Treatment of children with acquired heart diseases

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Treatment of children with acquired heart disease rheumatic etiology depend on the phase of rheumatoid arthritis, active or inactive. Children with active rheumatic process should be hospitalized. We solve two key treatment goals: the first is to eliminate as soon as possible acute exudative phase of the disease and the second is the removal of a child from this stage of the pathological process without new persistent lesions of the heart (A. I. Nesterov, 1973; B. A. Nasonova; I. J. Sigidin, 1974; A. C. Dolgopolova, 1977).
In complex therapy of active period of rheumatism great importance are the issues of the regime, physical therapy, nutrition.
Defining the purpose of the regime is the degree of the process activity and the presence of this or that stage of heart failure.
In complex treatment of patients with rheumatism with acquired heart diseases is of great importance for the correct organisation of clinical nutrition. Health food will largely determine the effectiveness of drug therapy, and in some cases prevents the negative effects of some drugs on the metabolism.
It is known that at rheumatism experience various metabolic disorders: protein, carbohydrate, lipid, water-salt. The use of steroid hormones compounding these violations (j. Clay, 1959; C. The Kolarov, 1964). Use in a complex therapy salicylates leads to increased excretion of ascorbic acid and vitamins group b (the So-Century Pariiskii, 1956). Properly conducted diet therapy helps to reduce these side effects.
Acute rheumatic fever in the absence of circulatory failure to children with acquired heart diseases it is recommended to fully diet according to the number and qualitative composition of proteins, fats and carbohydrates. The daily amount of protein should averaging 80 g, and 1/3 protein is given in the form of meat or fish, and the rest - products milk or vegetable origin. Daily quantity of fat should be at least 65-70, Can be recommended to include in the diet of children, suffering from rheumatism, chicken eggs in a boiled kind or in the form of steam omelet, as they contain a lot of phospholipids, which are part of inhibitor streptolysin. In feeding children should be widely used milk and milk products. Daily quantity of carbohydrates should be about 400 G. of Carbohydrates presented in the diet cereals, powdery products and sugar, which children receive with tea, compote, kissel. Some carbohydrates is provided by fruits and berries.
Shows a selection of fresh vegetables (salads, soup, raw chopped vegetables).
When medical nutrition therapy in the acute period of disease should be completely excluded from the diet of food products, stimulating the cardiovascular system: strong tea, coffee, spices, fried foods, and also vegetables and foods rich in essential oils - garlic, horseradish.
Given the possibility of active period of rheumatism deficit of potassium in the body, especially in the treatment of hormones, diet includes foods rich in this substance: baked potatoes, fresh cabbage, spinach, carrots, raisins, dried apricots, dried apricots, dates, nuts, plums, etc. Along with this a few limited to the content of table salt (up to 3-5 g / day).
In the first 2 weeks of illness, it is advisable to somewhat limit the amount of liquid. On average, the child must be supplied in the diet of 1 - 1.5 litres (free liquid 0.5 l).
After about 2-3 weeks of starting treatment with evident positive dynamics of the pathological process can recommend a more extended diet (table № 1). Increasing the amount of salt to 7.0 and liquid to normal.
The main principle of pathogenetic therapy of children with heart disease in the active phase of rheumatoid arthritis is the use of combination hormonal drug therapy (C. A. Nasonova, A. Ya. Sigidin, 1975; A. C. Dolgopolova; N. N. Kuzmina, 1976; A. I. Nesterov, 1973). In complex therapy must include antibiotics, of which the most commonly used penicillin - agent with a strong germicidal effect on In-haemolytic Streptococcus group A. the Dose of penicillin for young children - 300 000-400 000 IU a day, for children - 600 000-800 000 UNITS in day. Duration of treatment is 10-14 days. In the presence of chronic infections and after the course of penicillin appropriate to apply bicillin-3 at a dose of 400 000 - 600 000 UNITS 1 time per week during the whole period of stay in the hospital. When rejecting drugs penicillin use other antibiotics (erythromycin, oleandomitin).