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"Child`s Health" 6 (57) 2014

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Features of extracranial hemodynamics in children with bronchial asthma

Authors: Nedelskaya S.N., Akulova E.Y.

Categories: Pediatrics/Neonatology

Sections: Clinical researches

print version

Introduction. At present scientifically proven heterogeneity of etiology, pathogenesis and clinical asthma in the implementation of the manifestations of which involved not only the immune system but also a number of other systems, including the central nervous system plays an important role. Expanding the capabilities of modern diagnostic ultrasound diagnostic techniques - Doppler Ultrasound, duplex scanning - allows to apply this technique in patients with children's asthma to assess the functional status of brain structures, cerebral blood flow and its autoregulation. Several authors indicate on the relevance and necessity of systematic research on characteristics of cerebral hemodynamics of children with asthma.

Materials and methods. Conducted ultrasound examination 66 children with asthma and 22 healthy children. The groups were identical by gender and age (10-17 years) composition. We studied the rate (volumetric and linear), the state of peripheral vascular resistance and vascular reactivity in the right and left internal carotid artery and vertebral artery.

The study was conducted on the MyLab 50 ultrasound scanner (Esaote, Italy) with a phased transducer frequency of 2 MHz with color and power Doppler mapping. Statistical analysis of the original material performed by using statistical software application package «Statistika 6.0» methods of parametric and nonparametric statistics considered reliable differences at p ≤ 0,05.

Results. The linear flow velocity in the right internal carotid artery was statistically lower (development events hypoperfusion) in patients with asthma - respectively 91, 45 ± 4, 60 sm/s and 100,00 ± 3,41 sm/s (p = 0.046), but this did not affect the bulk flow velocity in this artery. Resistance index in patients and healthy children, it was statistically equal to - respectively 0, 61 ± 0,09 and 0,59 ± 0,07.

Hemodynamically significant features in the left internal carotid artery between patients and healthy children have been received. As in healthy and sick children with asthma, a significant part is cutting the volume of anterior cerebral blood flow - respectively, from 67.8% to 72.4% of the total volume of cerebral blood flow. The coefficient of asymmetry in the internal carotid artery in patients with asthma accounted for 18,13 ± 1,57% to 12,33 ± 2,5% in healthy children, that the rate of patients with asthma was statistically higher (p < 0,05).

The influence of the asymmetry of diameters of vessels on the asymmetry coefficient is not statistically significant because the asymmetry of blood flow in the internal carotid artery in children with asthma may explain preclinical manifestations of angiodystonia. Analysis of hemodynamic indices on the right and left vertebral arteries proves that volumetric rate in children with asthma is lower than in the healthy: the right vertebral artery, respectively 158,35 ± 8,07 ml / min vs. 198,46 ± 9.53 ml / min (p = 0.04); on the left vertebral artery - 180,29 ± 8,12 ml / min vs. 220,58 ± 9,00 ml / min (p = 0.02). Isolated decline in the volume of blood flow in the vertebral artery determines the statistically significant reduction in the posterior cerebral blood flow volume - from 412,32 ± 32,80 ml / min in healthy vs. 335,9 ± 10,07 ml / min in patients with asthma (p < 0,01).

Also, there is a decrease in the proportion of surround Posterior cerebral blood flow in total surround cerebral blood flow in cohorts of children are compared: 27.6 % of patients with asthma versus 32.2 % in the healthy. Decrease speed to surround both the vertebral artery, posterior cerebral surround, the proportion of rear surround in cerebral blood flow in total surround the brain of patients with asthma demonstrate hemodynamic breaches of ischemic type (hypoperfusion) in both basins of vertebral arteries, that is vertebrobazylyar area.

Conclusions

1. Patients with children's asthma found in violation of extracranial carotid basin area (in the form of reduced linear velocity of blood flow in the right internal carotid artery, the asymmetry of the linear velocity of blood flow in the basins of internal carotid arteries).

2. Detected extracranial vertebral abnormalities in the basins of the arteries (in the form of a decline in the volume of cerebral blood flow, blood volume reduction in the rear and its share in the total volume blood flow), indicating that the development of regional hypoperfusion in vertebrobasylyar area.

3. Regional hypoperfusion in vertebrobasylyar area did not lead to a decrease in total cerebral blood flow, indicating that the compensation of hemodynamic disorders due to constant volumetric flow velocity on both the internal carotid artery.

4. Changes indicators of extracranial hemodynamics in children with asthma should be considered as a predictor of occurrence of cerebrovascular complications in this group of patients.


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