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},
"code": "J81",
"name": "Легочный отек",
"icd_name": "Легочный отек",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "j81_legochnyy_otek",
"lead": "патологическое состояние, при котором жидкость начинает скапливаться в альвеолах",
"description": "<p><span id=\"docs-internal-guid-c8f98be1-7fff-93ba-2f4c-a817793f1295\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Отек легких определяется как жизнеугрожающее состояние, для которого характерен процесс накопления внесосудистой жидкости в легких. </span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К основным причинам развития кардиогенного отека легких относятся:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">инфаркт миокарда с подъемом сегмента ST электрокардиограммы;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">гипертонический криз;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пароксизм мерцательной аритмии (эпизод, длящийся от 30 секунд до семи дней, проходит самостоятельно или при помощи лечения).</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">недостаточность митрального клапана (отрыв хорды сосочковой мышцы).</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные факторы риска кардиогенного отека легких:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">постинфарктный и атеросклеротический кардиосклероз с систолической сердечной недостаточностью;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">диастолическая дисфункция миокарда у пожилых больных;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">систолическая и диастолическая дисфункция миокарда у больных с кардимиопатией или миокардитом;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">постоянная форма мерцательной аритмии;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">врожденные и приобретенные пороки левых отделов сердца;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">поражения клапанного аппарата, особенно митрального клапана, вследствие ревмокардита, инфекционного эндокардита, атеросклероза.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Альвеолы — это структурные элементы легких, в которых происходит газообмен. Обычно они заполнены воздухом. Когда в альвеолах накапливается жидкость, нарушаются процессы нормального газообмена. По различным причинам сердце не перекачивает кровь из легких. В результате кровь накапливается в кровеносных сосудах легких, а затем просачивается в просвет альвеол. Появляются признаки отека легких.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врач диагностирует состояние на основании анамнеза и типичных изменений, наблюдаемых во время обследования. При осмотре пациента с отеком легких врач слышит типичные аускультативные изменения. Показатели тонометра определяют высокое или слишком низкое АД. При пальпации определяется отек нижних конечностей (у людей с обострением хронической сердечной недостаточности).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инструментальная диагностика отека легких:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентген органов грудной клетки;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭКГ;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">эхокардиография сердца;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">лабораторные анализы крови;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови на кислород и углекислый газ.</span></li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На первом месте при лечении отека легких стоит неотложная медицинская помощь. Требуется немедленное выполнение интенсивного лечения. Пациенту назначают кислород с высокой скоростью потока и внутривенно вводят диуретики. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В зависимости от значений АД назначают соответствующие препараты для его стабилизации. Иногда, несмотря на прием лекарств, состояние пациента не улучшается и из-за недостаточной оксигенации крови. В этом случае при лечении отека легких необходимы интубация (размещение пластиковой трубки в трахее пациента для обеспечения проходимости дыхательных путей) и временная поддержка дыхания с помощью аппарата ИВЛ.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основная профилактика отека легких заключается в недопущении данного состояния путем лечения провоцирующего заболевания. Необходимы регулярный прием прописанных препаратов, регулярное измерение АД и его стабилизация при скачках. Снижение массы тела имеет первоочередное значение. Постоянное посещение врача поможет избежать тяжелого состояния.</span></p>",
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"etiology": "<p>Существует три группы причин аффективных расстройств: </p>\r\n<ol>\r\n<li>Биологические причины, связанные с обменом веществ в головном мозге. </li>\r\n<li>Генетические. О высокой вероятности того, что в основе этой патологии лежат генные мутации, говорит то, что примерно у половины больных биполярным синдромом, хотя бы один родитель страдает расстройством настроения. </li>\r\n<li>Психосоциальные факторы. </li>\r\n</ol>",
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"diagnostics": "<p>Диагностика аффективных расстройств проводится психиатром. Она начинается с тщательного сбора анамнеза. Для углубленного изучения особенностей психической деятельности может быть назначено медико-психологическое обследование. Аффективная симптоматика может наблюдаться на фоне заболеваний: эндокринной системы (адреногенитального синдрома, гипотиреоза, тиреотоксикоза); нервной системы (эпилепсии, рассеянного склероза, опухолей головного мозга); психических расстройств (шизофрении, расстройств личности, деменции).</p>",
"treatment": "<p>При лечении аффективных расстройств используются нормотимики, антипсихотики и антидепрессанты. </p>\r\n<p>Нормотимические препараты обладают антиманиакальными свойствами и способны значительно смягчать выраженность очередной аффективной фазы или предотвращать её наступление. </p>\r\n<p>Антипсихотические препараты используются для купирования маниакальных состояний, состояний с психомоторным возбуждением, а также для лечения маний и депрессий с психотическими признаками (в виде галлюцинаций и бреда). </p>",
"prevention": "<p>Профилактика аффективных расстройств состоит из таких правил: </p>\r\n<ul>\r\n<li>отказ от вредных привычек; </li>\r\n<li>доверительные отношения в семье, особенно между родителями и детьми; </li>\r\n<li>прием лекарств, включающих нейромедиаторы — поможет избежать развития такой проблемы, как сезонное аффективное расстройство, но все медикаменты должны быть выписаны клиницистом; </li>\r\n<li>раннее выявление и комплексное лечение заболеваний, которые могут вызвать коморбидные нарушения; </li>\r\n<li>регулярное прохождение полного профилактического осмотра в медицинском учреждении, в том числе с посещением психиатра — даст возможность на ранних стадиях выявить органическое аффективное расстройство.</li>\r\n</ul>",
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},
"code": "A69.2",
"name": "Болезнь Лайма",
"icd_name": "Болезнь Лайма",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"6",
"7",
"10"
],
"periodicity": 1,
"slug": "a69.2_bolezn_layma",
"lead": "инфекционное заболевание, вызываемое бактериями рода Borrelia, переносимое иксодовыми клещами",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Болезнь Лайма — это природно-очаговое заболевание, передающееся клещами. Оно характеризуется поражением кожи, суставов, нервной и сердечно-сосудистой систем и часто принимает хроническое, рецидивирующее течение.</span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Болезнь Лайма вызывается грамотрицательными спирохетами рода Borrelia трех видов: B. burgdorferi (доминирует в США), Borrelia garinii и Borrelia afzelii (преобладают в Европе и России). Боррелии попадают в организм человека преимущественно трансмиссивным путем, при укусах инфицированных клещей (пастбищных, лесных, таежных), принадлежащих к роду Ixodes. Возбудитель проникает в кровь со слюной клеща или его фекалиями (при расчесах мест укуса). Реже возможен алиментарный путь заражения (например, при употреблении сырого коровьего и козьего молока) либо трансплацентарная передача боррелий.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Резервуаром и источником распространения болезни Лайма служат домашние и дикие животные. Риск заражения болезнью Лайма возрастает в весенне-летний период (сезон активности клещей длится с апреля по октябрь). Факторами риска выступают посещения лесов и лесопарковых зон, а также длительное (более 12-24 часа) присутствие инфицированного клеща на коже. После перенесенной болезни Лайма вырабатывается нестойкий иммунитет; уже через несколько лет возможно повторное заражение клещевым боррелиозом.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вскоре после укуса клеща в месте его внедрения в эпидермис развивается комплекс воспалительно-аллергических реакций в виде мигрирующей кольцевидной эритемы. Из первичного очага с током лимфы и крови боррелии распространяются по организму, вызывая каскад иммунопатологических реакций в различных органах, преимущественно ЦНС, суставах, сердце.</span></p>",
"pathogenesis": "<p><span id=\"docs-internal-guid-09e97008-7fff-eb7c-b082-599276e38342\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Механизм заражения человека боррелиозом происходит через укус клеща. При укусе или же раздавливании клеща руками, когда его содержимое, часто в совокупности с боррелиями, попадает под кожу, в данном месте развивается аллергическо-воспалительная реакция, характеризующаяся эритемой, постепенно мигрирующей на соседние участки тела, а позже у человека проявляются признаки интоксикации организма.</span></span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На ранней стадии главным признаком заболевания является наличие эритемы в месте укуса клеща и гриппоподобное состояние. Для более точной диагностики, особенно когда болезнь приобретает устойчивый характер, выполняют следующие анализы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ПЦР-исследование;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">иммуноферментный анализ;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">анализ на реакцию иммунофлюоресценции;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">микроскопическое исследование.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дополнительно назначаются такие исследования:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">УЗИ пораженных органов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ЭКГ;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">рентгенологическое исследование суставов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">люмбальная пункция;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ЭЭГ;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">биопсия кожи;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">пункция суставов.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">На ранних стадиях серологические исследования непоказательны, потому что в кровотоке либо присутствует незначительное количество боррелий, либо они отсутствуют вообще. Повторное исследование рекомендуется проводить через 20–30 дней. При этом возможны ложные результаты на фоне сифилиса, тифа, инфекционного мононуклеоза, ревматических заболеваний.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение болезни Лайма проводится антибиотиками. Чем раньше будет начата терапия, тем успешнее она будет – на ранней стадии есть больше шансов на исцеление. Антибиотическая терапия может положительно влиять на течение заболевания и предотвращать осложнения.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выбор препарата зависит от стадии прогрессирования заболевания:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #092148; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">I стадия (при лимфоцитоме, блуждающей эритеме): доксициклин, амоксициллин, цефуроксим; продолжительность около 14 дней.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #092148; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">II стадия (при остром нейроборрелиозе): цефтриаксон, цефотаксим, доксициклин, пенициллин; продолжительность около 14 дней.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #092148; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">III стадия (при хроническом нейроборрелиозе): цефтриаксон, цефотаксим, доксициклин; продолжительность около 14-28 дней.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #092148; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Болезнь Герксгеймера: доксициклин, амоксициллин, цефуроксим; продолжительность около 21 дня.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #092148; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кардит (воспалительное заболевание сердца): цефтриаксон, цефотаксим, доксициклин, пенициллин G; продолжительность около 14 дней.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #092148; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Артрит (воспаление суставов): доксициклин, амоксициллин, цефуроксим; продолжительность около 28 дней.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Дети в возрасте до 8 лет не лечатся доксициклином, т. к. нарушается образование эмали. При беременности и в период лактации следует принимать амоксициллин. Те, кто когда-то болел болезнью Лайма и был вылечен, не застрахованы от повторного инфицирования.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика болезни Лайма подразумевает под собой соблюдение правил безопасности по недопущению укуса клещом. Других превентивных мер по недопущению появления и развития болезни Лайма, в том числе вакцинирование на сегодняшний день не существует.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Клещи могут передавать несколько типов бактерий, что может сделать симптомы очень разнообразными. Для болезни Лайма характерны очень быстро меняющиеся жалобы, которые часто кажутся несвязанными.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптомы болезни Лайма на ранней стадии:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Мигрирующая эритема. Первые признаки инфекции часто проявляются через 1-2 недели после укуса клеща в виде болезненного покраснения. Кольцеобразное покраснение постепенно мигрирует наружу. Если мигрирующий румянец не лечить, то в 78% случаев возникают более поздние симптомы болезни.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Симптомами гриппа (характерны для второй стадии прогрессирования болезни). Появляется мышечная и головная боль, боль в суставах, усталость, слегка повышенная температура и ночные поты.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Боль в нервах, паралич (у детей, особенно лицевых нервов) или нарушения чувствительности. Может развиться воспаление мозговой оболочки.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кроме того, сердечная аритмия, вызванная инфекцией, и воспаление сердечной мышцы очень редко являются одними из признаков болезни Лайма. Если инфекция остается незамеченной и, следовательно, не лечится, во многих случаях ставятся неправильные диагнозы, например ревматизм. Это может быть прогрессирующее воспаление суставов (артрит Лайма).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Незамеченная болезнь Лайма на третьей стадии переходит в болезнь Герксгеймера: кожа на внутренних сторонах рук и ног становится тонкой и обесцвечивается. Это редко может привести к онемению и параличу в руках и ногах (периферические невропатии) и хроническому нейроборрелиозу, который можно спутать с симптомами рассеянного склероза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Другие неспецифические симптомы включают усталость, истощение, головные и мышечные боли. Они часто ошибочно интерпретируются как депрессия. У взрослых относительно редко развиваются неврологические поздние последствия. У детей чаще возникает воспаление мозговой оболочки или паралич лица.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инкубационный период (время между заражением и вспышкой) и появление симптомов после укуса клеща могут быть самыми разными. Стадия I может тянуться от нескольких дней до нескольких недель, стадия II – от нескольких недель до нескольких месяцев, а стадия III — от нескольких месяцев до нескольких лет.</span></p>",
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"lead": "Выделения из глаз - появление различного по характеру отделяемого из конъюнктивального мешка или непосредственно со слизистой оболочки глазного яблока. В целом появление выделений из глаз является защитной реакцией организма: с их помощью глаза очищаются от пыли, микроорганизмов, аллергенов, мелких инородных частиц и пр. Сами по себе глазные выделения не опасны, однако в некоторых случаях они могут свидетельствовать о более серьезной патологии глаз, требующей активного лечения.Основными причинами появления глазных выделений являются:\r\n\r\nиндивидуальная аллергическая реакция\r\nвоспаление слизистой оболочки глаза (конъюнктивит) или век (блефарит)\r\nнекоторые процессы, не связанные с инфекцией (например, синдром сухого глаза) \r\nВ зависимости от причины, характер выделений из глаз бывает различным. Так, бактериальное или вирусное воспаление глаз обычно сопровождается появлением обильного, вязкого отделяемого, нередко имеющего вид мутной слизи или корочек в уголках глаз. Указанные симптомы требуют немедленного обращения за квалифицированной медицинской помощью, поскольку без лечения конъюнктивит прогрессирует, и состояние больного стремительно ухудшается. Следует иметь в виду, что конъюнктивит нередко заразен для окружающих больного людей, особенно восприимчивы к инфекции дети. Инфекция передается через пользование общими полотенцами, подушками, при посещении бассейна. В то же время, правильно назначенное лечение быстро ликвидирует симптомы воспаления глаз.\r\n\r\nВыделения из глаз аллергического характера обильны и могут напоминать слезотечение. Помимо этого, больных беспокоит зуд, а также отек и выраженное покраснение слизистой оболочки глаз. При применении антигистаминных препаратов (в виде таблеток или глазных капель), а также в случае прекращения контакта с аллергеном подобные выделения из глаз быстро исчезают. \r\n\r\nВоспаление век (блефарит) также сопровождается появлением отделяемого из глаз. Среди причин, которые могут вызвать развитие блефарита, следует упомянуть инфекции (как следствие нарушения гигиены, на фоне ослабления иммунитета, при избыточной продукции кожного жира), заражение демодексом. Нередко выделения из глаз при блефарите имеют вид сухих корочек или чешуек, расположенных по краям век, сами веки при этом могут быть отечными. Для исключения заражения демодексом необходимо будет пройти специальное обследование. Блефарит – не самое простое в плане лечения заболевание глаз, оно требует длительного целенаправленного комплексного лечения. При отсутствии адекватной терапии блефарит может привести к ухудшению зрения и деформации век. \r\n\r\nКакой бы ни была причина появления выделений из глаз, следует обязательно обратиться к врачу для обследования и назначения соответствующего лечения. Самолечение очень часто может быть не только неэффективным, но и привести к ухудшению состояния больного.\r\n\r\nВрачи нашей клиники проведут тщательное обследование для выявления причин появления выделений из глаз и назначат лечение, которое поможет быстро улучшить состояние пациента. Помните: только правильно подобранное лечение позволяет полностью избавиться от выделений из глаз и избежать появления осложнений.",
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},
"code": "A74.0+",
"name": "Хламидийный конъюнктивит (H13.1*)",
"icd_name": "Хламидийный конъюнктивит (H13.1*)",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"2",
"5",
"8"
],
"periodicity": 1,
"slug": "a74.0+_hlamidiynyy_konyunktivit_h13_1",
"lead": "инфекционное воспалительное заболевание конъюнктивы (слизистой оболочки глаза), вызванное микроорганизмами хламидиями",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В большинстве случаев хламидийный конъюнктивит возникает на фоне хламидиоза мочеполового тракта: по статистике, около 50% пациентов с офтальмохламидиозом имеют также урогенитальную форму инфекции. У взрослых глазной хламидиоз развивается в результате заноса возбудителя в конъюнктивальный мешок с половых органов через загрязненные выделениями предметы гигиены и руки. При этом носитель мочеполового хламидиоза может инфицировать не только свой орган зрения, но и глаза своего здорового партнера. Нередко хламидийный конъюнктивит является следствием орально-генитальных половых контактов с инфицированным партнером.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Известны случаи профессионального заражения хламидийным конъюнктивитом среди акушеров-гинекологов, венерологов, урологов-андрологов, офтальмологов, обследующих больных с различными формами хламидиоза.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заражение хламидийным конъюнктивитом возможно через воду при посещении публичных бассейнов и бань. Такая форма заболевания получила название «бассейнового» или «банного» конъюнктивита и зачастую может принимать характер эпидемических вспышек.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хламидийный конъюнктивит у новорожденных может развиваться вследствие внутриутробного (трансплацентарного) заражения или инфицирования глаз во время родов от больной хламидиозом матери. Хламидийная глазная инфекция встречается у 5-10% новорожденных.</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заражение определяют посредством следующих методик:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ИФА. Иммунологический метод выявляет возбудитель патологического процесса, установить фазу протекания. К недостатку ИФА относят то, что анализ достоверен только спустя пару недель после инфицирования.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ПЦР (полимеразная цепная реакция) назначается для выявления небольшого числа активных бактерий. Методика дает 100% результат.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Метод иммунофлуоресценции относится к наиболее достоверным, чтобы выявить провокатора заболевания. При заборе слизи конъюнктиву окрашивают особыми специфическими антителами, что позволяет обнаружить патогенные микроорганизмы.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Использование щелевой лампы (биомикроскопия глаза) способствует определению выраженности и степени патологических нарушений, наличие инфильтратов, их распространение.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Посев на xлaмидии обнаруживает чувствительность патогенной флоры к антибиотикам. Это исследование офтальмологи признают второстепенной диагностикой.</span></li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Препаратами этиотропного действия при хламидийном конъюнктивите являются антибиотики: фторхинолоны, макролиды, тетрациклины. Местная терапия включает инстилляции антибактериальных глазных капель (р-р офлоксацина, р-р ципрофлоксацина), мазевые аппликации за веки (тетрациклиновая мазь, эритромициновая мазь), применение противовоспалительных капель (р-р индометацина, р-р дексаметазона).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Системное лечение хламидиоза проводится по схеме терапии ИППП. Критериями излеченности хламидийного конъюнктивита служат: регрессия клинической симптоматики, отрицательные данные лабораторных тестов, проведенных через 2-4 недели после окончания курса лечения и трех последующих анализов, взятых с интервалом в один месяц.</span></p>",
"prevention": "<p> </p>\r\n<ul>\r\n<li><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap; font-family: Verdana;\">Необходимо отказаться от незащищенных пoлoвых актов, чтобы предупредить попадание xлaмидий из пoлoвых органов на слизистую глаза.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Соблюдать все общеизвестные правила при посещении общественных бань и бассейнов – при нырянии обязательно защищать глаза специальными очками.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Не пользоваться чужими предметами личной гигиены, чужими косметическими средствами, линзами, полотенцами и так далее.</span></li>\r\n</ul>",
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