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INTRODUCTION

Problem urgency

Throughout last 20-25 years there is a constant search new, improvement and modernisation of already existing methods of treatment of a pathology of an emiction (MI), combining high efficiency, a pathogenetic orientation, complex influence, the minimum invasiveness, and also possibility of psychological aftertreatment of the patient [23, 56, 92, 124, 146, 329].

During too time interest to research of psychological features of the person at children with psychosomatic diseases which number disturbances MI [14 concern, 40, 67, 147, 245, 326] does not die away. Prevalence of diseases of organs mochevydelitelnoj systems (MVS) in which basis the pathology urodinamiki the bottom departments of urinary ways lays, annually grows. On frequency of occurrence the leading place among them is occupied with neurogenic dysfunctions of a bladder (NDMP), meeting at 9-10 % of the children's population and more than from half of patients nefrourologicheskogo a profile [115, 157, 171, 204, 316]. Growth of disturbances MI at children is bound as case rate augmentation, and to improvement of quality of diagnostics. Observations of last years show, that in structure of pathology MI the disturbances of functional character caused in larger degree by modern features of psychosocial influence on the child [121, 217, 249, 276, 301] began to prevail. Disturbances MI which arise owing to diskoordinatsii works detruzora, necks and-or an external sphincter of a bladder (MT), can serve one of the reasons of an incontience of urine during a dream and-or wakefulness. The urine incontience negatively influences the psychological status of the child, sharply reduces quality of his life, leads partial or full social dizadaptatsii [14, 33, 57, 150, 300, 329].

At the somatic pathology bound to disturbance MI, the risk of formation of deviations in psychological development of the child and occurrence in it patoharakterologicheskih lines of the person is enlarged. The somatopathy, as a rule, does not stop psychological development of the child, but changes, slows down and deforms its course, influences development of an internal picture of illness (VKB) [17, 116, 143, 237, 299, 325]. Last years in the literature the formation problematics patoharakterologicheskih lines of the person at children with various disturbances MI, including with an incontience of urine during a dream and-or wakefulness is widely shined. However only individual domestic and foreign works devoted to influence of various kinds of therapy on psychological features of the child, transformation patoharakterologicheskih lines of the person and VKB during treatment and after recover of the patient [130, 183, 220, 325, 326] are known. Researches in this direction at children with pathology MI represent doubtless interest.

Today more and more actual there is a selection of schemes of treatment of disturbances MI combining diagnostic, medical and rehabilitational possibilities. It is bound to appreciable prevalence of disorders MI, and also with their leading part in formation of secondary changes MVS (a relapsing chronic cystitis, a vesicoureteral reflux, an ureterohydronephrosis,
Pyelonephritis, nephrosclerosis, an arterial hypertensia, chronic renal insufficiency), economically active groups of citizens leading to an early invalidism. To the basic directions of treatment of pathology MI at children today carry pharmacotherapy, physiotherapy (FZT), surgical treatment, and also not medicamental methods of influence among which the leading place is occupied with therapy with use of a method of functional biological management (FBU).

As about 90 % of disturbances MI have functional character at the present stage of treatment and aftertreatment of this pathology are activly applied as medicamental, and maloinvazivnye not medicamental kinds of therapy. It is necessary to consider, that various kinds of treatment, possessing high clinical efficiency, can negatively influence an accompanying pathology and psychological development of the child, worsening available psychoemotional deviations, and also negatively to influence on VKB. Hence, complex studying of clinico-psychological given children with pathology MI, receiving various kinds of therapy, will allow to define the optimal way of treatment and aftertreatment of patients that is an actual problem of pediatrics at the present stage [167, 175, 231, 269, 271, 274, 331].

For last 15-20 years accents in treatment and aftertreatment of patients with functional disturbances MI (including with an uracrasia) were displaced towards use of non-invasive and not medicamental techniques (therapy without medicines) which method FBU concerns. In the Russian Federation (Russian Federation) and abroad for treatment of children with various disturbances MI is more often applied FBU-THERAPY in an electromyography regimen (EMG, the trading name "MIO") [7, 95, 113, 145, 244, 266, 303]. But if abroad FBU is therapy of the first line in treatment of disturbances MI at children and adults in the Russian Federation to it address, when medicamental treatment, FZT, other methods have not rendered the due expressed effect. FBU - therapy "MIO" represents system of exercises for muscles tazovogo the bottoms, carried out in the game form under the control of the certificated medical-diagnostic is apparatus-computer complexes (LDAKK). Feature FBU in regimen EMG is the combination in sessions of diagnostic and medical possibilities. It allows to trace already at therapy carrying out effect from it and taking into account parametrical data necessarily to correct influence (a dose, force, frequency rate, frequency etc.), that considerably simplifies treatment and reduces time of stay in a hospital [146, 149, 232, 242, 270, 291, 304].

Demand all-round studying, an estimation and the complex analysis influence of some factors (a current of pregnancy and the sorts, accompanying pathology MVS, burdeness of the family anamnesis, psychological features of patients etc.) on occurrence, dynamics clinical and urodinamicheskih implications of pathology MI. Considering, that disturbances MI concern group of psychosomatic diseases, clinical and psychological implications of this pathology studying demand from children (for example, volume and frequency characteristics MI, uneasiness level, self-rating level etc.), data of a global (bending around) electromyogram (GEMGr), their communication with rezultatatmi urodinamicheskogo inspection and psychological testing of patients in dynamics before and after FBU-THERAPY sessions "MIO". The executed research has allowed to estimate comprehensively efficiency of FBU-THERAPY in regimen EMG and to prove its application at
Disorders MI. Algorithms of use of FBU-THERAPY in rezhme EMG at patients with pathology MI taking into account their age, clinical and psychological features have been developed. It has given the chance to raise efficiency of treatment of children with disturbances MI that corresponds to actual problems of pediatrics at the present stage. Earlier such researches were not spent to pediatrics.

The purpose and research problems

The purpose of the given work is the substantiation of application of a method of functional biological management taking into account its clinical and psychological influences on an organism at children with pathology MI for rising of efficiency of treatment.

According to an object in view following problems have been defined:

1. To estimate a role of provoking factors (accompanying pathology MVS, stressful the situations, the burdened family anamnesis etc.) in occurrence clinical and urodinamicheskih implications of pathology MI at children.

2. To prove necessity of carrying out of FBU-THERAPY for regimen EMG at children with pathology MI on the basis of an estimation of their psychological features.

3. To study and estimate clinical and psychological implications of pathology MI at children in dynamics before and after FBU-THERAPY sessions in regimen EMG.

4. To estimate efficiency of FBU-THERAPY in regimen EMG in treatment and aftertreatment of children with pathology MI.

5. To offer references on FBU-THERAPY application in regimen EMG in practical public health services for treatment and aftertreatment of children with pathology MI taking into account them klinikoyopsihologicheskih features.

Scientific novelty of work

For the first time complex research of results of sessions of FBU-THERAPY is carried out regimen EMG at children with disorders MI, their clinical and psychological features, and also predominating styles of education in families of these patients. The comparative estimation of efficiency of method FBU in regimen EMG and metabolic therapy (pikamilon and group vitamins), children applied in treatment with disorders MI is executed.

It is established, that clinical implications of disorders MI often are not bound to changes urodinamicheskih indicators, therefore alternatively (urofloumetrija) in the anamnesis collecting it is expedient to tool methods of research to include a blank technique - the Nephrological questionnaire (on Moiseevu A.B.). She allows on dodiagnosticheskom to tap a stage degree of expression of available disturbances MI and to be defined with therapy tactics, reducing thereby terms of inspection and treatment of patients.

It is proved, that at 41,2 % of patients pathology MI proceeds is not isolated, and in a combination with a chronic constipation and kalomazaniem in a kind sochetannyh function disturbances tazovyh organs (SNFTO) which strengthen implications of disorders MI. The major factors provoking formation of pathology MI and SNFTO at the present stage are taped, and also interrelations between a kind of disorders MI or SNFTO and certain provoking factors that confirms the leading part of the last in an etiopathogenesis of disturbances MI and SNFTO are established.

It is established, that at children against disorders MI and SNFTO the expressed personal psychological features in a kind negativizatsii the emotional background, the raised level of uneasiness, low levels of claims and a self-rating are formed. At every second child prevalence in families infantilizirujushchego both symbiotic styles of education and presence at mothers in third of cases of high levels of situational and personal uneasiness is taped.

It is proved, that efficiency of FBU-THERAPY in regimen EMG above, than at metabolic therapy (pikamilon and group vitamins) - in 2 times at disorders MI and in 2,5 times at SNFTO. It is established, that the clinical effect from FBU in regimen EMG was accompanied by statistically authentic augmentation of electric activity and endurance of muscles of a perineum in 2 times and 1,5 times, accordingly.

After the FBU-THERAPY course in regimen EMG, unlike metabolic therapy, children had normalisation of levels of uneasiness, rising of levels of a self-rating and claims is more often. Harmonisation of intrafamily mutual relations occurred only at children who have received FBU-THERAPY in regimen EMG. At mothers of these patients authentic depression of levels of situational, personal and general uneasiness with the subsequent transition of parents to socially comprehensible style of education "Cooperation" is proved.

The complex estimation of efficiency FBU in regimen EMG and metabolic therapy (pikamilon and group vitamins) has allowed to prove necessity of performance of FBU-THERAPY for regimen EMG to all children with disorders MI and SNFTO, and also to be defined in tactics of individual therapy.

Individual schemes of FBU-THERAPY in regimen EMG for treatment of children with disorders MI and SNFTO taking into account their age and clinico-psychological features that allows to optimise considerably the help to patients at the given pathologies are framed and offered.

The practical importance

The carried out research has allowed to prove scientifically application of method FBU taking into account its clinical and psychological influences on an organism at children with pathology MI and SNFTO, and also to prove its efficiency and advantage before metabolic therapy (pikamilon and group vitamins). With a view of convenience of the account and storage of results of trainings, and also personification of the received data the report of sessions of FBU-THERAPY in regimen EMG is developed.

Individual schemes of FBU-THERAPY in regimen EMG (courses А1, А2 and) for treatment of children with disorders MI and SNFTO taking into account their age and clinico-psychological features are developed and offered. Application of the given schemes for children with disorders MI and SNFTO allows:

- To individualise therapy;

- To train the patient in the correct strong-willed control of muscles of a perineum with a simultaneous relaxation of muscles-antagonists (direct muscles of a stomach, a hip and breeches);

- To reach proof augmentation of electric activity and endurance of muscles of a perineum;

- To provide offensive of fast and proof positive clinical effect;

- To carry out psikorrektirujushchee influence on the patient;

- To lower frequency of relapses of disease;

- To reduce therapy terms;

- To reduce number of repeated hospitalisation.

Introduction of results in practice

Results of research are successfully introduced in practice and used in work Morozovsky DGKB and Izmajlovsky DGKB (nowadays - branch № 2 Morozovsky DGKB) Department of public health services of a city of Moscow. Dissertation materials are used at training of students, clinical interns and interns, listeners FPK and FUV.

Work approbation

Work is approved at joint session of employees of chair of propaedeutics of children's illnesses RNIMU of N.I.Pirogova MZ the Russian Federation and doctors Morozovsky DGKB on December, 19th, 2014.

On a dissertation theme it is published 6печатных works, from them 4 in the magazines reviewed VAK. 1 grant for parents and doctors is published.

Volume and dissertation structure

The dissertation is stated on 292 pages of the typewritten text, contains introduction, the literature review, the description of materials and research methods, a statement of results and their discussion, the conclusion, conclusions, practical references and the list of the literature including 331 source (209 domestic and 122 foreign). Work is illustrated by 34 tables, 38 drawings and contains 9 appendices.

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Scientific source MIRONOV ANDREY ANATOLEVICH. the CLINICO-PSYCHOLOGICAL SUBSTANTIATION of APPLICATION of the METHOD of FUNCTIONAL BIOLOGICAL MANAGEMENT At CHILDREN With the EMICTION PATHOLOGY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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