / l, subsequent - 100 mg / l and for girls with a concentration of hydrogen sulfide in the water of the first bath - 25 mg / l, subsequent - 50 mg / l, every other day, on days free of inhalation and BOS, for a course of 8 physiotherapy and balneotherapy.