Respiratory organs provide gases between the human body and the environment surrounding it. Without breathing there is no life. A person absorbs oxygen from breathe air and highlights carbon dioxide and water pairs outward. The cessation of admission to the oxygen body causes death a few minutes. Due to the oxidizing processes in the cells and tissues of the body entered the body of oxygen in the cells and body tissues, which are a very substantial part of metabolism. The carbon dioxide released as a result of oxidation is removed from the body through the lungs during the exhalation process.
In terms of the structures, the respiratory organs in children and adolescents have a number of peculiar features that distinguish them from the respiratory organs in adults. The main features of the respiratory organs in children include the tenderness of their tissues, a light vanity of the mucous membranes, lining the respiratory tract, and an abundance of mucous membranes and the walls of the respiratory tract of blood and lymphatic vessels.
The upper respiratory tract, beginning with the cavities of the nose and nasopharynx, in children is significantly more than in adults, and covered with inside a very gentle mucous membrane. The nasal cavities in small children are small and underdeveloped, and no protrusion is not at all, it develops only by 15 years. Putting cavities The nose is also not developed enough, and frontal sickles They are developing and formed, too, only by 15 years.
These features are largely due to children in children more easily penetration of infection in the respiratory tract (according to statistics, children are twice as often as adults are ill with influenza), as well as respiratory disorders at various inflammatory processes in the nose. So, with a cold in children early age Difficult breathing appears, which causes the need to participate in the act of breathing the auxiliary muscles, expressed in inflating the wings of the nose, and in children of older age - in breathing through the mouth. The latter circumstance creates especially favorable conditions for children and adolescents in infections and penetration into the respiration organs of dust particles.
The throat in young children is also narrow. Almonds in children begin to develop by the end of the 1st year of life. Children often arises a peculiar disease, known as adenoid, that is, the growth of a special type of lymphatic tissue (adenoid), which also consists of paired almonds of ZEV. Most often, adenoid arrangements are among children aged 4 to 10 years, although they are found in adolescents.
Strengthening the growth of the larynx in children is observed from 5 years, when it is already noticeable and strengthening it physiological functions. But especially the intensive growth of the larynx occurs in adolescents, starting from 13-14 years. At the same time, the differentiation of the larynx in accordance with the floor is noticeable. By the end of the period of sexual maturity, the lads in their sizes in the young men and girls are not much different from the larynx of adults.
With the development and elongation of true voice ligaments, as well as with the strengthening of the cartilage larynx, the tones of voice are enhanced. The development and change in the form of neighboring nasophary cavities change its bellivity and timbre. With age, children and adolescents increase and voices.
In the period of puberty, adolescents take a sharp change of voice, which is especially manifested in the boys ("voice broken"). Externally, the voting change is manifested by peculiar hoarseness, easily turning into Falletet. The change in the voice sometimes occurs suddenly and is due to the enhancement of blood flow and swelling of the mucous membrane of the voice ligament. In the subsequent years of youth, as well as in mature years there is a different height of the voice in men and women. The boys in the prevailing sounds are breasts, and girls are thorns.
One of the tasks of personal hygiene of children and adolescents is care of the security and normal development of their voices. Basically, all that relates to the hygiene of the respiratory organs in children and adolescents, it can only be used and should be used to ensure their voice (the development of respiratory organs with respiratory gymnastics and other exercises, voice speech and singing, the fight against dust and the content of mucous membranes clean, no cold prevention, etc.). Especially useful for the development of voice apparatus in children and adolescents rational training for their singing, as well as loud reconnaissance with correct stress and modulation. It should be noted that such gymnastics of the voice apparatus also contributes to the development chest and lungs.
But if concerns about the security and development of the voice apparatus are necessary in all age periods, they are especially important during puberty when a voice change occurs. In this period, you should not allow the boys and girls to sing a lot and thereby annoying and tiring their voice apparatus. The obligation of this provision may entail heavy consequences: inflammatory phenomena in the larynx, in particular, the defeat of voice ligaments, damage to the voice, etc. In the event of the appearance of redness in the throat and inflammation of the voice ligaments, singing should be prohibited and resolved sharp change temperatures.
The mucous membrane of the trachea in children is very gentle, is abundantly permeated with capillaries and has a weakly developed elastic tissue.
The lumen of the bronchi in children already in adults, the cartilages did not grow them yet. Muscular and elastic bronchi fiber they are still developed in a small extent. Bronchi in children also have a more delicate mucous membrane and are abundant blood vessels.
All this indicates that trachea and bronets in children are more wounded than adults. Penetration of dust particles, as well as pathogenic (pathogens) microorganisms, is significantly greater danger compared to adults.
Easy in children are still minor. Alveoli in newborns have 3-4 times smaller than adults. Thus, the average diameter of the alveoli in the newborn is 0.07 mm, and in an adult is 0.2 mm. Only gradually with age, the dimensions of the Alveol are increasing. The capillaries of lungs in children are developed in much greater than large blood vessels, and the clearance of capillaries is wider than in adults. The growth of lungs in children and adolescents occurs throughout all periods of the body's development, but they are most intensively growing in the first 3 months of life and during puberty, i.e., aged 12 to 16 years inclusive. Intensive growth of lungs during puberty requires special concerns about the hygiene of respiratory organs in adolescents, especially since the antihygienic conditions at this age are a threat in the sense of light diseases, in particular tuberculosis.
For the development of lungs in children and adolescents, the exercises of the thoracic muscles are especially necessary. These muscles in children are developed in less than adults. Therefore, the lack of exercises of the respiratory muscles is adversely affected by the development of the chest and lungs.
The most intensely chest increases in adolescents during puberty, when respiratory muscles are developing strongly. In its circumference, the chest in boys in all periods more than girls, with the exception of age from 13 to 15, when girls actively happening paulic ripening And when they are activated by all growth processes.
The described features of the structure of the respiratory organs and the mechanism of their activities in children determine the nature of their respiratory movements. Breathing in children is superficially and at the same time more often than an adult. In one minute, the number of breathing is:
- in the newborn - 30-44 times;
- the child is 5 years old - 26 times;
- Teenagers have 14-15 years old - 20 times;
- in an adult - 16-18 times.
When driving, physical exercises and physical work, the respiratory frequency is enhanced. Breathing in young children is not only superficial, but also uneven, neurotic and can change from of various reasonsWhat is explained by the insufficient coordination of respiratory movements and the lung excitability of their respiratory center in the oblong brain. During the first 5-6 years in children deep breaths alternate with superficial, and gaps between inhams and exhalations have different duration. The lack of breathing depth in children is of great importance in hygienic terms, since it does not fully provide enough energetic ventilation of lungs in children. This is also confirmed by the data characterizing the vital capacity of lungs, which is an indicator of the capacity of lungs and the forces of the respiratory muscles.
The life capacity of the lungs in children is 5 years old, is 800-1,000 cm3. These data are relative, since the vital capacity of lungs in individual individuals depends on the state of health, the physique, the degree of training, etc. Other researchers obtained smaller data. Therefore, there are not so many absolute numbers that characterize the vital capacity of lungs in children and adolescents of one or another age as the process of changing them by age. The greatest increase in the life capacity of the lungs is observed in adolescents during puberty, i.e., aged 14 to 17 years old. The increase in the life capacity of the lungs is mainly flowing to 20 years, although in subsequent years, with appropriate training, it may increase. It is significant to note that due to more superficial respiration in children, a significant part of the inhaled air does not reach light bubbles. This circumstance also confirms the fact of insufficient ventilation of lungs in children and adolescents and put forward the requirement for the possibility of a long stay at fresh air In a state of active movement and ensuring benign air in the premises.
However, the frequency and depth of breathing taken to judge apologize from each other cannot serve as a sufficient criterion to assess the magnitude of the ventilation of the lungs. Correct solution This issue gives the so-called minute breathing volume, i.e., the volume of breathing multiplied by the number of breaths, per minute. In an adult, the passage of breathing comes to 10 liters (10,000 cm3), although it may be less. Children and adolescents are less than breathing less, it is:
- in the newborn - 650-700 cm3;
- the child is 1 year - 2,600 cm3;
- the child is 5 years old - 5,800 cm3;
- Teenagers have 12 years old - 8000 cm3;
- in an adult - 10,000 cm3.
Energy exchange in children proceeds more intense than adults. In this regard, children need relatively larger quantities air than adults. This is also confirmed by the fact that the passage volume of breathing in relation to 1 kg of body weight in children and adolescents is greater than in adults, and it decreases as they are growing. So, the minute volume of lungs in relation to 1 kg of body weight is:
- in a breast child - 220 cm3
- the child is 6 years old - 168 cm3;
- a teenager is 14 years old - 128 cm3;
- in an adult 96 cm3.
The need for more intensive ventilation of lungs in children and adolescents is associated with the construction and development of tissues and the increase in body weight.
Respiratory movements are provided positive influence On the whole body. Thus, the movements of the diaphragm and interrochemical muscles have a massaging effect on the organs of the chest and abdominal cavities. The deeper breathing, the stronger it will be a massaging effect. But besides this, respiratory rhythm affects the body through the nervous system. So, it knows its effect on the frequency of heart cuts and blood pressure.
Changing inhale and exhalation has its influence and mental work. At the tension, there is usually somewhat delayed breathing. Caution is enhanced with breathing and retention, and it is weakened and dissipated when inhaling. It is obvious from here that lady breathing Concentrated thought and generally productive mental work. Therefore, before proceeding to serious mental work, it is necessary to calm the breath. It is noted that the correct rhythmic breathing contributes to the concentrated mental work.
Turning to the hygiene of the respiratory organs in children and adolescents, it should be primarily indicated on the need for constant care for the normal development of the chest. The main in this direction is: the correct position of the body, especially during the seating by the desk and the house when cooking lessons, breathing exercises other physical exercisesEducational muscles controlling the movements of the chest. Especially useful in this respect such sports as swimming, rowing, skating and skiing.
Teaching children to proper breathing is also one of the important hygienic provisions. Proper breathing is primarily uniform, rhythmic breathing. Proper breathing is thought only through the nose. Breathing with an open mouth occurs in children either during a cold, or with other inflammatory phenomena in the upper respiratory tracts, or with adenoid growths in the nasophal. When breathing through the nose, a kind of barrier is created to penetrate pathogenic microorganisms and dust particles into the respiratory tract. In addition, when breathing through the nose, the cold atmospheric air is warmed in the clients of the nose and falls into the larynx and the underlying respiratory tract is not cooled, which happens when breathing through the mouth. Thus, breathing through the nose prevents children and adolescents from diseases by bronchitis and the Qatar of deep respiratory tract. It is especially important to breathe through the nose with a quick walking in winter frosts, since the breathing is deepened, and breathing through the mouth should be involved in the sharp cooling of the respiratory tract.
The dryness of the air, often irritating the respiratory tract, with breathing through the nose decreases, because in the cavities of the nose, air is moistened with a wet mucous membrane. Breathing through the nose, being a sign of a healthy body, ensures the rhythm of breathing and its relatively large depth, which in turn has a positive effect on the ventilation of the lungs.
One of the important requirements of the hygiene of the respiratory organs in children and adolescents is the need to teach children to walk and stand in a straightened position, as it contributes to the expansion of the chest, facilitates the activity of lungs and provides deeper breathing. On the contrary, during the bent position of the body, reverse conditions are created that violate the normal activity and the development of lungs, and they are absorbed by a smaller amount of air, and with it and oxygen.
In the system of the organization of life and academic work of children and adolescents, it is necessary to pay special attention to the fact that they can be spent more time in the fresh air and that their stay on it has been associated with movements. Therefore, it is so important in the summer, and if possible, during the winter holidays, to export children and adolescents at the cottages, in pioneer lags, forest schools, wherever they can be in the fresh air.
In the winter season for children to school age It is necessary to be in the fresh air at least 5 hours a day, not in a row, but with the intervals, with the exception of strong frosts below 15 °, especially in the wind; For children of younger school age - at least 4 hours and senior school age - at least 3 hours a day. For the same purpose, it is necessary to provide students in schools the ability to carry out changes between lessons, especially greater change, in the school area. For these same considerations, it is necessary to maintain the air in the apartment and the class is constantly fresh and systematically, several times a day, ventilate residential and school premises.
All the above hygiene measures, besides their meaning for the normal development and activities of respiratory organs, are one of the most important means of hardening the respiratory system and are equally important in terms of preventing diseases in this area. Diseases of respiratory organs in children and adolescents are most often observed in the winter and spring time. Therefore, it is of particular importance in this direction: rational clothing for children and adolescents in accordance with the season, hardening the skin care and gradualizing the body to change the temperature. It should be borne in mind that the style and childish avoidance of fresh air are one of the main factors contributing to the emergence of catarrhal lesions of respiratory organs (
Children occur on the 3-4th week of gestation. The respiratory organs are formed from the primaries of the embryo front: first - trachea, bronchi, acins (functional units of light), in parallel with which the cartilage frame of the trachea and bronchi is formed, then the blood and nervous Systems lungs. By birth, the lung vessels have already been formed, the respiratory tract is quite developed, but filled with liquid, the secret of the cells of the respiratory tract. After birth with the cry and the first breath of the child, absorption and flipping of this liquid occurs.
Special importance is a surfactant system. Surfactant is a superficially active substance that is synthesized at the end of pregnancy, helps breaks against the lungs at the first breath. With the beginning of breathing immediately in the nose there is a purification of inhaled air from dust, microbial agents due to biologically active substances, mucus, bactericidal substances, secretory immunoglobulin A.
The respiratory tract of the child with age is adapting to the conditions in which he should live. The nose in the newborn is relatively small, the cavity is developed badly, nasal moves are narrow, the lower nose has not yet been formed. Nose cartilage skeleton is very soft. The mucous membrane of the nose cavity is richly vascularized by blood and lymphatic vessels. Approximately four years formed a lower nasal stroke. Gradually develops a cavernous (cave) cloth of a child's nose. Therefore, children under the year are very rare nose bleeding. They have almost impossible to breathe through the mouth, since the oral cavity occupies a relatively large tongue, pushing the nastestrian by the post. Therefore, with acute rhinitis, when breathing is sharply difficult through the nose, pathological process Quickly lowers in bronchi and lungs.
The development of the apparent sinuses is also occurring after a year, so the children of the first year of life are rare their inflammatory changes. Thus than less childThe nose is more adapted to warming, moisturizing and cleaning air.
The throat of a newborn baby is small and narrow. The almond pharmaceutical ring is under development. Therefore, the skynings do not go beyond the edges of the sky. At the beginning of the second year of life, the lymphoid fabric is intensively developing, and the paradils begin to go beyond the edges of the forehead. By four years of the almonds are well developed, under adverse conditions (ENT infections) their hypertrophy may appear.
The physiological role of the almonds and the entire pharyngeal ring is filtering and deposition of microorganisms that fall from the environment. With long-term contact with a microbial agent, the sudden cooling of the child, the protective function of the almonds weakens, they are infected, their acute or chronic inflammation is developing with the appropriate clinical picture.
Increase nose-oxidium almonds Most often associated with chronic inflammation, against which the respiratory disorder is noted, allergyizing and intoxication of the body. Hypertrophy of palatal almonds leads to violations of the neurological status of children, they become inattentive, poorly learn at school. With hypertrophy, the almonds in children pseudo-compensator forms an incorrect bite.
Most frequent diseases The upper respiratory tract in children are sharp rhinitis and angina.
Lainan in the newborn has a funnel-shaped structure, with soft cartilage. The voice gap of the larynx is located at the level of the IV cervical vertebra, and in an adult at the level of the VII vertebra. The larynx is relatively narrow, mucous membrane covering it, has well-developed blood and lymphatic vessels. Its elastic cloth developed weakly. Sexual differences in the structure of the larynx appear to the publity period. The boys lads on the place of thyroid cartilage sharpened, and by the age of 13 she is already looking to the larynx of an adult man. And in girls by 7-10 years old, the building of the larynx becomes like the structure of an adult woman.
Up to 6-7 years, the voice gap remains narrow. From 12 years old, voice ligaments in boys become longer than girls. Due to the narrowness of the structure of the larynx, the good development of the submembraty layer in young children is often part of its defeat (laryngitis), they are often accompanied by a narrowing (stenosis) of the voice gap, a painting of a crunch with difficulty breathing is often developed.
The trachea for the birth of a child has already been formed. The top edge of the newborn is located at the level of the IV cervical vertebra (in an adult at the level of the VII vertebra).
Bifurcation of the trachea lies above than in an adult. The mucous membrane of the trachea tender, richly vascularized. Its elastic cloth developed weakly. The cartilage skeleton in children is soft, the lumen of the trachea is easily narrowed. In children with age, there is a gradual growth of trachea in length and width, but the overall growth of the body overtakes the growth of the trachea.
In the process of physiological respiration, the tracheal clearance changes, during cough it decreases approximately 1/3 of its transverse and longitudinal size. In the mucous membrane of the trachea many secreting glands. Their secret covers the flow of the trachea with a layer of 5 μm thick, the speed of movement of the mucus from the inside of the duck (10-15 mm / min) is provided by the camber epithelium.
Children often have such tracheal diseases as tracheitis, in combination with damage to larynx (laryngotrachites) or bronchi (tracheobronchites).
Bronchi for the birth of a child formed. Their mucous membrane is richly equipped with blood vessels, coated with a layer of mucus, which moves from the inside of the duck at a speed of 0.25 - 1 cm / min. Right bronchus is a continuation of the trachea, it is wider than the left. In children, in contrast to adults, elastic and muscle bronchi fibers are poorly developed. Only with age increases the length and width of the lumen of the bronchi. By 12-13 years old, the length and lumen of the main bronchi is doubled compared to the newborn. With age, the ability of the bronchi resist accusation. Most frequent pathology Children are sharp bronchitis, which are observed against the background of sharp respiratory diseases. Relatively often in children develop bronchiolites, which contributes to the narrow of the bronchi. Approximately an annual age can be formed bronchial asthma. Initially, it flows against the background of acute bronchitis with full or partial obstruction syndrome, bronchipolitis. Then the allergic component is turned on.
The narrowness of bronchiol is also explained by the frequent occurrence of lung atelectasis in young children.
The newborn baby has a lot of lungs and is approximately 50-60 g, it is 1/50 part of its mass. In the future, the mass of the lungs increases 20 times. In newborns pulmonary fabric It is well vascularized, there is a lot of loose connective, and the elastic tissue of the lungs is weaker. Therefore, children are often marked by emphysema in children with lung diseases. Azinus, which is a functional respiratory unit of the lungs, is also developed enough. Alveola's lungs begin to develop only from the 4th-6th of the child's life, their formation occurs up to 8 years. After 8 years, the lungs increase due to linear alveol size.
In parallel with the increasing of the number of Alveol, the respiratory surface of the lungs increases to 8 years.
In the development of the lungs, 4 periods can be distinguished:
I period - from birth to 2 years; Intense growth of the lungs alveol;
II period - from 2 to 5 years; the intensive development of elastic tissue, a significant increase in bronchi with peribroscial inclusions of lymphoid tissue;
III period - from 5 to 7 years; final ripening of acinus;
IV period - from 7 to 12 years; Further increase in the mass of the lungs due to the ripening of the pulmonary fabric.
The right lung consists of three pieces: the upper, middle and lower, and the left is from two: top and bottom. At the birth of a child, the top share of the left lung is designed worse. By 2 years, the size of individual shares correspond to each other as in adults.
In addition to the equity in the lungs, there is a segmental division corresponding to the division of bronchi. In the right lung distinguish 10 segments, in the left - 9.
In children due to the features of aeration, drainage function and evacuation of the Secret of the Easy inflammatory process More often is localized in the lower share (in the basal-top segment - the 6th segment). It is in it that the conditions of poor drainage are created in the lying position in children breast-age. Another place for pure localization of inflammation in children - 2nd segment upper Share and basal rear (10th) lower share segment. So-called paravertebral pneumonia develop here. Often affects the average share. Some lung segments: mid-unit (4th) and medium-line (5th) are located in the field of bronchopulmonal lymph nodes. Therefore, with inflammation of the latter bronchi of these segments, they are squeezed, causing a significant turning off the respiratory surface and the development of severe lung insufficiency.
Functional features of breathing in children
The mechanism of the first breath in the newborn is explained by the fact that at the time of birth ceases the umbilical blood circulation. The partial oxygen pressure (PO 2) decreases, the pressure of carbon dioxide (RSO 2) increases, the acidity of blood (pH) is reduced. There is an impulse from peripheral receptors sleepy artery and aortic to the respiratory center of the CNS. Along with this, the respiratory center comes impulses from skin receptors, as the conditions of the child's stay are changed in environment. He gets in more cold air with smaller humidity. These impacts are also annoyed by the respiratory center, and the child makes the first breath. Peripheral respiratory regulators are chem and baroreceptors of carotid and aortic formations.
The formation of breathing occurs gradually. In the first year of life, the breathing arrhythmia is often registered. In premature children, apnea is often noted (breathing cessation).
Oxygen reserves in the body are limited, they are enough for 5-6 minutes. Therefore, a person must maintain this reserve by constant breathing. From a functional point of view, two parts of the respiratory system are distinguished: conductive (bronchi, bronchioles, alveoli) and respiratory (acinas with leading bronchioles), where gas exchanges are carried out between the atmospheric air and the blood capillaries of the lungs. The diffusion of atmospheric gases occurs through the alveolar-capillary membrane due to the difference in the pressure of gases (oxygen) in the inhaled air and venous bloodflowing through the lungs according to the pulmonary artery from the right ventricle of the heart.
The pressure difference between alveolar oxygen and oxygen of venous blood is 50 mm Hg. Art. that ensures the transition of oxygen from the alveoli through the alveolar and capillary membrane into the blood. From the blood at this time, carbon dioxide is passed, also in the blood under greater pressure. In children, there are significant differences in external respiration compared to adults due to the continuing and after the birth of the development of respiratory acincions of the lungs. In addition, children have numerous anastomoses between bronchiolar and pulmonary arteries and capillaries, which serves the main reason Shunting (compounds) of the blood, which will pass the alveoli.
There are a number of external respiratory indicators that characterize its function: 1) pulmonary ventilation; 2) pulmonary volume; 3) respiratory mechanics; 4) pulmonary gas exchange; 5) Gas composition of arterial blood. The calculation and assessment of these indicators are carried out in order to clarify the functional state of respiratory and reserve capabilities in children of different ages.
Respiratory Research
This is a medical procedure, and the average medical staff should be able to prepare for this study.
It is necessary to find out the deadlines for the start of the disease, the main complaints and symptoms, did the child took any drugs and how they influenced the dynamics clinical symptomsWhat complaints today. This information should be obtained from the mother or by a child career.
In children, most diseases of the lungs begins with a runny nose. At the same time, in the diagnosis it is necessary to clarify the nature of the selection. The second leading symptom of the defeat of the respiratory organs is cough, according to the nature of which is judged on the availability of a particular disease. Third symptom - shortness of breath. Children in early age during shortness of breath, the wings of the nose wings are visible. In older children you can see compliant places Chest, abdominal retraction, forced position (sitting with hand support - with bronchial asthma).
The doctor examines the nose, mouth, zev and tonsils of the child, differentiates the cough. The croup in the child is accompanied by stenosis of the larynx. The true (diphtheria) croup is distinguished when the narrowing of the larynx occurs due to diphtheritic films, and the false croup (refrigerant laryngitis), which occurs due to spasm and edema against the background of acute inflammatory disease Large. True Develops gradually, days, false croup - unexpectedly, more often at night. Voice at the criterion can reach Afony, with sharp breakthroughs of ringing notes.
Cough with cough in the form of paroxysm (paroxy) with reprises (pulled high breath) is accompanied by redness of the face and vomiting.
Biton cough (rude basic tone and musical second tone) is noted with an increase in bifurcation lymph nodes, tumors in this place. The painful dry cough is observed in pharyngitis and nosedo-pharyngitis.
It is important to know the dynamics of cough change, whether the cough bothered before what was with the child and how the process ended in the lungs, was the contact of the child with a patient with tuberculosis.
When examining the child, the presence of cyanosis is determined, and if it is available - its character. Pay attention to the strengthening of cyanosis, especially around the mouth and eye, when screaming, the physical load of the child. In children, up to 2-3 months of life, there may be frothy allocations from the mouth.
Pay attention to the shape of the chest and the type of breathing. The abdominal type of breathing remains in boys and in adulthood. Girls from 5-6 years old appears a breast type.
Calculate the number of respiratory movements per minute. It depends on the age of the child. In early age children counts the number of breathing at rest when they are sleeping.
In respiration frequency, the ratio of his pulse is judged on the presence or absence of respiratory failure. According to the nature of the shortness of breath, they judge about one or another defeat of the respiratory organs. Dyspnea is inspiratory, when air passage is difficult in the upper respiratory tract (croup, foreign body, cysts and trachea tumors, congenital narrowing of larynx, trachea, bronchi, plug abscess, etc.). In a child, inhaling, the inhalation of the opposite region, intercostal intervals, subclavian space, jugular fox, is observed, the voltage M. Sternocleidomastoideus and other auxiliary muscles.
A shortness of breath may be expirator when the chest of bloat is almost not involved in breathing, and the stomach, on the contrary, is actively involved in the act of breathing. In this case, the exhalation is elongated compared to the breath.
However, there is a mixed shortness of breath - expiratory-inspiratory, when the muscles of the abdominal and chest take part in the act of breathing.
You can also observe shortness of a tire (expiratory shortness of breath), which arises as a result of the grinding of the root of the lung by increased lymph nodes, infiltrates, the lower part of the trachea and the bronchi; Inhale at the same time free.
Dyspnea is often observed in newborns with respiratory distress syndrome.
Palpation of the chest in a child is carried out by both hands to determine its pain, resistance (elasticity), elasticity. Also measured the thickness of the skin fold on symmetric sections of the chest to determine inflammation on one of the sides. On the affected side marked the thickening of the skin fold.
Next, go to percussion of the chest. Normally, children of all ages on both sides receive the same percussion. For different lesions The lungs percussion sound is changing (dull, box, etc.). Conduct and topographic percussion. There are age standards for the lung location, which in pathology can change.
After the comparative and topographical percussion, auscultation is carried out. Normally, children under 3-6 months listen to somewhat weakened breathing, from 6 months to 5 -7 years - a puery breathing, and in children over 10-12 years old, it is more often transient - between Puery and Vezicular.
In the pathology of the lungs, the character of breathing often changes. Against this background, they can listen to dry and wet wipes, the noise of friction of the pleura. To determine the seal (infiltration) in the lungs, the method of evaluating the Bronchophone is often used when the voice is listened under symmetric lung plots. When the lungs are sealing on the side of the lesion, the amplification of the bronchophone is heard. With caverns, bronchootases can also be observed an increase in the bronchophone. The weakening of the Bronchophony is noted if there is pleural cavity Liquids (discharge pleurisy, hydrotorax, hemotorax) and (pneumothorax).
Instrumental research
For diseases of the lungs, the most common study is x-ray. At the same time, radiography or x-ray is carried out. For each of these studies, there are testimony. When X-ray examination, lungs pay attention to the transparency of the pulmonary fabric, the appearance of various dimming.
Special studies include bronchography - a diagnostic method based on the introduction of a contrast agent into bronet.
With mass studies, fluorography is used, based on the study of the lungs using a special X-ray console and withdrawal to a film.
From other methods apply computer tomographyallowing you to explore in detail the condition of the mediastinum organs, the root of the lungs, see the changes of the bronchi and bronchiectasia. With the use of nuclear magnetic resonance, a detailed study of tracheal tissues, large bronchi, can be seen by the vessels, their ratio with breathing paths.
An effective diagnostic method is an endoscopic study, which includes the front and rear rosicopy (inspection of the nose and its moves) with the help of nasal and nasopharynk mirrors. The study of the lower part of the pharynx is carried out using special spatulas (straight laryngoscopy), larynx - with the help of a gustral mirror (laryngoscope).
Bronchoscopy, or tracheobronchoscopy, is a method based on the use of fibrous optics. Apply this method to identify and delete foreign languages Of the bronchi and trachea, drainage of these formations (suction of mucus) and their biopsy, drug administration.
There are also methods for studying external respiration based on graphic recording of respiratory cycles. According to these records, they judge the function of external respiration in children over 5 years. Then the pneumotometry is made by a special apparatus, which allows determining the condition of the bronchial conductivity. The condition of the ventilation function in patients with children can be determined using the picofloometer method.
The laboratory tests use the Gas Research (O 2 and CO 2) method in the capillary blood of the patient on the micro-ASTRUP apparatus.
Oxygemography is carried out with the help of photovoltaic measurement of the absorption of light through the ears.
From load tests use a sample with breathing delayed on inhale (shouting), a sample with physical exertion. When squating (20-30 times), healthy children do not reduce blood saturation with oxygen. The sample with the exhalation of oxygen is done when the breathing is turned on on oxygen. In this case, there is an increase in the saturation of exhaled air by 2-4% for 2-3 minutes.
Conduct a study of the sputum of the patient laboratory methods: Number, leukocyte content, erythrocytes, flat epithelium cells, mucus ground.
Respiratory organs are in close connection with the circulatory system. They enrich blood oxygen necessary for oxidative processes occurring in all tissues.
Tissue breathing, that is, the use of oxygen directly from the blood, occurs in the intrauterine period, together with the development of the fetus, and external breathing, i.e., the exchange of gases in the lungs, begins in a newborn after the break of the umbilical cord.
What is the breathing mechanism?
With each breath, the chest expands. Air pressure in it decreases and according to the laws of physics, the outer air enters the lungs, filling the discharged space formed here. With an exhalation, the chest is narrowed and the air from the lungs rushes outward. The chest is driven due to the operation of intercostal muscles and diaphragms (blessing obstacles).
Act of breathing manages the center of breathing. It is located in the oblong brain. Carbon dioxide accumulating in the blood serves as an irritant of the respiratory center. Inhale is replaced by exhale reflexively (unconsciously). But the Supreme Department - Cora takes part in the regulation of breathing big Hemispheres; Increased will be on a short time Hold your breath or make it more often deeper.
So-called air conductive pathways, i.e., nasal cavities, larynx, bronchi, in a child relative to narrow. The mucous membrane is gentle. It has a thick network of the subtlest vessels (capillaries), easily inflates, swelling; This leads to a turn off the breath through the nose.
Meanwhile, nasal breathing very important. It warms, moisturizes and cleans (which contributes to the preservation of dental enamel) air passing into the lungs, annoying nerve endingswhich affect the stretching of the bronchi and pulmonary bubbles.
Increased metabolism and in connection with this, the increased need for oxygen and active motor activity lead to an increase in the life capacity of the lungs (the number of air that can be exhaled after the maximum inhalation).
In a three-year-old child, the life capacity of the lungs is close to 500 cm cubic; By 7 years, it doubles, to 10 increases three times, and by 13 - four times.
Due to the fact that the volume of air in the airways in children is less than in adults, and the need for oxidative processes is great, the child has to breathe more often.
The number of respiratory movements per minute in a newborn is 45-40, at a year old - 30, at six years old - 20, in a ten-year-old - 18. In physically trained people, the frequency of breathing alone is less. This is explained by the fact that they have a deeper breathing. A coefficient of use of oxygen is higher.
Hygiene and coaching respiratory tract
It is necessary to pay serious attention to the hygiene of the respiration of children, in particular for hardening and teaching to nasal breathing.
Breath organs in a child Significantly different from adult respiratory organs. By the time of birth respiratory system The child still does not reach full development, so in the absence of proper care in children there is an increased incidence of respiratory organs. The greatest number These diseases fall at age from b months to 2 years.
Study of the anatomy-physiological features of the respiratory organs and conducting a wide range preventive events Taking into account these features, they can contribute to a significant decrease in respiratory diseases, which are still one of the main causes of child mortality.
Nose The child is relatively small, nasal moves of narrow. The lining of their mucous membrane is gentle, it is easy to rabbly, rich in blood and lymphatic vessels; This creates conditions for the development of the inflammatory reaction and swelling of the mucous membrane when infection of the upper respiratory tract.
Normally, breathing in a child occurs through the nose, he does not know how to breathe.
With age as developing upper jaw and the growth of facial bones Length and width of the claims are increasing.
Eustachiev Pipe, which connects the nasopharynx with the drum cavity of the ear, is relatively short and wide; It has a more horizontal direction than an adult. All this contributes to the drift of infection from the nasopharynx in the cavity of the middle ear than and the frequency of its defeat with the disease of the upper respiratory tract in the child is explained.
The frontal sinus and gaymorhs of the cavity are developing only by 2 years, the final development they achieve much later.
Larynx Children in early age has a funnel form. The lumen of her narrow, podiatile cartilages, the mucous membrane is very gentle, rich in blood vessels. Voice slot narrow and short. These features are explained by the frequency and ease of narrowing the voice slot (stenosis) even with a relatively moderate inflammation of the mucous membrane of the larynx, which leads to difficulty breathing.
Fuchery and bronchi also have a narrower lumen; The mucous membrane is rich in blood vessels, with inflammation easily swells, which causes the narrowing of the lumen of the trachea and bronchi.
Lungs, baby They differ from the light adult with the weak development of elastic tissue, large blood flow and lesser air. The weak development of the elastic tissue of the lung and insufficient journey of the chest is explained by the frequency of the atelectasis (falling out of the pulmonary fabric) and infants, especially in the lower seat of the lungs, since these departments are badly ventilated.
The growth and development of the lungs occur for quite a long time. Especially energetic growth of the lungs in the first 3 months of life. As the lungs are developing, their structure changes: the connecting interlayers are replaced by an elastic tissue, the amount of alveoli is growing, which significantly increases the life capacity of the lungs.
Breast cavity The child is relatively small. The respiratory excursion of the lungs is limited not only due to the small mobility of the chest, but also due to the small size of the pleural cavity, which in a child of early age is very narrow, almost pile. Thus, the lungs are almost completely filled with a chest.
The mobility of the chest is also limited due to the weakness of the respiratory muscles. The lungs are expanding mainly in the side of the militia diaphragm, so before walking the type of breathing in children's diaphragmal. With age respiratory excursion The chest increases and appears in the chest or breast-branched type of breathing.
The age anatomical and morphological peculiarities of the chest determine some functional features of the respiration of children in different age periods.
The need for oxygen in a child during the period of intensive growth is very large due to increased exchange. Since breathing in breast and early children has a superficial character, then the high need for oxygen is covered due to the respiratory frequency.
Already a few hours after the first breath of newborn, breathing becomes correct and rather uniform; Sometimes it is installed only in a few days.
The number of breaths The newborn is up to 40-60 per minute, in a child in 6 months - 35-40, at 12 months - 30-35, in 5-6 years - 25, at the age of 15 years - 20, in adult - 16.
Counting the number of breathing needs to be produced in the calm state of the child, watching the breathing movements of the chest or putting the hand on the stomach.
Little Life Capacity The child is relatively large. In school children, it is determined by spirometry. The child is offered to take a deep breath and a special device - spirometre- measure the maximum amount of exhaled after this air ( table. 6..) (According to N. A. Shalkov).
Table 6.. Lightweight capacity in children (in cm3)
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Age |
Boys |
Limits |
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With age, the vital capacity of the lungs increases. It also increases as a result of training, with physical work and sports.
Breathing is regulated respiratory centerIn which reflex irritation from the pulmonary branches of the vagus nerve. The excitability of the respiratory center is regulated by the cortex of the brain and the degree of blood saturation with carbon dioxide. With age, the cork regulation of breathing is improved.
As the lungs and chest develop, as well as strengthening the respiratory muscles, breathing becomes deeper and less. By 7-12 years, the character of breathing and the shape of the chest almost no differ from those in an adult.
The correct development of the chest, the lungs and respiratory muscles of the child depends on the conditions in which it grows. If a child lives in a stuffy room, where they smoke, cook food, wash and dried underwear, or is located in a stuffy, unprofitable ward, then conditions that violate conditions normal development Its chest and lungs.
To strengthen the health of the child and the good development of the respiratory authorities, prevent the disease of the respiratory tract, it is necessary that the child is for a long time in the fresh air in winter and summer. Especially useful moving air games, sports and exercise.
An extremely important role in strengthening the health of children is to export them for the city, where it is possible to organize the stay of children in the air for a whole day.
Premises in which children are, it is necessary to carefully ventilate. In winter, opening or framoufs should be opened several times a day at the established order. In a room with central heating in the presence of fraamug, ventilation can be carried out very often, without cooling it. In the warm season, the window must be opened around the clock.
The respiratory tract is divided into three departments: Upper (nose, throat), medium (larynx, trachea, bronchi), lower (bronchioles, alveoli). By the time of the birth of the child, their morphological structure is still imperfect, with which the functional features of breathing are connected. F. evrization of respiratory organs ends average to 7 years of ageand in the future only their size increase. All respiratory tract in children have significantly smaller sizes and a narrower lumen than adults. The mucous membrane is thinner, gentle, is easily damaged. The glands are not developed enough, the products of the IGA and Surfactant are insignificant. The submucosal layer is loose, contains a slight amount of elastic and connecting elements, many vascularized. The cartilage frame of the respiratory tract is soft and pure. This contributes to a decrease barrier function The mucous membrane, easier penetration of infectious and atopic agents in the bloodstream, the occurrence of prerequisites for narrowing the respiratory tract due to edema.
Another feature of the respiratory authorities in children is in young children have small sizes. The nasal moves are narrow, thick sinks (the lower develops up to 4 years of age), therefore even minor hyperemia and swelling of the mucous membrane predetermine the obstruction of the nasal moves, cause shortness of breath, complicate sucking. With the apparent sinuses, only Gaimorov are formed by the time of birth (up to 7 years of life). ETMOIDAL, sphenoidal and two frontal sinuses finish their development until age 12, 15 and 20 years, respectively.
The weasting duct is short, located close to the corner of the eye, the valves are underdeveloped, so the infection easily penetrates the nose into the conjunctival bag.
The throat is relatively wide and small. Eustachiev (auditory) pipes connecting the nasopharynk and eardrum, short, wide, straight and arranged horizontally, which facilitates the penetration of infection from the nose into the middle ear. A lymphoid ring Waldeer-Pirogov is located in the throat, which consists of 6 almonds: 2 pacular, 2 pipes, 1 nasopharynk and 1 language. When surveying the o'clock, the term "ZEV" is used. Zev is an anatomical education, surrounded by the bottom of the root of the tongue, on the sides of the Sky almonds and brackets, at the top - soft sky and the tongue, behind - back wall Rotoglotka, front - oral cavity.
The nastestrian in newborns is relatively short and wide, it may be the cause of the functional narrowing of the entrance to the larynx and the occurrence of stridorous breathing.
Lanes in children are located above and longer than in adults, has a funnel-shaped shape with a clear narrowing in the field of refrosion space (in a newborn 4 mm), which gradually expands (at 14 years of age to 1 cm). The voice slot is narrow, the muscles are easily tired. Voice ligaments thick, short, mucous membrane is very gentle, loose, significantly vascularized, rich lymphoid tissue, easily leads to an edema of a subtle shell respiratory infection and the occurrence of cereal syndrome.
Fucking relatively longer length and width, funnel-shaped, contains 15-20 cartilaginous rings, very mobile. The walls of the trachea are soft, easily fall. The mucous membrane is tender, dry, well vascularized.
By the time of birth, formed. The size of the bronchi is intensively increasing at the 1st year of life and in the adolescence. They also form cartilaginous semiring, which, in early childhood, do not have closure plates connected by a fibrous membrane. Crying bronchi is very elastic, soft, easily shifted. Bronchin in children is relatively wide, the right main armor is almost a direct continuation of the trachea, so it is often foreign objects that are often outlined. For the smallest bronchi, absolute narrow is characteristic than the occurrence of obstructive syndrome is in young children. The mucous membrane of large bronchi is covered with a flickering camber epithelium, which performs the function of cleansing the bronchi (mucocyllure clearance). The incompleness of the myelination of the wandering nerve and the underdevelopment of the respiratory muscles contributes to the absence of a cough reflex in young children or a very weak coughing. The mucus accumulated in small bronchops is easily clogging and leads to the emergence of atelectasis and infection of the lung tissue.
Light in childrenAs in adults, have a segmental structure. Segments are separated by subtle connecting partitions. The main structural unit of light - acinus, but its terminal bronchiols ends not with a brush Alveol, as in adults, and a bag (Sacculus), with the "lace" edges of which are gradually formed by new alveoli, the number of which in newborns is 3 times less than in adults. With age, the diameter of each alveoli increases with age. In parallel, the life capacity of the lungs is growing. The interstitial fabric of light loose, rich in vessels, fiber, contains few connective and elastic fibers. In this regard, the pulmonary fabric in children of the first years of life is more saturated with blood, less air-capable. The underdevelopment of the elastic frame leads to the emergence of emphysema and atelectasis. The tendency to the atelectasis also occurs as a result of a shortage of a surfactant - a film that regulates the surface alveolar tension and stabilizes the volume of terminal air vessels, i.e. Alveol. Synthesizes surfactant alveolocyte II type II and appears in a fetus weighing at least 500-1000. The smaller the gestational age of the child, the greater the shortage of the surfactant. It is the deficiency of a surfactant for the basis of insufficient light disappearances in premature babies and occurrence respiratory Distress Syndrome.
Basic functional physiological features Breath organs in children are such. Breathing in children frequent (which compensates for a small breathing volume) and superficial. The frequency is higher than younger child (physiological shortness of breath). The newborn breathes 40-50 times in 1 min, a child aged 1 year - 35-30 times in 1 min, 3 years - 30-26 times in 1 min, 7 years - 20-25 times in 1 min, at 12 years - 18-20 times in 1 min, adults - 12-14 times in 1 min. The acceleration or slowing down of breathing is stated with the respiratory frequency deviations from averages by 30-40% or more. Newborn breathing is nehydramine with short stops (apnea). The diaphragmal type of breathing prevails, from 1-2 years of age, it is mixed, from 7-8-year-old - in girls - breast, in boys - abdominal. The respiratory volume of the lungs are the less than the younger child. A minute volume of breathing also increases with age. However, this indicator relative to the body weight in newborns is 2-3 times more than in adults. The life capacity of the lungs in children is significantly lower than adults. Gas exchange in children is more intense due to rich vascularization of the lungs, high blood circulation rate, high diffusion opportunities.