RU2144345C1 - Method of correction of neurologic disturbances in children with acute lymphoblastic leucosis in period of remission - Google Patents

Abstract

FIELD: medicine, health resort treatment. SUBSTANCE: method includes administration of general pine-pearl baths. Bath temperature is 35-37 C. Bath treatment procedure takes 6-8 min. Concentration and pressure parameters depend on patient's age. EFFECT: increased period of remission of main disease. 2 ex

Description

 The invention relates to medicine, to the physiotherapeutic correction of neurological disorders in children with acute lymphoblastic leukemia (ALL) in the period of remission.

 As a result of the transition to high-dose chemotherapy programs for malignant neoplasms in children that are new for Russia over the past 3-5 years, an ever-increasing layer of children cured of hematologic diseases has appeared (Rumyantsev A.G., Vladimirskaya E.B., 1996).

 In this regard, the previously absolutely contraindicated methods of physiotherapy (Karachevcheva T.V. Guidelines for physiotherapy and physioprophylaxis of childhood diseases. - M .: Medicine, 1987, p. 20) are beginning to be used cautiously in this contingent.

 In the period of ALL remission, concomitant diseases are observed in 70% of children (Alekseev N.A., Vorontsov I.M., 1988). The lion's share of them are diseases of the nervous system: neurotic reactions, vegetovascular dystonia.

 The main pathogenetic moment in the development of this pathology in this group of patients is the influence of long-lasting difficult conditions, chronic overstrain of nervous processes (hospital stress), as well as the weakening of protective and adaptive reactions caused by the underlying disease and the use of radiation therapy and intensive doses of cytostatic preparations.

 The disadvantages of drug and herbal correction of neurological disorders in acute lymphoblastic leukemia during remission can be considered a large number of contraindications, a high likelihood of developing allergic and adverse reactions, and psychological fatigue of patients from the “tablet” “marathon”. Thus, the use of drug treatment is significantly limited.

The prototype is a method for the correction of neurological disorders in children with acute lymphoblastic leukemia in the period of remission, including exposure to the child’s body with common coniferous-pearl baths at a temperature of 35-37 ^o C for 6-8 procedures every other day (Filippov E.G. et al. . "Experience in the use of hydrotherapy in children with acute lymphoblastic leukemia in a sanatorium," J. Issues of balneology, physiotherapy and physiotherapy exercises. - Moscow: Medicine, 1995, p. 14-16).

 The technical result of the proposed method is to increase the effectiveness of the correction of neurological disorders in acute lymphoblastic leukemia in the period of remission, their prevention, increase the period of remission of the underlying disease.

The specified technical result is achieved by exposure to the body with common coniferous-pearl baths at a temperature of 35-37 ^o C for 6-8 minutes, carried out every other day, characterized in that for patients aged 8-10 years, coniferous-pearl baths are carried out at a concentration of 0.4 g / l and air pressure from 1.0 atm, and for patients over 10 years old - at a concentration of 0.5 g / l and a pressure of 1.5 atm, the course of treatment is 8-10 procedures.

 Mechanism of action. At the heart of the action of hydrotherapy procedures is the neuro-reflex mechanism. Water is only the medium through which various irritations are applied (temperature, mechanical, chemical). Hydrotherapy procedures have a distinct impact on the functional state of the nervous system, the processes of thermoregulation, cause shifts from various organs and systems, metabolism.

 Common pearl baths have a regulatory effect on the nervous system, vascular tone, cause positive changes in indicators of carbohydrate, protein and lipid metabolism. The most effective pearl baths in vegetovascular dystonia of the hypotonic type, mild thyrotoxicosis, hypersthenic neurosis, the initial stage of hypertension, as well as other diseases.

 The action of common coniferous baths is based on the presence in the needles of essential oils that favorably affect the skin, upper respiratory tract and have a calming effect (through the olfactory analyzer) on the nervous system. Such baths are indicated for rickets, rheumatism, peptic ulcer, with functional disorders of the nervous system in puberty.

The rationale for the specified temperature regime (35-37 ^o C) in the proposed correction method is based on the indifference of the specified temperature for the child's body, the absence of pronounced thermal effects; the duration of the procedure of 6-8 minutes allowed to obtain the optimal effect, the concentration parameters of the coniferous extract and pressure depended on the age of the patients (8-10 years - 0.4 g / l and 1.0 atm; older than 10 years - 0.5 g / l and 1.5 atm); conducting procedures every other day reduced the burden of general effects. The course nature of the impact is due to the need for stable consolidation of the correction results.

 The method is as follows.

 The course of bath therapy is preceded by a conversation between the doctor and the patient and his parents about a new correction method with the aim of psychological preparation of the child for exposure. Procedures are carried out 45-60 minutes after breakfast. Directly in front of the bath, the child rests for 10-15 minutes. The bath is filled with warm water from the mixer, the temperature is measured with a water thermometer, immersing the lower end of it in water. According to the readiness of the bath, after measuring blood pressure (A / D) and the number of heart contractions (HR), the patient slowly immerses in it, taking a comfortable semi-recumbent position, so that the upper part of the chest (above the level of the nipples) is not covered with water. In the event that the bath for the child is too deep and the water covers it to the level of the neck, a special ladder-stand is placed under the patient’s feet. During the procedure, medical personnel constantly monitor the well-being of the child, the color of his skin, pulse rate and respiration. It is especially important to monitor the child's reaction to the first two procedures in order to determine the general tolerance of the baths, as well as to the fourth and fifth, when there is a high probability of pathological balneoreaction; and in meteorolabile children, in addition, the reaction to the procedures is also monitored on days of contrasting changes in weather fronts.

 After the bath, the patient rests, lying on the couch, in the bathroom building for 20-30 minutes. Upon returning to the main room of the sanatorium, children additionally rest in bed for 1-1.5 hours. On the days of bathing, other procedures of general effect are not assigned to children, and they are limited to health paths and excursions.

 The advantage of the proposed correction method compared to the prototype is that the proposed regime of coniferous-pearl baths for treating patients, taking into account their age, increases the efficiency of correction, prevents the appearance of balneoreaction, and also saves consumables for preparing the bathtubs.

 Example 1. Patient N-va A., 9 years old.

 The main diagnosis: acute lymphoblastic leukemia, the first remission of 5 years.

 Concomitant diagnosis: neurosis of obsessive movements.

 Upon receipt of complaints of poor sleep, unmotivated fears, "often crying" for no apparent reason, headaches.

 Objectively: normal physical development. The skin and visible mucous membranes are pale, moist. Motor anxiety - constantly scratching, moving his arms and shoulders. He focuses poorly, is inattentive, often asks the doctor again.

 Zev is calm. Peripheral lymph nodes are small, painless on palpation, mobile. In the lungs, vesicular breathing, no wheezing. The number of breaths 16 in 1 min. Heart sounds are clear, rhythmic. A / D - 100/60 mm Hg Pulse - 95-100 beats per minute, satisfactory filling and voltage. The abdomen is soft, painless on palpation. Liver, spleen not enlarged. There are no dysuric phenomena. Tendency to constipation.

 Examination: general blood test before treatment: Hb - 124 g / l; erythritol. - 4.0 million; thrombus. - 300 thousand; lake. - 5.5 thousand; s / s - 2, s / s - 55; eosinoph. - 2; base - 0; lymph - 29; mon - 12; ESR - 4 mm / h.

 An. general urine - within the age norm.

 Ultrasound of the abdominal organs: the liver is not enlarged, the echo structure is homogeneous, the gall bladder is not enlarged. The pancreas is not enlarged, the echo structure is homogeneous, dimensions are 1.8-1.4-1.6 cm. The spleen is not enlarged. The kidneys are of normal shape and location, the collective system is not expanded. Intraperitoneal lymph nodes are not visualized.

 ECG: The frequency of contractions in 1 minute is 95. The PQ interval is 0.12; QRS - 0.08; QRST - 0.33. Sinus rhythm.

 FVD: norm.

 The sanatorium has undergone treatment: a gentle regime with the transition to a gentle trainer, diet No. 5, therapeutic exercises in the group, vitamin-oxygen cocktail No. 20.

On the 3rd day of the stay in the sanatorium, the girl was assigned general coniferous-pearl baths with a concentration of coniferous extract of 0.4 g / l, with an air pressure of 1.0 atm and a temperature of 37 ^o C, for 8 minutes, every other day, on course of 10 procedures.

 First bath - 6 minutes, A / D to the bath 100/65, pulse 90.

 TEKG is a physiological reaction. Heart rate - 95, 92, 90.

 PQ - 0.11; 0.12; 0.11.

 QRS - 0.08; 0.07; 0.08.

 Q-T 0.33; 0.34; 0.33.

 The second bath - 7 minutes, A / D to the bath 100/70, pulse 92, 85.

 TEKG is a physiological reaction. Heart rate - 90, 87, 85.

 The third bath - 8 minutes A / D to the bath 95/65, pulse 90, 85.

 TEKG is a physiological reaction. Heart rate - 95, 95, 98.

 PQ - 0.12; 0.12; 0.12.

 QRS - 0.07; 0.07; 0.07.

 Q-T 0.3; 0.30; 0.28.

 The fourth bath - 8 minutes, pulse 88, 85.

 The fifth bath - 8 minutes, pulse 90, 85, A / D - 95/60.

 Sixth bath - 8 minutes, A / D to the bath 95/65, pulse 90, 85.

 Seventh bath - 8 minutes, A / D to the bath 90/60, pulse 95, 90.

 The eighth bath - 8 minutes, pulse 95, 90.

 Ninth bath - 8 minutes, pulse 90, 85.

 Tenth bath - 8 minutes, A / D to the bath 95/60, pulse 95, 90.

 TEKG - physiological reaction, heart rate - 100, 90, 90.

 PQ - 0.12; 0.12; 0.12.

 QRS - 0.08; 0.08; 0.08.

 Q-T 0.34; 0.33; 0.33.

 He carried out the treatment and physical exercises satisfactorily. After treatment, significant positive dynamics were noted: sleep, appetite, well-being improved, fears disappeared, motor anxiety decreased, and she became “more confident, calmer”. General tests of blood and urine at the end of the course of exposure - without features.

 Follow-up observation during the year confirmed the effectiveness of the correction: there is no deterioration. Observed by a neurologist at the place of residence.

 Example 2. Patient Peninsula A., 10 years.

 The main diagnosis: acute lymphoblastic leukemia, the first remission of 5.5 years. Concomitant diagnoses: biliary dyskinesia. Kyphoscoliosis of the thoracic spine 1 tbsp. Neurotic state (tics).

 Upon receipt, the condition is satisfactory. Complaints of weakness, irritability, periodic “twitching of the face”, poor sleep, appetite.

 Objectively: the skin is clean, pale. Catarrhal manifestations from the pharynx, nasopharynx are absent. All groups of lymph nodes are palpated, small, up to 2 sizes, painless on palpation, mobile, not soldered to the surrounding tissue. Violation of posture. In the lungs, vesicular breathing, no wheezing. The number of breaths is 20 per minute. Heart sounds are clear, rhythmic. A / D - 105/65 mm Hg Pulse - 86 beats per minute, satisfactory filling and tension. The abdomen is soft, painless on palpation. Parenchymal organs are not enlarged. The chair is decorated. Pasternatsky’s symptom is negative on both sides. Urination is free.

 Examination: general blood test before treatment: Hb - 140 g / l; erythritol. 4.2 million; thrombus. - 340 thousand; L. - 5.6 thousand; e. - 6; PO Box - 2; s / I - 55; lymph - 27; mon - ten; ESR - 6 mm / h. An. general urine - without features.

 Ultrasound of the abdominal organs: parenchymal organs are not enlarged, the echo structure is uniform, a constriction is determined in the neck of the gallbladder. Intraperitoneal lymph nodes are not visualized.

 ECG: The frequency of contractions per minute is 75. The PQ interval is 0.12; QRS - 0.07; QRST - 0.34. Sinus rhythm. FVD: norm.

 Neurologist consultation: Neurotic tics.

 The sanatorium has undergone treatment: a gentle regime with the transition to a gentle trainer, diet No. 5, therapeutic exercises in the group, vitamin-oxygen cocktail No. 20.

The patient used the correction method in the form of common coniferous-pearl baths with a concentration of coniferous extract of 0.5 g / l, at an air pressure of 1.5 atm and a temperature of 36 ^o C, for 8 minutes, every other day, for a course of 10 procedures.

 First bath. A / D to the bath 110/70, pulse 94.

 TEKG is a physiological reaction. Heart rate - 94, 100, 85.

 Q-T 0.34; 0.35; 0.34.

 Second bath. A / D to the bath 105/70, pulse 90.

 TEKG is a physiological reaction. Heart rate - 92, 100, 85.

 Third bath. A / D to the bath 100/70, pulse 86.

 TEKG is a physiological reaction. Heart rate - 102, 98, 100.

 Q-T - 0.30; 0.32; 0.30.

 The fourth bath. A / D - 100/65, pulse 85.

 Fifth bath. A / D - 100/70, pulse 88.

 Sixth bath. A / D to bath 105/65, pulse 86.

 Seventh bath. A / D to the bath 105/65, pulse 92.

 The eighth bath. A / D to the bath 100/60, pulse 98.

 The ninth bath. A / D to the bath 100/60, pulse 92.

 Tenth bath. A / D to the bath 100/60, pulse 86.

 TEKG is a physiological reaction. Heart rate - 85, 85, 85.

 PQ - 0.11; 0.11; 0.11.

 QRS - 0.07; 0.07; 0.07.

 Q-T 0.33; 0.33; 0.33.

 He carried out the treatment and physical exercises satisfactorily. As a result of treatment, the patient's appetite and sleep improved, tics practically disappeared, and motor activity increased.

 Objective data on internal organs are the same. Complete blood count at the end of the course of treatment: Hb - 140 g / l; erythritol. - 4.2 million; thrombus. - 300 thousand, L. - 6200; eos. - 2; PO Box - 3, PO Box - 56; lymph - 25; mon - fourteen; ESR - 2 mm / h. Urinalysis is general - within the age norm.

 Follow-up data (11 months) indicate a significant improvement - there are no ticks. Observed by a pediatric neurologist at the place of residence.

 Such a persistent therapeutic effect (periods from 6 months to a year) was registered in 61 of 72 patients who received correction by the proposed method.

 Thus, the studies indicate a high therapeutic efficacy (85%) of the course of coniferous-pearl baths in case of neurological disorders in children with ALL in the period of remission. The proposed correction method is well tolerated by patients. Adverse reactions and complications were not noted. The advantage of the claimed method is the possibility of applying it at all stages of medical rehabilitation: outpatient, inpatient, sanatorium and resort.

Claims (1)

A method for the correction of neurological disorders in children with acute lymphoblastic leukemia during remission, including exposure to the body with common coniferous-pearl baths at a temperature of 35 - 37 ^o C, lasting 6 to 8 minutes, carried out every other day, characterized in that for patients aged 8 to 10 years coniferous-pearl baths are carried out at a concentration of 0.4 g / l and a pressure of 1.0 atm, and for patients over 10 years old - at a concentration of 0.5 g / l and a pressure of 1.5 atm, for a course of treatment of 8 to 10 procedures.