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"Child`s Health" 1 (60) 2015

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Efficiency vazotropnovi therapy in children with neurocyrcolatory dystonia of hypertensive type

Authors: Shlimkevych I.V. - SHEI "Ivano-Frankivsk National Medical University", Department of Pediatrics, Ukraine

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Hypertension (HT) is the most common cardio - vascular system in the adult population [1, 12]. Today prevalence of hypertension among students according to the literature ranges from 1 to 14 % [3]. The close relationship of elevated blood pressure (BP) in the future development of hypertension requires careful attitude to every fact of hypertension in children [4, 16]. Neurocirculatory dystonia (NCD) - рolyetiological functional neurogenic diseases of the circulatory system, which is based on disorders of the neuroendocrine regulation of many and varied symptoms that arise or are exacerbated by stress effects on the background, different course dobro¬yakisnym favorable prognosis, discouraged and cardiomegaly heart failure [6, 11].

Today it is believed that the effectiveness of NCD treatment depends not only on the proper selection of antihypertensive drugs, but also on adequate impact on the return and risk factors most important pathogenic mechanisms. Since the main clinical manifestations of NCD induced structural and functional changes of vessels both pools (arterial and venous), the rational study of the feasibility of using anhiotropnyh drugs in treatment of NCD in children.

Objective: To determine the effectiveness of the drug vazotropnoho vinpocetine treatment in children with hypertensive option NCD.

Material and methods. The study involved 60 children aged 14 - 18 years with neurocyrcolatory dystonia for hypertensive type 20 and their healthy peers, who made the comparison group. The average duration of the registration of high blood pressure in children was (2,4±0,7) years. In the study, all children performed a complete clinical examination, ophthalmoscopy, study of cerebral hemocirculation by analyzing the performance rheoencephalography (ReoEH) and transcranial Doppler (TKDH). ReoEH recorded by the computer system reography "Regina-2000". Established indicators rheographic index (RI USD), duration anakroty (α), anakrotychnoho index (α/ %), speed slow blood supply (υ,Om/s) dykrotychnoho index (DKI%) and diastolic index (DUI%). Transcranial Doppler (TKDH) was performed on the machine "Multigon" 500M TSD. We determined the nature of blood flow to the brain, vertebral artery and internal jugular vein system; measured lumen internal jugular vein. Regarding drug applied technology, all examined with NCD were distributed as follows: 30 children received basic therapy according to Protocol 30 children - except basic therapy received nootropic drug metabolic action Vinpocetine 15 mg. The course of treatment was 2 months. A survey was conducted of patients before and after a course of adjuvant therapy. Statistical analysis of data was performed using the software package Statistica 5,5A (StatSoft, USA). The average values presented in the form of (M±m), where M - the average rate, m - standard error of the mean. When comparing the average values used Student test. Results considered statistically significant for values of p<0,05.

Results and discussion In children with NCD tsefalhiyi occurred in 51,6 %. They often appeared in the afternoon (after school to school) and in the evening. Headache was mainly periodic usually diffuse nature (covered parietal, temporal and occipital areas), mainly pressing or squeezing, provokuvavsya mental or physical overload, or decreased arbitrarily required to purchase their medication. Nearly half (55,0 %) patients with NCD expressed meteozalezhnist noted that often manifested mihrenepodibnym headache or occurrence of autonomic crises. In the study of the fundus revealed that changes in the fundus in children with NCD manifested mainly decreased tone of veins in violation of venous blood against the backdrop of vasospasm and angiodystonia (pn<0,05). Among the changes to reoentsefalohrami in children with arterial dystonia NCD dominated with a tendency to hypertonicity. All the variability changes concerned primarily increase vascular tone against the background of altered vascular wall rigidity. Thus, the observed decrease in probable rheographic index (PI), (M±m) (pn<0,001). ReoEH peculiar to children with NCD was also a significant increase in the duration anakroty (α) to (M±m) (pn<0,001). This trend is evidenced in favor of changing the resistive properties of the vascular wall. On the change in tonic properties vessels indicating the likely growth rate anakrotychnoho index (α/T%) to (M±m). Noted and growth rate dykrotychnoho index (DKI%), reflecting primarily arteriolar tone. Yes, he reached (68,12±1,29)%, (pn<0,05). The lower figure and was DUI, reflecting the state of the outflow of blood from arterioles to venules and veins and the tone was (58,74±1,56)%, (pn<0,001). These findings were confirmed in the analysis of results TKDH. Thus, in 51,6 % of patients with hypertension has been a decrease in blood flow in posterior cerebral artery in 46,6 % - on the basilar artery. In 58,3 % of children with hypertension detected vasospasm of the middle cerebral artery in 41,6 % and 48,3 % of the patients - anterior and posterior cerebral arteries, respectively. Mizhpivkulova asymmetry of cerebral blood flow in the carotid and vertebral basilar-basins observed respectively in 35,0 % of children with NCD. In 36,6 % of the patients were recorded signs of NCD arterio-venous shunt in the pool zadnomozkovyh and medium arteries (arterial premature discharge of blood in venous bed), increased venous outflow through the veins and bilateral nadblokovyh ekstravazalna compression nadblokovyh arteries. Children of NCD were inherent and venous discirculation evidenced by reduction of the linear flow velocity in the system of internal jugular vein.

Thus, hemodynamic changes in children with NCD is quite significant and affect both arterial and venous systems hemocirculation. For patients with NCD is inherent dystonia against the background of altered vascular wall rigidity. Changes tonic properties vessels especially pronounced in the microcirculation and relate primarily growth arteriolar tone in severe hypotension venules. Under these conditions, there is an imbalance in the system vnutrishnotserebralnoyi hemocirculation.

The use of treatment in children with NCD proved quite effective and has led to regression of the main complaints and improved feel. In patients with NCD quite as effective was the use of standard therapy and its combination with vinpocetine. However, quality unidirectional changes were quantified unequal. In particular, the use of standard treatment was accompanied by regression tsefalhichnoho syndrome in 33,3 % (p<0,01), while a combined - in 46,6 % (p<0,001) patients with NCD. However, quite effectively regressed and concomitant symptoms as dizziness and a feeling of noise and pulsation in the head - in 56,6 % (p<0,001) influenced the standard and in 63,3 % (p<0,001), respectively, under the influence of combined therapy (p<0,05). The use of standard therapy induced regression kardialhichnoho syndrome in 50,0 % (p<0,001), while both combined - in 60,0 % (p<0,001) children of NCD. Both approaches medications were almost equally effective in correcting meteozalezhnosti, while efficiently as arrhythmia syndrome (p<0,05) korehuvavsya combined therapy. In particular, under the influence of the latter by 33,3 % (p<0,05) regressed incidence of failure of the heart, at 36,6% - palpitation sensation alone (p<0,01) and 20,0 % - in loading. The use of standard therapy led to stabilization of blood pressure in 30,0 % of patients (p<0,01), combined - in 46,6 % (p<0,001), weakness regressed to 43,3 % (p<0,001) and 46,6 % (p<0,001), dyspnea sensation in 13,3 % (p>0,05) and 20,0 % (p<0,05) when using both medication approaches, respectively. Under the influence of standard therapy decreased psycho-emotional lability in 50,0 % (p<0,001) and increased anxiety - in 43,3 % (p<0,001) influenced by combined - in 66,6 % (p<0,001) and 60,0 % (p<0,001) patients, respectively. This affective coloring complaints as feeling short of breath and breath better dissatisfaction subjected to correction of combined therapy (p<0,05). Thus, despite the same direction and relatively high efficiency of both medication approaches to correction of clinical symptoms in patients with NCD, though combined therapy was more effective. Positive clinical dynamics under the influence of adjuvant therapy in children with NCD accompanied and optimization of key parameters of cerebral blood flow, as evidenced by data ReoEH. Thus, as a result of drug therapy indicator RI in patients with NCD increased, and this increase under the influence of combined therapy was significantly (p<0,05), and the resulting performance of such treatment RI probably close to those determined in healthy (pn> 0,2). And noted the positive effect of drug therapy on vascular resistive properties. Thus, the rate α under the influence of both treatment options with NCD decreased. Maximum dynamics of α achieved when using combined therapy. So, at the end of the treatment course vinpocetine inclusion rate was α (0,103±0,005) s (pn>0,5). Such dynamics induced, in turn, decrease of anakrotychnoho index (α/T). Thus, accounting for treatment (18,32±0,55) % index α / T after a course of combined therapy was (16,31±0,56) % (p<0,05), while significantly approaching similar in healthy (pn>0.5).

A similar trend was observed in the analysis of data TKDH. In particular, under the influence of standard therapy celebrated reducing the signs of the central and peripheral venous stasis and arterial dystonia in 23,3 % of intracranial hypertension - in 21,6 %, improving blood circulation in the vertebral artery - in 33,3 % decrease vasospasm in cerebral arteries pools - in 35.0% of patients with hypertension. Thus, the use of combined therapy was accompanied by a decrease in signs of central and peripheral venous stasis and arterial dystonia in 33,3 % of patients, intracranial hypertension in 51,6 %, improving blood circulation in the vertebral artery - in 46,6 % decrease vasospasm in cerebral arteries pools - in 40,0 % of patients with NCD. Under the influence of this therapy increased the speed and rate of venous blood flow. In particular, at the end of treatment course combined therapy in patients with NCD he was (34,4±1,4) cm / s to (30,1±1,8) cm/s before treatment (p>0,05) with almost equaling with the corresponding index in healthy (pn>0,5). Thus, the conduct of the study showed a positive trend hemodynamic changes in children with NCD treatment influenced the inclusion of comprehensive treatment vinpocetine. Moreover, improvements touching both arterial and venous systems hemocirculation. In particular, optimized tonic properties of blood vessels (arterioles decreased with increasing tone tone venules), increased the value of their pulse blood filling, improved condition of venous blood from the cerebral vascular system.

Conclusions: Clinical NCD for hypertensive type in children consists of tserebroastenichnoho manifestations, cardiac, autonomic, vascular, astenonevrotychnoho syndromes and their combinations. The most common complaints are headache, dizziness, flashing "dark flies" in front of the eyes, tinnitus, fatigue, heart rate at rest and worsening of visual acuity. Children of NCD have a pronounced circulatory changes in the arterial and venous pools. They are characterized by dystonia against the background of altered vascular wall rigidity. Changes tonic properties vessels especially pronounced in the microcirculation and relate primarily growth arteriolar tone in severe hypotension venules. The use of combined medical approach with the inclusion of nootropics vinpocetine children with NCD induces an effective correction of clinical and functional changes (decrease tsefalhiy, dizziness, noise and pulsation in the head, blood pressure lability) and cerebral hemodynamic optimization that allows to recommend it to the complex treatment of patients with NCD.

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