Children rheumatism has a significant tendency to acute, severe, recurrent course. Usually affects the cardiovascular system, and with each attack, its damage increased. Basis
of cardiovascular decompensation in children is always activated
rheumatic process (despite the absence of symptoms such as fever,
arthritis, ESR increase, etc.).
"Absolute" signs of rheumatic fever in childhood - a progressive heart disease, especially in combination with joint disease, chorea, availability anulyarnoy rash and rheumatoid nodules.
Latent rheumatism - hard recognizable variant of the disease: the accuracy of the diagnosis is confirmed only the presence of valvular heart shaped. Along with the existence of a latent primary and secondary latent rheumatic heart disease: proceeding without clinically significant activity, this form also leads to the formation of defects of the heart, often combined, and develop cardiosclerosis.
Treatment in a hospital, the duration of 45-60 days. Provide medical treatment to the patient, depending on the activity of the pathological process and the severity of the changes of the heart. Power should be age-appropriate.
Drug treatment: one of antirheumatics - aminopyrine or analgin by 0.15-0.2 g per year of age (no more than 2-2.5 g / day), acetylsalicylic acid - 0.2-0.25 g / day year; sodium salicylate -0.5 g per year of a day in 4-6 receptions to process activity subsided when the dose start to reduce to 2/3, and then to third but not earlier than 30-35 days from the start attack.
Phenylbutazone appoint 0.05 g 3 times a day for children of preschool age, children of 0.08 g of 8 to 10 years and 0,1-0,12 g children over 10 years. Phenylbutazone and aminopyrine often combine or give their combined forms as tablets and reopirin pirabutola by third tablet children 6-8 years, 1/2 tablets for children 8-10 years and 1 tablet for children 12-15 years 3 times day.
Corticosteroids are generally shown in the earliest period of the active phase of rheumatism (to prevent the development of heart disease.) The course of treatment for at least 1-1.5 months. In recent years more and more use of such high-performance drugs like indomethacin (indomethacin) and voltaren at a dose of 1-3 mg / (kg day) alone or in combination with hormonal therapy.
With sluggish flow and low activity of the process can be used instead of the glucocorticoid drugs hlorohinovogo series-delagil, Plaquenil at 0.5-10 mg / (kg day). Prednisolone prescribed to children 4-7 years old, 10 - 15 mg / day (1 tablet contains 5 mg), 8 - 10 years - 15-20 mg / day 11 -14 years of age and older - 15-25 mg / day (children early age of 1-3 mg / day for 1 kg of body weight) in 3-4 divided doses (morning and afternoon 2/3 RDA) with a gradual decrease (with an evening reception) to maintenance dose (usually ud therapeutic dose), which is given by until no signs of activity.
Assign also triamcinolone (4 mg equivalent to 5 mg of prednisolone and 25 mg of cortisone), dexamethasone (0.75 mg equivalent to 4 mg of triamcinolone, etc.). For the prevention of acute exacerbation of chronic focal infection or at the time of accession of infectious diseases at the same time with corticosteroids injected antibiotics (within? 14 days).
With arthritis in the affected joints should dry heat, Solux, ultraviolet irradiation, UHF. Chorea along with antirheumatic therapy administered vitamins: vitamin Bg (pyridoxine) 50 mg daily for 10 days, in / m to 1 ml of vitamin C - 1 ml of 5% solution in 10-15 ml of 20% solution glucose / O, 0.5% solution of novocaine in / from 3 to 10 ml (daily by adding 1 ml) antihistamines.
In severe changes of cardiovascular system, leading to heart failure, prescribe cardiac glycosides (strophanthin - 0.05% solution; digitalis - 0,03-0,075 g 3 times daily-dose saturation korglikon - 0.06% solution) and diuretics means (aminophylline inside in candlelight and / in; novurit 2-3 times a week / 0.25-0.5 m - 1 ml or in candlelight to 0.25-0.5 g fonurit). Sick child in the hospital being treated for an average of 1.5-2 months, and then at 2 - 3 months for staged treatment is sent to a sanatorium. After a child enters a nursing home surveillance pediatric cardiologist, the child is put account form Ns30.
Forecast remains at current treatment seriously, because even after the first attack, a heart defect is formed in 10-15% of children. With early treatment and the adequacy of the forecast in most cases favorable.
Prevention. Primary prevention - treatment of acute streptococcal diseases.
Secondary prevention - bicillin drug, was carried out for 3 - 5 year-round, depending on the severity of the disease. Use bicillin 1 (preschool 600,000 units 1 every 2 weeks, the school - 1200000 ME 1 per month) or bicillin 5 (school age 1 750 000 IU every 2 weeks, school - 1500000 ME 1 once a month).
In addition, two times a year (spring and fall) was carried out for 6 weeks course of nonsteroidal anti-inflammatory drugs. All children who have had rheumatic fever, when a viral respiratory infections, tonsillitis, sinusitis within 10 days of prescribed antibiotics and anti-inflammatory drugs.
"Absolute" signs of rheumatic fever in childhood - a progressive heart disease, especially in combination with joint disease, chorea, availability anulyarnoy rash and rheumatoid nodules.
Latent rheumatism - hard recognizable variant of the disease: the accuracy of the diagnosis is confirmed only the presence of valvular heart shaped. Along with the existence of a latent primary and secondary latent rheumatic heart disease: proceeding without clinically significant activity, this form also leads to the formation of defects of the heart, often combined, and develop cardiosclerosis.
Treatment in a hospital, the duration of 45-60 days. Provide medical treatment to the patient, depending on the activity of the pathological process and the severity of the changes of the heart. Power should be age-appropriate.
Drug treatment: one of antirheumatics - aminopyrine or analgin by 0.15-0.2 g per year of age (no more than 2-2.5 g / day), acetylsalicylic acid - 0.2-0.25 g / day year; sodium salicylate -0.5 g per year of a day in 4-6 receptions to process activity subsided when the dose start to reduce to 2/3, and then to third but not earlier than 30-35 days from the start attack.
Phenylbutazone appoint 0.05 g 3 times a day for children of preschool age, children of 0.08 g of 8 to 10 years and 0,1-0,12 g children over 10 years. Phenylbutazone and aminopyrine often combine or give their combined forms as tablets and reopirin pirabutola by third tablet children 6-8 years, 1/2 tablets for children 8-10 years and 1 tablet for children 12-15 years 3 times day.
Corticosteroids are generally shown in the earliest period of the active phase of rheumatism (to prevent the development of heart disease.) The course of treatment for at least 1-1.5 months. In recent years more and more use of such high-performance drugs like indomethacin (indomethacin) and voltaren at a dose of 1-3 mg / (kg day) alone or in combination with hormonal therapy.
With sluggish flow and low activity of the process can be used instead of the glucocorticoid drugs hlorohinovogo series-delagil, Plaquenil at 0.5-10 mg / (kg day). Prednisolone prescribed to children 4-7 years old, 10 - 15 mg / day (1 tablet contains 5 mg), 8 - 10 years - 15-20 mg / day 11 -14 years of age and older - 15-25 mg / day (children early age of 1-3 mg / day for 1 kg of body weight) in 3-4 divided doses (morning and afternoon 2/3 RDA) with a gradual decrease (with an evening reception) to maintenance dose (usually ud therapeutic dose), which is given by until no signs of activity.
Assign also triamcinolone (4 mg equivalent to 5 mg of prednisolone and 25 mg of cortisone), dexamethasone (0.75 mg equivalent to 4 mg of triamcinolone, etc.). For the prevention of acute exacerbation of chronic focal infection or at the time of accession of infectious diseases at the same time with corticosteroids injected antibiotics (within? 14 days).
With arthritis in the affected joints should dry heat, Solux, ultraviolet irradiation, UHF. Chorea along with antirheumatic therapy administered vitamins: vitamin Bg (pyridoxine) 50 mg daily for 10 days, in / m to 1 ml of vitamin C - 1 ml of 5% solution in 10-15 ml of 20% solution glucose / O, 0.5% solution of novocaine in / from 3 to 10 ml (daily by adding 1 ml) antihistamines.
In severe changes of cardiovascular system, leading to heart failure, prescribe cardiac glycosides (strophanthin - 0.05% solution; digitalis - 0,03-0,075 g 3 times daily-dose saturation korglikon - 0.06% solution) and diuretics means (aminophylline inside in candlelight and / in; novurit 2-3 times a week / 0.25-0.5 m - 1 ml or in candlelight to 0.25-0.5 g fonurit). Sick child in the hospital being treated for an average of 1.5-2 months, and then at 2 - 3 months for staged treatment is sent to a sanatorium. After a child enters a nursing home surveillance pediatric cardiologist, the child is put account form Ns30.
Forecast remains at current treatment seriously, because even after the first attack, a heart defect is formed in 10-15% of children. With early treatment and the adequacy of the forecast in most cases favorable.
Prevention. Primary prevention - treatment of acute streptococcal diseases.
Secondary prevention - bicillin drug, was carried out for 3 - 5 year-round, depending on the severity of the disease. Use bicillin 1 (preschool 600,000 units 1 every 2 weeks, the school - 1200000 ME 1 per month) or bicillin 5 (school age 1 750 000 IU every 2 weeks, school - 1500000 ME 1 once a month).
In addition, two times a year (spring and fall) was carried out for 6 weeks course of nonsteroidal anti-inflammatory drugs. All children who have had rheumatic fever, when a viral respiratory infections, tonsillitis, sinusitis within 10 days of prescribed antibiotics and anti-inflammatory drugs.
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