Abstract
The purpose of this study was to develop and evaluate the algorithm for cardiovascular disorders prevention and therapy effectiveness in children with chronic bronchopulmonary pathology. Materials and methods. There was catamnestic examination of 57 patients with chronic bronchopulmonary pathology (29 children with severe, controlled or partially controlled persistent bronchial asthma and 28 children with cystic fibrosis and pancreatic insufficiency) who were analyzed the dynamics of left ventricular myocardial remodeling, depending on the administrated treatment. Catamnesis duration was 1 year. The average age of children in the observation group was 9.2 ± 0.6 years. The ultrasound examination of the heart was performed using the Medison SonoAce 8000 ultrasound machine (USA) according to the standard procedure. The mathematical analysis and statistical processing of data were performed on a PC using the licensed software package of Statistic for Windows 10.RU using variation, correlation, regression and nonparametric methods of statistical analysis. Variables were expressed as M ± m and P value <0.05 was considered to indicate statistical significance. Results . It has been established that there is a structural and functional left ventricular myocardium rearrangement on the background of left ventricular diastolic dysfunction development, sympathetic branch of the autonomic nervous system functional impairment, myocardium electrical instability and endothelium-depended vasodilation disturbance in children with chronic bronchopulmonary diseases. The algorithm has been worked out for choosing tactics of cardiovascular disorders therapy based on the study results, which is a complex of non-medicamentous and medicamentous methods with drug modulators of – nitric oxide system – ACE and L-arginine inhibitors inclusion in the therapy. The effectiveness of proposed algorithm was estimated in 27 children with chronic bronchopulmonary diseases. The other 30 patients, who were treated with traditional therapy, made up a comparison group. It has been found that proposed therapeutic method application in the complex treatment of children with chronic bronchopulmonary pathology contributed to left ventricular myocardium morphofunctional state improvement by slowing processes of left ventricular remodeling and increasing the number of patients who had normal left ventricular myocardium geometry. There was a progression of the left ventricle morphofunctional state changes in the comparison group, which was manifested by an increase in the left ventricular myocardium mass and structural-geometric myocardial restructuring by concentric type of cardiac remodeling. Conclusions. The use of proposed algorithm can prevent cardiovascular disorders progression and provide more effective rehabilitation of children with chronic bronchopulmonary diseases.
Highlights
We have found in our previous studies that left ventricular remodeling occurred in 49% of patients with bronchial asthma and 58% of children with cystic fibrosis [15]
There was a violation of endothelium-depended vasodilatation, which showed a decrease in the nitric oxide blood serum content by 1,4 times in the group of patients with bronchial asthma and by 6,9 times in patients with cystic fibrosis in comparison with the control group (7.39 ± 0.29 μmol/l and 5.79 ± 0.32 μmol/l against 8.88 ± 0.53 μmol/l, respectively, P < 0.05) [18]
The nitric oxide synthesis was inhibited due to a decrease in the endothelial shear stress, which acts as the main stimulator of nitric oxide activity in patients with chronic bronchopulmonary diseases [19,20]
Summary
The purpose of this study was to develop and evaluate the algorithm for cardiovascular disorders prevention and therapy effectiveness in children with chronic bronchopulmonary pathology
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