RU2118149C1 - Method of treatment of children with primary arterial hypertension of 1-b stages - Google Patents

Abstract

FIELD: medicine, pediatrics. SUBSTANCE: method involves carrying out an adaptation period to hydrogen sulfide balneotherapy by total hydrogen sulfides baths and additional carrying out acupuncture-reflexotherapy every day for 10 days. EFFECT: simplified method.

Description

 The invention relates to medicine, namely pediatrics, and can be used in the treatment of children with primary arterial hypertension 2-B stage.

A known method of treating children with primary arterial hypertension 1 A - B Art. by hydrogen sulfide baths at a concentration of hydrogen sulfide of 50 mg / l, a water temperature of 36 ^o C with an exposure of 5 to 10 minutes for a course of 8-10 baths, every other day.

 However, when using the known method of persistent normalization of hemodynamics does not occur.

 The purpose of the invention is the reduction of treatment time and lengthening remission by improving hemodynamic processes.

 The goal is achieved by the fact that after a five-day adaptation of the child in the resort against the background of hydrogen sulfide balneotherapy, acupuncture is additionally carried out daily for 10 days. On bath days, acupuncture is carried out 2-3 hours after taking a bath.

 Scheme vacation procedures are given in table. one.

 The method is as follows.

After a five-day adaptation, children (12-14 years old) with primary arterial hypertension of the 1-B stage are prescribed hydrogen sulfide baths with a concentration of hydrogen sulfide of 100 mg / l (first introduction bath of 50 mg / l) at a water temperature of 36 ^o C, lasting 4 -10 min s 1 min exposure Acupuncture is connected to the general treatment on the seventh day of the child’s stay in the resort, after 2-3 hours if the hydrogen sulfide baths coincide with acupuncture (after the bath).

 The needles are introduced into the corporal acupuncture points for 30-40 minutes according to the second, so-called inhibitory option, followed by a 20-minute rest. For procedures using steel needles of Russian manufacture.

Recipe for acupuncture by treatment day:
First day: Qu-ni GI-II (2); Hae-gu GI-4 (2); San-yin-jiao PP-6 (2) - treatment begins with classic acupuncture points that have a restorative and sedative effect, as well as effective for high blood pressure.

 The second day: Shan-men C-7 (2), Nei-guan MC-5 (2), Zu-san-li E-36 (2) - to normalize the functional state of the nervous system, improve sleep, relieve tension; these points have a selective effect on the increased minimum arterial pressure.

 Third day: Wai-guan TR-5 (2), Da-Zhu Y-11 (2), Fei-shu Y-13 (2) for influencing the collar zone - the centers of the sympathetic and parasympathetic nervous system, as well as for removing neurotic layering.

 Fourth day: Wai-hui T-20, Xin-shu Y-15 (2), Ge-shu Y-17 (2) - to relieve headaches, dizziness, heaviness in the heart and palpitations.

 Fifth day: Qi-hai-shu Y-24 (2), Da-nan-shu Y-25 (2), Shen-shu Y-23 (2) - to restore normalization of the kidneys, removal, neutralization of the renal factor in hypertension .

 Sixth day: Wai-guan TR - 5 (2), Da-Zhu Y-11 (2), Fei-shu Y-13 (2) - to normalize the tone of the sympathetic nervous system, affect the spinal cardiovascular center and have a sedative effect.

 Seventh day: Wai-hui T-20, Xin-shu Y-15 (2), Geishu-shu Y-17 (2) to remove cardiac stratifications, normalize cardiac activity and cerebrovascular symptoms.

 Eighth day: Qi-hai-shu Y-24 (2), Da-chan-shu Y-25 (2), Shen-shu Y-23 (2) - to affect the spinal renal center, to remove renal deposits in hypertension .

 Ninth day: Shen-men C-7 (2), Nei-guan MC-5 (2), Zusan-li E-36 (2) - to consolidate the positive results, normalize blood pressure and relieve tension.

 Tenth day: Qu-chi CI-11 (2), He-gu CI-4 (2), San-yin-jiao RP-6 (2) - to normalize blood pressure, provide a sedative-normalizing, restorative effect.

 Paired points are used on both sides symmetrically and simultaneously no more than six points per procedure. The combination of all the above points is the main therapeutic acupuncture prescription.

 Example. Patient M., 14 years old. Diagnosis: Primary arterial hypertension 1-B Art.

 A child from a second physiological pregnancy was born full-term. Up to a year grew and developed according to age. Transfer of chicken pox, laryngotracheitis, 2 times a year is sick with acute respiratory infections, tonsillitis. Heredity is burdened; a mother suffers from hypotonic disease, an increase in blood pressure was observed in a sister in adolescence.

 Since 1992, headaches and dizziness began to bother. HELL 170/100 mm Hg The boy was examined at the institutes of endocrinology and cardiac surgery. Bakuleva - symptomatic hypertension is excluded. Received antihypertensive drugs. Outpatient received symptomatic treatment.

 Upon admission to the clinic of the institute - complaints of headache, dizziness, drowsiness, fatigue. Height 168 cm, body weight 63.7 kg. The skin is clean, moderately moist. Demographics are red, persistent. Respiratory, digestive, musculoskeletal systems without pathology. Borders of the heart: relative cardiac dullness left +1 cm from the nipple line. Apical impulse in the Y-intercostal space, tones muffled, rhythmic, emphasis II tone on the aorta. At the apex there is a short systolic murmur of moderate intensity, it is not carried out outside the heart, it weakens after exercise. Pulse 80 beats per 1 min. HELL (right hand) 150/90 mm RT. Art., blood pressure (left hand) 140/80 mm Hg

The results of the survey: blood Hb 144.4 g / l, er-4.5 • 10 ¹² / l, CP-0.86, L-7.05 • 10 ⁹ / l, ESR-3 mm / h, s / I-46, p / 2, E-2, M-12, L-38. Clinical analysis of urine is within normal limits. Medium molecular peptides 0.364 conv. units, serum catalase 16.73 mkkat / l, ceruloplasmin - 0.217 mg / l, diene conjugates 1.67 rel.un., malondialdehyde 36.01 nmol / ml. ECG results: rhythm 66 in 1 min, RR - 0.95``, PQ - 0.16 '', QRS - 0.08``, QT - 0.36 ''. Sinus rhythm, semi-horizontal position of the electrical axis of the heart. Signs of left ventricular hypertrophy, incomplete blockade of the right leg of P. His.

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

Indicators of ECHO cardiography: heart rate - 63 beats. in 1 min, systolic blood pressure 140mm RT. Art., diastolic - 90 mm Hg, mean dynamic 113 mm Hg, UO - 75.2 ml, MO - 47 l, SI - 2.79 g / min / m ² , OPSS - 1961 dyne / cm / s, UPS - 42.4 conventional units Bicycle ergometry results: heart rate 82 beats per minute, blood pressure 140/90 mm Hg, heart rate and blood pressure at 3 minutes of I load - 124 beats per 1 minute, 170/100 mm of mercury, 3 minutes of II load - 135 beats per minute, 180/100 mm Hg, 3 minutes III of the load 160 beats per minute, 185/100 mm Hg, heart rate and blood pressure during the recovery period (4 minutes): 96 beats / min , 140/90 mmHg Index DP (SADh HR / 100 at load height) - 296.

 Physical performance - 503.2 m / min. In the process of bicycle ergometry at load III, complaints of headache, shortness of breath, and fatigue appeared. Headache persisted throughout the day.

After examination on the sixth day after the adaptation period, the child is prescribed a course of treatment according to the proposed method: hydrogen sulfide baths with a concentration of hydrogen sulfide 100 mg / l (first inlet bath 50 ml / l) at a water temperature of 36 ^o C, lasting from 4 to 10 minutes with exposure to 1 min, per course of 8 baths, every other day. On the seventh day, free of baths, a course of acupuncture was prescribed, daily No. 10, on days of baths acupuncture was released 2-3 hours after taking a bath. In addition, on days free of baths, the child received physical therapy, dosed walking using sports and fitness games.

The child tolerated acupuncture well. After the 4th procedure, complaints of dizziness and headache disappeared. HELL decreased to 130/80 mm RT. Art. When taking balneotherapy, a pathological reaction was not noted. After taking the 5-6th bath, headaches ceased to bother, a decrease in blood pressure to 120/80 mm RT was noted. Art. During physical exertion, the child did not make complaints; he was engaged in sports and fitness games willingly. The general treatment complex for the proposed method, the child suffered well. Clinical tests of blood, urine, ECG after a course of treatment by the proposed method is within normal limits. Echocardiography results: heart rate 66 beats / min, systolic blood pressure 130 mmHg, diastolic blood pressure 80 mmHg, UO 72.5 ml, MO - 4.2 l, SI-2.43 l / min / m ² , OPSS - 1923 dyne / cm / s, UPS - 40.4 conv. units Bicycle ergometry data: heart rate - 72 beats / min, BP-130/80 mm Hg, heart rate and blood pressure at 3 minutes of I load - 108, 150/90 mm Hg, at 3 minutes of II load - 125, 160 / 90 mmHg, heart rate and hell at the 3rd minute of III load 145, 165/90 mmHg During the recovery period (4 min) - 86, 130/85 mm Hg, index DP - 239.6. Physical performance 764.3 kgm / min.

 As a result of the treatment, the child showed a positive dynamics in clinical data: complaints disappeared, heart sounds became louder, systolic murmur was less intense, the pulse was 76 beats / min, blood pressure was 120/80 mm Hg. The child was discharged with significant improvement. According to the follow-up data, there were no appeals to the clinic at the place of residence for 12 months.

 From the data of the table it can be seen that the child revealed 10 positive shifts in indicators, which is assessed as "improvement".

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

 In order to confirm the effectiveness of the proposed method of treatment, a study and treatment of 80 sick children with primary arterial hypertension 1-B stage 12-14 years.

 Depending on the treatment received, sick children were divided into 2 groups.

 Group I - 40 children, received treatment according to the prototype, treatment with hydrogen sulfide balneotherapy 50 mg / l - concentration of hydrogen sulfide.

 Group II - 40 children received treatment according to the proposed method by the appointment of hydrogen sulfide balneotherapy at a concentration of hydrogen sulfide 100 mg / l every other day for a course of 8 baths with the inclusion of acupuncture daily N 10 for a course of treatment.

 Patient groups were identical in gender, age, and disease duration (within 2 years).

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

 The formation of PAT in children depends on the type of hemodynamics, i.e. from a coordinated relationship between cardiac output and peripheral resistance to blood flow. In most cases, hyperkinetic and eukinetic types of blood circulation were detected.

 After the treatment, in the group of children treated according to the prototype, there was a decrease in systolic, diastolic and average dynamic blood pressure, a more pronounced therapeutic effect was revealed with hyperkinetic type of blood circulation due to a decrease in stroke volume (UO).

 So, before treatment, systolic blood pressure was (127.3 ± 3.51) mm Hg, and after treatment (117.6 ± 2.63) (p <0.05); diastolic: before treatment (72.7 ± 2.45) mm RT. Art., and after treatment (65.4 ± 2.11) (p <0.05); the average dynamic blood pressure - before treatment (89.3 ± 2.82) mm Hg, after treatment - (82.8 ± 2.33) mm Hg. Art. (p <0.05). The RO before treatment was (82.1 ± 4.63) ml, after treatment - (76.7 ± 3.73) ml (p <0.05). Changes in the OPSS were not noted. Positive changes in the eukinetic type of blood circulation occurred due to a decrease in the total heart rate (before treatment 2623.1 ± 183.4) dyne / cm / s, after treatment (1883.0 ± 143.7) dyne / cm / s (p <0.01 )

 In the group of children treated with the proposed method, significant shifts were noted both with the hyperkinetic type of blood circulation and with eukinetic.

 In the case of the hyperkinetic type, a decrease in systolic, diastolic, and average dynamic blood pressure occurred against the background of a significant decrease in UO (before treatment, 85.8 ± 4.14 ml, after treatment, 74.6 ± 3.67 ml, p <0.05). There was also a decrease in minute volume (MO) from 7.51 ± 0.49 to 5.58 ± 0.36 L (p <0.01). The systolic index (SI) significantly decreased from 4.58 ± 0.30 to 3.56 ± 0.21 (p <0.01). OPSS remained within the normal range. In the case of eukinetic type of blood circulation, positive dynamics occurred against the background of a significant decrease in SPS (2283.1 ± 162.5 before treatment and 1624.4 ± 129.4 dyne / cm / s after treatment (p <0.01). Systolic blood pressure also decreased significantly. from 129.4 ± 3.27 to 122.1 ± 2.41 mm Hg, p <0.05; diastolic - from 73.1 ± 2.68 to 64.5 ± 2.47 mm Hg ., p <0.02 and the average diastolic from 92.3 ± 3.12 to 81.5 ± 2.56 mm Hg, p <0.01. Reduced heart rate occurred as with the hyperkinetic type of blood circulation from 86.1 ± 2.56 to 77.6 ± 2.09 (p <0.02) bpm, and with eukinetic - from 83.7 ± 2.43 to 76.2 ± 2.11 (p <0.02 ) bpm

 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 were noted in 86.7 ± 1.56% of cases, while during treatment by the prototype method, only in 72.2 ± 2.21%.

 The terms of disease remission during treatment by the proposed method were 12 months, while according to the prototype method, remission did not exceed 6 months.

 Treatment with the proposed method allows to reduce the treatment time from 40 days to 25 days, completely eliminating the complications associated with taking balneotherapy and improve hemodynamic processes in the child's body.

Claims (1)

 \ \ \ 1 A method for the treatment of children with primary arterial hypertension by means of common hydrogen sulfide baths at a concentration of 50 mg / l of hydrogen sulfide, characterized in that after the adaptation period, common hydrogen sulfide baths are carried out at a concentration of hydrogen sulfide of 50-100 mg / l, lasting from 4 to 10 minutes , with an increase in each subsequent procedure by 1 min, every other day, with a course of 8 baths, against the background of acupuncture, which begins after the first bath, daily for 10 days by introducing needles into the corporal acupuncture points for 30 - 40 min according to the second option the braking method.

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