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FEATURES OF AUTONOMIC REGULATION OF HEART RHYTHM
IN CHILDREN WITH CORRECTION OF ATRIAL SEPTAL DEFECT
AT THE PRIMARY STAGE OF REHABILITATION
Khasanova G.M.
Tashkent Pediatric Medical Institute
Tojiboyeva D.Sh.
Tashkent Pediatric Medical Institute
Uzbekistan, Tashkent
Introduction
Cardiac activity has a double regulation system: humoral and neuro-
vegetative, the latter controls not only the frequency and strength of heart
contractions, but also, through the trophic function, has a major influence on
adaptation mechanisms. Trophic function is the property of the nervous system
to regulate the level of metabolism and corresponding tissue differentiation
determined for age and functional state [1]. To date, the structure of nerve fibers
and plexuses in adult patients with sudden cardiac death and coronary heart
disease has been studied in sufficient detail [2], when, first of all, degeneration of
the sympathetic component of innervation is detected to varying degrees. It
correlates not only with age, but also with the stage of the disease. These studies
have deepened knowledge of the pathophysiological mechanisms of the disease
and allowed clinicians to select more adequate treatment at all its stages. The
structural organization of the nerve plexuses in children has received much less
attention in both domestic and world literature. Pre- and postnatal ontogenesis
of the nervous autonomic system is normally described in detail by V.N. Shvalev
et al. [3]. As for the study of cardiac innervation in congenital heart disease, only
a few studies have been devoted to this issue [4]. It has been shown that at the age
of 3 to 7 years, the innervation of the heart and great vessels becomes developed
and the choline ratio of the adrenergic nerve plexuses reaches a state of relative
stability. It has also been established that with congenital heart disease, the state
of the autonomic nervous system can be characterized as compensated, in
contrast to acquired pathology, where degenerative and inflammatory changes
predominate [5,6]. In children with correction of atrial septal defect, the features
of autonomic regulation of heart rhythm at the primary stage of rehabilitation
have not been sufficiently studied.
Purpose of the study:
to study the dynamics of autonomic regulation of
heart rhythm in children with ASD correction at the primary stage of
rehabilitation in primary healthcare settings in comparative groups with different
magnitudes of the total effect of autonomic regulation (SDNN).
Material and methods
At the stage of primary rehabilitation in the conditions of primary
healthcare, two groups of children were identified, comparable in gender, age and
physical development: with the value of the total effect of autonomic regulation
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SDNN less than 75 ms (Group I, 20 children) and more than 75 ms (Group II, 15
children).
Results
In group II, significantly higher activity was observed in the total power of
the TP spectrum, the sympathetic part of the VLF regulation, the activity of the
vasomotor center LF, the higher regulatory centers ULF and the centralization
index IC. Under the influence of the resort stage of rehabilitation in children,
SDNN indicators changed in group I from 42.0 ± 2.64 to 65.9 ± 4.72 (p < 0.01), in
group II from 108.7 ± 6.50 to 84 .4 ± 10.6 ms. In both groups, the indicators of ULF
(261.3 ± 57.7 and 264.8 ± 68.5 ms), LF (1079.4 ± 1467.5 ± 729.1 ms) and IC (2.13
± 0, respectively) were equal. 20 and 1.86 ± 0.23). The indicator of physical
activity according to the SF-
36 test was 71.3 ± 4.82 in group I, and 59.5 ± 6.75
points in group II. In both groups, there was an average correlation between LF
indicators and physical role functioning (RP) according to the SF-36 test: r=-
0.557 and r=0.590, respectively, and SDNN and RP indicators: r=- 0.465 and r=-
0.483. In group I, there was a significant increase in HF indicators (the relative
level of activity of the parasympathetic regulation link): from 634.7 ± 100.1 to
1431.9 ± 215.2 (p < 0.01) and TP: from 1703.6 ± 246, 2 to 3686.9 ± 612.9 ms (p <
0.05), in the comparative group there was a significant decrease in these
indicators.
Conclusion
The primary stage of rehabilitation contributed to the normalization of
indicators of autonomic regulation of the heart rhythm of the examined children,
while in the group with initial SDNN values less than 75 ms, the dynamics of TP
and HF indicators can suggest a greater level of adaptive capabilities of the
cardiovascular system.
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