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0COURSE OF OBSTRUCTIVE BRONCHITIS WITH CARDIOVASCULAR SYSTEM DISORDERS IN CHILDREN
JKhudaynazarova S. R., 2Valieva S., 3Agzamkhodzhaeva N.Sh.
1,2Tashkent Pediatric Medical Institute 3TashPMI Head of the department of pulmonology https://doi.org/10.5281/zenodo.12497465
Annotation. In the last decade, a clear increase in the proportion of obstructive bronchitis has been noted in the structure of respiratory diseases. Our goal is to study the clinical course of obstructive bronchitis with disorders of the cardiovascular system in preschool children. We examined 50 children aged 3 to 7 years who were hospitalized with a diagnosis of Acute obstructive bronchitis in the pulmonology department of the TashPMI clinic. A number offeatures of changes in cardiac activity in patients with obstructive bronchitis have been identified, among which the following can be distinguished: a high frequency of heart rhythm disturbances in preschool children, the predominance of sinus arrhythmias, disturbances in repolarization processes and partial blockade of the right bundle branch.
Key words: children, broncho-obstructive syndrome, preschool age, ECG.
Relevance. The leading place among diseases of children of various ages belongs to pathology of the respiratory system [1]. In the last decade, a clear increase in the proportion of obstructive bronchitis has been noted in the structure of respiratory diseases. Acute broncho-obstructive syndrome (ABS) of viral or viral-bacterial etiology has the highest frequency in childhood . According to Tatochenko V.K. (2016) in every fourth child with an acute respiratory disease, the bronchi with prolonged broncho-obstructive syndrome are involved in the inflammatory process. Respiratory disorders in acute obstructive syndrome of infectious origin have varying degrees of severity and are accompanied by hypotension and metabolic acidosis [2]. In the works of both domestic and foreign researchers, it was shown that it is the combination of viral infection, autonomic disorders and acute hypoxia that occurs with bronchial obstruction in young children that underlies multiple organ lesions, including the cardiovascular system[3]. A number of studies have proven the cardiotropism of influenza viruses , which contribute to the development of acute infectious myocardial damage in children . Recently, chlamydial and mycoplasma infections have been assigned a significant role in the development of acute infectious lesions of the cardiovascular system [4]. At the same time, the nature and severity of changes in the cardiovascular system and their prognostic significance in acute respiratory diseases accompanied by bronchial obstruction in young children have not been sufficiently studied. Bronchial obstruction syndrome in preschool children has been attracting the attention of scientists and practitioners for many years, which is associated with the heterogeneity of its genesis and the difficulties of diagnosis, especially in children 3-7 years old. The uniformity of clinical symptoms in acute obstructive bronchitis and other diseases accompanied by bronchial obstruction makes it difficult to verify the diagnosis and, therefore, slows down the timely prescription of etiopathogenetic therapy [1,5]. Considering that in preschool children the use of many traditional research methods is difficult due to age characteristics, the question arises of developing new diagnostic programs that allow the diagnosis to be verified as quickly as possible. The main etiological factors of obstructive bronchitis are respiratory viral, chlamydial and mycoplasma infections[6,7]. Currently, the incidence of this pathology is steadily increasing, which is associated with an increase in the number of frequently ill children, an increase in the survival rate
of premature newborns with severe damage to the respiratory and other systems, an increase in the number of children with atopy, and the effect of a wide range of adverse environmental factors, including passive smoking. According to various sources, the state of the cardiovascular system in young children with acute respiratory diseases occurring with bronchial obstruction has practically been little studied; risk factors for the formation of pathological changes and their prognostic significance have not been determined[7].
Target. To study the clinical course of obstructive bronchitis with disorders of the cardiovascular system in preschool children.
Material and research methods. We examined 50 children aged 3 to 7 years who were hospitalized with a diagnosis of Acute obstructive bronchitis in the pulmonology department of the TashPMI clinic. The following research methods were used: clinical and anamnestic, functional and instrumental - ECG, echocardiography. Consultations with specialized specialists: ENT, neurologist, allergist. An analysis of the child's medical record was carried out - 025. A survey was conducted by parents. When analyzing general clinical data, boys accounted for 62.6%, girls 37.4%, which corresponds to literature data.
Research results and discussion. An analysis of the studies showed that AOB in preschool children occurred with concomitant diseases. According to the anamnesis of these mothers, in children with obstructive bronchitis, 76% had anemia during pregnancy, 35% had acute respiratory diseases, 82% had toxicosis in the first and second trimester, 76% of children were born naturally and 24% by cesarean section. Heredity is burdened with allergic diseases, in 32.3% of all cases of AOB. It should be noted that the leading one in the structure was food allergy (17%) with sensitization to cow's milk, chicken, and eggs. 9% of children had atopic dermatitis, less often drug allergies, allergic conjunctivitis, urticaria, etc., as well as their combination. ENT -allergopathologies; allergic rhinitis (AR) -29.5%, allergic external otitis -12%, eczema of the external nose -7.8%. Bronchial asthma occurred in 12.6% of parents, food and drug allergies -34.6%, contact dermatitis - 36.5%. Premorbid background factors predisposing to the development of BOS are a family history of aggravated allergies, bronchial hyperreactivity, prematurity, manifestations of rickets, protein-energy malnutrition, thymic hyperplasia, perinatal encephalopathy, early artificial feeding, and frequent respiratory diseases. According to the analysis of outpatient cards of children, 45% belonged to the group of frequently ill people and at an early age suffered from various diathesis - 56.6% of children.
An important link in the diagnosis and management tactics of children with bronchitis is the identification of risk groups for the possible development of bronchial obstruction. The premorbid background of children was studied in order to identify risk factors for the development of AOB, as well as to identify conditions that aggravate its course. Of the concomitant pathologies, the following prevailed: nasopharyngitis in 95%, otitis media - 15%, GER - 9.5%, anemia - 37.5% of all cases. It should be noted that in 41% of cases a combination of the above diseases was observed (Figure 1).
Allergy + otitis media 20%
H
t- anemia 2%
otitis + anemia 12%
Allergy + anemia 46%
Allergy + GER 22%
Allergy + anemia ■ Allergy + GER ■ Allergy + otitis media ■ otitis + anemia
Fig. 1 Various associated pathologies
To assess the influence of premorbid background on the duration of AOB, the number of bed days in the hospital was assessed. The results were compared with the average hospital stay for children with AOB, which was 7.1 bed days. There was a tendency to increase the length of hospital stay in the presence of concomitant pathologies (GER, otitis, allergic diseases) and especially when they were combined (otitis - 7, 3 bed-day; combination of otitis and allergies -8.7; GER - 9.5; combination of GER and allergies - 11.1; GER, anemia and otitis - 15.5 bed days). According to the clinical data of the study, children more often presented with a cough of various types, manifested especially in the evening-night time and first dry and then wet (100%), low-grade fever (65%), shortness of breath was of a mixed nature (97%), runny nose (8.3 %). As concomitant diseases, perinatal damage to the central nervous system, iron deficiency anemia (36%), atopic dermatitis (16%) and residual effects of rickets (26%) were identified. These concomitant diseases lead to complications and a protracted course of the AOB disease. As a result of hypoxia, the cardiovascular system is primarily damaged, we were convinced of this by a biochemical blood test according to recalcification (GRP) (>120%) - 25% of children are elevated, which indicates a violation of the cardiovascular system. ECG analysis showed a high incidence of heart rhythm and conduction disturbances in the form of sinus tachycardia (29.0%) and bradycardia (8.3%), sinus arrhythmia (17.6%), incomplete blockade of the right bundle branch (25.3 %), as well as metabolic changes in the myocardium in the form of early ventricular repolarization syndrome (67.3%). When analyzing the heart rate, two degrees of its increase were identified: moderate tachycardia was diagnosed when the heart rate increased by 20-50% relative to age norms; pronounced tachycardia was established when the heart rate increased by more than 50% compared to normative indicators for a given age; on the radiograph, CTI > 0.5 showed a functional disorder of the cardiovascular system - 12.5% of children. Along with changes in heart rate, patients were found to have disturbances in rhythmic activity, which consisted of the appearance of moderate and severe arrhythmia and isorhythmia. In children with obstructive bronchitis, moderate sinus arrhythmia was recorded significantly more often (P <0.05).
Conclusions. Thus, a number of features of changes in cardiac activity in patients with obstructive bronchitis have been identified, among which the following can be distinguished: a
high frequency of heart rhythm disturbances in preschool children, the predominance of sinus arrhythmias, disturbances in repolarization processes and partial blockade of the right bundle branch. Increased recalcification in the blood, changes in ECG and radiographs indicate the severity of the disease and impaired adaptation of the cardiovascular system.
These facts reflect age-related patterns and indicate the predominance of heart sensitivity to hypoxia and toxic effects in preschool children.
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