Relationship between oral fluid pH, dental caries and enamel resistance in children Текст научной статьи по специальности «Клиническая медицина»

DOI 10.26724/2079-8334-2019-1-67-107

ya,K: 616.316-008.843.4:616.314-002:616.314.13-053.4

RELATIONSHIP BETWEEN ORAL FLUID pH, DENTAL CARIES AND ENAMEL

RESISTANCE IN CHILDREN

E-mail:nchukhray@gmail.com

The present study was carried out to determine the oral fluid pH in children with enamel resistant to dental caries, conditionally resistant enamel and caries susceptible enamel, and to determine the correlation between the oral fluid pH, DMF index and index of oral hygiene (HI). The study was performed on 7, 12 and 15-year-old healthy-looking children from Lviv (Ukraine). The sample population consists of 292 male and female ones. Dental caries was recorded using DMFT (Decayed, Missed, and Filled Teeth) index. Structural and functional resistance of the tooth enamel was determined by the express-method (TER-test - test of enamel resistance), suggested by V.R. Okushko (1983) in our modification. The salivary pH was measured using pH indicating paper. It was found that in children with enamel, resistant to carious process, (TER=2,26±0,19 points) oral fluid reaction is slightly alkaline (pH=7,08±0,06 units), the lowest values of caries intensity of the permanent teeth and oral hygiene index (DMF=1,51±0,16 tooth, GI=1,55±0,21 points) were established. In group of children with conditionally resistant enamel (TER=4,28±0,10 points) the insignificant shift was detected in the oral fluid pH towards the acidic side (6,95±0,05 units), the average mean of hygienic index was 1,64±0,24 points (satisfactory hygiene) and DMF=2,43±0,19 tooth. It was found that children with caries susceptible enamel demonstrated the high level of the permanent teeth caries intensity (DMF=5,68±0,19 teeth), poor oral hygiene (GI=2,13±0,24 points), shift of the oral fluid pH towards the acid side (6,35±0,07 units), that changes the function of oral fluid toward demineralizing solution (TER=6,25±0,23 points). The physical properties of oral fluid, such as pH, have a correlation with dental caries activity and enamel resistance in children.

Keywords: enamel resistance, dental caries, DMFS, oral fluid pH.

The work is a _ fragment of the research project "Estimation of stomatological diseases in children taking into account the ecological and social aspects and the efficacy of dental caries and periodontal diseases prevention ", state registration No. 0115U000037.

Oral fluid plays a very important role in oral health. Based on its constituents, the oral liquid acquires properties, such as lubrication, removing of unwanted substances, digestion, neutralization of acids or alkalies, protection against demineralization and also an antimicrobial role [8, 9, 13]. Oral fluid is an exocrine secretion consisting of approximately 99% water, while the rest 1% is a combination of organic and inorganic molecules, containing a variety of electrolytes (calcium, magnesium, potassium, sodium, chloride, bicarbonate and phosphate), which play an important role in the oral cavity and in maintaining oral health and function by providing oral self protective mechanisms through its constituents [12, 11].

Oral fluid affects the incidence of dental caries by four ways: as a mechanical cleansing agent that results in the reduced plaque accumulation; by reducing enamel solubility by means of calcium, phosphate and fluoride; by buffering and neutralizing the acids produced by cariogenic organisms or introduced directly through diet and by antibacterial activity.

Oral fluid, by constantly bathing the teeth, functions as a cleansing solution, a lubricant, a buffer and a ion reservoir of calcium and phosphate, which are essential for the remineralization of initial carious lesions. Saliva controls the equilibrium between demineralization and remineralization in a cariogenic environment. Salivary buffers can reverse the low pH in plaque and permits oral clearance thus preventing demineralization of enamel. The flow rate and viscosity of oral fluid may also influence the development of caries. [5].

The purpose of the study was to establish the correlation of the oral fluid pH with enamel resistance and dental caries.

Materials and methods. The study was performed on 7, 12 and 15-year-old children from Lviv (Ukraine). Sample population consists of (292) male and female. Children were free from any medication (acute illness or chronic diseases as well as medication should be considered) and smoking. The collection of stimulated oral fluid samples were performed under standard condition following by dentists instruction. All participants were instructed not to eat or drink (except water) at least 1 hour prior to donation of saliva. Saliva was collected between 9-12 am. After the subject rinse his mouth several times by sterilized water and then wait for 1-2 minutes for water clearance, then saliva was collected in a sterile screw capped bottle. The pH of oral fluid was measured using pH indicating paper with the resolution within 0,2 pH units.

Clinical examinations were conducted using plane mouth mirror and dental explorer. Examinations and oral health assessments were performed according to the basic method proposed by WHO (1997). Dental caries was recorded using DMFT (Decayed, Missed, and Filled Teeth) index.

© N.L. Chukhray, O.O. Mashkarynetz, 2019

Stuctural and functional resistance of the tooth enamel was determined with express-method (TER-test - test of enamel resistance), proposed by V.R. Okushko (1983) in our modification [2, 13]. The technique of TER-test is as follows: a drop of 1N hydrochloric acid with a diameter of about 2 mm is put on the vestibular surface of the central upper incisor which is washed with distilled water and dried with a cotton swab. After 5 seconds the acid is washed off with distilled water, and tooth surface is dried with a cotton swab and drawn with 5% solution of methylene blue. The coloring is removed from the enamel surface by a wiping motion, tightly clutching a cotton swab to the tooth surface. The color intensity corresponds to the depth of etching enamel. The intensity of shading is evaluated on a ten-score color printing scale of blue colour.

According to the level of enamel resistance (color shading) distinguish the following types of enamel resistance:

area shading with pale blue color (1-3 points) is determined as high structural and functional resistance of enamel (caries resistant enamel);

area shading with light-blue color (4-5 points) is determined as conditionally resistant enamel;

area shading with blue color (6-7 points) is determined as decreased structural functional resistance of enamel (caries susceptible enamel);

area shading with dark-blue color (8-10 points) is determined as a very low enamel resistance, maximal risk of dental caries development (very susceptible enamel).

Comparing the results of DMF index with data of TER-test we didn't reveal significant differences in means DMF in children with decreases and very low enamel resistance. That's why we combine results of 6-7, 8 and more points and (by V.R. Okushko) and interpretate as caries susceptible enamel. Result in 1-3 points we considered as enamel resistant to dental caries, 4-5 points - as conditionally resistant enamel, 6 and more points - as enamel susceptible to dental caries. The pH was measured using pH strips (LACHEMA).

Statistical analysis was presented by descriptive statistics including mean standard deviation (SD). Inferential Statistics included Student's t-test. In the statistical assessment, the following levels of significance are used: p>0.05 - non-significant (NS); 0.05> p>0.01* - significant (S); and p< 0.01** -highly significant (HS).

Results of the study and their discussion. In the present study, 292 healthy- looking persons were divided according to their ages into three groups of 7, 12, 15 years old children. This study also divided the total sample (292 children) into three groups depending on the type of enamel resistance. There were represented 90 persons (30.82%) with resistant enamel to dental caries, 112 persons (38.36%) with conditionally resistant enamel, and 90 persons (30.82%) with caries susceptible enamel.

During analyzing the main indicator of biological equilibrium of the oral cavity pH it was found that the concentration of hydrogen ions in the oral fluid in examined children, on average, is 6.79±0.05 units and is characterized as neutral. The obtained results are summarized in table 1. It was established that with the age the average mean of salivary pH increases. Whereby if from 7 to 12 years it is a minor increasing, from 12 to 15 years this value increases from 6.75±0.06 units to 6.96 ± 0.05 units (p1>0.05, p2> 0.05). It should be noted that the displacement of pH of oral liquid of children to the alkaline side with age may be due to better oral hygiene (HI increases from 2.27±0.09 points in the 7-year-olds to 1.76±0.08 points and 1.46±0.08 points, respectively, in the 12 and 15-year-old children).

Table 1

Oral fluid pH in children (Mean and Standard Deviation)

Salivary pH, (in units) 7 years 12 years 15 years

Mean±SD Mean±SD Mean±SD

6.67±0.06 6.75±0.06 6.96±0.05**

Note: - differences in probability compared to 7-year-old children: * - significant p<0.05, ** - highly significant p<0.01.

We analyzed the physical parameters of oral fluid depending on dental caries intensity of the permanent teeth, enamel resistance and oral hygiene based on medium data. So it was found that children with enamel, resistant to carious process (TER=2.26±0.19 points) oral fluid reaction slightly alkaline (pH of oral fluid is 7.08±0.06 units). In children, of this group there were set the lowest values of caries intensity of the permanent teeth and oral hygiene index (Fedorov-Volodkina's index) (DMF=1.51±0.16 tooth, GI=1.55±0.21 points). In group of children with conditionally resistant enamel (TER=4.28±0.10 points) there were established insignificant shift in oral fluid pH to the acidic side (6.95±0.05 units). In this group the average mean of hygienic index 1.64±0.24 points (satisfactory hygiene) and DMF=2.43±0.19 tooth. It was found that in children with caries susceptible enamel was observed the high level of caries intensity of the permanent teeth (DMF=5.68±0.19 teeth), poor oral hygiene (GI=2.13±0.24 points), shift of oral fluid

pH to the acid side (6.35±0.07 units), that changes the function of oral fluid toward demineralizing solution (TER=6.25±0.23 points).

Another purpose of our study was to evaluate the physical properties of the oral liquid in details depending on dental caries of the permanent teeth, the enamel resistance and oral hygiene taking the age into consideration. The results are shown in table 2. As shown in the table data, in 7 and 12-year-old children with enamel resistant to dental caries hydrogen ion concentration was on 11.17% and 10.10% higher, respectively, compared to children with enamel susceptible to the dental caries. In the 15-year-old individuals such difference was 9.42%. Therefore, data assessment of pH of oral fluid measuring revealed the presence of significant shift in reaction to the acid side in children of all age groups with caries susceptible enamel.

Table 2

Oral fluid pH in children depending on dental caries intensity of the permanent teeth, enamel resistance

and oral hygiene (M±m)

Indices Groups of children 7 years 12 years 15 years

pH of oral fluid, (in units) enamel caries resistant 6.98±0.07 7.03±0.08 7.22±0.03

conditionally resistant enamel 6.83±0.04 6.90±0.06 7.12±0.06

caries susceptible enamel 6.20±0.08**** 6.32±0.06**** 6.54±0.06****

DMF enamel caries resistant 0.27±0.09 1.51±0.07 1.99±0.11

conditionally resistant enamel 0.53±0.31 2.65±0.23* 4.12±0.46****

caries susceptible enamel 1.99±0.16**** 5.71±0.31**** 9.34±0.26****

HI (Fedorov-Volodkina's index) enamel caries resistant 1.54±0.19 1.52±0.21 1.32±0.12

conditionally resistant enamel 1.57±0.21 1.57±0.23 1.54±0.14

caries susceptible enamel 2.64±0.12**** 1.96±0.18 1.57±0.17

TER-test enamel caries resistant 2.64±0.23 2.50±0.32 1.60±0.16

conditionally resistant enamel 4.64±0.17**** 4.24±0.12**** 3.98±0.17****

caries susceptible enamel 6.82±0.26**** 6.56±0.20**** 5.69±0.57****

Note: - differences in probability compared to children with enamel resistant to dental caries: (Significant P< 0.05, Highly significant P<0.01) * - p<0.05; ** - p<0.02; *** - p<0.01; **** - <0.01.

In a order to presented data in the table, 7 and 12-year-old children had caries-resistant enamel, the concentration of hydrogen ions was 2.14 % and 1.85 %, respectively, higher compared to children with conditionally resistant enamel. At the age of 15 years this difference was 1.38%. On the contrary, during the analysis of this indicator in children the same age groups with caries resistant and cariously acceptable enamel, it was found that in the case of children with enamel, resistant to carious process, the pH of the oral fluid was 11.17 %, 10.10 % and 9.42 %, respectively, higher compared to children with enamel, susceptible to dental caries. Consequently, the assessment of the data of the pH-meter of the oral fluid revealed the presence of a significant shift to the acid side of the schoolchildren with caries-susceptible enamel in all age groups.

Taking into account the established changes in the pH of the oral fluid in children of different age groups, with varying enamel resistance, we analyzed the caries intensity of the permanent teeth, the hygienic state of the cavity and structural and functional resistence of the enamel, depending on the age of children. The insignificant increasing of the value of the index of caries intensity in persons with conditionally resistant enamel (by 2.12, 1.75 and 2.07 times) of the corresponding age groups was established in comparison with children with caries resistant enamel. At the same time, the hygienic state of the oral cavity according to Fedorov-Volodkin's index is good. Significant increase in the caries intensity of the teeth and the deterioration of oral hygiene was recorded in children with caries susceptible enamel. So, if in 12 and 15-year-old schoolchidren the caries intensity increases by 3.78 and 4.69 times with satisfactory and good oral hygiene, in 7-year-olds this index increases by 7.37 times with poor oral hygiene.

An analysis of the structural and functional resistance of enamel in the examined children of different age groups testifies about a significantly higher value of the TER-test in caries resistant enamel comparing to the children with carious ssusceptible enamel (by 4.18 times in 7-year-old children, by 4.05 and 4.09 times in 12 and 15-year-old children). The highest indicis of structural and functional enamel resistance were recorded in a group of 7-year-old children, regardless of the type of enamel resistance, which may be due to incomplete secondary enamel mineralization.

It has been established that the level of enamel permeability can vary under the influence of the various factors. According to the data [10] acidification of the oral fluid up to 6.0-6.2 quickly leads to its pronounced undersaturation with hydroxyapatite, increasing the solubility and making formation of caries susceptible. The clinical studies conducted by us have showed that in caries resistant individuals the pH of the oral liquid is higher compared with caries susceptible ones, which is confirmed by the data of other researchers [1, 3, 4, 6,]. However, studies [7] haven't revealed relationship between pH value and susceptibility to dental caries.

The results of our studies indicate that with the age pH of oral fluid in children increases, which coincides with other studies. Instead of this, these investigations indicates on the tendency of decreasing the alkalinity of saliva in adults with age [7]. Therefore, the tasks of further research will be the study of the relationship between the oral fluid pH and dental caries and the study of the causes of changes of the oral fluid pH in acid side with age.

Thus, the performed studies of the oral fluid physical properties indicate that decreasing of oral fluid pH that changes the function of oral liquid toward demineralizing solution. It may leads to faster accumulation of plaque, especially in condition of poor oral hygiene. This condition is an essential component among all factors which together take part in formation of enamel susceptible to dental caries.

Therefore, the pH test, which allow to identify and predict the risk for dental caries, involving saliva testing, can motivate patients to improve their oral hygiene. Saliva pH testing should be routinely performed by dental practitioners during check-ups to involve the patients with high risk of dental caries in educational and prophylactic measures.

1. Doifore D, Damle SG. Comparison of salivary IgA levels in caries free and caries active children. Int. J. Clin. Den. Sci. 2011; 2(1): 10-14.

2. Donagh ST, Wylie LJ, Winyard PG, Vanhatalo A., Jones AM. The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure. Int J Sports Med. 2015; 36(14): 1177-1185.

3. Dwitha A, Venkata TRB, Pranitha V, Sunil BK, Swetha A, Noorjahan M. Evaluation of pH, buffering capacity, viscosity and flow rate levels of saliva in caries-free, minimal caries and nursing caries children: an in vivo study: Contemp Clin Dent. 2014 Jul-Sep; 5(3): 324-328.

4. Eubanks DL, Woodruff KA. The basics of saliva. J. Vet. Dent. 2010; 27 (4): 209-214.

5. Kühnisch J., Thiering E., Kratzsch J. Elevated serum 25(OH)-Vitamin D levels are negatively correlated with molar-incisor hypomineralization. J. Dent. Res. 2015; 94(2): 381-387.

6. Lihorad EV, Shakovets NV. Saliva: importance for organs and tissues of the oral cavity in norm and pathology. Medichniy zhurnal. 2013; №3: 7-11.

7. Marsh PD, Devine DA. How is the development of dental biofilms influenced by the host? J. Clin. Periodontol. 2011; 38(11): 28-35.

8. Obuhov YuA. Local and system processes, influencing on caries development in children (literature review). Pediatricheskiy vesnik Yuzhnoho Urala. 2015; №2: 63-66.

9. Okushko VR, Chependyuk TA. Initial and following steps of caries development. Innovatsii v stomatologii. 2013; №2: 42-46.

10. Pannunzio E, Amancio OM, Vitalle MS, Souza DN, Mendes FM, Nicolau. Analysis of the stimulated whole saliva in overweight and obese school children. JRev Assoc Med Bras (1992). 2010 Jan-Feb; 56(1):32-6.

11. Prabhakar AR, Dodawad R, Raju OS. Evaluation of flow rate, pH, buffering capacity, calcium, total proteins and total antioxidant capacity levels of saliva in caries free and caries active children: an in vivo study. Int J Clin Pediatr Dent. 2009; 2:9-12.

12. Preethi BP, Reshma D, Anand P. Evaluation of flow rate, pH, buffering capacity, calcium, total protein and total antioxidant capacity levels of saliva in caries free and caries active children: an in vivo study. Indian J Clin Biochem. 2010; 25:425-8.

13. Smolyar NI, Chukhrai NL. Pat. 121657 Ukraina. Method of estimation of structural and functional enamel resistance in children; zajavnyk I patentovlasnyk Lvivskyi natsionalnyi medychnyi universytet imeni Danyla Halytskoho. No. u201706580 ; zajavn. 26.06.17 ; opubl. 11.12.17; 23.

взлемозв'язок рН ротово! р1дини

З КАР1ССОМ ЗУБ1В ТЛ РЕЗИСТЕНТШСТЮ

ЕМАЛ1 У Д1ТЕЙ Чухрай Н.Л., Машкаринець О. О., Чемерис О.М.

Мусш-Семенщв Х.Г.

Дане дослщження було проведено з метою оцшки рН ротово! рщини у дтей з карieсрезистентною, умовнорезистентною та карieссприйнятливою емаллю, а також для оцшки взаемозв'язку мiж рН ротово! рщини, показниками шдексу (КПВ) та шдексу ппени порожнини рота (Г1). Матерiал та методи дослщження. Обстежено 292 дтей 7, 12 та 15 роюв м. Львова (Укра!на). 1нтенсившсть карieсу постшних зубiв визначалась за допомогою шдексу КПВ (карюзш, пломбоваш та видалеш зуби). Структурно-функцюнальну резистентшсть емалi визначали експрес-методом (ТЕР), запропонованим В.Р. Окушко (1983) у нашш модифкацп. Визначення рН ротово! рщини проводили з використанням шдикаторного паперу. Результати. Встановлено, що у дтей з карieсрезистентною емаллю (2,26±0,19 бала) реакщя ротово! рщини е слаболужною (7,08±0,06 одиниць), були встановлеш найнижчi значення штенсивност карiесу постшних зубiв (1,51±0,16 зуба) та шдексу ппени порожнини рота (1,55±0,21 бала). У груш дтей з умовнорезистентною

ВЗАИМОСВЯЗЬ рН РОТОВОЙ ЖИДКОСТИ С КАРИЕСОМ ЗУБОВ И РЕЗИСТЕНТНОСТЬЮ ЭМАЛИ У ДЕТЕЙ Чухрай Н.Л., Машкаринець О. О., Чемерис О.М.,

Мусий-Семенцив Х.Г. Данное исследование было проведено с целью оценки рН ротовой жидкости у детей с кариесрезистентной, условнорезистентной и кариесвоприимчивой эмалью, а также для оценки взаимосвязи между рН ротовой жидкости, показателями индекса (КПУ) и индекса гигиены полости рта (ГИ). Материал и методы исследования. Обследовано 292 детей 7, 12 и 15 лет г. Львова (Украина). Интенсивность кариеса постоянных зубов определялась с помощью индекса КПУ (кариозные, пломбированные и удаленные зубы). Структурно-функциональную резистентность эмали определяли экспресс-методом (ТЭР), предложенным В.Р. Окушко (1983) в нашей модификации. Определение рН ротовой жидкости проводили с использованием индикаторной бумаги. Результаты. Установлено, что у детей с кариесрезистентной эмалью (2,26±0,19 балла) реакция ротовой жидкости является слабощелочной (7,08±0,06 единиц), были установлены самые низкие значения интенсивности кариеса постоянных зубов (1,51±0,16 зуба) и индекса гигиены полости рта (1,55±0,21 балла). В группе детей с условнорезистентной эмалью

емаллю (4,28±0,10 бала) встановлено незначне змщення рН ротово! рщини в кислотну сторону (6,95±0,05 одиниць), середне значення ппешчного iндексу 1,64±0,24 бала (задовшьна гiгiена) i iнтенсивнiсть карiесу 2,43±0,19 зуба. Виявлено, що у дтей з карiессприйнятливою емаллю (6,25±0,23 бала) спостертаеться високий рiвень iнтенсивностi карiесу постiйних зубiв (5,68±0,19 зубiв), погана ппена порожнини рота (2,13±0,24 бала), зсув рН ротово! рiдини в кислу сторону (6,35±0,07 одиниць). Висновки: змiна рН ротово! рiдини впливае на резистентшсть емалi, а отже i на розвиток карiесу зубiв.

Ключовi слова: резистентнiсть емалi, карiес зубiв, КПВ, рН ротово! рщини.

Стаття надiйшла 11.06.18 р.

(4,28±0,10 балла) установлено незначительное смещение рН ротовой жидкости в кислотную сторону (6,95±0,05 единиц), среднее значение гигиенического индекса 1,64±0,24 балла (удовлетворительная гигиена) и интенсивность кариеса 2,43±0,19 зуба. Выявлено, что у детей из кариесвосприимчивой эмалью (6,25±0,23 балла) наблюдается высокий уровень интенсивности кариеса постоянных зубов (5,68±0,19 зубов), плохая гигиена полости рта (2,13±0,24 балла), сдвиг рН ротовой жидкости в кислую сторону (6,35±0,07 единиц). Выводы: изменение рН ротовой жидкости влияет на резистентность эмали, а следовательно, и на развитие кариеса зубов.

Ключевые слова: резистентность эмали, кариес зубов, КПУ, рН ротовой жидкости.

Рецензент Ткаченко П.1.

DOI 10.26724/2079-8334-2019-1-67-111 УДК 616.12-007.2-071

ОСОБЛИВОСТ1 ВЕДЕННЯ ПАЩеНТШ З П1ЗНО Д1АГНОСТОВАНОЮ ВРОДЖЕНОЮ ВАДОЮ СЕРЦЯ

E-mail: shevchenkot67@gmail.com

Р!зномаштшсть проявiв вроджених вад серця ускладнюе !х своечасну дiагностику. Але, незважаючи на це, розумiння принцитв розвитку дано! патологи серця у пащенив старшо! вiково! групи, професшна обiзнанiсть лiкарiв, у тому чи^ завдяки шформацп, отриманiй при ознайомленш i3 матерiалами наведеного клiнiчного випадку, дозволять сформувати сучасш пiдходи до диференцшованого лiкування з використанням консервативних та хiрургiчних методiв, що позитивно впливатиме на яюсть життя пащенив, оптимiзуватиме прогноз.

Ключовi слова: вроджена вада серця, тзня дiагностика, методи лкування, оптимiзацiя прогнозу.

Стаття е фрагментом НДР «Запалъний, rneMiuHm, больовий синдром у хворих на rneMiuHy хворобу серця: тригери, роль супутнъоi патологи, мехатзми, критери дiагностики, л^вання» (№ державно! реестраци 0112U003122).

Вроджеш вади серця (ВВС) - патолопчш стани, пов'язаш ¡з наявшстю структурных дефекпв мюкарда або кровоносних судин, що виникають внутршньоутробно. Симптоми можуть проявлятися вщразу тсля народження, у ранньому дитинсга, 1нод1 ВВС мають безсимптомний перебп до повнол1ття або, досить нечасто, виявляються у дорослому вщг

Р1зноман1тн1сть прояв1в вроджених вац серця ускладнюе !х своечасну д1агностнку. Кшшчна картина ВВС у пащенпв старшого вшу залежить не лише вщ типу вади серця та можливих наслщюв попередшх оперативних корегуючих втручань, в1рог1дних шзшх ускладнень, але i вщ наявносп коморбщних сташв [1,4,6], розвитку набутих захворювань серцево-судинно! системи, пов'язаних iз вiковими змшами, полiорганних проявiв процесу старiння [3,7]. Розумшня принципiв розвитку, особливостей гемодинамши ВВС, вiрогiдних наслiдкiв проведеного х1рурпчного лiкування у дитинствi, пiзня первинна дiагностика потребують достатньо високо! квашфшацп лiкарiв первинно! ланки.

Метою роботи була оптишзащя дiагностики вроджених вад серця у дорослих, визначення конкретних завдань для лiкарiв загально-лiкувально! мережi по своечасному виявленню пацiентiв iз даною патологiею.

Матер1ал i методи дослщження. Проаналiзовано iсторiю хвороби пащента О., 1949 року народження, що в ургентному порядку був госпiталiзований до кардiологiчного вiддiлення Полтавсько! обласно! клiнiчно! лiкарнi iм. М.В. Сктфосовського зi скаргами на виражену задишку змiшаного характеру, вiдчуття нестачi пов^ря при незначному фiзичному навантаженнi, пекучий, iнодi колючий бiль у д^нщ серця без iррацiацi!, загальну слабюсть.

За перiод спостереження хворого на базi кардiологiчного вiддiлення ПОКЛ проведет загальноктшчш, лабораторнi та iнструментальнi обстеження (ЕКГ на апаратах «Юкард-100, «Юкард-200», ехокардiоскопiя на апаратi «Acuson X300» фiрми «Siemens», добове монiторування з використанням Холтерiвсько! системи «LABTECH Ltd», версiя програмного забезпечення V4.04.RC14).

Результати дослщження та Тх обговорення. 3i слiв пацiента припущення про наявшсть вроджено! патологi! серця виказувалось лшарями пiд час оглядiв ще з дитинства. Однак, у зв'язку

© Т.1. Шевченко, О.А. Шапошник, 2019