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INTRODUCTION

Urgency

The problem of preventive maintenance and treatment of an arterial hypertensia and teenagers occupies priority position in children's cardiology from children. It is bound to high prevalence of an arterial hypertensia, and also with possibility of transformation of an arterial hypertensia in the ischemic and hypertensive illnesses which are a principal cause of an invalidism and a mortality of adult population.

Preventive maintenance and treatment of an arterial hypertensia at children's age is more effective in comparison with an adult contingent of patients [74]. The complexities bound to diagnostics and treatment of an arterial hypertensia at teenagers, are caused, on the one hand, by many-sided nature of the problem of an arterial hypertensia, and with another - are defined by specificity of teenage age [49].

Value skriningovoj diagnostics of cardiovascular diseases is great, especially at children's age when early diagnostics or predisposition revealing allows to prevent development of a pathological condition. An accessible method of screening of an arterial hypertensia is regular measurement of level of arterial pressure with the subsequent estimation of 95th pertsentilja systolic and diastolic arterial pressure depending on age, growth and a floor. However procedure of measurement of level of arterial pressure on pediatric reception is not always perceived as obligatory [32]. Now it is known, that a debut of formation of an idiopathic hypertensia are functional disturbances. Only at late stages to functional disturbances join organic [9]. Researches of a functional condition of cardiovascular system at children and the teenagers, suffering an arterial hypertensia are not numerous.

The most widespread method of screening of a cardiovascular pathology now is the electrocardiography, use

The method variance kartirovanija electrocardiograms has good indicators on sensitivity to metabolic changes in a myocardium of any genesis, and also concerning the transient functional disturbances which are harbingers of a pathology. It is known, that at the heart of this method the analysis nizkoamplitudnyh fluctuations of registered parametres which at approach to points of loss of structural fastness start to change earlier lays, than it will be shown on a standard electrocardiogram. For this reason of the characteristic nizkoamplitudnyh fluctuations kardiotsikla it is possible to apply as effective diagnostic markers of coming nearer structural reorganisation [44].

Recently the variance analysis nizkoamplitudnyh fluctuations kardiotsikla is widely used as screening-method in the various Centers of health for definition of degree of an ischemia in adult population. However, considering use of the given method at children is more senior 12 years, there is a problem of incorrect interpreting of results of research at teenagers when such significant part of the conclusion as is ignored, for example, a detailed elaboration code.

Data about an estimation of a functional condition of cardiovascular system at the teenagers, suffering an arterial hypertensia, a method of the variance analysis nizkoamplitudnyh kardiotsikla in the accessible literature we have found fluctuations.

Research objective

On the basis of the analysis variance kartirovanija nizkoamplitudnyh fluctuations PQRST to tap possibility of use of this method in
Quality skriningovoj diagnostics of vegetative regulation and a myocardium condition at an arterial hypertensia at children of teenage age.

Research problems

1. To estimate character of vegetative regulation on the basis of value of an indicator "Rhythm" by results of variance kartirovanija electrocardiograms at children of teenage age with various stages of formation of an arterial hypertensia.

2. To estimate a condition of a myocardium on the basis of value of an indicator "Myocardium" by results of variance kartirovanija electrocardiograms at children of teenage age with various stages of formation of an arterial hypertensia.

3. To tap features depoljarizatsii and repoljarizatsii auricles and ventricles at children of teenage age with various stages of formation of an arterial hypertensia with application of the variance analysis nizkoamplitudnyh electrocardiogram fluctuations.

4. To establish correlation communications of value of a code of detailed elaboration and clinico-functional parametres at an arterial hypertensia.

5. To define criteria of formation of group of risk on development of an arterial hypertensia in children of teenage age with use of the variance analysis nizkoamplitudnyh fluctuations kardiotsikla.

Scientific novelty

For the first time the functional condition of cardiovascular system of children of the teenage age, suffering is studied by an arterial hypertensia, by means of a method variance kartirovanija nizkoamplitudnyh fluctuations PQRST and new data are obtained about
doklinicheskih disturbances of electrophysiological properties of a myocardium at an arterial hypertensia.

The analysis of value of indicators "Rhythm" and "Myocardium" at teenagers with various degree of expression of an arterial hypertensia (a syndrome of vegetative dysfunction on synpaticotonic type, a labile and stable arterial hypertensia) is carried out; data about their possible including in diagnostic algorithm of an arterial hypertensia at teenagers are obtained.

By means of variance kartirovanija nizkoamplitudnyh fluctuations kardiotsikla features depoljarizatsii and repoljarizatsii auricles and ventricles at children of the teenage age, suffering are taped by an arterial hypertensia, at a normal electrocardiogram of rest.

Diagnostic criteria of process of formation of an arterial hypertensia at teenagers are defined at asimptomnom a current and-or absence of changes on a standard electrocardiogram that will allow to use more effectively variance kartirovanie electrocardiograms at skriningovyh researches in the health Centers.

The theoretical and practical importance of work

The obtained data were a basis for working out of practical references on revealing of group of risk of formation of an arterial hypertensia at mass inspections.

Results of research have given the chance to dilate a circle of persons, requiring preventive actions for elimination of risk factors of an arterial hypertensia at carrying out skriningovyh researches. The teenagers having pathological value of indexes "Rhythm" and-or "Myocardium" in a combination to deviations in depoljarizatsii of the left auricle (G2), depoljarizatsii a left ventricle (G4) and-or hypertrophy signs

Results of work have dilated possibilities of a method of an electrocardiography and have shown expediency of including of a method of the variance analysis nizkoamplitudnyh fluctuations kardiotsikla in complex inspection of children and teenagers, including suffering a syndrome of an arterial hypertensia.

The positions which are taken out on protection

1. Variance kartirovanie electrocardiograms with definition of an indicator "Rhythm" can be used as additional criterion of vegetative dysfunction at teenagers on doklinicheskoj stages of an arterial hypertensia.

2. Doklinichesky disturbances of electrophysiological properties of the myocardium, not taped on a standard electrocardiogram at an arterial hypertensia at teenagers, can be estimated on the basis of an index of microalternations "Myocardium".

3. Pathological value of an index "Rhythm", an indicator of microalternations "Myocardium" and depoljarizatsii the left auricle (G2) in a combination to deviations from norm depoljarizatsii a left ventricle (G4) and-or signs of a hypertrophy of ventricles (G9) are prognostically adverse signs concerning formation of an arterial hypertensia.

Degree of reliability and approbation of results

Research materials are presented and discussed on nauchnoyoprakticheskih conferences young scientific (Arkhangelsk, 2010, 2011,
2013); at VII All-Russia seminar of memory of professor N.A.Belokon «Children's cardiology in aspect of interdisciplinary communications» (Ufa, 2011); at total scientific session SGMU «Northern medical school: history and the present» (Arkhangelsk, 2011); on X International slavic congress on an electrical stimulation and a clinical electrophysiology of heart "Kardiostim" (St.-Petersburg, 2012); at XIII International scientific conference «science and education Pressing questions» (Moscow, 2012); at V Arkhangelsk international medical scientific conference of young scientists and students (Arkhangelsk, 2012); on VII All-Russia Congress «Children's cardiology 2012» (Moscow, 2012); on XI nauchnoyoprakticheskoj conferences «science Youth-engine» (Arkhangelsk, 2012); at VI scientifically-practical conference with the international participation «Vorontsovsky readings» (St.-Petersburg, 2013); On IV and V inter-regional scientifically-practical conference of the devoted memory of the professor of Pikkel M. V (Arkhangelsk, 2013, 2014); at VI Arkhangelsk international medical conference of young scientists and students (Arkhangelsk, 2013); at the International conference «Scientific researches of the higher school in priority directions of a science and technics» (Switzerland, Bern, 2014); on International nauchnoyoprakticheskoj conferences «the World and a science» (Czechia, of Brno, 2014); at the All-Russia scientifically-practical conference of young scientists and students with the international participation «Medical Spring 2015» (Moscow, 2015).

On dissertation materials 23 printing works, from them 5 publications in the reviewed editions recommended VAK for dissertational researches (1 article in editions of database Scopus) are published.

Results of dissertational research are introduced in lechebnoyodiagnostichesky process of children's unit and children's out-patient department FGBUZ «SMKTS by it N.A.Semashko FMBA Russia» in a kind skriningovogo inspections
Patients with an arterial hypertensia for doklinicheskogo revealings of signs of disturbance of electrophysiological properties of a myocardium (the certificate of introduction from 9.04.2014 years), and also in pedagogical process on FPK and PPS GBOU VPO «Northern state medical university (Arkhangelsk)» MZ the Russian Federation in the form of an initial material for the block of lectures on themes «the Arterial hypertensia at children» and «Methods of functional diagnostics of a cardiovascular pathology at children of teenage age» (the certificate of introduction from 11.12.2013 years).

Work is executed within the limits of research program SGMU «Health of the population of the European North of Russia» (№ gos. Registration 01201267432).

The personal contribution of the author

The personal contribution of the author consists in carrying out of the review of the special literature on a problem of an arterial hypertensia at children of teenage age; in kuratsii patients with various degree of expression of a syndrome of an arterial hypertensia, including interpreting of clinico-laboratory and tool results of inspection; in research carrying out by a technique variance kartirovanija electrocardiograms; in the independent collecting and the statistical analysis of data; in preparation of publications and reports by results of research.

Volume and dissertation structure

The dissertation is stated on 145 pages of the typewritten text and 6 heads, discussions of results of research, the conclusion, conclusions, practical references and a bibliographic index consist of introduction. Work is illustrated by 37 tables, 18 drawings. The bibliography includes 198 publications, from them 150 domestic and 48 foreign.

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Scientific source KRAEVA Natalia Vasilevna. POSSIBILITIES SKRININGOVOJ of DIAGNOSTICS of VEGETATIVE REGULATION And the MYOCARDIUM CONDITION AT the ARTERIAL HYPERTENSIA At CHILDREN of TEENAGE AGE. The dissertation on competition of a scientific degree of the candidate of medical sciences. Arkhangelsk - 2015. 2015

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