When studying the age structure of children with broncho-obstructive syndrome (BOS), it was noted that broncho-obstruction was most often observed in children between 0 and 7 years of age. The children were divided by age as follows: the first year of life – 5 children; from 1 to 4 years old - 8 children and from 4 to 7 years old - 47 children. There were 35 boys and 25 girls among the studied children. The study of anamnestic data made it possible to identify risk factors for the development of BOS in young children. The most important factors contributing to the development of the disease were: early artificial feeding of children (in 70% of cases), severe allergic history (in 51.6% of cases) and bronchial hyperreactivity (in 40% of cases). The following main symptoms were noted in these children: expiratory shortness of breath, dry unproductive obsessive cough, distant wheezing and dry whistling wheezing. In 50% of the children, a burdened epidemiological history was found, because on the eve of the disease, they were in contact with ARVI patients.
Among all studied, 80% of children had acute obstructive bronchitis for the first time, 20% of children had an episode of BOS in their anamnesis. It was noted that repeated episodes of broncho-obstruction were observed in children with a heavy family history of allergies. In most children (60%), the disease began acutely, with a rise in temperature, symptoms of intoxication, pronounced catarrhal symptoms from the upper respiratory tract, which suggested acute obstructive bronchitis of viral etiology.
In most cases, acute obstructive bronchitis is characterized by an acute onset, an increase in body temperature to feverish numbers, rhinitis of a mucous nature, a short dry cough with a rapid transition to a wet one, the presence of intoxication - a decrease in appetite, poor sleep, the child becomes weak, capricious. On the 2nd-4th day against the background of already pronounced catarrhal phenomena and an increase in body temperature, a BOS develops: dyspnea of an expiratory nature without pronounced tachypnea (RR 40-60 per minute), oral crepitation, sometimes distant wheezing in the form of noisy, hoarse breathing, box-like tone of sound, during auscultation - prolonged exhalation, dry rough wheezing, wet wheezing of various calibers on both sides.
In children with asthma, the reverse obstructive type of ventilation insufficiency with a decrease in the speed of the function of external breathing is more often noted. In 5 children (8.3%), who did not receive sufficient basic therapy, an uncontrolled course of the disease was observed. In patients who took inhaled corticosteroids to some extent (3 children), a partially controlled course was diagnosed, which was caused by the addition of fibrotic changes of the bronchopulmonary tissue with a decrease in volume indicators as a result of the persistence of the allergic inflammatory process without adequate basic therapy.
The clinical course of ARVI in children was characterized by an acute onset, fever, moderately pronounced symptoms of intoxication that developed in the first 2–3 days of the disease, catarrhal symptoms such as: nasal congestion, nasal discharge, sore throat, hyperemia of the pharynx, hyperemia and granularity of the posterior wall pharynx, dry or expectorated cough, conjunctival hyperemia. Clinical manifestations of rhinitis, pharyngitis, laryngitis, tracheitis and bronchitis were observed. In 8 children (13.3%), the disease proceeded in a mild form, the body temperature was elevated to subfebrile numbers, the symptoms of intoxication were not expressed. In 4 children (6.6%), the disease acquired moderate severity, the temperature reached 38.5–39.5 °C, and the classic symptoms of the disease were noted: profuse sweating, weakness, pain in muscles and joints, headache, catarrh symptoms
Nebulizer inhalation therapy was used as the main pathogenetic treatment. When determining the amount of therapy, the peculiarities of clinical and anamnestic data, the severity of broncho-obstructive syndrome and respiratory failure were taken into account. Taking into account the main mechanisms of the development of bronchial obstruction in young children, the prescription of steroid drugs with an anti-inflammatory purpose was sufficiently justified. All patients received therapy, which was regulated by the protocol for providing medical care with bronchial obstruction and infectious inflammation.
The main criteria for the effectiveness of the treatment was a decrease in severity, and then the disappearance of the obstructive syndrome. Schemes for nebulizer therapy were compared using modern protocols for the treatment of diseases with broncho-obstructive and infectious-inflammatory syndrome, and according to the compatibility of drugs.
The evaluation of the effectiveness of the treatment was carried out on the basis of a 10-point visual-analog scale, which reflects the dynamics of BOS in various clinical conditions: 0 points - absence of symptoms, from 1 to 3 points - a weak degree of severity, from 4 to 6 points - moderate and from 7 to 10 points - a pronounced degree.
The severity of BOS was assessed according to the following main criteria: the severity of expiratory dyspnea, the number of dry, whistling wheezing during auscultation, productivity and frequency of coughing.
Aminocaproic acid in combination with Lorde Hyal was used for the treatment of acute respiratory viral infections using nebulizer therapy. Control data on the 3rd, 7th and 14th day from the start of treatment were taken into account. The dynamics of clinical manifestations were performed on the basis of such symptoms as difficulty in nasal breathing, runny nose and cough. At the beginning of treatment, the indicators of these clinical manifestations were 7.4, 6.2, and 3.5 points, respectively. By the 14th day, the symptoms significantly decreased and were eliminated almost completely. No side effects were observed.
Next investigations shows the effectiveness of treatment of infectious diseases (bronchitis) with the help of nebulizer therapy using the following combination of drugs: bronchodilators + mucolytics + Dekasan. Control data on the 1st, 2nd, 3rd, 4th and 5th day from the start of treatment were taken into account. Against the background of inhalation therapy, rapid positive dynamics of clinical symptoms were observed: a significant improvement in well-being, reduction of body temperature and runny nose was noted on the second day; reduction of intoxication, hyperemia of the pharynx — on the third day; reduction of cough and wheezing in the lungs — on the fourth day of treatment. This combination of drugs is safe and effective for this pathology.
In the clinical practice of nebulizer therapy in the treatment of allergic conditions of the upper respiratory tract, the following combination of drugs is used: local corticosteroids (pulmicort) + Lorde Hyal. Against the background of inhalation, a significant reduction in symptoms was observed in all children already on the second day of treatment. In the following days, further improvement of indicators was observed. On the 7th day of treatment, the symptoms were completely eliminated. Side effects of therapy were not detected in any patient.
Next - shows the effectiveness of the treatment of allergic conditions of the lower respiratory tract with the help of nebulizer therapy using the following combination of drugs: local corticosteroids (pulmicort) + bronchodilators. During the analysis of clinical effectiveness in patients on the third day, a decrease in cough, the volume of sputum produced, positive dynamics of the auscultatory picture in the lungs was observed. At the same time, no side effects were detected.
In next cases shows the effectiveness of treatment of bronchial asthma with the help of nebulizer therapy using the following combination of drugs: glucorticosteroids + Berodual. In case of exacerbation of BA, the sum of points, which characterizes the severity of nocturnal attacks of the disease, suffocation and wheezing, significantly decreased by the 4th day of treatment, and by the 2nd Sunday after the start of therapy, the night symptoms completely disappeared.
Thus, this analysis demonstrated the high efficiency of nebulizer inhalation therapy of BOS with the use of combined therapy. In most children, improvement of the condition and regression of obstruction was observed already on the 3-5th day of treatment. By the 7th day of broncholytic therapy, BOS was eliminated in 98.4% of patients. However, in 1.6% of cases, insufficient effect of the treatment was observed. None of the patients experienced any adverse side effects associated with the use of nebulizer therapy.
References
1. Ehrmann S., Roche-Campo F., Sferrazza Papa G. F. et al. Aerosol therapy during mechanical ventilation: an international survey // Int. Care Med. ‒ 2013. ‒ Vol. 39. ‒ Р. 1048–1056.
2. McPeck M. Improved aerosol drug delivery with an electronic mesh nebulizer during non-invasive ventilation // Am. J. Respir. Crit. Care Med. – 2012. – Vol. 185. – Р. A3136.
3. Morgan S. E., Mosakowski S., Solano P. et al. High-flow nasal cannula and aerosolized β-agonists for rescue therapy in children with bronchiolitis: A case series // Respir. Care. – 2015. – Vol. 60. – Р. 161–165.
4. Небулайзерна терапія в педіатричній практиці: методичні рекомендації. – Київ, 2005. – С. 24.
5. Островський М. М. Вибір оптимальної схеми подолання обструктивного синдрому при вірус-індукованих гострих бронхітах / М. М. Островський, О. І. Варунків // Астма та алергія. – 2014. - №1. – С. 52-54.
6. Охотнікова О. М. Синдром бронхіальної обструкції у дітей: диференційна діагностика та лікування / О. М. Охотнікова // Мистецтво лікування. – 2010. - №1(67). – С. 46-52.
7. Колосова Н.Г., Геппе Н.А. Інгаляційна терапія в педіатрії: від фундаментальної науки до практичного використання // Педіатрія (Додаток. До журн. Consilium Medicum). – 2018. - № 3. – С. 66-68.
8. Закірова А.М., Пікуза О.І., Шаяпова Д.Т., Рашітова Е.Л., Волянюк Є.В. Ефективність небулайзерів в терапії респіраторного ураження дихальних шляхів у дітей різних вікових груп // Медична Рада. – 2020. - № 1. – С.152-157.
|
Голосування 
Ця робота ліцензується відповідно до Creative Commons Attribution 4.0 International License
Знайшли помилку? Виділіть помилковий текст мишкою і натисніть Ctrl + Enter