INTRODUCTION

Constipation (from a language armour constipation, obstipacio - a clump) - one of difficult and unresolved mediko-social problems in pediatrics. The urgency of this disease is caused both high frequency of prevalence, and insufficient understanding of this problem from parents and, as consequence, to the untimely reference to the expert.

Frequency of occurrence of a constipation at children in the Russian Federation makes about 25-30 % [30, 48]. According to data mnogotsentrovogo researches in Federal districts of Russia (2195 children) the chronic constipation (by the Roman criteria III) has been diagnosed in 53 % of cases [73].

Despite a wide arsenal of the medical products used in therapy of a constipation at children, till now a choice of tactics of treatment of the given pathology remains an unresolved problem because of complexity of the mechanism of formation of a delay of a chair, and also because many preparations including the purgatives used for correction of the certificate of a defecation, are forbidden in children's practice because of by-effects. Considering the above-stated, now wider application in constipation treatment find physical methods of treatment, such as: magnitoimpulsnaja stimulation, an inductothermy, DMV-THERAPY (the method of a high-pitched electrotherapy based on application of superhigh-pitched electromagnetic fluctuations of a decimeter range, or decimeter waves), diadynamotherapy (DDT), therapy
The sinusoidal modulated current, interferentsionnye currents, kriomassazh, it is barefooted-THERAPY, physiotherapy exercises [40, 41, 44, 46, 63].

The scientific works devoted to an objective estimation of efficiency of acupuncture at a constipation at children, were not spent. However the given method well has shown itself and is widely applied at children at diseases of nervous system, breath and digestion organs, both as an independent method, and as a part of complex treatment [8, 15 114, 115]. It is known, that the reflexotherapy is most effective at treatment of diseases of functional character, that is the pathological conditions caused, mainly, by disturbances of mechanisms of regulation of functions. Hence, in children's practice the reflexotherapy can be applied with larger productivity, for at children many diseases including a constipation, in the big percent of cases have functional character [78, 98].

Till now the comparative analysis of efficiency of various methods of treatment of a syndrome of a constipation depending on duration of a current of disease has not been carried out, accurate references after tactics of reflexotherapy and its combination to appointment of those or other schemes of treatment taking into account complaints and clinical implications are not developed.

On the basis of the above-stated, does not cause doubts an urgency of the researches referred on optimisation of rendering of medical aid children with an acute and chronic constipation in a complex with acupuncture.

Research objective - optimisation of the complex approach in treatment of an acute and chronic constipation at children with acupuncture use.

Research problems:

1. To spend an estimation of the clinical characteristic of a current of an acute and chronic constipation with the analysis of risk factors of its formation in gender and age aspects.

2. To analyse features of clinical implications and results of laboratory-tool methods of inspection at children depending on duration and gravity of a current of a constipation.

3. To estimate efficiency of a method of acupuncture in treatment of an acute constipation at children depending on acuteness, clinical semiology and gravity of a current of disease.

4. To carry out the comparative analysis of efficiency of various methods of treatment at children with a chronic constipation with acupuncture use.

5. To analyse results katamnesticheskogo observations over children with the acute and chronic constipation, received acupuncture courses in complex treatment of disease.

6. To develop algorithm of organizational-medical actions at children with an acute and chronic constipation with use of a method of acupuncture.

Scientific novelty of work:

For the first time in pediatric practice the complex comparative analysis of data anamnestic, clinical, laboratornoyoinstrumentalnyh methods of inspection of children with an acute and chronic constipation has been carried out, statistically authentic risk factors of their formation are taped. Features of clinical implications of disease in gender and age aspects depending on the reasons of its formation, acuteness of a current and presence of an accompanying pathology are defined. At children with an acute constipation for the first time in pediatric practice efficiency of reflexotherapy as major method of correction motorno-evakuatornoj has been proved function of a colon and preventive maintenance of formation of the chronic form of disease to what results katamnesticheskogo observations over children with an acute delay of a chair testified.

For the first time the comparative analysis of results of various methods of treatment of a chronic constipation at children with use of acupuncture is carried out and its efficiency as in the course of treatment of an exacerbation of disease is shown, and
According to a catamnesis on the basis of what the algorithm of the differentiated approach to use of the given method in the decision of so actual problem of children's age is offered.

The practical importance of work.

The acute delay of a chair at children of any age groups is the basis for the reference to the doctor-gastroenterologist. Efficiency of treatment of an acute constipation at children's age depends on in due time spent adequate therapy taking into account risk factors and triggers of its formation, and also regular dynamic observation over a condition motorno - evakuatornoj colon functions. Use of a triple course of acupuncture (against an acute delay of a chair, later 3 - 4 weeks and 6 months) authentically reduces risk of formation of the chronic form of disease.

The chronic delay of a chair demands the careful analysis of the reasons from children causing a constipation, the mechanism of its formation and the clinical features of a current supported with results of all-round inspection that defines tactics of rendering of medical aid of this category of patients.

The choice of a complex of medical actions (a diet and a diet, pharmacotherapy, massage, medical gymnastics, fizio - and acupuncture) depends on degree motorno-evakuatornyh disturbances, expression of a painful syndrome, dispepsicheskih symptoms, presence of complications (kalomazanie) and accompanying pathology.

Course of treatment of acupuncture at children with the chronic constipation, consisting of 10 sessions in a combination to basic therapy, allows to raise efficiency in achievement of the clinical remission which stability promote its repeated carrying out through 3 - 4 weeks and 6 months. Presence kalomazanija dictates necessity of a combination of basic treatment, fizio - and acupunctures.

IRT is an effective, accessible and safe method of correction motorno-evakuatornoj colon functions as in complex treatment at a stage of clinical implications of disease, and in monotherapy from a position of preventive maintenance of formation of a chronic constipation and further him retsidivirovanija, that defines the algorithm of treatment of a syndrome of a constipation presented in work with use of the given method.

The positions which are taken out on protection:

The acute delay of a chair in the presence of certain risk factors can be a debut of a chronic constipation at children of any age that defines necessity of the reference to the doctor adequate to therapy and dynamic observation for motorno-evakuatornoj by function of a colon.

Therapy both acute, and a chronic constipation at children should be complex and include along with traditional methods of treatment (a diet, a diet, massage, physiotherapy exercises, physiotherapy) acupuncture which at a stage of remission of disease can be used for the purpose of preventive maintenance of formation of chronic disease and depression of its risk retsidivirovanija.

Clinical efficiency of acupuncture at a syndrome of a constipation at children is caused by reduction of vegetative disturbances, stimulations of metabolic processes in organs and the tissues normalising a motility zheludochnoyokishechnogo of a tract, and also rising of allocation of biologically active bonds promoting depression of abdominal pains and a meteorism.

Tactics of carrying out of the reflexotherapy including superficial acupuncture by means of the massage platen, korporalnoe and auricular acupuncture, segmentary massage of area of a stomach should be individual taking into account complaints of the patient and presence of objective clinical symptoms of disease that defines efficiency of the given treatment.

Introduction of results of research

The developed algorithm, schemes and techniques of treatment of a syndrome of a constipation at children are introduced in gastroenterologicheskoe branch unit № 2 Morozovsky children's city hospitals and GBUZ the Children's city out-patient department №39 DZM by of Moscow. The basic scientific positions and conclusions are introduced in pedagogical process of chair of propaedeutics of children's illnesses, a course of gastroenterology and dietology FUV of chair of hospital pediatrics № 1 and chairs of aftertreatment and sports medicine GBOU VPO «RNIMU of N.I.Pirogova of Ministry of Health of the Russian Federation».

Work approbation

Dissertation substantive provisions are reported and discussed on XIX congress of children's gastroenterologists of Russia and the CIS countries (Moscow, on March, 13-15th, 2012), X anniversary Russian scientifically-educational forum with the international participation «the World of people with physical inability» (Moscow, on November, 14-15th, 2013), X Russian conference with the international participation «Pediatrics and children's surgery in Privolzhsky federal district» (Kazan, on November, 26-27th, 2013).

Publications

On dissertation materials 13 printing works, from them 7 in reviewed magazines VAK of the Russian Federation are published.

Volume and dissertation structure

Work is stated on 139 pages of the typewritten text, includes 14 tables and is illustrated by 23 drawings and 1 scheme, 2 appendices. The dissertation consists of introduction, the literature review, 4 heads of own researches, the description of volume and methods of research, the conclusion, conclusions, practical references and the list of the literature which includes 152 sources, from them 75 domestic and 77 foreign.