The study of intracranial pressure (eICP), cerebral perfusion pressure (eCPP), cerebral blood flow index (CFI), zero flow pressure (ZFP) in 49 children hospitalized in the intensive care unit with severe course of neuroinfections was carried out. The level of consciousness was determined by the Glasgow pediatric scale. Monitoring of central and peripheral hemodynamics (ECG, heart rate, systolic, diastolic and mean blood pressure, and cardiac output), pulse oximetry, capnography, hemoglobin, hematocrit, total protein, urea, creatinine, lactate, glucose and serum electrolytes was done. An ultrasound scanner was used to perform ultrasound duplex scanning of blood flow in the left and middle cerebral artery (MCA), measuring maximum, minimum and average blood flow velocities, pulsation index (PI), and resistance index (RI). Based on the formulae of Edouard et al. indicators of eCPP, ZFP, CFI, eICP were calculated. The eSCP was also determined by the formulae of Kligenchöfer et al. and Bellner et al. All patients were divided into group I with RI > 1.3 and group II with RI < 1.3. It was found that eCPP in the group I was significantly less (29.5 ± 1.3 mm Hg) than in the II group (41.6 ± 1.7 mm Hg). Despite the lack of a reliable difference in blood pressure between groups I and II, the difference in eCPP was found due to a significant difference in eICP 34.6 ± 1.4 and 27.6 ± 0.89 mm Hg in I and II groups respectively. ZFP in group I was significantly higher than in group II. The indexes of the Glasgow coma scale was significantly lower in group I and 7.8 ± 0.6 points. There were observed direct moderate correlations between systolic blood pressure, cardiac output and eSRP and CFI, presumably associated with a loss of autoregulation. CFI in the group I was lower than in the group II. Thus, non-invasive examination of cerebral flow in MCA by duplex sonography revealed that PI > 1.3 is an informative marker of intracranial hypertension and reduction of cerebral perfusion, which is common in children with neuroinfections. To determine the eSRP and CFI it is advisable to use the formula of Edouard et al. and to determine the eICP the formula of Kligenchöfer et al. The obtained data can be useful for objectifying the severity of the condition, predicting the outcomes of neuroinfections, choosing the directions of intensive care and evaluating its effectiveness.
Meningococcal infection is caused by the bacterium Neisseria meningitidis (also termed meningococcus). Invasive meningococcal disease remains a rare infectious disease not only with high mortality but also with important morbidity and remains as a leading cause of sepsis and septic shock. The pathogenic mechanisms of microcirculatory disorders in meningococcal septic shock have been subject to controversy. This article presents the results of a study of 11 paediatric patients’ (4 boys and 7 girls) with meningococcal septic shock (Group I) who were hospitalized at the Regional Children's Infectious Hospital from 2009 to 2011. The average age of the patients was 37.4 ± 8.4 mo. Septic shock was diagnosed according to International Pediatric Sepsis Consensus Conference: definitions of criteria for sepsis and organ dysfunction in paediatrics. Heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, average blood pressure, SpO2 were monitored. The cardiac output, ejection fraction, fraction shortening, stroke volume were measured by ultrasound in M-mode by Teichholz method. Blood circulation in the a. mesenterica, a. hepatica, a. lienalis, a. renal sinister, v. porta, v. lienalis, v. renal sinister was determined by impulse Doppler’s wave. Acid-base and electrolytes level in serum, nitric oxide (NO), endothelin I, creatinine, C-reactivity protein and lactate blood level were measured. The control group consisted of 21 healthy children (9 boys and 12 girls), aged 37.5 ± 5.4 mo. in average (Group II). We used t-criteria (Student’s) and correlation with R-criteria (Spearmen) for statistical analysis. The data showed a statistically significant lower fraction of ejection, fraction of shortening, stroke volume in Group I. Moreover, our data showed a statistically high level of mesenterial and portal blood flow rate and high pulse index in v. renal sinister compared to healthy children. The blood level of NO was increased in Group I as well as in Group II. Direct correlations were determined between the level of NO and mesenteric, hepatic arterial and venous blood flow rate. Statistically significant inverse correlations between the level of NO and pulse resistive index in splanchnic vessels were discovered as well as inverse correlations between the NO level and the indicator of the severity of condition on PRISM scale (r = –0.952). At the same time, we have found no correlation between splanchnic circulation value and cardiac output. Based on the results of this study, we consider that NO has organ protective effects in children with meningococcal sepsis. Future research should aim to introduce new strategies of intensive care for patients with meningococcal septic shock with early use of inotrope and NO-donor therapy in fluid restriction combination.
Харківський національний медичний університетРезюме. Вивчено перебіг обструктивного бронхіту в дітей раннього віку з бронхолегеневою дисплазією. Виявлені особливості морфологічного стану слизової оболонки гортані хворих, які впливають на запальний процес дихальних шляхів, а також можуть бути предикторами формування в подальшому склеротичних змін.Ключові слова: бронхіти, бронхолегенева дисплазія, морфологія, діти.
У 53 дітей раннього віку, хворих на тяжкі форми шигельозу, сальмонельозу та ешерихіозу, вивчена ефективність використання в комплексній терапії розчину стерофундин. Виявлено його позитивний вплив на регресію клінічних симптомів, покращення показників гемодинаміки.
У 65 дітей віком 3–18 міс., хворих на ротавірусні гастроентерити, вивчено ефективність застосування безлактозних сумішей у дієтотерапії. Було виявлено, що на тлі дозованої безлактозної дієти у хворих спостерігалась позитивна динаміка основних клінічних симптомів, швидше нормалізувались випорожнення, покращувався апетит, зникала блювота. Використання лікувальної дієти прискорювало нормалізацію лабораторних показників хворих.
The analysis of the cellular immune response indicators in shigellosis in 90 children aged four to ten years infected with cytomegolovirus. It was found that in the acute period of the disease in children with mixed infection, the content of CD3 +, CD4 + and CD8 + cells of peripheral blood decreases, and by the period of early reconvalescence, the full recovery of cellular immunity indicators in these children does not occur. The revealed features of cellular immunity in shigellosis in children infected with CMV may be the cause of an unfavorable course of the disease and require further research.
Бактеріальні кишкові інфекції (КІ) у дітей супроводжуються порушенням травлення, що обумов лене насамперед пошкодженням слизової оболонки кишечника внаслідок впливу збудника на морфологічні характеристики та функнаціональну діяльність шлунково-кишкового тракту (ШКТ), прискоренням транзиту по кишечнику, зміною активності залоз і порушенням перетравлювальної функції ШКТ, водно-електролітними розладами, дисфункцією біліарного тракту, значним зрушен-ням мікробіоценозу тонкого та товстого кишечника [3]. Усе вищезазначене може призводити до пору-шень всмоктування основних поживних речовин, формування тривалої діареї, розвитку гіпотрофії, дефіциту мікро-та макронутрієнтів.Доведено, що в гострому періоді інфекційного процесу при тривалій анорексії посилюються ка-таболічні процеси внаслідок підвищеного спожи-вання амінокислот під час синтезу білків гострої фази запалення, цитокінів та інших імунних фак-торів [10].Адреса для листування з авторами: Курлан Наталія Юріївна
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