Despite the numerous researches spent on studying of disturbances motorno-evakuatornoj of function of a colon, a constipation remains to one of actual problems in pediatrics. It is caused by annually enlarged frequency of occurrence of the given pathology among the children's population [73] and gravity of consequences which involve constipations [35, 72, 97].

Existing opinion, that children outgrow a problem of constipations, does not prove to be true long observations: at 30 % of children symptoms remain after puberty, and 25 % of children continue to suffer constipations at adult age [85].

The problem of treatment and constipation preventive maintenance also has not lost the urgency. Absence of a common opinion on tactics of treatment, efficiency of various methods of therapy and duration of the further observation both acute, and at children continues to draw of a chronic constipation attention of pediatrists and gastroenterologists of all world. For today there is a considerable quantity of publications which are devoted quality of a life [30], to features of a food [103, 122], medicamental therapy [43, 66, 78, 91, 135], to various physiotherapeutic methods [9, 44, 64, 75] in constipation treatment. However use of such method as acupuncture at the given pathology only is mentioned; there is no analysis of efficiency of this method of treatment and its application at this or that stage from the scientific point of view. For today there is no information under the careful analysis of the reasons of occurrence and the further approach to tactics of treatment and observation over children with OZ, there are no data on uses IRT at LAKE treatment Till now the comparative analysis of the anamnesis, features of a current of disease and laboratornoyoinstrumentalnyh researches at children with OZ and HZ has not been carried out. Moreover, it was not spent katamnesticheskogo observations over children, receiving those or other methods of treatment at OZ and HZ.

In connection with the aforesaid, the purpose of our work optimisation of the complex approach in treatment of an acute and chronic constipation at children with acupuncture use was.

For the decision of an object in view we had been surveyed 205 children with a constipation syndrome, from them 66 children with OZ and 139 children with HZ. At all observable children constipations have not been caused by organic lesion TSNS, mental diseases, a pathology of endocrine system and did not demand surgical treatment.

In our observation among children both with OZ, and with HZ patients at the age from 7 till 11 years (45,5 % and 66,2 %) prevailed, thus OZ authentically was more often diagnosed for children at the age from 4 till 6 years (r 0.01) while HZ authentically more often - in age group from 12 years also is more senior (r 0.01). It is possible to explain the received pattern psychological features of children of school age at which because of unwillingness to address for medical aid much more often the disease current gets chronic character. The analysis of gender features has taped, that both among children with OZ, and with HZ boys prevailed, except for children with OZ in age group is more senior 12 years in which girls prevailed.

At the analysis of the anamnesis of a life at children with a constipation syndrome it has been shown, that risk factors in development OZ and HZ differ depending on character of a current of disease.

In development OZ by the most significant risk factors served: disturbances of a microbiocenosis of an intestine (84,8 %), which reason were infectious (25,8 %), parasitogenic diseases (18,3 %) and an antibioticotherapia (41,4 %); less often - the accompanying somatic anamnesis (34,8 %), an error in a diet (32,4 %), the hereditary factor (24,2 %), the burdened allergological anamnesis (21,2 %) and stressful situations (21,2 %).

At children with HZ the most significant risk factors in disease development serve: thoracal feeding less than 6 months (79,1 %), accompanying

The somatic pathology GASTROINTESTINAL TRACT (70,5 %), diet non-observance (51,8 %), the burdened neurologic status (51,8 %), an adverse situation in a family (48,2 %), the burdened obstetric anamnesis (38,8 %), is more rare - stress (33,8 %), the burdened family anamnesis on colon pathologies (30,2 %) and the transferred intestinal infections (28,1 %).

Thus, as risk factors in development HZ authentically more often, than in development OZ serve: the burdened obstetric anamnesis (r 0.01), duration of feeding less than 6 months (r 0.01), non-observance of a rational diet (r 0.01), an accompanying pathology from digestion organs (r 0.01) and an adverse psycho-emotional situation in a family (r 0.01).

Considering the obtained data, to children with a constipation syndrome expediently carrying out of the profound collecting of the anamnesis and in need of additional methods of inspection of a somatic pathology for timely and purposeful rendering medical and if it is necessary, the psychological help for the prevention of synchronisation of disease at the child.

At the analysis of terms of the reference of children with OZ, attracted attention, that the most part of children with OZ (51,5 %) have addressed for medical aid within a month (37,9 %) or on 2-3 month of disease (13,6 %) while in the first week of disease 48 % of children from the LAKE In turn have addressed only, the untimely reference behind medical aid can lead to a chronic current of disease and various complications.

The comparative analysis of the basic symptom of disease has shown duration of intervals between certificates of a defecation depending on character of a current of disease. At children with HZ statistically more often duration of intervals between defecation certificates made 5 and more days (44,6 %) in comparison with children with OZ (12,1 %) at which the delay of a chair till 2 days (r 0.01) prevailed. In turn, long intervals between defecations promote development of such terrible complication, as kalomazanie. Acknowledgement above
Stated we have received in our work: at children with HZ authentically took place kalomazanie (54,7 %), than at children with OZ (10,6 %) (r-.0.01) is more often.

Considering that fact, that at the majority of children with OZ (91,9 %) a constipation manifestation was after the transferred intestinal infection (25,8 %), a parasitogenic invasion (17,6 %) or antibioticotherapias (48,5 %), at them authentically became perceptible complaints to abdominal pains mainly in paraumbilical and ileal areas (r 0.01) and presence of pathological impurity (slime and blood in a chair) (r 0.01), in comparison with children with HZ is more often. Children with HZ authentically were disturbed by abdominal pains at a defecation (r 0.01) is more often, long natuzhivanie during a defecation (r 0.01) and a chair of the big diameter (r 0.01), that testifies to a clump of dense fecal masses in distal departments of a colon, to their pressure upon walls of an intestine with the subsequent formation of a functional megarectum, diskoordinatsii muscles tazovogo bottoms and, as consequence, to proof disturbance of the certificate of a defecation. The obtained data will be compounded with results of clinical survey: At 87,1 % of children with HZ the sigmoid intestine was palpated painful, enlarged in diameter and filled in dense fecal masses. At clinical survey at children with OZ hemorrhoidal knots were taped authentically less often (the river 0.01).

Also at survey attracted attention, that more than at half of children with HZ (51,7 %) took place symptoms of a chronic fecal intoxication, unlike children with OZ at which the given symptoms were absent (the river 0.01).

The comparative analysis of laboratory researches has not taped any statistical differences in investigated groups depending on duration of a current of disease. However at children with OZ more often (84, 8 %), than at children with HZ (46 %) were taped disturbance of a microbiocenosis of an intestine at the expense of depression laktobatsill and the raised level hemolyzing E.coliи yeast mushrooms and mushrooms of sort Candida.Полученные results of inspection is confirmed with data of the anamnesis which testify, that at 91,9 % of children with OZ a constipation manifestation
Was after the transferred intestinal infection (25,8 %), a parasitogenic invasion (17,6 %) or an antibioticotherapia (48,5 %).

At carrying out of ultrasonic research of organs of an abdominal cavity at children with OZ and HZ with identical frequency ultrasonic changes in a kind of a lesion of a pancreas (81,8 % and 85,6 %, accordingly) and pathologies zhelchevyvodjashchih ways (34,8 % and 40,3 %, accordingly) were taped. However the augmentation of the sizes of a liver authentically was more often taped at children with OZ р001).

It is necessary to notice, that at 38,1 % of children with HZ, arrived in a hospital repeatedly in connection with small efficiency of the previous treatment, on consultation at the psychologist psychological features which demanded correction have been taped. Thus, at an inefficiency of treatment of children with HZ carrying out of consultation of the clinical psychologist for an exception of psychological problems at the child is expedient.

Considering, that at 1/3 children with HZ, disease demonstrates from an acute delay of a chair [67], we have studied efficiency of treatment of an acute constipation depending on tactics of observation and treatment in conditions ambulatornoyopoliklinicheskogo a link. All children with OZ have been parted on 3 groups:

I group - 22 children were under constant observation of the pediatrist from the moment of the reference within 1 year and receiving basic treatment.

II group - 21 child which also were under constant observation of the pediatrist and besides basic treatment have received a course of reflexotherapy at the moment of the primary reference, and then later 3 - 4 weeks and later 6 months.

III group - 23 children with various terms of the reference to the pediatrist concerning an acute constipation which after the first course of basic therapy were not under observation of the doctor.

Children I and II groups which were under constant observation of the pediatrist within year and receiving basic treatment or basic treatment in a complex with acupuncture had authentically higher effect from treatment through
1, 3 and 12 months (r

<< | >>
Scientific source IPATOV ANDREY ALEKSANDROVICH. EFFICIENCY of ACUPUNCTURE In COMPLEX TREATMENT of CHILDREN With the CONSTIPATION SYNDROME. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

Скачать оригинал источника

Other medical related information THE CONCLUSION:

  2. Conclusions
  5. Chapter 8. The CONCLUSION
  12. the CONCLUSION