One hundred and fifty bronchial asthma patients aged 6 to 14 yrs were complexly examined for haemodynamic parameters in correlation with the lung function and the diaphragm activity in different stages of the disease. The respiratory dysfunction based on the bronchial obstruction, irregular lung ventilation and reduction in the diaphragm functional activity was shown to be accompanied by changes in the regional and central blood circulation. A consistency of these disorders depended on the basic therapy

Purpose of the study. The parameters of microhemodynamics and regional blood flow have been analyzed with the aim of clarifying their significance in the formation of capillary-trophic insufficiency syndrome in children with bronchial asthma. Material and methods. 225 patients aged from 6 to 14 years with bronchial asthma were examined. Pulmonary and capillary blood flow, pulmonary respiratory activity, morphofunctional parameters of platelets, erythrocytes and endothelium were studied depending on the course of the disease. Results. A decrease in tissue perfusion, low vasomotor activity and stagnant-stasis phenomena in the microcirculation system, accumulation of pathological forms of blood cells in the bloodstream, their functional inconsistency, a change in the morphofunctional status of endothelial cells were recorded. Conjugacy of the studied parameters with the activity of inflammation and respiratory dysfunction with the achievement of disease control makes it possible to consider them as markers of capillary-trophic insufficiency, which are predictors of the risk of exacerbations and justify the need for personification of therapy schemes for these patients.

In children with asthma aged 6 to 14 years parameters of metabolic activity of lung analyzed. Exacerbation was accompanied by disorganization of the phospholipid layer of surfactant, electrolyte imbalance, variations in oxidant-antioxidant system. In remission sohranyalis changes, most pronounced in patients with severe and long-term course of the disease. The nature and orientation of metabolic changes in patients with severe asthma patients, their conjugation with reduced FEV1 and dysregulation of the internal environment of the organism, can be considered as criteria for uncontrolled cell death, leading to disruption of the structure and remodeling in bronchopulmonary system.

Цель установить характер изменений капиллярного кровотока, морфофункциональных параметров клеток крови (эритроцитов, тромбоцитов) и эндотелия с тем, чтобы патогенетически обосновать необходимость и оценить эффективность применения низкоинтенсивного лазерного излучения (НИЛИ) в комплексе медицинской реабилитации детей с бронхиальной астмой (БА). Материал и методы. На базе Ивановской областной клинической больницы обследованы 225 детей с БА в возрасте от 6 до 14 лет. В контрольную группу вошли 35 практически здоровых детей. Ежедневно регистрировались показатели пиковой скорости выдоха (утро/вечер) в дневнике самоконтроля. Исследовали морфометрические параметры, поверхностную цитоархитектонику, реологические характеристики эритроцитов, морфологические параметры, функционально-метаболические характеристики тромбоцитов, состояние эндотелиальной системы, уровень антитромбина III, оксида азота, состояние капиллярного кровотока, функцию внешнего дыхания. Дополнительно проведено рандомизированное контролируемое исследование влияния различных терапевтических комплексов на характер микрогемодинамических нарушений, в которое включено 64 ребенка в возрасте 10-14 лет с БА средней степени тяжести в периоде обострения, получавшие комбинированную терапию будесонидом и формотеролом. В основную группу вошли 29 человек, которые дополнительно получали НИЛИ, в группу сравнения 35 человек, не получавшие НИЛИ. Комплексное лабораторно-инструментальное обследование осуществлялось до начала терапии и через 4 недели от начала лечения. Результаты. У больных с обострением БА, наряду с респираторными расстройствами, отметили снижение величины тканевой перфузии, ухудшение функционирования механизмов регуляции тканевого кровотока, низкую вазомоторную активность микрососудов, наличие застойно-стазических явлений в системе микроциркуляции. На всех этапах патологического процесса микрогемодинамические изменения были сопряжены с изменением морфофункционального статуса эритроцитов (микроцитозом, сферуляцией, нарушением цитоархитектоники, снижением деформируемости, повышением агрегации, нарушением эритрокинетического равновесия) и тромбоцитов (увеличением агрегационной активности, внутриклеточного содержания биоаминов, нитрат-ионов, процессов липопероксидации и жесткости тромбоцитарных биомембран). При обострении заболевания имели место увеличение количества циркулирующих эндотелиоцитов, уровня эндотелина-1, нитрит-ионов, активация фактора Виллебранда на фоне сниженной антитромбогенной активности сосудистой стенки. Указанные изменения не регрессировали при достижении контроля заболевания, определяя персистирование синдрома капиллярно-трофической недостаточности. В рандомизированном исследовании установлено, что при использовании НИЛИ было более выраженным восстановление параметров респираторной функции легких (суточной вариабельности ПСВ и ФЖЕЛ) и микрогемодинамики (амплитуд в диапазоне медленных колебаний (ALF). У пациентов, получавших НИЛИ, морфофункциональные свойства клеток крови (эритроцитов, тромбоцитов) и эндотелия нормализовались, в отличие от группы сравнения. Выводы. Развитие БА у детей сопровождается разнонаправленными изменениями капиллярного кровотока, структурно-функциональных показателей клеток крови и эндотелия, определяющих формирование капиллярно-трофической недостаточности, стойко сохраняющейся при достижении контроля заболевания на фоне поддерживающей терапии. Включение НИЛИ в комплексную схему реабилитации детей с БА обеспечивает восстановление изучаемых параметров и респираторной функции легких, отражая клиническую эффективность и преимущества этого терапевтического подхода.

Objective to evaluate the effectiveness of two complexes of therapeutical rehabilitation measures in children with recurrent stenotic laryngotracheitis. Materials and methods. 40 children with recurrent stenotic laryngotracheitis were observed; the efficacy of two complexes of therapeutic rehabilitation measures was estimated. The complex of therapeutic rehabilitation measures in 20 children of I group included hypoallergenic diet, irrigation of mucous membranes of upper respiratory tracts by NaCl physiological solution 4 times per day, massage of biologically active facial sites 3 times per day, chest massage, respiratory gymnastics. Patients from 2 group were additionally administered broncho-munal П, bifiform, eurespal and vitamin A. The authors evaluated the influence of these complexes on the content of microbiocenosis of mucous membranes of respiratory and digestive tracts, parameters of external respiration function, general blood E immunoglobulin level and remission duration. Results. The normalization of microflora content of mucous membranes of upper respiratory tracts and colon, decrease of general IgE level, lung ventilation indices and restoration of long remission 26,0 ± 3,5 months in children from 2 group in comparison with 8,5 ± 2,9 in patients from 1 group. Conclusions. The suggested complexes of therapeutical rehabilitative measures were proved to be effective and necessary for long remission achievement. Purposeful single-momentous impact on the microflora of mucous membranes of respiratory and digestive tracts in combination with the preparations which had anti-inflammatory action, vitamin A and vitamin E allowed to remove dysbiotic phenomena and to restore disordered lung ventilation, to obtain long remission.

The process of recurrent bronchitis is accompanied by increased threshold sensitivity of the bronchi to inflammatory mediators, the occurrence of which affect brain activity with a predominance of irritation meso diencephalic structures, autonomic tone, manifesting hypersympathicotonia and increase the level of central regulation contour, cerebral hemodynamics, characterized by increased tone of arterioles and veins , peripheral vascular resistance and venous outflow obstruction. The emerging of bronchial hyperresponsiveness in children with recurrent bronchitis leads to bronchial obstruction at all levels of the bronchial tree, furthermore it leads to reduction of redundant lung capacity and is, apparently, one of the pathogenic mechanisms of persistent flow of inflammatory changes in the bronchi and increased cough readiness.

Children who are sick with asthma respiratory disorders were accompanied by a decrease in bronchial obstruction, irregular zone of ventilation, hyperairiness of lung, oppression of mucociliary clearance, which implementation is associated with increasing lung tissue and respiratory tract, flattening and decreasing mobility of the diaphragm, hyperventilation and decrease in leisure time of respiratory muscles, increase of «oxygen price» breathing.

Central hemodynamics status in 70 children with arterial hypertension was examined. It was stated that patients had various changes of central hemodynamics and these changes were depended on its type. Hyperkinetic cardial syndrome was revealed in children with hyperkinetic and eukinetic types. Hypokinetic type was initially characterized by low functional state of cardiovascular system. Polyvariation of hemodynamics adaptive alterations was marked in all groups. These alterations were directed to maintain cardiovascular system functional resources.

The compensatory adaptive and dezadaptsionnye changes are exposed if children have bronchial asthma. The erythrocytes become roundish, the strengthen of the erythropoiesis, activity of enzymes in lrukocytes, the level of nitric oxide, concentration of t-PA – all these characteristics belong to the compensatory adaptative changes.Changes of cytoarchitectonics of erythrocytes, aggregative activity and hemolysis of red corpuscles of blood, accumulation of MDA, increase of stiftness of membranes of blood sells, increase of serotonin and catecholamine in platelrts, increase of platelets aggregation, strengthen of destruction of endothelium, the formation of endothelin-1, PA-I, activity of Willebrand factor, reduction of substance of hemoglobin, duration of erythrocytes life, activity of peroxidase of leukocytes and antithrombin III. All these characteristics belong to dezadaptsionnye changes.

Leucocytes metabolic characteristics in various phases of pathological process were studied in children with bronchial asthma. Increased dehydrogenase activity, heightened glycogen level, increased leucocytes membranes rigidity were revealed side by side with decreased peroxidase activity. These alterations attended by obstructive respiratory disorders and NO high level (allergic inflammation activity marker) had pathogenetic significance in chronic immune inflammation persistence in bronchopulmonary system. It substantiated the development of measures to соrrесt them.

An influence of ribosomal-proteoglycan complex (Ribomunyl) on respiratory system in treatment and rehabilitation of 40 children with recurrent stenosing laryngotracheitis developed on the basis of respiratory viral infections was studied. Inclusion of this drug into complex of treatment and rehabilitation resulted in normalization of lungs’ ventilation and threshold sensitivity of airways, decreasing of common IgE and nitric oxide in these patients. The effect means significant decrease of persistent infectious-allergic inflammation. Treatment with this drug resulted in prolongation of remission in increase of children’s quality of life. Key words: children, recurrent stenosing laryngotracheitis, hypersensitivity of airways, Rybomunyl, treatment. ( Voprosy sovremennoi pediatrii — Current Pediatrics. 2010;9(5):36-41)