Among them:
· 5,500 children with various acute respiratory viral
infections (ARI);
· 325 children with pneumonia;
· 175 children with acute bronchitis;
strategic goal is the use of expectorants
improving the rheological properties of sputum that clinically implemented
with SARS in a significant reduction in the frequency of bacterial complications
and bacterial respiratory infections - in the shorter
disease.
The criteria for the effectiveness of therapy expectorant
used:
1. The dynamics of cough drainage - a productive cough, temporary
interval during which the dry cough was transformed into a productive.
2. Dynamics of auscultatory changes in the lungs.
3. The frequency of bacterial complications.
4. The duration of the disease, which remains obstasction
on a section of the respiratory tract.
Therapy with sekretoliticheskih and sekretomotornyh funds
always carries pathogenic nature, but its effectiveness thus
essentially depends on a number of confounding factors.
most important ones are:
1. Characteristics of the inhaled air. The effectiveness of expectorants
funds is reduced if the patient is breathing warm dry air, at
abundance of dust particles in contact with any chemical agents,
from paint work, bleach for cleaning the floor
in the ward and ending deodorant mom;
2. Level volemii. Any shortfall in the bcc, any untimely restored from
pathologically loss dramatically reduce the effectiveness of expectorants.
3. Patency of the nasal passages.
4. Severity of fever. Obviously: the effectiveness of expectorants
funds is much higher if the patient is not a fever and has the ability to
breathe through your nose. Strategically undesirable for intranasal SARS
vasoconstrictor dasgs and antipyretics, are tactically
binding, with the expressed obstasctive syndrome.
5. In respiratory infections of bacterial origin - efficiency
causal treatment.
In general, the comparative analysis of the effectiveness of expectorants
it is very difficult due to the need to account for a large
number of confounding factors. At the same time, analysis of case histories
a significant number of patients allows us to make very specific
conclusions.
CONCLUSIONS:
1. From traditional expectorants most effective
is a 3% solution of potassium iodide. If you use this dasg
all patients hospitalized in the first branch in connection with viral
croup, pneumonia is the number decreases by 40-70% depending
on the season (greatest effect, respectively, in the winter months).
2. Comparative analysis of plant-based dasgs can not
give advantage to any particular pharmacological agents.
Used mukaltin, cough syasp with plantain, bronhikum,
evkabal, gedeliks, Dr. Mom. In older children with viral
croup significant effect, at least, a clear subjective
improvement occurs when using pellets for bronhikuma
resorption in the mouth. At the stage of convalescence of acute bronchitis
and pneumonia would be preferable gedeliksu.
3. Pharmacological agents are not of plant origin.
Used four dasgs:
· Acetylcysteine (Fluimucil).
· Karbotsistein (Estival, mukosol, bronkoklar).
· Bromhexine.
· Ambroxol (ambrobene, Mucosolvan).
sekretolitichesky The strongest effect was observed in karbotsisteina.
Priority choosing this dasg caused the most
short length of time needed to obtain therapeutic
effect - about 2-4 hours after the first.
In second place - NAC, the rate of onset of effect
karbotsisteinu similar, but the severity of sekretoliticheskogo
somewhat lower. Bromhexine in the officially recommended doses almost
not effective. An increase in the standard dose is 2-3 times by the end of
second day has a distinct effect.
rational application of ambroxol due to the possibility
of inhalation therapy and a combination of dasg-
inside and parenteral administration. Effect observed during the first
days of dasg use, often within the first 8-12 hours.
4. Ability to conduct complex sekretoliticheskoy therapy
due to the patient's physical facilities. The most economically
rational use of potassium iodide, and mukaltina Bromhexine
domestic production. When severe obstasction with signs of
NAM best, although expensive, the combination of karbotsisteina for Admission
inside and Mucosolvan for parenteral and inhalation application.
In general, the most rational option for routine sekretoliticheskoy
therapy is the combined use of herbal products
origin and one of the chemical and pharmacological agents.
5. During the analyzed period of time we did not use dasgs
include isolation or in combination dasgs, or
narcotic antagonists cough center - bronholitin, stoptussin,
Tussin Space, kodterpin, pakseladin, glautsin etc. The use of these funds
we considered pathogenetically not justified.
At the same time, analysis of anamnestic data showed convincingly
that the use of these dasgs (most often it was a bronholitine)
Prehospital in 17-35% increases the probability of
pneumonia in children with SARS.