ОСОБЕННОСТИ ОСТРОГО МИОКАРДИТА У ДЕТЕЙ НА ФОНЕ ПНЕВМОНИИ

Аннотация

The purpose of the study was to evaluate the effectiveness of carnitine in the treatment and prevention of myocarditis in children. We examined 120 children aged from 6 months to 7 years with pneumonia, whom we divided into 2 groups. Group I (control) included 60 children who were on standard treatment. Group II (main) included 60 sick children with pneumonia who had disorders of the cardiovascular system, the presence of which was confirmed by instrumental methods. The results obtained emphasize that against the background of community-acquired pneumonia, all symptoms of acute heart failure are masked, the cause of which in most cases is acute coronary insufficiency; changes in the heart muscle with this pathology in children increase the risk of severe undesirable complications from the heart. Key words: acute myocarditis, community-acquired pneumonia, children. ОСОБЕННОСТИ ОСТРОГО МИОКАРДИТА У ДЕТЕЙ НА ФОНЕ ПНЕВМОНИИ Аннотация. Цель исследования — оценить эффективность карнитина в лечении и профилактике миокардита у детей. Обследовано 120 детей в возрасте от 6 месяцев до 7 лет с пневмонией, которых мы разделили на 2 группы. В I группу (контрольную) вошли 60 детей, находившихся на стандартном лечении. Во II группу (основную) вошли 60 больных детей пневмонией с нарушениями сердечно-сосудистой системы, наличие которых было подтверждено инструментальными методами. Полученные результаты подчеркивают, что на фоне внебольничной пневмонии маскируются все симптомы острой сердечной недостаточности, причиной которой в большинстве случаев является острая коронарная недостаточность; изменения сердечной мышцы при этой патологии у детей повышают риск развития тяжелых нежелательных осложнений со стороны сердца. Ключевые слова: острый миокардит, внебольничная пневмония, дети. 194 Relevance. For several decades now, severe pneumonia has remained one of the pressing problems of modern medicine due to the steady trend towards an increase in the number of patients and consistently high mortality, despite the use of new principles and methods of treatment [3,4]. The likely reason for this is late diagnosis and, as a consequence, late initiation of treatment, as well as the inability to adequately assess the effectiveness of therapy. The diagnosis of pneumonia in children is often difficult, especially if signs of respiratory failure develop against the background of acute respiratory viral infection. The problem of acute myocarditis is currently due to its widespread occurrence, especially in childhood. One of the main causes of acute myocarditis today is acute respiratory viral infections (ARVI), which remain the most common and global diseases in children. Cardiovascular failure is typical of pneumonia, especially in young children. It develops rapidly, already in the early stages of the disease. In an uncomplicated course of the disease, clinically hidden heart failure occurs and is diagnosed using instrumental studies such as ECG, EchoCG. With community- acquired pneumonia in children, dysfunction of the cardiovascular system can clinically manifest itself in the form of coronary insufficiency, and more often cardiovascular failure. [2,7.8]. Each influenza epidemic accompanied by complications of pneumonia in children is associated with an increase in the number of cases of acute myocarditis, which determines the relevance of studying this problem. An even more serious task is the timely diagnosis of complications of pneumonia, especially myocarditis, since identifying this cardiac complication allows one to avoid severe and sometimes fatal consequences for the patient. Previously developed clinical criteria and diagnostic criteria for diagnosing heart failure are not always objective enough to identify circulatory disorders in young children. For example, anxiety, decreased appetite, and poor sleep are almost always noted in children. Tachypnea and tachycardia can not only be a sign of pneumonia, but also occur in a healthy child during examination, feeding, etc. Dyspnea and tachypnea always accompany diseases of the bronchi and lungs. The frequency of myocarditis in pneumonia, according to different authors, varies from 1% to 15. From a diagnostic point of view, there are no specific electrocardiographic changes characteristic only of myocarditis. Myocarditis is an inflammatory lesion of the heart muscle of infectious, toxic-infectious, infectious-allergic, autoimmune and toxic etiology [6]. It is a disease predominantly of children and young adults, although the disease can develop at any age. Myocarditis can be caused by any viral or bacterial agents, as well as non-infectious factors. The most common cause of the disease 195 is viruses. In 6-8% of cases, myocarditis develops during or shortly after various sporadic or epidemic viral infections [1]. Of the bacterial myocarditis, the most dangerous are diphtheria (infectious-toxic), myocarditis with scarlet fever, typhoid fever and salmonellosis, tuberculosis, yersinio