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Жінка та війна: формули виживання

Коморбідний ендокринологічний пацієнт

Журнал "Здоров`я дитини" 2 (61) 2015

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Effect of basic pharmacotherapy on the condition of cerebral hemodynamics in children with bronchial asthma.

Автори: Akulova O. Yu., Nedel''skaya S.N.

Рубрики: Педіатрія/Неонатологія

Розділи: Клінічні дослідження

Версія для друку

Ключові слова

bronchial asthma, cerebral hemodynamic, basic pharmacotherapy, children.

Introduction. At the present stage of research of the pathogenesis of bronchial asthma has made significant progress, but there are still research gaps. This investigated area is the state and characteristics of cerebral hemodynamic in children with asthma. Scientific-pedagogical staff of the Department of faculty Pediatrics Zaporozhye state medical University several years investigating this issue, according to the results of our work was proven by the presence of changes in indicators of extra - and intracranial hemodynamic in children with asthma. This research area includes a number of unexplored questions, one of which is the influence of basic pharmacotherapy on the condition of cerebral hemodynamic in children with asthma.
The study of the influence of basic pharmacotherapy and development of practical recommendations regarding the optimal scheme, which will contribute to the elimination of the negative effect of disturbance indicators of external respiration function on the state cerebral hemodynamic of children with asthma, will improve the level of control over the course of the disease.
Materials and methods. According to this goal, we have deleted the following groups of observations: children who received basic therapy of inhaled corticosteroids (n=26), children who received monotherapy in the form of antileukotriene drugs (n=5) and the combined basic treatment using inhaled corticosteroids and antileukotriene drugs simultaneously (n=11). From the study were excluded children who according to history and neurologic examination had neurological pathology - organic lesions of the Central nervous system or other pathology of the brain. Control groups comparison group of healthy children (n=30) and children with asthma who were more than one year in remission and did not take any medicines about asthma (n=15).
The groups were identical by gender and age (10-17 years) composition. The study was conducted on the MyLab 50 ultrasound scanner (Esaote, Italy) with a transducer frequency of 2-10 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. Treatment with all three schemes have led to the increase of the maximum linear velocity of blood flow (V max) in the internal carotid artery (ICA), i.e. to improve the perfusion of the brain and leveling statistically significant differences with the maximum linear velocity of blood flow (V max) in healthy children. However, in patients with asthma in remission rate V max in ICA is still statistically lower than that of healthy - respectively 90,1±4,1 sm/s and 100,00± 3,41 sm/s (p= 0,02).
In children, in which to achieve control of the disease used antileukotriene drugs and their combinations with inhaled corticosteroids, the asymmetry index of blood flow in the ICA significantly decreased and were not statistically different from similar index in healthy children, i.e. manifestations of asymmetry of blood flow were reduced to normative indicators. Basic therapy of inhaled corticosteroids did not give such result, since the indicator of asymmetry index on ICA remained significantly higher (19,3±2,2%) than in other groups of observations. The asymmetry index of blood flow shows the development of the disruption of blood supply to the brain and may indicate the development of pre-clinical manifestations of angiodystoniya.
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). The treatment does not affect the increase in posterior cerebral blood flow volume to the level of healthy children, therefore, not depending on the regimen in patients with children᾽s asthma observed phenomena of hypoperfusion in the vertebro-basilar zone.
The treatment of inhaled corticosteroids and their combinations with antileukotriene drugs did not lead to statistically significant improvement in coefficient of reactivity on hypercapnic load (K+) - 1,06±0,02 and 1,06±0,05 respectively, have not improved the ability of blood vessels of children with asthma react to hypercapnic load. At the same time, patients who as a basic therapy took an antileukotriene drugs, and children in remission (1,23±021 and 1,13±0,05 respectively) these figures were not statistically different from values in healthy children (1,18±0,02).
In children, which as a basic monotherapy received antileukotriene drugs statistically significant difference maximum linear velocity of blood flow (V max) in Vienna Rosenthal compared with healthy was not observed (15,4±2,7 and 14,4±2,8 sm/s respectively, p= 0,45), i.e. it is possible to ascertain the positive impact of this therapy on parameters of the venous outflow.
The use of all three schemes the basic therapy resulted in reduction of the index Lindegard to the level of healthy children. Noteworthy high index Lindegard in girls in remission, significantly exceeds the same indicator as in healthy girls, and the girls who were on the basic therapy of all of the above listed drugs. The index Lindegard significantly higher in girls compared with boys in remission to 1,47±0,07 and 1,20±0,09 respectively (p<0,05). We can conclude that the main cerebral vessels girls, even during remission of the underlying disease, prone to latent functional angiospasm, therefore, these children should be treated as contingent increased risk of cerebrovascular complications.
1. Among the three analyzed schemes basic therapy of asthma monotherapy with antileukotriene drugs normalizes the greatest number of indicators of cerebral hemodynamic, second place - combined treatment with inhaled glucocorticosteroid and antileukotriene drugs, the least efficient on the indicators of cerebral hemodynamic affects basic inhaled glucocorticosteroid therapy.
2. In the selection of basic anti-inflammatory therapy may offer the use monotherapy of antileukotriene drugs as a priority relative to the positive impact on performance condition of cerebral hemodynamic provided an adequate assessment of the clinical picture, phenotype and severity of asthma.
3. In the case of more severe uncontrolled flow of asthma and the need for appointment as basic therapy inhaled glucocorticosteroid, it is possible to propose the appointment of combined treatment using inhaled glucocorticosteroid and antileukotriene drugs.
4. Basic anti- inflammatory pharmacotherapy none of these schemes did not affect Posterior cerebral blood flow, i.e. none of the analyzed schemes does not contribute to the elimination of the regional hypoperfusion in vertebrobasylyar area in patients with children's asthma.
5. Due to the fact that in remission multiple indicators of cerebral hemodynamic deteriorated and were not statistically different from those of patients with uncontrolled asthma, patients with asthma should be supervised of a children's neurologist and require planned Doppler examination of the main vessels of the head and neck, regardless of whether the exacerbation and the degree of control of the underlying disease.
6. In case of diagnosis in patients with children's asthma of hypoperfusion in the vertebro-basilar pool, it is necessary to include this group of children to those who have a tendency to cerebrovascular complications and requires the use of cerebroprotective and drugs, which can improve perfusion of the brain.

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