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

ФАКТОРЫ ЯТРОГЕННОГО РИСКА РАЗВИТИЯ КРИТИЧЕСКИХ СОСТОЯНИЙ У ДЕТЕЙ С ИНФЕКЦИОННОЙ ПАТОЛОГИЕЙ

Critical states developed during infectious diseases are amongst main causes of lethal outcomes in children.The objective of the study: to find major signs of iatrogenic risk of critical states during infectious diseases in children.Subjects and methods. The examination protocols of 1 237 children in the age from 3 months to 15 years old were studied, all children had sepsis and were staying in central district hospitals and managed by doctors from emergency wards and planned care units from 2007 to 2011.Results of the study. The retrospective analysis proved the significance of the delayed start of intensive care for the risk of unfavorable outcome of gastrointestinal infections in children. The maximum permissible time of 45 minutes before the start of intensive care was substantiated. The risk factors of unfavorable outcome of gastrointestinal infections were defined for the period of treatment before the transfer to anesthesiology and intensive care wards: early prescription of intestinal antiseptics during in-take of antidiarrheal drugs (OR=4.0) and use of paracetamol and ibuprofen (OR=3.2).Conclusion: intensive care started as early as possible in children with infectious diseases and initiated within 15 minutes after the admission to intensive care ward is associated with the reduced risk of a lethal outcome.Критические состояния, развивавшиеся на фоне инфекционных заболеваний, являются одной из основных причин летальных исходов у детей.Цель исследования: выявить опорные признаки ятрогенного риска критических состояний при инфекционных заболеваниях у детей.Материалы и методы. Изучены протоколы консультаций 1 237 детей в возрасте от 3 месяцев до 15 лет, находившихся в центральных районных больницах и наблюдавшихся специалистами отделения экстренной и плановой консультативной помощи в период с 2007 по 2011 г. по поводу сепсиса.Результаты исследования. В ходе ретроспективного анализа определена значимость несвоевременного начала интенсивной терапии для риска неблагоприятного исхода гастроинтестинальных инфекций у детей. Обосновано максимально допустимое время до начала интенсивной терапии ‒ 45 мин. Определены факторы риска неблагоприятного исхода гастроинтестинальных инфекций на этапе лечения до перевода пациентов в отделение анестезиологии-реанимации: раннее назначение кишечных антисептиков на фоне противодиарейных препаратов (OR = 4,0) и применение парацетамола или ибупрофена (OR = 3,2). Заключение: максимально ранние мероприятия интенсивной терапии у детей с инфекционными заболеваниями, начатые в течение 15 мин от момента поступления пациента в отделение реанимации и интенсивной терапии, ассоциируются с уменьшением риска летального исхода

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

IATROGENIC RISK FACTORS OF CRITICAL STATES IN CHILDREN WITH INFECTIOUS PATHOLOGY

Critical states developed during infectious diseases are amongst main causes of lethal outcomes in children.The objective of the study: to find major signs of iatrogenic risk of critical states during infectious diseases in children.Subjects and methods. The examination protocols of 1 237 children in the age from 3 months to 15 years old were studied, all children had sepsis and were staying in central district hospitals and managed by doctors from emergency wards and planned care units from 2007 to 2011.Results of the study. The retrospective analysis proved the significance of the delayed start of intensive care for the risk of unfavorable outcome of gastrointestinal infections in children. The maximum permissible time of 45 minutes before the start of intensive care was substantiated. The risk factors of unfavorable outcome of gastrointestinal infections were defined for the period of treatment before the transfer to anesthesiology and intensive care wards: early prescription of intestinal antiseptics during in-take of antidiarrheal drugs (OR=4.0) and use of paracetamol and ibuprofen (OR=3.2).Conclusion: intensive care started as early as possible in children with infectious diseases and initiated within 15 minutes after the admission to intensive care ward is associated with the reduced risk of a lethal outcome