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INTRODUCTION.

Cerebral ischemia at newborn children and children of thoracal age ostetsja extremely actual prblemoj pediatrics. Leading value of ischemic damages of a brain in formation of the various psychoneurological disturbances resulting further to socially - biological disadaptation and invalidism of children is established.

In structure of children's physical inability of 35-40 % of lesions of the central nervous system (TSIS) are consequences perinatalnoj pathologies. Among risk factors perinatalnogo lesions TSNS the great value has morfofunktsionalnaja immaturity of structures of a brain owing to a prematurity.

Now in perinatalnoj neurologies have appeared new possibilities of an estimation of changes of morfo-functional condition TSNS by means of new informative non-invasive technologies, such as echoencephalography (EEG), dopplerografija brain vessels, a computer tomography, magnitno-rezrnansnaja a tomography, EEG with visualisation and topographical kartirovaniem (J.I.Barashnev, 2001; G.V.Jatsyk, 2005). The spectrum of specialised laboratory researches has essentially extended, during too time keeps the urgency search of new markers of the cerebral ischemia, allowing to estimate degree of a lesion of a brain at its initial stage, and also to carry out the analysis of efficiency of spent therapy and to prognosticate development of a psychoneurological pathology (V.I.Skvortsova, 2001).

The special attention last years is given endotelijzavisimym to the factors regulating a cerebral vascular tonus, system of a hemostasis and participating in realisation of ischemic damages (E.I.Gusev, 2001, V.I.Gorbachev, 2002). The taped mechanisms of participation oksida nitrogen (N0) in regulation of a cerebral circulation, demand studying of its dynamics
Production at novorzhdennyh children with various damages TSNS. It is necessary for opening of new pathophysiological mechanisms of damages of a brain novorzhdennogo the child at gipoksicheski - ischemic lesions and prevention or development reduction invalidizirujushchej for a psychoneurological pathology.

Now the big successes in nursing and aftertreatment malovesnyh children are reached. Effective methods of aftertreatment of children of the first months of a life - medicamental (vascular preparations, nootropy, anticonvulsants, relaxants, etc.) are offered And not medicamental (a dry immersion, laserotherapy, aromoterapija, muzykoteranija, psycho-sensory stimulation, massage, LFK, exercises in water) (Е.ГІ. Bombardirova, G.V.Jatsyk, 2005). The Primary goal of medical actions at a cerebral ischemia at newborn children is maintenance of normalisation of a circulation and a metabolism of a brain and optimisation of conditions of functioning of the remained structures of a brain for the prevention of formation of serious cerebral disorders. In connection with the above-stated search of new agents nejroprotektornogo actions, and also perfection of existing methods of treatment, in particular, the prevention of stressful influence of a procedural pain on an organism novorozhdennoju the child is actual.

It is necessary to notice, that despite the numerous researches devoted to various forms perinatalnyh of damages TSNS, till now there is no algorithm of realisation of a complex of effective diagnostic and therapeutic actions at various gravity of a cerebral ischemia at children of the first months of a life, as was the basis for carrying out of the given work.

Research objective: to establish patterns of a current of a cerebral ischemia at newborn and thoracal children for optimisation of diagnostics,
Risings of efficiency of rehabilitational therapy and preventive maintenance of neurologic damages.

Research problems.

1. To establish leading mechanisms of formation of a cerebral ischemia of various gravity at newborn children different gestatsionnogo age.

2. To define changes electroencephalographic and ehoentsefalograficheskih parametres at newborn children with various gravity of a cerebral ischemia.

3. To establish dynamics of the maintenance of markers of ischemic damage of a brain at various gravity of a cerebral ischemia at newborn children.

4. To define changes of plasma factors of coagulation of blood at a cerebral ischemia at newborn children different gestatsionnogo age.

5. To tap damaging action of transitional painful factors on a current of a cerebral ischemia at newborn children.

6. To estimate efficiency of use nejroprotektorov in complex rehabilitational therapy of children with various gravity of a cerebral ischemia.

Scientific novelty.

For the first time with use of informative diagnostic technologies complex inspection of newborn children of different terms gestatsii with perinatalnym lesion TSNS is spent and patterns of interaction reguljatornyh systems of an organism of the child in the conditions of a cerebral ischemia are established. It is established, that the structurally functional disturbances caused by a cerebral ischemia, are accompanied by significant changes bioelekticheskoj activity of a brain,
Which expression is enlarged in process of depression gestatsionnogo age of newborn children.

For the first time the diagnostic and prognostic importance of changes total sodsrzhnija metabolites okida nitrogen and plasma factors of a hemostasis in blood of children various gestatsionnogo age with different gravity of a cerebral ischemia in dynamics of the early regenerative period and in a catamnesis is established. It is shown, that concentration definition okida nitrogen and plasma factors of a hemostasis in blood at newborn children are markers of a cerebral ischemia, intensity of adaptic processes and efficiency complex nejroprotektivnoj therapies.

For the first time between the maintenance of the purine bases in a blood plasma of newborns degej on the one hand, and severity level of ischemic lesions TSNS and indicators of saturation of blood oxygen connection is established with another, that testifies to diagnostic value of definition of total concentration purinov at a cerebral ischemia and allows to assume use endogenous purinov as biochemical markers of a hypoxia.

For the first time efficiency nejroprotektora Gliatilina in complex therapy of newborn children with the cerebral ischemia, accompanied by normalisation klinchisskogo conditions, reduction of endogenous production oksida nitrogen and stabilisation of a plasma hemostasis that defines optimum rates of regenerative treatment of ischemic damages of a brain is proved.

For the first time at intracellular level patterns of perception and reaction of newborn children to transitional painful stimuluses are established, their dependence from gestatsionnogo age of children is proved. It is established, that not full-term newborn who is in a grave condition, it is to a lesser degree capable to the answer to a painful stimulus.

Necessity of depression of quantity of aggressive methods of introduction of medical products for neonatal clinic is proved.

The step algorithm of diagnostics, treatment and aftertreatment of children of early age with a cerebral ischemia on set klinikoyolaboratornyh data which allows to define severity level of lesions TSIS is developed and to spend adequate nejroprotektivnuju the therapy including both medicamental treatment, and not medicamental influences.

The practical importance.

For the first time is apparatus - program complex for dynamic monitoring of a functional condition of a brain is offered, approved and introduced in clinic at a cerebral ischemia at newborn children. The original composition of consecutive use of modern instrumentalno-laboratory methods of the research, providing topical diagnostics and the differentiated choice of effective therapy of a cerebral ischemia of various gravity at newborn children - as medicamental (posindromnaja is developed; etiopatogeniticheskaja; the fortifying; antibacterial), and not medicamental (massage; physical exercises; exercises in water; a dry immersion; muzykoteralija; psychosensorial stimulation with participation of mother).

Creation of step algorithm of diagnostics, treatment and aftertreatment of children with a cerebral ischemia various stpeni gravities allow to optimise spent therapy, to provide invalidism preventive maintenance in the first months of a life and to reduce negative effects polipragmazii.

Maintenance definition oksida nitrogen in blood serum and plasma factors of a hemostasis at newborn children different gestatsionnogo age
Helps to use them as diagnostic criteria of gravity of a cerebral ischemia and to supervise quality and efficiency of spent therapy in neonatal clinic. Levels of the total maintenance of metabolites oksida nitrogen in blood serum and value of indicators of plasma factors of the hemostasis, established at full-term newborn children, can be recommended as control indicators.

The new composition of reagents is developed for quantitative definition of the maintenance of metabolites oksida nitrogen in biological mediums (the patent application of the Russian Federation №2007107670 from 01.03.2007).

Course use nejroprotektora Gliatilina (L - glitserilfosforilhodiia) in complex therapy of children with a cerebral ischemia in a dosage of 0,1 ml/kg (25 mg/kg) intramusculary 1 time a day daily №10, providing high efficiency in the early regenerative period is recommended.

The developed original scale of an estimation of behavioural reactions of newborn children on transitional painful influence and the offered painful index allow to define damaging effect of medical manipulations and are necessary for a substantiation of a choice of anaesthetics before painful and invasive manipuljatsujami at newborn children. The used technique of local anaesthesia at carrying out of medical manipulations with application EMLA (the anaesthetic consisting of 2,5 % of an emulsion of lidocaine and 2,5 % of an emulsion prilokaina), and a complex of metabolites (glitsin, biotredin, limontar) reduce negative effects of painful influence on newborn children, raise efficiency of treatment and promote improvement of quality of their life.

Introduction in practice.

Results of researches are introduced in unit for not full-term children, unit of a pathology of children of early age of scientific research institute of pediatrics GU NTSZD

The Russian Academy of Medical Science, in the Federal centre of aftertreatment malovesnyh and glubokonedonoshennyh children, in the family centre of vaccinal prevention KDTS GU NTSZD the Russian Academy of Medical Science, unit of resuscitation of newborn children of scientific research institute of obstetrics, gynecology and perinatologii the Russian Academy of Medical Science. Dissertation materials are included in the program of training of clinical interns and post-graduate students GU NTSZD the Russian Academy of Medical Science. The developed measures of preventive maintenance and anaesthesia of therapeutic influences at newborn children are included in Federal standards on a neonatology (2005), are used in curriculums and improvements of professional skill of doctors-neonatologov. Separate sections of the dissertation are published in a management on a neonatology (2004), clinical references on pediatrics (2006). Work materials are noted by the diploma and a prize of competition of young scientists within the limits of VI Congress of pediatrists of Russia (2000) and the second award of competition

Innovative scientific works Pediatrics the XXI-st century MEDSI (2006).

On dissertation materials 34 works, including in 15 central presses are published.

Structure and dissertation volume.

The dissertation is stated on 204 pages of the typewritten text and consists of introduction, the review of the literature, five heads of own researches, the conclusion, conclusions and practical references, the bibliographic list including 299 sources. Work is illustrated by 24 drawings,

24 tables.

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Scientific source STEPANOV Andrey Alekseevich. CEREBRAL ISCHEMIA At CHILDREN of the FIRST MONTHS of the LIFE: MODERN CRITERIA of DIAGNOSTICS And TREATMENT PRINCIPLES. The dissertation on competition of a scientific degree of the doctor of medical sciences. Moscow - 2007. 2007

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