Vegetative dysfunction and the method of correction in children with chronic gastroduodenal pathology
Donetsk National Medical University. M. Gorky
60 children with chronic gastroduodenal pathology and 30 conditionally healthy children were examined. Clinical manifestations of asthenovegetative syndrome, as well as functional indicators of the autonomic nervous system in all patients were studied. It was established that children with chronic gastroduodenal pathology were characterized by pronounced disturbances of autonomic regulation. These violations of vegetative homeostasis can be considered as one of the reasons for the progression of the pathological process in the mucous membrane of the stomach and duodenum. The proposed method of correction of autonomic dysfunction in children with chronic gastroduodenal pathology after successful eradication of Helicobacter infection through the use of a physiotherapeutic method of treatment - halotherapy in combination with the use of a plant-vitamin sedative complex ¦Valerin Cardio of the nervous system from the use of the proposed complex course of autonomic dysfunction correction in children with erosive tubercle.
Chronic gastroduodenal pathology (CHGDP) is considered as a polyetiological multifactorial problem from the modern point of view. One of the reasons for the development of chronic diseases of the stomach and duodenum (DPK) in patients of various age groups, along with Helicobacter pylori (HP), most authors consider dysfunction of the autonomic nervous system (ANS). It is known that there is a close relationship between the state of the nervous system and the clinical manifestations of acid-dependent erosive-ulcer diseases. Disorganization of neurotrophic control in the body of patients can lead to changes in microcirculation, the formation of secretion and motility disorders of various departments of the digestive system, which creates conditions for the persistence of HP and promotes ulcer disease. The majority of researchers confirm the fact that the treatment of CHGDP should not be limited to measures aimed at eradicating HP, but should also include methods of correcting ANS dysfunction.
One of the promising methods of correcting the dysfunction of the central nervous system in patients with chronic obstructive pulmonary disease is the use of therapeutic air environments with simulation of natural factors. One of these methods is halotherapy (HT) - a method based on the therapeutic effect of highly dispersed dry salt aerosol (haloaerosol). HT is a section of speleotherapy - a method of using the microclimate of salt caves for therapeutic purposes. The microclimate of salt caves has certain features. It is characterized by stability of temperature and pressure, gas composition of air, low relative humidity, high content of negatively charged ions, absence of bacterial flora and allergens. The main component of the air environment of salt caves is the presence in the air of the smallest salt particles - dry salt aerosol in a certain concentration, the main component of which is sodium chloride.
Speleotherapy became the basis of methods that use the microclimatic factors of salt speleo-cabinets in the conditions of ground rooms (halo chambers) as part of medical institutions. The use of HT involves the creation and maintenance of all parameters of speleo-influences, differentiated dosage and control of the salt aerosol level during the procedure. Management by the HT method is carried out using the equipment of the halo complex based on the halo generator, which creates and maintains in the halo chamber in real time the level of natural concentration of salt aerosol with several treatment modes. An important feature of the halo chamber is the ability to precisely dose the aerosol concentration. Sodium chloride aerosol contains light negative aeroions, which in the air environment activate metabolism and local protection of biological tissues, improve redox processes, have antispasmodic and anti-inflammatory effects. HT has a beneficial effect on the cardiovascular, endocrine, digestive and respiratory systems, activates systemic immunity, has a stimulating effect on the central and peripheral stress-limiting systems of the body, has a positive psycho-emotional and antidepressant effect, reduces the degree of fatigue, increases the degree of fatigue, increases the degree of fatigue .
The lack of effectiveness of non-standard treatment methods, the growing allergy of the population and the adverse effect of long-term drug loads on the body, give special urgency to the development and further improvement of methods of treatment of CHGDP using a combination of drug and physiotherapeutic methods. Determining the peculiarities of the ANS in patients with CKD and correcting them, it is possible to improve the effectiveness of the treatment of these patients. Taking into account the therapeutic properties of HT, it is promising to use this method of physiotherapy for the treatment of children with CKD as a supplement to the generally accepted drug therapy regimens.
The purpose of the study was to study the effectiveness of the course of HT associated with the use of the plant-vitamin sedative complex Valerin Cardio in the correction of autonomic dysfunction in children with CKD.
Materials and methods
On the basis of the gastroenterology department of the City Children's Clinical Hospital No. 1 in Donetsk and the "Gastroline" medical center, 60 children with erosive tubercle (EB) associated with RP, aged from 14 to 17 years, were examined. To confirm the diagnosis, all children at the time of admission to the department underwent an endoscopic examination with a mucosal biopsy. Diagnosis of HP was carried out using two methods: invasive - rapid urease test with biopsy material and non-invasive - urease breath test, which was carried out using the Helik test system with indicator tubes (AMA LLC, Russia). In case of positive results of both diagnostic methods, it was said that HP was infected. The study included patients with successful eradication of HP infection by using a three-component therapy scheme. The effectiveness of HP eradication was assessed 4 weeks after the end of anti-helicobacter therapy. Successful eradication was diagnosed with negative results of both HP diagnostic methods.
All children were divided into two groups: the main group and the comparison group. There were 30 patients in each group. All children of the main group underwent a course of HT one month after the end of traditional eradication anti-helicobacter therapy and elimination of the acute inflammatory process in a specialized halo chamber using the ASA-01.3 dry salt aerosol therapy device (Aeromedia CJSC, St. Petersburg). The HT course consisted of 10 daily sessions lasting 30 minutes. The aerosol concentration in the air of the halo chamber was 3-4 mg/m3. All patients of the main group were prescribed a course of the medicinal drug - a plant-vitamin sedative complex Valerin Cardio (Vitetera LLC, Ukraine) in the form of 500 mg tablets, in parallel with the use of HT. The drug was used 1 tablet 2 times a day for 1 month. Valerian Cardio contains medicinal herbs: melissa, valerian, nettle, passionflower, combined with vitamins of group B (B1, B2, B6, B12), vitamin C and trace elements (magnesium).
Complaints and functional indicators of the central nervous system were evaluated in all examinations of patients upon admission and after comprehensive treatment. The results of treatment were compared with similar indicators of patients with EB who did not undergo this treatment method, and the therapy was limited only to the use of anti-helicobacter therapy with correction of gastric secretory function. These children formed the comparison group. There were no significant differences between the experimental and comparison groups in terms of gender, age, initial indicators of vegetative status (p>0.05). The long-term results of treatment were evaluated after 3 months. As a control group, 30 conditionally healthy children were examined.
The following functional characteristics of the central nervous system were used to assess autonomic homeostasis: initial autonomic tone (IVT), autonomic reactivity (AR) and autonomic maintenance of activity (VOD). OVT was determined using the stress index (SIN), obtained using cardiointervalography (CGI). BP was evaluated according to the results of CIG with the registration of indicators in horizontal and vertical positions with further calculation of IN1 and IN2. A clinoorthostatic test was performed to assess the body's VOD. Statistical analysis of the research results was carried out in the MedStat package and Microsoft Excel 2003.
Examination of children with EB upon admission to the department showed that, along with abdominal pain and dyspeptic syndromes, they were characterized by the development of asthenovegetative syndrome, the main manifestations of which were: weakness, fatigue, emotional lability, irritability, sleep disturbances (difficulty falling asleep), headache , changes in blood pressure, dizziness, intolerance to transport, stuffy rooms, etc.
When studying the functional indicators of the ANS for children with erosive processes in the mucous membrane of the DPC, an increase in the specific weight of patients with a sympathotonic variant of IVT is characteristic, which was recorded in 19 (63.3 ± 8.8%) patients of the main group and in 20 (66.7 ± 8 , 6%) of children in the comparison group. The parasympathetic variant of IVT was registered in 11 (36.7±8.8%) and 10 (33.3±8.6%) patients, respectively. The peculiarity of children with EB was that none of them had an eitonic variant of IVT.
The study of BP was conducted in order to assess the body's ability to respond to external and internal stimuli. It was established that the majority of patients with EB had a pathological (hypersympathetic, asympathetic) BP, which indicates the inadequacy of the body's autonomic reactions to the transition from one state to another. Thus, the hypersympathetic tonic variant of BP, which indicates a decrease in the reserve capabilities of the ANS, was registered in 15 (50.0±9.1%) children of the main group and in 18 (60.0±8.9%) patients of the comparison group. Asymptotic BP, indicating unsatisfactory adaptation, was established in 12 (40.0±8.9%) and 9 (30.0±8.4%) children, respectively. In this case, the normal variant of BP (sympatheticotonic type) was registered only in 3 (10.0 ± 5.5%) patients of each group.
The ability of the patient's central nervous system in long-term BP support at a certain level was assessed by the characteristics of the child's body's blood pressure. In patients with EB, the most common type of asymptotic VT was detected, which was registered in 14 (46.7±9.1%) children in the main group, and in 15 (50.0±9.1%) children in the comparison group. The asympathicotonic type refers to the most maladaptive variants of VOD, which indicates a decrease in the adaptive capabilities of patients, exhaustion of the sympathoadrenal system during the erosive process of the mucous membrane of the DPC. Mixed VOD variants were also recorded with a high frequency among patients with EB. Thus, the sympathic asthenic variant of VOD was established in 6 (20.0±7.3%) children in each group, and the asthenosympatheticotonic variant in 6 (20.0±7.3%) patients of the main group and in 3 (10.0±5 , 5%) of the children of the comparison group. Normal and hyperdiastolic VOD variants were registered only among the patients of the comparison group - 2 (6.7±4.6%) children each.
A course of complex therapy with the use of HT and the use of a plant-vitamin sedative complex Valerin Cardio in children with EB made it possible to eliminate the clinical manifestations of asthenovegetative syndrome in a short period of treatment.
Positive dynamics of all vegetative indicators were achieved. Thus, the dynamics of IVT when using the proposed course of correction reflected a single trend of balanced interaction of the sympathetic and parasympathetic departments of IVT, which was expressed in an increase in the specific gravity of eitonia and a decrease in sympathicotonia and parasympatheticotonia (Table 1).
Thus, after using the course of correction of ANS dysfunction in the main group, eitonium in IVT was found in 12 (40.0±8.9%) patients, statistically significantly (p>0.05) did not differ from healthy children. Among the patients of the comparison group against the background of eradication of HP, the establishment of eytonia in IVT was recorded in 3 (10.0±5.5%) patients, which was significantly (p<0.01) less than in the main group. In other patients of the comparison group, the hyperergic influence of the sympathetic or parasympathetic system remained, which indicates the persistence of maladaptation even against the background of eradication of HP.
The study of BP in patients with EB after complex therapy recorded significant differences between the comparison groups (Table 2).
In the course of therapy, among the children of the main group, normal responses of adaptation systems to short-term stress in the form of sympathotonic BP were recorded significantly more often (p<0.05) compared to the comparison group - 17 (56.7±9.0%) patients, which was not significantly different ( p > 0.05) from the frequency of detection of this type of BP among children of the control group. In parallel, the specific weight of the hypersympatheticotonic type of BP decreased and the prognostically most unfavorable type of BP leveled off, which indicates the exhaustion of adaptation of the asympaticotonic type of BP. Among the children of the comparison group against the background of HP eradication, the number of patients with a sympathic tonic BP variant was 7 (23.3±7.7%) due to a slight decrease in the number of patients with hypersympathetic tonic BP. The number of children with an asympathicotonic type of BP did not change, which indicates a steady depletion of the adaptive reserves of patients with EB and the impossibility of their recovery even against the background of the elimination of the main provoking factor of inflammation of the mucous membrane.
The proposed course of complex therapy within a month made it possible to achieve in the main group the absence of the most prognostically unfavorable variants of VOD - hyperdiastolic and asympaticotonic due to redistribution towards sufficient VOD, which indicates the adequacy of the stress reaction and the transition of the ANS to a more economical level of functioning. At the same time, the number of children in the main group with normal VOD was 16 (53.3±9.1%), which was not significantly different from the control group (p>0.05). Among the patients of the comparison group, no statistically significant positive dynamics of VOD was noted, asymptotic, hyperdiastolic, and other pathological variants of VOD were preserved (Table 3).
During the re-examination of the patients after 3 months, it was established that more than half of the patients in the comparison group had manifestations of asthenic syndrome - 17 (56.7±9.0%) children. Complaints about weakness, fatigue, and headache were registered most often. Among the patients of the main group, manifestations of asthenic syndrome were recorded significantly less often - in 5 (16.7±6.8%) children (р<0.05). After 3 months, eytonia in IVT remained in 10 (33.3±8.6%) children of the main group, while in the comparison group only 1 (3.3±3.3%) children. The sympathicotonic type of BP in the main group was preserved in 15 (50.0±9.1%) patients, among the children in the comparison group there were 3 (10.0±5.5%) of such children. A normal type of VOD during the catamnestic study was established in 13 (43.3±9.0%) patients of the main group and only in 3 (10.0±5.5%) children of the comparison group.
Thus, the proposed complex treatment method of therapy using a ten-day course of HT together with the intake for 1 month of the plant-vitamin sedative complex Valerin Cardio in children with EB against the background of successful eradication of NR made it possible to achieve a favorable course of the general adaptation syndrome due to adequate work of stress-limiting systems , the formation of resistance to the damaging factor, thereby ensuring adaptation to the majority of children who received this therapy. This is evidenced by the results obtained in the form of reliably positive dynamics of IVT, BP, VOD in the subjects who received the proposed therapy, compared to patients who received only the anti-helicobacter course of therapy. The use of the course of correction of autonomic imbalance in children with CKD allows us to achieve a prolonged effect and stable compensation of the state of ANS indicators. The safety and good tolerability of HT by children opens up new opportunities and directions in the use of this physiotherapeutic method in pediatric practice.
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