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7CLINICAL PECULIARITIES OF CARDIAC ACTIVITY IN CHILDREN WITH RESPIRATORY DISEASES Shavazi N.M.1, Zakirova B.I.2, Lim M.V.3, Azimova K.T.4, Shavazi R.N.5
1Shavazi Nurali Mamedovich - Professor, Head of the Department;
2Zakirova Bakhora Islamovna - Associate Professor; 3Lim Maxim Vyacheslavovich - PhD, Assistant, DEPARTMENT OF PEDIATRICS № 1; 4Azimova Kamola Talatovna - Assistant, DEPARTMENT OF PEDIATRICS № 3;
5Shavazi Ramiz Nuralievich - Student, MEDICAL FACULTY, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: according to WHO, acute pneumonia in children in developed countries accounts for 3-4% of the total number of patients with pulmonary pathology per year, while in developing countries it is 10-20 %; moreover, 5.5 — 7.2% of cases are fatal, accounting for 15-20% in children under 6 months of age. In Uzbekistan (who, 2007), infant mortality is 13.2%, of which pneumonia accounts for 40 %. In pneumonia, the cardiovascular system is involved in the pathological process, and a combination of infectious and inflammatory processes in the lungs and heart is often observed.
Relevance. The problem of respiratory diseases and evaluation of cardiac activity is one of the leading places in the children's population [1, 2]. Most authors believe that with an unfavorable course of acute respiratory diseases, often with the formation of a chronic focal infection, various changes in the cardiovascular system can occur, ranging from minor functional to dystrophic changes [3, 4, 5]. This fact dictates the need for early diagnosis of cardiac pathology in respiratory diseases [6, 7].
Purpose. Establish clinical and anamnestic features of cardiac disorders in pneumonia in children.
Material and methods. The analysis of the results of the observation and multifactorial anamnestic, generally accepted clinical, laboratory, paraclinical and instrumental methods of examination of 58 young children with pneumonia who were hospitalized in the children's resuscitation and II emergency pediatrics of the Samarkand branch of the Republican Scientific Center for Emergency Medical Care were carried out. Group I (control) comprised 22 sick children with acute pneumonia who had no cardiovascular disorders, group II (main) - 36 patients children with acute pneumonia who had disorders of the cardiovascular system. The clinical characteristics of the observed patients were based on the study of the influence of risk factors for the development of cardiovascular disorders in children with pneumonia, the severity and course of the disease.
Results. Of all patients, 12 (20,7%) were hospitalized during the first days of the onset of the disease, 38 (65,5%) for 2-3 days and the remaining 8 (14,8%) for more than 3 days. Observations showed that the parents of patients in group II significantly more often (27,6% vs. 6,8%) late (3 days and later from the onset of the disease) sought medical help, which was probably the cause of the complicated course of the disease. The main complaint on admission to the hospital was difficulty breathing. In 51,7% of patients, shortness of breath was mixed, and in 48,3% of inspiratory type. In contrast to patients of group I, in group II, pneumonia with cardiovascular maladjustment showed a high incidence of dyspnea (34,5% and 53,4%, respectively), and its strengthening with little exertion in 100% of cases and every third child in nighttime. Upon auscultation of patients, moist crepitus rales were heard in the majority (70,7%) of cases. Unproductive cough was more common in these patients, and only in 3 (5,2%) sick children did the cough be wet and productive. In patients with the second group, respiratory failure 1-2 degrees was detected in 27 (46,6%) cases and grade 3 - in 16 (10.3%) patients who were
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hospitalized in the pediatric intensive care unit. In the second group of patients, there was a higher incidence of fever in children (58,6%) in contrast to patients in group I (41,4%) and particularly persistent hyperthermia (12,1% and 8,6% respectively). Clinical signs of impaired cardiovascular system, such as cyanosis, deafness of heart sounds, tachycardia and bradycardia, were more common in patients with group II and disappeared significantly later. The clinical symptoms inherent in irritable bowel syndrome (loose stools, constipation and their alternation with stool disorder) were found in both groups of sick children with the same frequency, flatulence 3,2 and vomiting 1,9 times more often in patients with pneumonia with the presence of disorders of the cardiovascular system. However, in patients of group I, only 8,6% of mothers did not complain of the gastrointestinal tract, and in the second group there were no such children. Quite frequent manifestations of gastrointestinal disorders were diarrhea (every second sick child), flatulence (every third patient) and vomiting (29,3%). Intestinal disorders caused by acute pneumonia in the observed patients were accompanied by a toxic syndrome. Such a course of pneumonia with complications was more often observed in children aged 4-9 months. We have identified the most characteristic clinical signs associated with myocardial ischemia, recorded simultaneously with changes on the ECG. These included: deafness of heart tones was observed in 11 (18.9%) children of group I, while in children of group II, the deafness of heart sounds was recorded 2,5 times more often - in 27 (46,5%); systolic murmur was heard in 8 (13,7%) children, versus 31 (53,4%) children; bradycardia (heart rate episodes less than 90 per 1 min) was present only in 2 (3,4%) children of group I, versus 17 (29,3%) in children of group II; tachycardia (heart rate at rest more than 170 beats per 1 min) was observed in 21 (36,2%) patients with pneumonia and having changes in the cardiovascular system was observed 3 times less often - only 3 (12,9%) children I groups with pneumonia without changes in the cardiovascular system. In children of group I, the frequency of signs of cardiovascular disadaptation was lower than in patients of group II.
Findings. Thus, with pneumonia in children, transient clinical changes in the cardiovascular system should be considered as a phenomenon of cardiovascular maladjustment, which contributes to an increase in the symptoms of toxicosis and respiratory failure.
References
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3. Shavazi N.M., Lim M.V., Zakirova B.I., Lim V.I., Kodirova Sh.S., Uzokova M.F., 2017. Possibilities of nebulizer therapy for broncho-obstructive syndrome in children. Physician's Herald (2). 34-38.
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5. LimM.V., Shavazi N.M. "The combined use of acetylcysteine and 3% of sodium chloride in the nebulizer therapy of acute bronchiolitis" European science review. № 11-12, 2016. Рp. 63-66.
6. Shavazi N.M. and Lim M. V. The effectiveness of nebulizer inhalations of acetylcysteine in the therapy of acute bronchiolitis in infants. Problems of Biology and Medicine. 2 (2016): 87.
7. Shavazi N.M. et al. "The assessment of the degree of broncho-obstruction in acute bronchiolitis in infants." Materials of III conference of the Association of Doctors of Emegency Medical Care of Uzbekistan. Tashkent, 2015.
