RU2336070C1 - Method of children's vegetative dysfunction syndrome treatment - Google Patents

Abstract

FIELD: medicine; paediatrics.

SUBSTANCE: dry carbonic acid gas baths are applied as follows: carbon dioxide concentration is 25%, carbon dioxide supply time is 3 minutes, and dosing rate is 8 rpm. Procedure time is 15-18 minutes for children aged 9-11 years old and 20-23 minutes - for children aged 12-15 years old. Temperature of baths is 26-28C. Additionally 30 - 40 minutes prior to each bath procedure Infita therapy is applied at effect frequency 20 Hz within 2 minutes for children with hypotonic vegetative dysfunction and at 30 Hz within 3 minutes for children with hypertensive vegetative dysfunction. Treatment course is 8-10 procedures.

EFFECT: higher efficiency of regenerative processes; restoration of vegetative nervous system functioning and increase of adaptive resources; balance of excitation and inhibition processes in central nervous system; higher physical activity tolerance.

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Description

The invention relates to medicine, in particular to pediatrics, and can be used in sanatoriums, outpatient institutions and hospitals as a method of treating children with autonomic dysfunction syndrome.

The relevance and significance of the invention determines the high frequency of autonomic dysfunction syndrome in children, especially among schoolchildren, whose prevalence is from 40 to 60%.

SVD is not an independent nosological form of the disease, but a syndrome that can precede the development of many chronic diseases of the adult population (Yu.E. Veltishchev, 1984, S.K. Klyueva, 1990). In the absence of timely diagnosis and adequate treatment, the possibility of the transition of SVD to such psychosomatic diseases as coronary heart disease, hypertension, atherosclerosis, bronchial asthma, peptic ulcer and 12 duodenal ulcer, etc. (N.A. Belokon, M. B Kuberger, 1987). In this regard, it is extremely important to conduct early diagnosis and timely correction of these disorders, which will help maintain good health and prevent the likelihood of their progression. The need to prevent the progression of the syndrome, the formation of psychosomatic pathology leading to early disability, and sometimes premature mortality in young and older people, determines the expansion of the boundaries of complex treatment of children with autonomic dysfunction syndrome (A.A. Aleksandrov, 1995, E.M. Spivak , 1993).

Physiotherapy is one of the main methods of treating autonomic dysfunction syndrome in children. Therapeutic physical factors are prescribed in conjunction with the daily regimen, rational nutrition, physical education, hardening and drug therapy. Children with SVD are recommended the optimal use of sanatorium factors in resorts and local health resorts.

The basis of pathogenetic therapy of autonomic dysfunction syndrome in children is non-drug effects aimed at increasing the body's adaptive resources and eliminating risk factors in order to prevent the progression of the syndrome.

Physiotherapeutic methods for treating autonomic dysfunction syndrome are known. These include: galvanization by a reflex-segmental technique, electrophoresis with drugs: with vagotonia, with calcium, caffeine, mesatone; with sympathicotonia - with a 0.5% solution of euffilin, papaverine, magnesium, bromine on the upper cervical spine; electrosleep, acupuncture (A.N. Razumov, M.A. Khan, L.A. Krivtsova, V.I.Demchenko, 2003), Ural Federal District, magnetotherapy, laser therapy (A.N. Razumov, M.A. Khan, N .I. Averyanova, I.A. Shipulina, 2001).

The disadvantages of these methods are: individual intolerance to electric current, the presence of contraindications for a number of techniques often associated with SVD: moderate myopia, neurosis-like conditions; pronounced hypotensive effect. The use of magneto and laser therapy is constrained by the lack of unified, standard treatment methods and in-depth analysis systematizing its results, as well as the lack of data on the long-term effects of laser radiation on the morphofunctional and reproductive structures of a growing organism (A.A. Kurochkin, V.V. .Anikin, N.N. Slyusar, 2000). Certain difficulties are also created by the large scatter of recommended therapeutic doses of laser radiation, which are mainly empirical (A.R. Evstigneev et al. 1994). The lack of simple, easily reproducible and reliable methods of monitoring the process of laser therapy also prevents the more active use of laser therapy. Ultraviolet irradiation has a photodynamic effect, which can cause tissue damage in case of an overdose, requires special work skills.

Drug therapy for SVD is prescribed, as a rule, with a long course of the pathological process, with insufficient effectiveness of physiotherapy. Medication includes herbal remedies, tranquilizers, antidepressants, antipsychotics, vascular drugs, cerebroprotectors.

The main disadvantages of drug treatment are the toxicity of a number of drugs, their side effects on organs and systems, allergization of the body, the duration of the course of therapy, which for children is an additional stressful effect.

Closest to the technical nature of the proposed method is a method of treating a syndrome of autonomic dysfunction, which consists in the use of aqueous carbon dioxide baths. The method is as follows: cold water using a special apparatus is saturated with carbon dioxide and fed into the bath, which is pre-poured hot water. The child sits in the bath freely, the water level reaches the nipple line of the baby’s chest, the duration of the carbon dioxide bath is from 5 to 10 minutes. The gas concentration at the beginning of the course of treatment is not more than 0.6 g per 1 liter of water, in the future it can be brought up to 1-1.4 g / l. Water temperature 36 ° C, every other day, for a course of treatment of 8-10 baths (A.N. Razumov, M.A. Khan, L.A. Krivtsova, V.I.Demchenko // Physiotherapy in Pediatrics. 2003).

The disadvantages are as follows.

1. Hydrostatic pressure, which increases the return of venous blood to the heart and, thus, the hemodynamic load, increases cardiac output and increases oxygen consumption.

2. The temperature effect of water (the higher the temperature of the water, the greater the specific gravity of carbon dioxide entering the body by inhalation). In addition, with an aqueous carbon dioxide bath, the physiological effect of carbon dioxide penetrating the skin is supplemented by the mechanical action of gas bubbles deposited on the skin (skin micromassage) and due to the intensive expansion of skin capillaries, heat transfer increases - the internal temperature of the body and venous blood decreases, as a result of which it is cooling effect (M. Voronin, 1963).

3. Inhalation component (carbon dioxide, entering the body through the respiratory tract, causes rapid reactions of various body systems, along with a slower action through the neurovascular apparatus of the skin).

4. A pronounced vagotonic effect when in the aquatic environment, which causes a significant decrease in blood pressure and a decrease in heart rate and does not allow to achieve a training effect in relation to physical activity, especially with initial vagotonia.

5. The inability to use with concomitant skin lesions.

The technical result of the proposed method for the treatment of autonomic dysfunction syndrome in children is to increase the efficiency of recovery processes, restore the functioning level of the ANS, restore and increase adaptive resources of the body, balance the processes of excitation and inhibition in the central nervous system, increase tolerance to physical activity, reduce risk factors and prevent disease.

The specified technical result is achieved by the use of "dry" carbon dioxide baths with a carbon dioxide concentration of 25%, a gas supply time of 3 minutes, with a feed speed of 8 rpm, at a gas mixture temperature of 26-28 ° C, the duration of the procedure is 15-18 minutes in children 9 -11 years and 20-23 in children 12-15 years old daily in combination with infitherapy, with a frequency of exposure of 20 Hz for 2 minutes with SVD according to the hypotonic type and 30 Hz for 3 minutes with SVD according to the hypertonic type 30-40 minutes before the bath, 8-10 procedures per treatment course.

A feature of the proposed method is that a concentration of carbon dioxide of 25% allows to achieve the necessary therapeutic effect, providing a mild sparing effect on the cardiovascular, autonomic nervous system, avoiding possible adverse reactions to the child's body in the form of severe hypotension, bradycardia. The temperature regime was selected by the test method and is most comfortable for children of different age groups and vegetative orientation. There is no heat load on the child’s body, at the same time it is optimal for the therapeutic effect of carbon dioxide concentration. The exposure time of 15-23 minutes, depending on age, allows to achieve optimal penetration of carbon dioxide into the skin with further preservation of the effect for 4 hours.

Using in this method an alternating pulsed low-frequency electric field from the Infita apparatus increases the effectiveness of the treatment.

The recommended frequency of 20-30 Hz is the most acceptable and optimal for children, being therapeutically effective and not causing any negative symptoms during and after the procedure. A time of 2-3 minutes is enough to achieve a therapeutic effect and concentration — continuous optical interaction of the child with the device.

DESCRIPTION OF THE METHOD OF TREATMENT.

For carrying out dry carbon dioxide baths, a special Reabox bathtub manufactured by Prima XXI with a capacity of 660 l with a dosed supply of carbon dioxide and temperature is used.

The bath is heated to 26-28 ° C, carbon dioxide is supplied in a concentration of 25%. The duration of the procedure is 15-18 minutes (9-11 years) and 20-23 minutes (12-15 years). The course is 8-10 procedures. The patient undresses, remaining in the swimming trunks, and sits in the bath in a position convenient for him. The patient’s head, due to a neck cut, is outside the action of carbon dioxide. A neck seal is used to prevent carbon dioxide from entering the patient’s airways. After establishing the procedural time, carbon dioxide is supplied for 3 minutes. After the procedure, the exhaust fan is turned on.

For 30-40 minutes before taking a bath, infit therapy is applied with a frequency of exposure of 20-30 Hz, for 2-3 minutes, depending on the type of vegetative orientation of SVD. On a course of 8-10 procedures.

The exposure to an alternating low-frequency pulsed electric field of low intensity from the Infita apparatus is carried out through an optical-vegetative system. The patient is placed on a chair at a distance of 20-25 cm from the electrode-mirror (mirror plate-capacitor). In a sitting position, the patient looks into the emitter (mirror). The exposure time is 2 minutes in children with autonomic dysfunction according to the hypotonic type, frequency 20 Hz, 3 minutes in children with autonomic dysfunction according to the hypertonic type, frequency 30 Hz. The course of treatment is 8-10 procedures.

SPECIFIC EXAMPLES OF IMPLEMENTATION OF THE METHOD.

EXAMPLE 1

E.D. 14 years old, was in recovery at the Klyazma Republican Children's Cardiac Rheumatology Sanatorium from November 12 to December 13, 2004. She was observed with a diagnosis of Hypertensive autonomic dysfunction syndrome. Exogenous constitutional obesity of the 1st degree.

A girl from 1 pregnancy, proceeding with the phenomena of toxicosis, acute respiratory infections in the 2nd half, urgent delivery. Weight growth indicators, psychomotor development without deviations from the norm. Heredity is burdened: the mother has hypertension.

Upon receipt of a complaint about fluctuations in blood pressure with an increase in max to 160/100, accompanied by headaches, nausea, cardialgia, sleep disturbance, increased fatigue, irritability.

This symptomatology has been observed since May 2004, when the increase in blood pressure to 150/90 was first observed, accompanied by headache, nausea. In this regard, the girl was hospitalized in the cardiology department of the Children's Clinical Hospital, where after the examination she was diagnosed with the syndrome of autonomic dysfunction of the hypertonic type. In the hospital she received massage, peony tincture, and vascular therapy. After discharge, I felt satisfactory for a month, then the headaches resumed, were associated with psycho-emotional overloads, usually occurred by the end of the day, often accompanied by an increase in blood pressure.

Upon receipt of blood pressure 130/75, t = 37.4 ° C, heart rate 98. Objectively - hypersthenic physique, increased nutrition. The skin is pale, dry. Brushes are cyanotic, cold to the touch. Dermographism pink. Zev is calm. In the lungs, vesicular breathing. Heart tones are rhythmic, clear. At the top, a soft systolic murmur is heard, decreasing in the ortho position. By internal organs without pathology.

In the sanatorium, the girl underwent the following examination:

- determination of the initial vegetative tone (IWT) according to the standard method developed by A.M. Wayne and N.A. Belokon and the method of cardiointervalography (CIG);

- assessment of the vegetative support of the activity by the method of clinically orthostatic test (CPC);

- control of blood pressure and heart rate before and after each procedure;

- electrocardiography (ECG) in the supine position, standing, and after 10 squats;

- daily monitoring of blood pressure (BPM).

General treatment procedures (treatment regimen, rational nutrition, massage of the cervical-collar zone, pool) are prescribed as therapy. As a physiotherapeutic procedure, “dry” carbonic baths from the Reabox installation with an exposure temperature of 28 ° C, a concentration of carbon dioxide of 25%, a duration of 23 minutes in combination with an infi-therapy with a frequency of 30 Hz, an exposure time of 3 minutes in 30 minutes were prescribed to every bath. There are 10 procedures per course.

During the examination: IWT - sympathicotonia, BP-hypersympathicotonic reactivity, excessive autonomic provision (IN) of heart activity. On the ECG, an increase in the electrical activity of the left ventricle. According to the ABPM, the average values of systolic blood pressure are elevated, diastolic blood pressure is within normal limits, pressure load indicators for the hypertension time index for systolic (IVSAD) and diastolic blood pressure (IVDAD) are increased. Values of variability for SBP and DBP are presumably increased. The daily index of blood pressure: for SBP within normal limits, for DBP - an increased degree of nighttime decline. The average daily value of pulse blood pressure is increased.

After a single procedure, there was a tendency to normalize blood pressure and heart rate, the maximum effect was observed by the middle of the course of treatment. Blood pressure and heart rate during treatment have become more stable, lability has decreased.

By the middle of the course, the state of health improved, working capacity improved, and sleep was normalized.

In the analysis of CPC after treatment, the hypersympathicotonic orientation of autonomic activity was replaced by normotonic: the initial data for SBP, DBP and heart rate decreased, the reactivity of SBP and DBP in orthostasis decreased and the hemodynamic parameters of blood pressure remained stable throughout the test, the increase in heart rate slightly decreased, indicating a decrease in adrenergic effects on the rhythm of the heart and a decrease in sensitivity to catecholamines, as a result of the adaptogenic-training effect of baths and how manifestation - increased exercise tolerance, increased performance.

According to the CIG data, after 1 procedure, an increase in ∧x was noted, as the appearance of an increase in parasympathetic influences, a decrease in Amo, indicating inhibition of the sympathetic part of the ANS, an increase in Mo, which is a sign of activation of the humoral channel of heart regulation. In the initial sympathicotonia, after 1 procedure, it decreased from 141 to 70 (eutonia), by the middle of the course 55-51, by the end of the course 53-51.

A comparative analysis of the ECG before and after the course of treatment shows a decrease in heart rate, an increase in the RR interval, a slight lengthening of the PQ interval, a decrease in the voltage of the QRS complex in the left chest leads.

Smad data are as follows:

SMAD: cf. GARDEN up to 133 - after 127 mmHg (norm 126 mmHg)

Wed DBP up to 76 - after 70 mm Hg

Wed hemodynamic up to 95-89

Wed Heart rate up to 96 - after 81 / min

PAD (pulse) up to 55 - after 52.8 mmHg (norm up to 55)

SISAD before 13 - after 14

DBP up to 26 - after 17 (normal up to 10-20%)

SDSAD up to 16 - after 14 (normal up to 15%)

DBP up to 15-12

IGSAD up to 62 - after 27 (normal up to 25%)

DBP up to 28-15

DP up to 13037 - after 10588

Analyzing the results of BPA before and after treatment in a child with initially elevated blood pressure figures with pathologically elevated IG values, an excessive nightly decrease in DBP, with high average SBP values and percentiles of growth, normalization of the above parameters after a course of treatment is noted. The indicator of oxygen consumption (DP) has a clear tendency to decrease after a course of treatment.

Also, against the background of therapy with the proposed method, in parallel, the girl noted a weight loss from 76 to 71.

Follow-up observations carried out 6 months after treatment established the persistent positive effect in the regulation of the autonomic nervous system: headache, cardialgia significantly decreased, sleep improved, physical performance improved, emotional lability decreased, and blood pressure stabilized.

EXAMPLE 2

S.A. 10 years, was in recovery in the Klyazma RDKS from November 20 to December 22, 2004. Was observed with a diagnosis of Autonomic dysfunction syndrome of hypotonic type. Chronic compensated tonsillitis. Mild myopia. A child with a weighed perinatal background - from 2 pregnancies, 1 urgent delivery by cesarean section. Early psychomotor development by age. Allergic history, heredity are not burdened.

The diagnosis of SVD from 8 years.

Upon admission, she complained of headaches, dizziness during prolonged standing, in a stuffy room, cardialgia, sighs, intolerance to transport, weakness, increased fatigue, irritability, insomnia, frequent colds. Objectively - the correct physique, moderate nutrition. The skin and visible mucous membranes are clean, pale pink. Marble, distal hyperhidrosis. Dermographism is red, persistent. Zev - tonsils are hypertrophied. Peripheral l / u units, small. In the lungs - vesicular breathing. Heart tones are rhythmic, clear. Heart rate 72, blood pressure 80/50 mm Hg. Art.

General treatment procedures (treatment regimen, rational nutrition, massage of the cervical-collar zone, pool) are prescribed as therapy. As a physiotherapeutic procedure, “dry” carbonic baths from the Reabox installation with an exposure temperature of 26 ° C, a concentration of carbon dioxide of 25%, an exposure duration of 15 minutes in combination with an infi-therapy with a frequency of 20 Hz, a duration of 2 minutes in 40 were prescribed minutes to each bath. On a course of 8 baths.

By the middle of the course, the frequency of complaints of headache, dizziness decreased, sleep normalized, by the end of the course exposure increased performance, stabilized psychoemotional tone - decreased irritability, emotional lability.

As a result of treatment, IWT changed from vagotonic to eitonic, BP after a course of treatment with a tendency to normalization. When analyzing ECG data in a girl with initial disorders of repolarization processes, an improvement in metabolic processes in the myocardium is noted. In the analysis of BPM after the course of treatment, normalization of variability (SD) and a decrease in the double product (DP) are noted, which indicates the normalization of the function of the autonomic response and the economization of the heart.

For 6 months observation after treatment, there was a significant decrease in symptoms from the autonomic and cardiovascular systems.

The proposed method of treatment was applied in 87 children with a syndrome of autonomic dysfunction of the hypotonic and hypertonic type, aged 9-15 years. All children tolerated treatment with the proposed method, no adverse reactions were noted.

By the middle of the course, all patients noted an improvement in overall health in the form of a decrease in complaints of a vegetative nature (headaches, dizziness, cardialgia, poor sleep), increased exercise tolerance, and stabilization of psychoemotional tone. In 88% of children, by the end of treatment, normalization of IWT with initial sympathicotonia, a decrease in autonomic reactivity to the load, and stabilization of autonomic activity were observed. According to the CIG data, in a single procedure, IN increased with a reduced initial, decreased with increased and normal. In general, towards the end of treatment there is a tendency to decrease, mainly with increased baseline data. When evaluating the autonomic provision of heart rhythm activity according to the schedules after the course of treatment, there is a decrease in the reactivity of blood pressure and heart rate to the load and during the test they stabilize with a tendency to normalize to baseline by the end of the test. Under the influence of treatment, there was a decrease in blood pressure and heart rate, starting with 1 procedure, more pronounced in children with initially higher numbers; in children with a hypotonic variant, the use of dry carbon dioxide baths did not cause distinct changes in blood pressure and heart rate. When analyzing the ECG, there was an improvement in metabolic processes in the myocardium in all children with impaired repolarization processes. Along with the vagotonic effect (decrease in heart rate, increase in RR, prolongation of PQ), there was a decrease in the severity of signs of electrical instability of the ventricular myocardium. The average blood pressure and heart rate over a 24-hour interval according to the ABPM after the course of treatment in 72% of children tended to decrease, especially in the group of children with high blood pressure, pressure load, variability, and daily index were normalized. All patients showed a decrease in the value of the double product, indicating the economization of oxygen consumption, as a result of increased adaptive resources of the body.

Follow-up observation conducted within 6-12 months after treatment, testified to the persistence of the therapeutic effect of this method. School performance improved, motor activity increased, psychoemotional tone normalized, blood pressure stabilized, blood pressure and heart rate fluctuations decreased, meteosensitivity decreased, and the incidence of acute respiratory diseases decreased.

The data obtained indicate that the proposed method for the treatment of autonomic dysfunction syndrome in children leads to an increase in the level of functional reserves of the body, an increase in the adaptive potential of the organism as a whole and its individual systems, an increase in overall resistance and an adaptive effect with increasing psychoemotional stresses on the body, and increased resistance to physical activity and improving the quality of life of children.

The proposed method of treatment helps to eliminate impaired functional activity of the sympathetic department of the autonomic nervous system and has a beneficial regulatory effect on the parasympathetic nervous system, as well as a normalizing effect on the psychoemotional tone, normalizes autonomic reactivity, which is proposed to be considered when building a treatment complex in children with altered blood pressure and consider dry carbonic baths and infitherapy with a pathogenetically substantiated method of treating patients autonomic dysfunction syndrome.

Claims (1)

A method of treating autonomic dysfunction syndrome in children by carrying out carbon dioxide baths, characterized in that they carry out "dry" carbon dioxide baths with a carbon dioxide concentration of 25% and a gas supply time of 3 minutes, at a speed of 8 rpm, the procedure time is 15-18 minutes for children 9-11 years, 20-23 min - for children 12-15 years old, at a temperature of 26-28 ° C and, additionally, 30-40 min before each bath, an infatotherapy is carried out with a frequency of exposure to 20 Hz for 2 min in children with vegetative hypotonic type dysfunction and 30 Hz for 3 min in children with autonomic dysfunction hypertonic type, in the course of 8-10 procedures.