ОСОБЕННОСТИ ВАРИАБЕЛЬНОСТИ РИТМА СЕРДЦА У ДЕТЕЙ С ЛОР-ПАТОЛОГИЕЙ, НУЖДАЮЩИХСЯ В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ

Detection of anesthetic risk factors in children with ENT diseases in need of surgery is one of the most important issues in pediatric anesthesiology. The objective of the study: to investigate specific features of heart rate variability in children with chronic ENT pathology in need surgical treatment with general anesthesia. Subjects and methods. 79 children in the age from 7 to 14 years old were examined. The patients were divided into three groups depending on the main disease. Group 1 included 15 (21%) children who had only been diagnosed with hyperplasia of the tonsils; Group 2 included 13 (18%) children with impaired nasal patency; Group 3 consisted of 22 (31%) children who had hyperplasia of the tonsils combined with nasal obstruction; and Group 4 consisted of 21 children who had neither hyperplasia of the tonsils nor nasal obstruction. The criterion for nasal obstruction was the following: decrease in the total volume of flow below 400 ml/s, a flow increase between 150 and 300 Pa (∆V) below 20%, an increase in the total resistance above 0.5 Pa ⋅ ml-1 ⋅ s-1. When assessing heart rate variability, standard parameters were evaluated. Results. It was found out that chronic inflammatory ENT diseases altered the vegetative pattern depending on the localization of the pathology: in case of adenoid vegetations there was a parasympathetic vegetative dysfunction, and in case of hyperplasia of the tonsils, it was of the sympathetic type. Conclusion. Pre-operative assessment of heart rate variability in children with ENT pathology allows identifying risk factors of hemodynamic disorders during anesthesia and preventing the use of drugs providing an undesirable effect on the vegetative nervous system.Выявление факторов риска анестезии у детей с заболеваниями лор-органов, нуждающихся в хирургических вмешательствах, является одной из наиболее важных проблем педиатрической анестезиологии. Цель исследования: изучить особенности вариабельности ритма сердца у детей с хронической лор-патологией, нуждающихся в оперативном лечении в условиях общей анестезии. Материал и методы. Обследовано 79 детей в возрасте от 7 до 14 лет. В зависимости от основного заболевания все пациенты разделены на четыре группы. В 1-ю группу включено 15 (21%) детей, у которых была диагностирована только гиперплазия небных миндалин; во 2-ю ‒ 13 (18%) детей с нарушением проходимости носа; в 3-ю ‒ 22 (31%) ребенка, у которых имела место гиперплазия небных миндалин в сочетании с обструкцией носа; 4-ю (контрольную) группу составил 21 ребенок, не имевший гиперплазии небных миндалин и назальной обструкции. Критерием назальной обструкции считали снижение суммарного объемного потока ниже 400 мл/с, прироста потока между 150 и 300 Па (∆V) ниже 20%, повышение суммарного сопротивления выше 0,5 Пa ⋅ мл-1 ⋅ с-1. При исследовании вариабельности ритма сердца проводили оценку стандартных параметров. Результаты исследования. Установлено, что хронические воспалительные лор-заболевания изменяют вегетативный паттерн в зависимости от локализации патологического процесса: при аденоидных вегетациях имеет место вегетативная дисфункция по парасимпатическому типу, а при гиперплазии небных миндалин – по симпатическому типу. Заключение. Предоперационная оценка вариабельности ритма сердца у детей с лор-патологией позволяет выявить факторы риска гемодинамических расстройств во время анестезии и предотвратить применение препаратов с нежелательными эффектами на вегетативную нервную систему

SPECIFIC FEATURES OF HEART RATE VARIABILITY IN CHILDREN WITH ENT PATHOLOGY IN NEED OF SURGICAL TREATMENT

Detection of anesthetic risk factors in children with ENT diseases in need of surgery is one of the most important issues in pediatric anesthesiology. The objective of the study: to investigate specific features of heart rate variability in children with chronic ENT pathology in need surgical treatment with general anesthesia. Subjects and methods. 79 children in the age from 7 to 14 years old were examined. The patients were divided into three groups depending on the main disease. Group 1 included 15 (21%) children who had only been diagnosed with hyperplasia of the tonsils; Group 2 included 13 (18%) children with impaired nasal patency; Group 3 consisted of 22 (31%) children who had hyperplasia of the tonsils combined with nasal obstruction; and Group 4 consisted of 21 children who had neither hyperplasia of the tonsils nor nasal obstruction. The criterion for nasal obstruction was the following: decrease in the total volume of flow below 400 ml/s, a flow increase between 150 and 300 Pa (∆V) below 20%, an increase in the total resistance above 0.5 Pa ⋅ ml-1 ⋅ s-1. When assessing heart rate variability, standard parameters were evaluated. Results. It was found out that chronic inflammatory ENT diseases altered the vegetative pattern depending on the localization of the pathology: in case of adenoid vegetations there was a parasympathetic vegetative dysfunction, and in case of hyperplasia of the tonsils, it was of the sympathetic type. Conclusion. Pre-operative assessment of heart rate variability in children with ENT pathology allows identifying risk factors of hemodynamic disorders during anesthesia and preventing the use of drugs providing an undesirable effect on the vegetative nervous system