RU2482889C1 - Method of treating rumination syndrome in infants - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely paediatrics and may be used for treating rumination syndrome in infants. For this purpose, the state of the infant's vegetative nervous system is assessed by cardiointervalography. It is followed by electrophoresis on the area of the cervical sympathetic ganglia by Steam 1 galvaniser apparatus at current density 0.01-0.03 mA/cm². The electrophoresis procedure is performed in the infant lying on his/her back with a head lifted at 45°-60° in a fixed position from 13 to 14 o'clock 1 hour prior to the feeding. The length of the procedure is 8 minutes; the therapeutic course makes 8 daily sessions. If observing sympathicotonia, a cathode is placed on the both side surfaces of the infant's neck, an anode is placed on the posterior surface of the neck. In this case, 5% sodium bromide is introduced from the cathode. If observing vagotonia, the anode is placed on the both side surfaces of the infant's neck, and the cathode - on the posterior surface of the neck. In this case, 5% calcium chloride is introduced from the anode.

EFFECT: method provides the higher clinical effectiveness, reduced length of treatment, and faster rumination syndrome relief, reduction of complications, improved protective and adaptive body responses by correcting imbalances in the state of the vegetative nervous system depending on the characteristics of the patient's vegetative status.

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Description

The invention relates to medicine, in particular to pediatrics, and can be used in the treatment of children with regurgitation syndrome.

Regurgitation is one of the most common functional disorders of the gastrointestinal tract in infants (Khavkin AI Functional disorders of the gastrointestinal tract in young children. - M., 2000. - 71 pp.; Belmer S.V. , Gasilina T.V., Khavkin A.I., Ponomareva A.P. Functional disorders of the upper digestive tract in children. // Attending physician. - 2005. - No. 8. - P.64-67).

According to general statistics, the frequency of regurgitation syndrome varies from 18% (France) to 20% (USA) in the population of young children. Complaints of regurgitation account for up to 40% of all reasons for seeking advice from a pediatrician (Australia). Up to 67% of children 4 months of age spit up at least once a day, and in 23% of cases, spitting up is considered by parents as "anxiety."

According to domestic authors, regurgitation is detected in 47% of children (Khavkin A.I., Keshishyan E.S., Kazakova S.N. Modern ideas about gastroesophageal reflux in children. Spitting up syndrome. // Pediatric gastroenterology 2000: Sat. Mat. 7 Conf. "Actual problems of abdominal pathology in children." - M., 2000. - P.78-83). The maximum frequency of regurgitation is observed in the first 6 months of life. With artificial feeding, the frequency of regurgitation is 1.5-2 times higher than with natural (Khorosheva E.V. Alimentary correction of regurgitation syndrome in children of the first year of life. // Abstract of thesis ... Candidate of Medical Sciences. - M., 2001 .-- 26 s). The high frequency of regurgitation syndrome in infants is caused by structural features of the upper digestive tract and the immaturity of the neuro-humoral link in the regulation of the sphincter apparatus and gastrointestinal motility, and feeding disorders (Denisov M.Yu. Clinical pediatrics. Selected lecture course. M. Publisher Mokeev 2003 S. 73-74).

The primary failure of the antireflux barrier in young children is most often caused by dysregulation of the esophagus and stomach by the autonomic nervous system. Autonomic dysfunction, as a rule, is caused by previous hypoxia of the brain. The most studied mechanisms of impaired nervous regulation (Denisov M.Yu. Digestive system diseases in young children. - M.: Medical Information Agency LLC, 2010. - P.59).

Persistent complex violations of the motility of the esophagus and other parts of the gastrointestinal tract suggest that regurgitation is one of the manifestations of an independent disease (Denisov M. Yu. Clinical pediatrics. Selected lectures. M. Publisher Mokeev 2003. P.73-74).

Vomiting syndrome can be a clinical manifestation of gastroesophageal reflux disease, which is associated with the possibility of developing reflux esophagitis, reflux-induced bronchospasm, aspiration pneumonia, the formation of chronic inflammatory diseases of ENT organs, bronchi and lungs, reflux-induced laryngospasm, with subsequent apoplasm, with and sudden death syndrome (Mayev IV Extra-esophageal manifestations of gastroesophageal reflux disease. Experiment. and wedge. gastroenterol. 2005: 5: 55-56).

The regurgitation syndrome can lead to a decrease in the intake of nutrients in the child’s body and the development of the phenomena of malnutrition, anemia (Kon I.Ya., Sorvacheva TN “Dietotherapy of functional disorders of the gastrointestinal tract in children of the first year of life” // Attending physician. - 2004. - No. 2. - S.55-59).

A known method of treating regurgitation syndrome in young children is medical therapy, which includes the appointment of drugs that normalize the motor-evacuation function of the digestive tract and has an antireflux effect (prokinetics).

The only drug currently used in Russia in children, starting from infancy, is domperidone. Its effect is due to the blockade of peripheral dopamine receptors. This eliminates the inhibitory effect of dopamine on the motor function of the upper digestive tract, increases the evacuation and motor activity of the esophagus and stomach. Motilium is prescribed in the form of a suspension at the rate of 2.5 ml per 10 kg of body weight (corresponding to 250 μg / kg body weight) 3 times a day before meals for 30-40 minutes and, if necessary, before bedtime. The course of treatment is individual: from 10-15 days to 2-3 months. The typical lack of influence on the central nervous system for domperidone is mainly the result of mild penetration through the blood-brain barrier, but the occurrence of neurological symptoms cannot be completely excluded in children under the age of 1 year. An overdose can cause neurological side effects. Therefore, the appointment of domperidone in children under 1 year old should be carried out under close medical supervision (Denisov M.Yu. Digestive system diseases in young children. - M .: Medical Information Agency LLC, 2010. - P 71-72).

The disadvantages of the method:

- it is difficult to take the drug through the mouth in the presence of regurgitation syndrome;

- age restrictions;

- limited possibilities for medical monitoring of the patient at the outpatient stage of treatment;

- side effects of the drug;

- negative emotions of the child when taking drugs through the mouth;

- does not correct vegetative dysfunction.

There is a method of treating regurgitation syndrome in young children - therapeutic dietary correction. It is advisable to use condensed or coagulated food. This is achieved industrially by adding thickeners, for example carob gluten. By structure, the polysaccharide is galactomannan. Another corrective component of the mixture (thickener) may be rice or corn starch. The following treatment mixtures have been developed for infants with regurgitation syndrome: gum based on Nutrilak AR, Nutrilon AR, Frisov 1, Frisov 2, Humana AR; based on starch Nutrilon Comfort 1, Nutrilon comfort 2, Semper Lemolak, Enfamil AR. Enriched infant formulas are well tolerated, side effects are rare, as are serious complications. Mixtures that include starch as a thickener act slightly more softly, the effect of their use occurs in a more distant period compared to products containing gum. AR mixtures cannot be used uncontrollably, as an alternative to conventional adapted dairy products. It is necessary to try to avoid an overdose of medicinal mixtures. The duration of the use of antireflux mixtures should be determined individually, it can be quite long (about 2-3 months). After achieving a lasting therapeutic effect, the child is gradually transferred to an adapted milk mixture (Denisov M.Yu. Digestive system diseases in young children. - M .: Medical Information Agency LLC, 2010. - P.68-71).

The disadvantages of the method:

- the possibility of an overdose;

- mixtures do not correct the motor function of the gastrointestinal tract;

- mixtures do not correct vegetative dysfunction;

- a rather expensive and long course of treatment;

- modern diagnostic methods using ultrasonography have shown that AR mixtures do not significantly affect the evacuation function of the stomach (Fabiani E., Bolli V., Pieroni G., Corrado G., Carlucci A., De Giacomo C., Catassi C. , Effect of a water-soluble Fiber (galactomannans) -enriched Formula on gastric emptying time of regurgitating infants evaluated using an ultrasound technique. // J. Pediatr. Gastroenterol. Nutr. - 2000. - Vol.31. - No. 3. - P.248-250).

The closest is a method of treating regurgitation syndrome in young children - postural therapy, i.e. body position treatment. The position of the mother during feeding should be sedentary, while the baby is at an angle of 45-60 ° degrees from the horizontal plane.

Postural treatment should be carried out not only throughout the day, but also at night when self-cleaning of the lower esophagus from aspirate is reduced due to the absence of peristaltic waves caused by swallowing and the neutralizing effect of saliva (Denisov M.Yu. Digestive system diseases in early children age. - M .: Medical Information Agency LLC, 2010. - S.66-67).

The disadvantages of the method:

- Prevents only aerophagy (ingestion of air);

- does not affect the motor function of the gastrointestinal tract;

- does not correct vegetative dysfunction.

The objective of the invention is to increase the effectiveness of treatment and accelerate the relief of regurgitation syndrome in young children due to the correction of autonomic dysfunction.

The task is achieved by a method of treating regurgitation syndrome in young children, including the position of the child in the mother's arms, with the mother sitting, holding the child at an angle of 45-60 °. The state of the child’s autonomic nervous system is determined by cardiointervalography. Electrophoresis is carried out on the region of the cervical sympathetic nodes with the apparatus - a flow 1 galvanizer, with a current density of 0.01-0.03 mA / cm ² in the position of a child with a raised head end at an angle of 45-60 ° in a fixed position from 13 to 14 hours in 1 an hour before feeding. If sympathicotonia is detected on the lateral surfaces of the child’s neck, a cathode is placed on both sides, an anode is placed on the back of the neck, 5% sodium bromide solution is introduced from the cathode. If vagotonia is detected on the lateral surfaces of the child’s neck, an anode is placed on both sides, a cathode is placed on the back of the neck, a 5% calcium chloride solution is injected from the anode, the procedure takes 8 minutes, a course of 8 procedures, daily.

The novelty of the invention.

- Determine the state of the autonomic nervous system of the child by cardiointervalography.

- Electrophoresis is performed on the region of the cervical sympathetic nodes with the Potok 1 galvanizing apparatus, with a current density of 0.01-0.03 mA / cm ² in the position of the child on the back with the raised head end at an angle of 45-60 ° in the fixed position from 13 to 14 hours 1 hour before feeding. The time of electrophoresis was selected taking into account the characteristics of the daily pulsogram of healthy children in their first year of life (Shkolnikova M.A., Kravtsova L.A. Physiology and pathology of the cardiovascular system in children of the first year of life. M .: Medpraktika - M., 2002, p. .39-40). An analysis of the heart rate trend provides information on the functioning of the cardiovascular system. This applies to assessing the variability of heart rate under the influence of repeated changes in the daily cycle of free activity. First of all, this is a state of sleep and wakefulness (Makarov L.M. Holter monitoring. 3rd ed. - M: Publishing House "Medpraktika - M". - 2008. - 118-119). Electrophoresis allows you to partially correct the imbalance in the state of the autonomic nervous system, depending on the characteristics of the autonomic status of each child. Electrophoresis allows you to enter drugs for medication more effectively than through the mouth, when there is a regurgitation syndrome.

- If sympathicotonia is detected on the lateral surfaces of the child’s neck, a cathode is placed on both sides, an anode is placed on the back of the neck, 5% sodium bromide solution is introduced from the cathode. The current density of 0.01-0.03 mA / cm ² . The procedure lasts 8 minutes, a course of 8 procedures, daily. Indirectly through the cervical sympathetic ganglia and autonomic centers of the brain, reflex processes in the brain, a decrease in sympathicotonia and reflex excitability of the spinal cord, change.

- If vagotonia is detected on the lateral surfaces of the child’s neck, an anode is placed on both sides, a cathode is placed on the back of the neck in the region of the lower cervical vertebrae, 5% calcium chloride solution is introduced from the anode. The current density of 0.01-0.03 mA / cm ² . The procedure lasts 8 minutes, a course of 8 procedures, daily. Indirectly through the cervical sympathetic ganglia and autonomic centers of the brain, the reflex processes in the brain, an increase in the tone of the sympathetic nervous system and reflex excitability of the spinal cord change. Direct current has a humoral and reflex effect on the body as a whole and individual organs and tissues reflexively associated with the affected area. For example, during galvanization of the collar zone indirectly through the cervical sympathetic ganglia and autonomic centers of the brain, blood circulation, trophic and reflex processes in the brain change. Irritation of the nerve receptors by direct current during the procedure, and subsequently prolonged, continuous irritation of them with ions of a medicinal substance introduced into the patient’s skin, is transmitted to higher vegetative centers. The resulting response in the form of a generalized ion reflex is specific for the action of the administered drug substance. This substance enters into metabolic processes and affects cells and tissues in the affected area. Slowly entering the blood and lymph, the medicinal substance introduced by electrophoresis affects the organs and tissues sensitive to it, and the body as a whole (Ushakov A.A. Guidelines for Practical Physiotherapy. - Moscow, AMNI LLP, 1996, p.5- 14), which in turn affects the state of the vegetative status of children with regurgitation syndrome, correction of autonomic dysfunction.

The set of essential features we have not found in the available literature, therefore, the invention has a "novelty."

The set of essential features allows you to get a new technical result:

- carry out the correction of autonomic dysfunction;

- more effective without loss to administer the drug;

- prolonged exposure to ions of drugs introduced into the skin;

- faster stopping regurgitation;

- allows not to sterilize the drug substance, which reduces treatment costs;

- if necessary, a repeated course of treatment after 1 month.

The sympathetic and parasympathetic parts of the nervous system, intramural plexuses, hormones, and gastrointestinal peptides are involved in the regulation of the motor-evacuation function of the stomach. Stimulation of the fibers of the vagus nerve leads to increased motor activity of the stomach, and stimulation of the sympathetic nervous system leads to inhibition of its motility and slowdown of emptying (Ado AD Pathological physiology. Moscow Triada-X, 2000. Pages 514-517, p. 522- 523; Schmidt R., Tevs G. Human physiology 3. Moscow: World 1996. P 753-758).

Therefore, it is important to identify and, if possible, normalize autonomic dysfunction with regurgitation syndrome in order to improve treatment outcomes.

The state of the child’s autonomic nervous system is determined by cardiointervalography according to the method described in the source (Belokon N.A., Kuberger M. B. Diseases of the heart and blood vessels in children. Manual for doctors: 2 volumes, T.1. - M .: Medicine , 1987. - S. 94-96, S. 111-117; Methodological recommendations. Moscow 1985. Abstract. Cardiointervalography in assessing the reactivity and severity of the condition of sick children, http://www.medexpert-tech.ru).

Cardiointervalography can be considered as a universal method of functional research of the autonomic nervous system. Cardiointervalography allows us to judge not only about the initial vegetative tone, but also about vegetative reactivity. Vegetative tone and reactivity give an idea of the homeostatic capabilities of the body, of adaptive mechanisms. Cardiointervalography can be used in a child of any age. There are no contraindications to this study (Methodological recommendations. Moscow 1985. Abstract. Cardiointervalography in assessing the reactivity and severity of the condition of sick children, http.//www.medexpert-tech.ru).

The daily pulsogram (heart rate trend) of healthy children of the first year of life during Holter monitoring (The characteristic pattern of daily heart rate on the heart rate trend clearly visualizes periods of sleep and wakefulness) (Shkolnikova MA, Kravtsova LA Physiology and pathology of the cardiovascular system children of the first year of life. M: Medpraktika - M, 2002, pp. 39-40, Fig. 6; Webb U., Dube M. Temporary sleep characteristics “Biological rhythms” under the editorship of U. Ashoff // Moscow, 1985, p.189-218; Makarov L.M. Holter monitoring. 3rd ed. - M.: Publishing House Medpraktika - M. - 2008. - 11 8-119) allows you to identify wakeful periods characterized by an increase in heart rate, which corresponds to the state of the greatest functional tension of the sympathetic system and makes it possible to choose the optimal time for cardiointervalography, as well as time for electrophoresis. We have chosen the waking period from 13 to 14 hours an hour before feeding.

Physiotherapy as a specialized field of medicine is an integral part of the comprehensive treatment of patients. With the greatest effect, physical methods are used for functional disorders in various organs and systems, etc. (Fletcher R., Fletcher S., Wagner E. Clinical epidemiology. Fundamentals of evidence-based medicine: Transl. From English. - M., 1998; Sackett D ., Richardson W., Rosenberg W., Haynes R. Evidence-based Medicine. How to practice and Teach EBM. - Edinburgh, 1997).

The tasks of physiotherapy are the restoration of the motor function of the esophagus, the secretory function of the stomach, the restoration of the balance of the autonomic mechanisms for regulating the tone of the lower esophageal sphincter and esophageal-gastric dysfunction (vegetative corrective methods), (antispasmodic methods), restoration of psychoemotional status (sedative methods), etc. (Ponomarenko G. N. Physiotherapy. National leadership. Moscow. Publishing group GEOTAR-Media. 2009. S. 401-405; Ponomarenko G. N. Private physiotherapy. Textbook. M.: OJSC "Publishing House" editsina ", 2005, pp 124-129;).

Under the influence of direct current, biologically active substances (bradykinin, kallikrein, prostaglandins) and vasoactive mediators (acetylcholine, histamine) are formed in the tissues, blood and lymph circulation are enhanced, tissue resorption capacity is increased, metabolic trophic processes are stimulated, regeneration of the nervous, bone, and connective tissue is accelerated. tissue. In addition to local influence, direct current has a humoral and reflex effect on the body as a whole and individual organs and tissues reflexively associated with the affected area. During galvanization of the collar zone through the cervical sympathetic ganglia and autonomic centers of the brain, blood circulation, trophic and reflex processes in the brain change (Ushakov A.A. Guidelines for Practical Physiotherapy. - Moscow, ANMI LLP, 1996. - p.5-6 ) Irritation by a direct current of the walls of the vessels and the nerve endings embedded in them leads to an increase (cathodization) or a decrease (anodization) of the excitable tissues. There are reflex-segmental techniques for applying direct current to the cervical and lumbar reflex zones that stimulate blood flow and trophism of brain neurons - the collar technique Ponomarenko G.N., Vorobyov M.G. Guide to physiotherapy. - St. Petersburg: IIC "Baltika", 2005. - P.68).

The excitability of the brain and spinal cord changes depending on the direction of the flow of direct current. If you place the cathode on the cervical spine (ascending galvanization), and the anode on the sacral part, the reflex excitability of the spinal cord (the stimulating effect of the galvanic current) increases, when the polarity changes, the reflex excitability of the spinal cord decreases (Ushakov A.A. Guidelines for Practical Physiotherapy. - Moscow, ANMI LLP, 1996. - P.6).

Medicinal electrophoresis is a method of combined exposure to direct electric current, which is an active therapeutic factor, and a medicinal substance introduced into the body using current. Direct current has a humoral and reflex effect on the body as a whole and individual organs and tissues reflexively associated with the affected area. Irritation of nerve receptors by direct current during the procedure, and subsequently prolonged, continuous irritation of their ions of a drug substance introduced into the patient’s skin, is transmitted to higher vegetative centers. The resulting response in the form of a generalized ion reflex is specific for the action of the administered drug substance. Slowly entering the blood and lymph, administered by the method of electrophoresis, the drug substance acts on organs and tissues sensitive to it, on the body as a whole (Ushakov A.A. Guidelines for Practical Physiotherapy. - Moscow, AMNI LLP, 1996, p.5- fourteen). Against a changed functional background created by the action of direct current - an active physiological stimulus, the effect of even small amounts of a drug substance is quite pronounced; it accumulates in the skin, from here it slowly enters the blood and lymph circulation and is slowly excreted from the body. With this method, the drug substance retains its therapeutic activity, specific tropism to tissues and stays in the skin depot for up to 20 days or more (Sbrosov A.N. Handbook of physiotherapy. M., “Medicine”, 1976, p.136). Medicinal substances accumulate not only in the tissues under the electrodes, but also on the internal organs located in the current passage zone (in the interpolar zone) (Ponomarenko G.N., Vorobyov M.G. Physiotherapy guidelines. - St. Petersburg: IIC "Baltika" ", 2005, p. 79-80). In children, various factors are prescribed at different periods of life from 1 month to 14 years (Ponomarenko G.N., Vorobyov M.G. Guide to physiotherapy. - St. Petersburg: IIC "Baltika", 2005, p.15).

During electrophoresis there is no pain, the integrity of the skin is not violated, the drug does not require sterilization (Ponomarenko G.N., Vorobyev M.G. Guide to physiotherapy. - St. Petersburg: IIC "Baltika", 2005, p. 80).

Physiotherapeutic procedures are used for neurocirculatory dystonia (NDC). When NDC with a predominance of vagotonia, electrophoresis of a 5% calcium chloride solution is recommended according to the collar technique. When NDC with a predominance of sympathicotonia, galvanization is used according to the reflex-segmental technique, electrophoresis of the collar zone of 5% sodium bromide (Shabalov NP Children's diseases: a textbook. 5th ed. In two volumes. Volume 2. - St. Petersburg: Peter, 2003 . 540-541). Physiotherapy is an additional treatment for chronic gastroduodenal pathology with concomitant symptoms of vegetovascular dystonia. During the period of exacerbation, electrophoresis with calcium or bromine to the collar region is shown (Shabalov NP Children's diseases. - Textbook. 5th ed. In two volumes. Volume 1. - St. Petersburg: Peter, 2003. P.599).

However, this method has not been used to treat regurgitation syndrome in young children.

We examined 70 children (36 boys, 34 girls) aged 1 to 4 months, of which 60 children with regurgitation syndrome, 10 healthy children. The examination included collecting an anamnesis of the disease and life, general clinical methods, determining the initial vegetative tone according to the table - questionnaire (Wayne A.M. 1981, modified by Belokon N.A. 1987), cardiointervalography before treatment and after treatment in the daytime from 13 to 14 hours, laboratory examination with a general blood test and biochemical blood test, pyloric ultrasound, fibroesophagogastroscopy according to indications, X-ray examination of the gastrointestinal tract according to indications.

In the future, in order to evaluate the results of treatment of children with regurgitation syndrome using electrophoresis and evaluate its effect on the state of the autonomic nervous system, children with regurgitation syndrome were divided into two groups: 1 - group, the main group - children who received drug electrophoresis in the complex treatment taking into account their vegetative status, 30 children; Group 2 - received treatment according to the generally accepted methodology - comparison group of 30 children; 3 group - healthy children - control group of 10 children.

Taking into account the vegetative status of children with regurgitation syndrome, we additionally use electrophoresis to the region of cervical sympathetic nodes with the apparatus - a galvanizer Potok 1 “EMA Plant”, with a current density of 0.01-0.03 mA / cm ² . Electrophoresis is carried out in the position of the child in the arms of the mother with a raised head end at an angle of 45-60 ° in the period of calm wakefulness from 13 to 14 hours an hour before feeding.

With sympathicotonia, a cathode is located on both sides of the neck, and an anode is located on the back of the neck. The current density of 0.01-0.03 mA / cm ² . The introduction of a 5% sodium bromide solution from the cathode in order to reduce sympathicotonia and reflex excitability of the spinal cord. With vagotonia, an anode is located on the lateral surfaces of the neck on both sides, and a cathode is located on the back of the neck. The current density of 0.01-0.03 mA / cm ² . The introduction of a 5% solution of calcium chloride is carried out from the anode in order to increase the tone of the sympathetic nervous system and reflex excitability of the spinal cord. The duration of the procedures is 8 minutes. The course of treatment is 8 treatments daily. At the end of the course of treatment, all children in compliance with all conditions again underwent cardiointervalography followed by a comparative analysis, we obtained the following results (Table 1, Table 2)

Table 1 The CIG indicators of children with regurgitation syndrome and the control group (healthy children) (M ± m) age 1-4 months before treatment. CIG indicator 1 group main n = 30 2 comparison group n = 30 3 group healthy children n = 10 To load After loading To load After loading To load After loading AMo,% 39.5 ± 12.7 50.7 ± 12.8 ** 41 ± 14.9 57.5 ± 13.3 *** 35.2 ± 8.7 39 ± 7.1 Mo, sec 0.39 ± 0.02 0.37 ± 0.01 0.39 ± 0.03 0.37 ± 0.03 0.4 ± 0.03 0.38 ± 0.03 DX, sec 0.09 ± 0.02 0.08 ± 0.01 0.11 ± 0.03 0.09 ± 0.04 0.09 ± 0.02 0.08 ± 0.016 IN, conventional units 531 ± 261 852 ± 256 ** 551 ± 341 990 ± 645 *** 510 ± 195 637 ± 148 BP 1.92 ± 0.81 ** 2.04 ± 0.99 *** 1.3 ± 0.29 Arithmetic mean values ± standard error of the mean are presented. * significant differences from control values by t-student test at a significance level of p <0.05; * p <0.05 between 1 and 2 groups; ** p <0.05 between 1 and 3 groups; *** p <0.05 between groups 2 and 3.

table 2 The CIG indicators of children with regurgitation syndrome and the control group (healthy children) (M + -m) age 1-4 months after treatment. CIG indicator Group 1 main treatment with e / phoresis 2 comparison group treatment without e / phoresis 3 group healthy children To load After loading To load After loading To load After loading AMo,% 33.4 ± 11.8 39.8 ± 11.5 * 38.5 ± 11.9 53 ± 19.2 *** 35.2 ± 8.7 39 ± 7.1 Mo, sec 0.43 ± 0.05 * 0.4 ± 0.03 * 0.38 ± 0.02 0.38 ± 0.02 0.4 ± 0.03 0.38 ± 0.03 DX, sec 0.15 ± 0.05 * / ** 0.13 ± 0.06 * / ** 0.08 ± 0.02 0,07 ± 0,02 0.09 ± 0.02 0.08 ± 0.01 IN, conventional units 293 ± 165 * / ** 463 ± 252 * / ** 620 ± 293 985 ± 355 *** 510 ± 195 637 ± 148 BP 1.62 ± 0.43 ** 1.74 ± 0.28 *** 1.3 ± 0.29 * p <0.05 between 1 and 2 groups; ** p <0.05 between 1 and 3 groups; *** p <0.05 between groups 2 and 3.

The results obtained indicate that drug electrophoresis has a humoral and reflex effect on the body as a whole and on individual organs and tissues reflexively associated with the zone of sympathetic cervical nodes. Irritation of nerve receptors by direct current during the procedure, and subsequently prolonged, continuous irritation by their ions of a medicinal substance (5% sodium bromide solution for sympathicotonia, 5% calcium chloride solution for vagotonia) introduced into the patient’s skin, is transmitted to higher vegetative centers and has reflex processes in the brain, the resulting response in the form of a generalized ion reflex is specific for the action of the introduced drug substance, which in turn leads to a pony eniyu or increase the activity of the sympathetic component of the autonomic nervous system, autonomic dysfunction correction (first cause srygivianiya syndrome), or substantial relief of deceleration regurgitation, shortening of treatment. This is confirmed by a change in the parameters of cardiointervalography. In the group of children with regurgitation syndrome who received additional electrophoresis in treatment, in comparison with children who received standard therapy, AMo indices significantly decreased,%, characterizing a decrease in the activity of the sympathetic component of the autonomic nervous system, a decrease in IN indices, conventional units, indicate a decrease degree of tension of regulatory mechanisms. A slight increase in the DX indices, sec, indicates the normalization of the functional interaction of the sympathetic and parasympathetic divisions of the autonomic nervous system, regulated by the humoral channel, which affects the indices of Mo, sec. All this indicates the correction of autonomic dysfunction as the cause of regurgitation syndrome in young children, which is confirmed in the clinic by the relief of regurgitation syndrome.

The method is as follows.

The state of the child’s autonomic nervous system is determined by cardiointervalography (CIG) on the apparatus - a three-channel portable electrocardiograph Schiller AT - 101 made in Switzerland 2009. An electrocardiogram is recorded in 2 standard leads with a tape speed of 50 mm / sec. The first 100 cardio intervals are recorded lying down in a state of calm wakefulness, then the next 100 cardio intervals are recorded in an upright position for a period of time from 13 to 14 hours. The main indicators that have a certain physiological meaning are the following: Mo - mode in sec, characterizes the humoral channel of heart rhythm regulation; AMO (fashion amplitude) - as a percentage of the total number of registered cardiocycles, characterizes the activity of the sympathetic department of the autonomic nervous system; DX (variation range) - sec, characterizes the activity of the parasympathetic department of the autonomic nervous system; IN (stress index) in conventional units, the total indicator that most fully reflects the degree of tension of the regulatory mechanisms of the body, the level of centralization of blood circulation control. ID at rest can serve as an indicator of the initial autonomic tone (IWT), and its dynamics in response to a change in the functional state reflects autonomic reactivity. Registration of the CIG is carried out in the supine position: 1st recording of the CIG (initial); 2nd - in the "standing" position, immediately after the transition to a vertical position. In each of the 2 arrays of cardiocycles, IN is calculated, i.e. respectively IN1, IN2. The initial vegetative tone (IWT) is evaluated by IN1. IWT is assessed as follows: eutonia (balanced state of the ANS regulatory systems) is characterized by IN equal to 30-90 conventional units; vagotonia - IN less than 30 srvc .; sympathicotonia with moderate predominance of the tone of the sympathetic part of the autonomic nervous system (ANS) - IN from 90 to 160 conventional units; hypersympathicotonia - IN more than 160 conventional units (such values of IN may indicate an overstrain of regulatory systems). Vegetative reactivity characterizes the direction and degree of change in the functioning of the ANS at the time of the transition of an organism from one state to another. According to this technique, it is estimated by the ratio IN2 / IN1. It is possible to judge the severity of changes in sinus heart rhythm only if the indicators of the cardiointervalogram are compared in patients and healthy children of similar age groups. CIG indices in healthy children under standard registration conditions have confidence constancy and, therefore, can characterize vegetative homeostasis depending on age. The dynamics of CIG indicators is ahead of changes in clinical, laboratory, radiological, electrocardiographic and other data, substantiating one or another tactic of treatment (Belokon N.A., Kuberger M. B. Diseases of the heart and blood vessels in children: A guide for doctors: In 2 volumes, T.1. - M .: Medicine, 1987. - S.94-99).

Table 3 CIG indicators of healthy children (M + -m) KIG indicators Age 1-3 years 4-7 years old 8-10 years 11-13 years old 11-13 years old Mo, sec 0.58 ± 0.02 0.62 ± 0.03 0.72 ± 0.03 0.73 ± 0.02 0.74 ± 0.02 DX, sec 0.23 ± 0.04 0.23 ± 0.05 0.28 ± 0.02 0.27 ± 0.02 0.38 ± 0.04 AMO,% 28 ± 2.5 27 ± 1.0 16 ± 0.9 23 ± 1.5 18 ± 1.0 IN, conventional units 134 ± 17.7 94 ± 15.0 57 ± 11.0 82 ± 10.0 39 ± 6.6

After determining the vegetative status, electrophoresis is performed.

The child is in the arms of the mother with a raised head end at an angle of 45-60 °.

Electrophoresis in the area of the cervical sympathetic nodes is carried out by the apparatus - Potok-1 galvanizer “EMA Plant” as follows: current is dosed in milliamperes, current density is 0.01-0.03 mA / cm ² : two rectangular electrodes 3 × 6 cm in size each is located on the sides of the neck 2 cm below the angle of the lower jaw to the right and left along the sternocleidomastoid muscle and connected by a bifurcated wire to one pole. The third electrode 6 × 8 cm in size is placed on the back of the neck, the procedure lasts 8 minutes. The procedure is carried out daily, course 8 - procedures (Ponomarenko G.N., Vorobiev M.G. Guide to physiotherapy. - St. Petersburg: IIC "Baltika", 2005. - P.68-92).

If sympathicotonia is detected on the lateral surfaces of the child’s neck, a cathode is placed on both sides, an anode is placed on the back of the neck, a 5% sodium bromide solution is introduced from the cathode, when vagotonia is detected, the anode is placed on both sides of the child’s neck, and the cathode , 5% calcium chloride solution is injected from the anode. The procedure is carried out for 8 minutes, daily, a course of 8 - procedures.

An hour after electrophoresis, the baby is fed while the mother is sitting, holding the baby at an angle of 45-60 °. Subsequent feedings are carried out in the same position.

Example 1. Patient S., age 3 months. Received complaints of regurgitation after almost every feeding, sometimes vomiting no less than ½ of the volume of food eaten, expressed anxiety, plaque on the oral mucosa. Regurgitation is noted from birth. A child from the 1st pregnancy on the background of the threat of interruption in the 2nd trimester. On mixed feeding, supplemented with Unclean. A history of perinatal CNS damage of hypoxic origin. Weight gain is good, in growth does not lag behind. On examination, anxiety, white curd coating on the oral mucosa. Evaluation of the intensity of regurgitation on a 5-point scale of 3 points. Assessment of vegetative status according to the questionnaire table is sympathicotonia. In the afternoon during the period of calm wakefulness at 13 o'clock cardiointervalography was performed. The results were obtained: in the supine position, AMo1 - 49%, Mo1 - 0.4 sec, DX1 - 0.12 sec, IN1 - 510 conventional units; in the standing position, AMo2 - 57%, Mo2 - 0.4 sec, DX2 - 0.08 sec, IN2 - 890 conventional units, IN2 / IN1 = 1.74. Conclusion: IVT - sympathicotonia, hypersympathicotonic autonomic reactivity.

In addition to postural therapy, mother's diet, and the feeding regimen in the treatment complex an hour before feeding from 13.00 to 14.00, the child received electrophoresis on the cervical sympathetic ganglia with 5% sodium bromine. After 3 sessions of electrophoresis with 5% sodium bromine in the region of the cervical sympathetic nodes, the mother noted improvements in the child’s behavior, became calmer, the number of regurgitation decreased not more than 3 times a day and less than 1 teaspoon. At the end of the course of treatment, regurgitation is stopped. After the treatment, cardiointervalography was performed again in the supine and vertical position, the results were obtained: AMo1 - 41%, Mo1 - 0.44 sec, DX1 - 0.14 sec, IN1 - 333 conventional units; in the standing position, AMo2 - 45%, Mo2 - 0.4 sec, DX2 - 0.12 sec, IN2 - 469 conventional units, vegetative reactivity IN2 / IN1 = 1.4.

Conclusion: IVT - sympathicotonia, normal autonomic reactivity. Thus, it was possible to affect the autonomic imbalance, reduce the activity of the sympathetic nervous system, act on the primary cause of regurgitation syndrome, stop the regurgitation syndrome, and achieve balance in the state of the autonomic nervous system.

Example 2. Patient I., age 1 month. He received complaints of frequent spitting up, after each feeding of up to 2 - 3 teaspoons, stool retention, reduced urination, the appetite was preserved. Regurgitation is noted from birth. A child from the 4th pregnancy on the background of transferred acute respiratory infections against the background of normal temperature in the second trimester of pregnancy. On breastfeeding. In weight behind, weight deficit at the time of admission 16.2%. On examination, excited. Evaluation of the intensity of regurgitation on a 5-point scale of 4 points. Assessment of vegetative status according to the table-questionnaire - vagotonia. In the afternoon during the period of calm wakefulness at 13 o'clock cardiointervalography was performed. The results are obtained: in the supine position AMo1 - 20%, Mo1 - 0.44 seconds, DX1 - 0.34 seconds, IN1 - 66 conventional units; in a standing position, AMo2 - 30%, Mo2 - 0.36 seconds, DX2 - 0.16 seconds, IN2 - 260 conventional units, IN2 / IN1 = 3.9. Conclusion: taking into account the indicators Mo1 and DX1, IWT is regarded as vagotonia, hypersympathicotonic autonomic reactivity.

The child underwent: an ultrasound of the pylorus - no signs of pyloric hypertrophy were detected, FGDS - revealed catarrhal esophagitis, superficial gastritis. Pyloric stenosis. Performed R-graphy of the abdominal cavity with the introduction of barium suspension. There is no data for pyloric stenosis.

In addition to postural therapy, mother's diet, 2 ml Maalox drug therapy 30 minutes before meals, feeding regimen in the treatment complex, an hour before feeding from 13.00 to 14.00, the child received electrophoresis on the cervical sympathetic nodes with 5% calcium chloride solution. After 5 sessions of electrophoresis with sodium 5% solution of calcium chloride on the cervical sympathetic nodes, there are improvements in the form of appetite, a decrease in the volume of regurgitation not more than 5 ml, not more than half the feedings. After a full course of treatment, regurgitation is very rare no more than 1-2 times a day, in small volumes - less than 1 teaspoon. Positive dynamics in weight is noted (+480 g), weight deficit at the end of treatment was 9.6%. After the treatment, cardiointervalography was again performed in the supine and vertical position, the results were obtained: AMo1 - 20%, Mo1 - 0.5 sec, DX1 - 0.24 sec, IN1 - 83 conventional units; in a standing position, AMo2 - 24%, Mo2 - 0.44 sec, DX2 - 0.14 sec, IN2 - 194 conventional units, vegetative reactivity IN2 / IN1 = 2.3.

Conclusion: IVT - normotonia, hypersympathicotonic autonomic reactivity. Thus, it was possible to affect the autonomic imbalance, increase the activity of the sympathetic nervous system, act on the primary cause of regurgitation syndrome, stop the regurgitation syndrome, and achieve balance in the state of the autonomic nervous system.

Thus, electrophoresis on the area of the cervical sympathetic nodes taking into account cardiointervalography indicators for children with regurgitation syndrome, in addition to the generally accepted treatment regimens, can stop regurgitation by completely or partially correcting the imbalance in the state of the autonomic nervous system, reduce treatment time, reduce the number of complications, and improve protective and adaptive body reaction.

Thus, electrophoresis on the cervical sympathetic ganglia with 5% sodium bromine or 5% calcium chloride solution for children with regurgitation, depending on the state of the autonomic nervous system, in addition to conventional treatment, made it possible to stop spitting up by restoring the imbalance in the autonomic nervous system system.

When conducting electrophoresis there are no restrictions for this age; regurgitation is not aggravated, since the drug is not administered by mouth, there is no pain, the integrity of the skin is not violated, the drug does not require sterilization, there are no side effects inherent in drug therapy.

The method makes it possible to partially correct the imbalance in the state of the autonomic nervous system depending on the characteristics of the autonomic status of each particular patient, which allows affecting the primary basis of the failure of the antireflux mechanism in children with regurgitation syndrome, thereby stopping regurgitation syndrome. A comprehensive, timely and adequate treatment of regurgitation syndrome in young children helps to prevent the development of more serious pathological conditions, restore the protective and adaptive mechanisms of the child's body.

Claims (1)

A method of treating regurgitation syndrome in young children, including treating the child with the mother sitting, holding the child at an angle of 45-60 °, characterized in that the condition of the child’s autonomic nervous system is determined by cardiointervalography, electrophoresis is performed on the area of the cervical sympathetic nodes with an apparatus - galvanizer Flow 1, with a current density of 0.01-0.03 mA / cm ² in the position of the child on the back with a raised head end at an angle of 45-60 ° in a fixed position from 13 to 14 hours 1 hour before feeding, if sympathies are detected Onions on the lateral surfaces of the child’s neck have a cathode on both sides, an anode is placed on the back of the neck, a 5% sodium bromide solution is injected from the cathode, when vagotonia is detected on the sides of the child’s neck, an anode is placed, on the back of the neck there is a cathode , 5% calcium chloride solution is injected from the anode, the procedure takes 8 minutes, a course of 8 procedures daily.