CC BY
34
Section 6. Medical science
References:
1. Analysis of cardiac rhythm variability with using various electrocardiographic systems (methodic recommendations)/ Edited by R.B. Babyevski. - M.: CMTV MHC RF, 2000. - 50 p.
2. Bayevski R.M., Ivanov G.G. Variability of cardiac rhythm: theoretical aspects and possibilities of clinical application//http://www. ecg.ru.
3. Baranov A. A., Kaganov B.S., Girelov A.V. Acute respiratory diseases in children: therapy and prophylaxis. - M., 2004.
4. Bobrov M. V. Clinical-economic basis of etiotropic therapy of respiratory viral infection in children: Abstract of doct. diss. - Volgograd, 2006. - 24 p.
5. Galeyev A.R., Igisheva L.N., Kazin E.M. Variability of cardiac rhythm in healthy children in the age 6-16 years old//Human physiology. - 2002. - V. 28, № 4. - P. 54-58.
6. Kokoulin G.S. Lebedeva A.B., Tatarinova S.V., Tatareva S.V. About the peculiarities of cardiac rhythm variability in children with tachy-arythmia//Information resource of electrocardiography (http://www.ecg.ru, 2008).
7. Slobodskaya E.R., Tataurov U.A. Vegetative regulations of cardiac rhythm and temperament in young children//Human Physiology. - 2001. - V. 27, № 2. - P. 86-90.
8. Suess P. E., Alpan G., Dulkerian S. J. et al. Respiratory sinus arrhythmia during feeding: a measure of vagal regulation of metabolism, ingestion, and digestion in preterm infants//Dev. Med. Child. Neurol. - 2000. - № 42(3). - P. 169-173.
Ibragimova Nargiza Sayfutdinovna, Assistant of the Tashkent Medical Academy E-mail: [email protected]
Effect of the type of vegetative nerve system on the quality of life of the patients with itching in old and senile age
Abstract: We established dependence of reactivity type of vegetative nerve system and life quality in elderly and old people. Expression of deterioration of life quality, over-tension state, and failure of adaptation adjustment mechanisms in the regulation system depends on the presence of skin itching.
Keywords: itching, vegetative nerve system, old and senile age, quality of life.
At the modern time it is proven that the parameters of SI of a patient have independent prognostic value and serve to be more accurate criteria for the definition of a patient' status during the therapy than values of common somatic status [7].
Aging is a final period of organism development; it is a complex ofvarious physiologic mechanisms occurring on molecular, cellular and systemic levels with alive tissue structural and functional alterations, which decrease ability of an organism to maintain its isolation and resistance [4]. In some authors' opinion the part of people elder than 65 years old to the modern time is 10-14% of the whole population [5]. Similar situation is observed in Uzbekistan.
Among various symptoms met in elderly people itching takes a prominent place. According to literature data about 50% of people above 60 have itching, often continuous and intensive, leading to depression and insomnia, and that decreases quality of patients' life
[3, 6].
Recently in literature there appear publications about influence of not only immune and endocrine systems, but also vegetative nerve system on skin [2]. It is known that activation of immune competent cells and further stage of pathologic physiologic process in allergic diseases is under the control of neural vegetative regulation. Sensitizing of skin with further dystrophic alterations in it is formed with the background functional drifts in central and vegetative nerve system [1, 8].
On the basis of the aforesaid, performance of the study of interrelation of life quality and vegetative nerve system is a topical problem in elderly and senile people suffering itching.
Thus, the objective of that research is study of the interrelation of the values of vegetative nerve system and life quality in old and senile age people with itching.
Materials and methods of the research: we checked 85 people aged from 48 to 90 years old staying clinical supervision in the CP № 2 MCO in Tashkent. Among them there were 37 (43.5%) women and 48 (56.5%) men. Patients were divided to two groups: 55 patients with skin itching (1st main group) where patients were united by prevailing in clinical picture symptom — itching and patients considered it to be intolerable; and 30 patients without skin itching (2nd group — comparison).
All patients had cardio-immunography (CIG) — test in compliance with the common method with classification according to the types ofVNS: hyper sympathetic tension, sympathetic tension, eitonia and vagotonia. Together with that we determined vegetative reactivity such as failure of adaptation-compensatory processes, over-tension, tension, prevailing of sympathetic tension and preservation of adaptation-compensatory processes.
We worked out a questionnaire about life quality among old and senile people with itching. The questionnaire provides assessment of patients' opinion about their health, especially health criteria which are significant (from the patient's point ofview) in itching. The questionnaire contains 4 scales (physical and social status, emotional status and general health) including 12 subscales. The values of the questionnaire are measured in points interval from 1 to 6. And the higher values correspond to less expressed symptoms and higher quality of life. Maximal gathered score was 110 points, and minimal score was 24.
Digital material was processes by means of variation statistics method.
Results of the study: Performed studies showed the tendency for decrease of Mo values and variation range (AX) in the patients with itching in comparison with the values of the group of patients
Effect of the type of vegetative nerve system on the quality of life of the patients with itching in old and senile age
without itching. We noted statistically reliable rise of AMo value and vegetative reactivity in comparison with the group of patients without itching (p<0.001). It should be noted, that among the patients of comparison group (without itching) the number of patients with hyper sympathetic tension was 56.7%, sympathoto-nia — 23.3% and only insignificant part consisted of the patients with eitonia (13.3%) and vagotonia (6.7%).
In 18.2% of the patients with skin itching we revealed expressed hyper sympathetic tension which was not registered among the patients of the same age without itching. Prevalence of hyper sympathetic tension in that group of the patients did not significantly differ from that value in comparison group, and it was equal to 56.4%. prevalence of sympathetic tension and eitonia patients was 2.14 and 1.82 fold lower than in the comparison group, equal to 10.9% and 7.3% respectively. Analysis of vegetative reactivity showed increase of the number of patients with dysfunction of both parts of VNS, sudden decrease of accommodation-compensatory mechanisms (failure of the mechanisms of adaptation and compensation) to 27.4% and dysfunction of both parts of VNS, over-tension of accommodation-compensatory mechanisms to 65.4%. it should be noted that with the increase of lifetime of the patients the number of patients with dysfunction of both parts of VNS and sudden decrease of accommodation-compensatory mechanisms (failure) increases to 31.6 and 27.6% respectively in old and senile age, while dysfunction of both parts of VNS and over-tension of accommodation-compensatory mechanisms had high frequency manifestation in the age from 40 to 59 years old.
Overwhelming majority of the patients without itching had sympathetic hypertonic type of VR, indicating excessive involvement of sympathetic adrenalin system. Only few patients of that group had normotonic type of vegetative reaction and its deficit (sympathetic atonia). The number of patients in the group with skin itching with excessive sympathetic adrenalin supply two-fold exceeded that number in the group of patients without itching. At the same time patients with sympathetic atonic type in the same group. Patients with skin itching compared with the patients without itching had significant increase of the number of patients with
sympathetic atonic type of vegetative reactivity (respectively 2.5 fold more than among the patients without itching).
Analysis of life quality revealed that among the patients with itching there was decrease of quality of life in comparison with people of old and senile age without itching. And, the most expressed values were registered in the analysis of emotional status, which was decreased 3.2 fold (10.7±1.5 points and 34.2±1.8 points respectively in the main and comparison groups). Physical status of the patients with itching also decreased 1.2 fold, and social one 2.1 fold. General health in the main group decreased 1.7 fold in comparison with the control group. Total score in the comparison group was 107.7±2.5, and that was almost 2 fold higher than the values in the main group (54.9±1.5 points; P<0.001).
Thus, seen from the achieved results, patients of old and senile age have reliable decrease of the quality of life compared with the control group including people opf the same age without itching. At the further stage we performed the assessment of quality of life dependently on the type of VNS reactivity. As it is seen from the represented data there is dependence of the values of life quality and type of VNS reactivity. So, in case of sympathetic hypertonic type there are the lowest values of quality of life. We also want to mention that presence of itching effects the expression of life quality alterations and the VNS reactivity type.
Thus, on the basis of the achieved data we can make the following conclusions:
1. Patients of old and senile age with itching have clear alterations of both vegetative adaptation (over-tension and failure), and vegetative reactivity (change of the later was expressed, as a rule, by exhaustion of sympathetic adrenalin activity).
2. Patients of old and senile age with itching have reliable decrease of the quality of life.
3. We detected dependence of the VNS reactivity type and values of the quality of life in the people of old and senile age. Expression of the deterioration of the values of the quality of life and over-tension status and failure of adaptation-adjustment mechanisms in the regulation system depends on the presence of itching.
References:
1. Arifov S. S. Clinical dermatology and venereology. Atlas. - T., 2008. - P. 257-260.
2. Wein A. M. Vegetative impairments: clinics, diagnostics, therapy. - M.: MIA, 2003. - 752 p.
3. Dovjanski S. I. Skin itching (part 2).//RJDVD. - 2007. - № 5. - P. 40-43.
4. Manturova N. E., Gorodilov R. V., Kononov A. V. Alteration of the expression of endothelial markers in human skin vessels in age involution/Annals of plastic, reconstructive and esthetic medicine. - 2010. - № 3. - P. 78-82.
5. Manturova N. E., Gorodilov R. V., Kononov A. V. Aging of skin: mechanisms of formation and structural alterations//Annals of plastic, reconstructive and esthetic medicine. - 2010. -№ 1. - P. 88-92.
6. Review of the modern concepts of the quality of life from the position of prophylactic medicine/N. F. Izmerov, R. G. Organov, V. V. Zverev, I. B. Ushakov//Med. Academic journal. - PUb, 2005. - № 3. - P. 3-12.
7. Udina M. M., Toropina G. G., Lvov A. N., Ivanov O. L. Neuroanatomic and neurophysiology aspects of itching//Russ. Jour. Of dermal and vener. diseases. - 2009. - № 1. - P.19-23.
8. Lonsdale-Eccles A., Carmichael A. J. Treatment of pruritus associated with systemic disorders in the elderly//Drugs. Aging. - 2003. -vol.3. - P. 197-208.
