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treatment Methods

Treatment of a constipation at children - difficult mnogoetapnyj the process demanding individual selection of various methods of correction of disturbances of the certificate of a defecation, the control over their efficiency and adequate preventive actions for achievement of proof positive clinical effect.

To all observable children the food correction, which purpose has been spent - to restore motorno-evakuatornuju colon function. A dietary food is referred on augmentation of quantity of the products containing gruboyovoloknistuju a fat (vegetables, fruit, bread from a flour of a rasping grinding with bran, groats oat, buckwheat), the use of products rich with a potassium (raisin, dried apricots, prunes, a fig), a physiological water drinking regimen (40-80 ml/kg of mass of a body). Application of the products raising an aerogenesis in an intestine (grapes, peas, bean) and detaining an intestine peristalsis (chocolate, a white loaf, pasta, semolina and boiled rice) was limited. At children with intolerance to fiber of the cow milk the diet with an exception of milk and milk products was prescribed.

Basic treatment depended on complaints, clinical implications of the constipation, an accompanying pathology GASTROINTESTINAL TRACT and included application of laxatives
Agents (a macrogoal (forlaks), lactulose preparations); at a painful syndrome on hypomotor type with an accompanying pathology of the top departments of a digestive tube - prokinetiki (domperidon, trimebutin); at a painful syndrome on hypermotor type - selective cholinolytics (giostsina butilbromid) or miotropnyh spazmolitikov with direct action on a smooth musculation (mebeverin). To children with dysfunction biliarnogo a tract cholagogue therapy (hofitol) in age dosages was prescribed. For the purpose of desire development on a defecation cleansing enemas on 300,0 - 400,0 ml of an isotonic solution once a day a course 5 - 10 days. The patient with cracks of a fundament after a clyster prescribed candles with Calendulae or oblepihovym oil. For correction disbioticheskih intestine disturbances - pro-and prebiotiki (atsipol, bifiform, hilak forte).

2.2.2.1 Methods of physiotherapy

In complex treatment of constipations physiotherapeutic treatment (FTL), spent by means of the sinusoidal modulated currents (SMT-THERAPY) from apparatus "Amplipulse" on stomach area was used. Electrodes had on the right and to the left of a white line of a stomach.

At a hypermotor dyskinesia of a colon the regimen variable was used, frequency of modulation 100 - 150 Hz, depth of modulation of 25 %, duration of parcels 2 - 3 seconds made Duration of a session no more than 10 mines, daily, a course of 10 procedures.

At a hypomotor dyskinesia of a colon the regimen variable, frequency of modulations of 30 Hz, depth of modulations of 100 %, duration of parcels 2 - 3 sec, force of a current before the expressed vibration, duration of a session 5 - 10 mines, daily, by a course 8 - 10 procedures was used.

2.2.2.2 Method of acupuncture

Method main objective is regulation of functional systems
Organism by means of various influence on its tissue, supervised and controlled through the central nervous system. In the mechanism of action of reflexotherapy great value have nejrogumoralnye factors, intensifying of metabolic processes, allocation of biologically active bonds becomes perceptible, painful sensations are blocked, the motility of a gastroenteric tract [120] is normalised.

The reflexotherapy method included different ways of influence on akupunkturnye (biologically active) points: superficial acupuncture by means of the massage platen, korporalnuju and auricular acupuncture, segmentary massage of area of a stomach. The superficial acupuncture was spent on area of a back along a zadne-median meridian and two lines of a meridian of a bladder that fortifying an effect had, and also on area of a stomach for reduction of the phenomena of a meteorism and a painful syndrome. Korporalnoe and auricular acupuncture had specific and segmentary an effect.

For improvement motorno-evakuatornoj intestine functions [101, 120] were used local points in the field of a stomach, located on peredneyosredinnom a meridian, meridians of a stomach, a lien and kidneys: VC12 chzhun-van, VC6 tsi-find fault, ѴС4гуань-юань, E21 ljan-men, E25 tjan-shu, RP15 yes-hen, RP16 faugh - ah, R16 huan-shu, and also the remote points: E36 a tszu-dignity-whether, GI10 show-dignity-whether, GI11 tsjuj-chi, R3 thaw-si, R6 chzhao-find fault, GI2 ages-tszjan, GI5 jan-si, GI4 he-gu, TR6 chzhi-gou, V25 yes-tub-shu, V27 a sjao-tub-shu, V23 shen-shu, V20 pi-shu, V21 vej-shu. On an auricle following points were applied: АР91 a colon, АР89 a small bowel, АР87 a stomach, АР51 sympathetic, АР43 a stomach, АР194 three parts of a trunk, АР55шэнь-мэнь, АР109 the bottom stomach, АР110 the bottom stomach, АР98 a lien, АР97 a liver, АР34 a brain cortex.

In the presence of meteorism symptoms following points were used: VC14 tszjuj-tsjue, VC6 tsi-find fault, R17 shan-tsjuj, RP2 yes-du, R10 in-gu, RP4 gun - put, F14 tsi-men, VB41 tszu-lin-tsi. In the presence of a painful syndrome
Points were used: VC12 chzhun-van, V45 i-si, E34 ljan-tsju, E36 a tszu-dignity-whether, E44 nej-oozes, VB38 jan-faugh, VB43 sja-si [120].

Segmentary massage in the field of a stomach was spent after acupuncture during 4 - 5 minutes: stroking in the beginning and then kneading movements on a course of an intestine from the bottom left angle of a stomach upwards and to the right over a belly-button and then down to a sigmoid intestine, with circular movements round a belly-button of 10 times on and counter-clockwise, with accent in points Е25 tjan-shu, VC12 chzhun-van, VC6 tsi-find fault, VC4 gun-yuan [120]. Point Е25 tjan-shu is especially effective in the presence of painful sensations.

Reflexotherapy sessions were spent daily, in 10 - 15 minutes depending on age of children, in one session was used 5 - 7 korporalnyh and 2 - 3 auricular points. Points got out taking into account complaints and survey of patients at the moment of treatment. Daily massage of feet with the help skalki or a glass bottle which was necessary for rolling with pressing forward-back during 3 - 5 minutes in the morning was recommended to patients of the house.

The reflexotherapy was carried out by three courses in 10 - 12 procedures which were spent daily with a break on the target. The repeated course was spent through 3 - 4 weeks. The following course of treatment was prescribed in 6 months (the appendix 2).

The reflexotherapy raises functionality of an organism and is effectively applied for the purpose of correction at dysfunction of separate systems and organs. Acupuncture was spent simultaneously with medical gymnastics.

2.2.2.3 Medical gymnastics

The medical gymnastics is one of methods of the physiotherapy exercises consisting from specially picked up and methodically developed physical
Exercises. The medical gymnastics was prescribed the doctor of physiotherapy exercises and spent individually to each child by instructor LFK. The medical gymnastics included exercises for prelum abdominale improvement (retraction of a stomach and slow otpuskanie it, a raising and load lowering, mass 5001000г depending on age of the child), strengthenings of muscles tazovogo bottoms (a raising of knees in a sitting position and their keeping in such position 1015 sec, a raising of one knee alternately at freely hanging down second foot, knee keeping in such position 10-15 sec and then its slow lowering). Each exercise was carried out on 10 times. Also for stimulation of evacuation of a chair exercise jerks by a stomach was recommended to children: deeply to inhale, having involved a stomach, then simultaneously with an exhalation to "throw out" a stomach forward. The Physiotherapy exercises were spent by 3 courses on 10 employment, simultaneously with reflexotherapy.

The volume of the spent inspection is presented in table 2.3.

Table 2.3

Volume of the spent researches and treatment

The research name Quantity of researches
Clinical inspection, the anamnesis collecting, survey 205
The clinical analysis of blood 205
The general analysis of urine 205
Koprogramma 205
Urine diastase 119
The biochemical analysis of blood 139
The feces analysis on a dysbacteriosis 120
ELECTROCARDIOGRAM 182
Ultrasonic research of organs of an abdominal cavity 205
Fibroezofagogastroduodenoskopija 93
Irrigoscopy 139
Proctosigmoidoscope 33
Colonoscopy (under indications) 2
Consultation of the neurologist 139
Consultation of the psychologist 53
Basic treatment 54
Basic treatment and physiotherapy 40
Basic treatment and IRT 40
Basic treatment, physiotherapy and IRT 37
Treatment IRT 11

2.2.2

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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

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