DYNAMICS OF HEART RATE VARIABILITY IN CHILDREN OPERATED FOR VENTRICULAR SEPTAL DEFECT IN THE PROCESS OF SANATORIAL SPA TREATMENT
The purpose of the study is to study the effectiveness of medical rehabilitation in children operated on for a ventricular septal defect, based on the dynamics of heart rate variability indicators. Material and methods of research. Heart rate variability was evaluated in 75 children operated on for ventricular septal defect. The control group (CG) consisted of 30 healthy children. The effectiveness of medical rehabilitation was assessed by the dynamics of heart rate variability indicators. Children of the 1st group (20 people) took the cardiometabolic drug Elkar at a dose of 30 mg/kg/day for 1 month. With children of the 2nd group (20 people) for 3 months, Nordic walking classes were held (NW). In addition, children of the 2nd group received the drug Elkar for 1 month (30 mg/kg). Results. According to the time analysis of heart rate variability, operated children had significantly lower values of SDNN 82 [69;103] (p<0.001), SDANNi 50.5 [39;87] (p<0.05), SDNNi 69.5 [54;80] (p<0.05), rMSSD 50.5 [39;87] (p<0.05), pNN50 % 18.4 [6.7;28.3] (p<0.05) lower power in the high - frequency range of the spectrum (p<0.001) and a change in the vegetative balance towards the predominance of the sympathetic division of the autonomic nervous system (LF/HF=3.16, p=0.009) than in the control group. After the treatment, there was no reliable HRV dynamics in children who received Elcar. There was a significant difference between SDNN and rMSSD with KG. In the second group, there was a significant increase in HRV according to SDNN data by 37.7 % (p<0.01), SDANNi by 45.6 % (p<0.05), rMSSD by 6.5 % (p<0.05), pNN50 % by 32.7 % (p<0.05). The difference in indicators with CG is leveled. Conclusions. In children operated on for VSD, there was a decrease in the parameters of the time analysis of HRV in comparison with healthy peers (p<0.05). The combined use of Nordic walking and Elkar have a normalizing effect on the HRV, causing a decrease in the tension of the Central circuit of heart rate regulation, significantly increasing the parasympathetic effect on the heart rate.