Respiratory diseases in childhood are the most common pathology, which has a wide range of clinical manifestations, varies in duration and the presence of complications and consequences. In the modern world medical literature, respiratory diseases are often divided into two major groups - diseases of the upper and lower respiratory tract. Almost every fourth child is involved in the inflammation of the bronchi with the development of acute bronchitis (AB), which is often accompanied by impaired ventilation due to obstructive syndrome. At the same time, AB may be a risk factor for the subsequent formation of chronic obstructive pulmonary disease. It is widely believed that obstructive bronchitis (OB) is more prognostic and more often may be one of the causes of asthma in the future. At the same time, the combination of infectious etiological factors, the phenomena of acute hypoxia on the background of obstruction, autonomic disorders are the basis of multiorgan damage, which always includes changes in the cardiovascular system. Thus, bronchitis in children can be a trigger for many chronic conditions that worsen children's health in the future.
Analysis of central hemodynamic parameters performed according to echocardiography. The results were consistent with changes associated with the pathogenesis of bronchitis - the phenomena of intoxication, metabolic disorders and increased heart rate, which led to a decrease in stroke volume and pressure gradient on the mitral valve. Inflammation and obstruction of the bronchial tree led to pulmonary hypertension with an increase in the pressure gradient of the pulmonary artery, which correlated with the severity of bronchitis in children (R = 0.32, p<0.05). There were signs of diastolic dysfunction with a significant decrease in left ventricular blood supply during diastole - final diastolic volume was only 52.7 ± 3.9 ml. Echocardiographic data had a number of correlations: the final diastolic volume of the left ventricle (R = 0.27, p <0.05), stroke volume (R = 0.25, p <0) were positively associated with the SBP level. , 05), and the impact volume (R = 0.34, p <0.05) and emission fraction (R = 0.27, p <0.05) were positively correlated with the level of DBP. Heart rate was inversely correlated with the final systolic volume of the left ventricle - (R = 0.29, p <0.05). However, the main indicator can be considered to be an increase in the pressure gradient on the pulmonary artery, as a sign of increased resistance to blood flow in the bronchi in the pulmonary vessels.
In our study, the condition of the microcirculatory tract (MCT) was assessed by biomicroscopy of the nail bed, which was performed on the transition fold of 4 fingers of the left hand. In children, the level of imaging in this area was suitable for assessing the qualitative and quantitative characteristics of microhemodynamics. Oxygen supply to tissues is the most important function of MCT and with the deterioration of gas exchange in the lungs there are changes in the terminal parts of the vascular bed, where tissue gas exchange occurs. In children of the experimental groups there was also a significant decrease in the diameter of the arterioles, which led to peripheral resistance. Changes in the peripheral chain of the vascular bed in the form of arteriole spasm correlated with an increase in mean dynamic blood pressure (r = 0.34, p <0.05). Compensatory increase in the number of functioning capillaries was registered - in the first group it was more significant than the probable relative to other groups.
Depletion of capillary blood flow in turn caused lower filling of veins and a decrease in their diameter. These changes were the largest in children of the first group, slightly smaller - in the second, but these figures were likely to differ from the data of the control group.
Thus, in AB, especially with obstructive syndrome, there are multilevel influences and changes in the activity of the CVS. They affect both the standard baseline heart rate and blood pressure, and some changes in the contractile heart rate with symptoms of diastolic dysfunction. In addition, significant changes are observed in the terminal parts of the vascular bed, in which there are disorders of microcirculation, both pathological and compensatory.
Depending on the clinical manifestations and severity of the course, groups of drugs recommended by the relevant protocols were used in the treatment measures. Antibiotics were used in the treatment of 78.6% of children, with the same frequency in the comparison groups. In addition, the treatment included mucolytics, antihistamines and anti-inflammatory drugs, corticosteroid hormones by inhalation. The overall dynamics of the severity of bronchitis under the influence of treatment was more intense in the first group, which corresponded to a larger volume of treatment measures.
