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},
"code": "J04.2",
"name": "Острый ларинготрахеит",
"icd_name": "Острый ларинготрахеит",
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"age_min": 15,
"age_max": 100,
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"slug": "j04.2_ostryy_laringotraheit",
"lead": "воспаление слизистой оболочки гортани и трахеи",
"description": "<p>Ларинготрахеит — это воспалительное поражение слизистых оболочек гортани и трахеи, которое приводит к появлению отека, спазма верхних дыхательных путей, нарушений голоса и грубого «лающего» кашля. </p>\r\n<p> </p>",
"etiology": "<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;\">При остром ларинготрахеите отмечается выраженная гиперемия слизистой ярко-красного оттенка, скопление в просвете гортани и трахеи большого количества гноевидного экссудата, утолщение слизистой за счет ее пропитывания экссудативной жидкостью. В начальном периоде ларинготрахеита экссудат имеет жидкую консистенцию, по мере развития заболевания он сгущается, на слизистой появляются фибринозные пленки. В случае стрепто- или стафилококковой этиологии ларинготрахеита наблюдается образование желто-зеленых корок, заполняющих просвет дыхательных путей.</span></p>",
"pathogenesis": "<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;\">Ларинготрахеит диагностируется на основании жалоб пациента и данных его анамнеза; результатов осмотра, перкуссии и аускультации легких; результатов ларинготрахеоскопии, бактериологических исследований, рентгена и КТ диагностики.</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;\">Диагностировать ларинготрахеит и определить его форму помогает микроларингоскопия, позволяющая при необходимости осуществить забор биопсийного материала. Выявление возбудителя ларинготрахеита проводится путем бактериологического посева мокроты и мазков из зева и носа, микроскопии мокроты и анализа мокроты на КУБ (кислородоустойчивые бактерии), ИФА, РИФ и ПЦР-исследований. При обнаружении туберкулезной этиологии ларинготрахеита необходима консультация фтизиатра. В случаях, когда ларинготрахеит является проявлением сифилиса, пациент обследуется отоларингологом совместно с венерологом.</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;\">В большинстве случаев терапия острого ларинготрахеита осуществляется в амбулаторных условиях. Случаи ложного крупа могут требовать госпитализации в стационар. Пациенту с острым ларинготрахеитом рекомендован прием большого количества теплой жидкости (чай, компот, кисель). В помещении, где находится больной должен быть достаточно увлажненный теплый воздух.</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;\">Этиотропная терапия вирусного ларинготрахеита заключается в назначении противовирусных препаратов (интерферон, ремантадин, умифеновир, протефлазид). При бактериальном и смешанном ларинготрахеите показана системная антибиотикотерапия препаратами широкого спектра действия (цефуроксим, цефтриоксон, амоксициллин, азитромицин). Симптоматическая терапия ларинготрахеита состоит в применении противокашлевых, антигистаминных, муколитических и жаропонижающих препаратов. Хороший эффект у пациентов с ларинготрахеитом оказывают масляные и щелочные ингаляции, электрофорез на область гортани и трахеи.</span></p>",
"treatment": "<p> </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: 8pt; font-family: Verdana; color: #333333; 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;\">Мероприятия, направленные на укрепление иммунитета.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; 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;\">Отказ от курения (в том числе электронные сигареты и кальян).</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; 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;\">Соблюдение голосового режима.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; 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;\">Лечение неинфекционной патологии ЛОР-органов (полипы, аденоиды, искривление носовой перегородки).</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; 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;\">Использование средств индивидуальной защиты (медицинские маски) при сезонных вспышках заболеваний.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #333333; 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;\">Консультация врача-профпатолога (при наличии профессиональной вредности).</span></p>\r\n</li>\r\n</ul>",
"prevention": "<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;\">Обычно симптомы ларинготрахеита появляются на фоне уже протекающей вирусной инфекции дыхательных путей: лихорадки, заложенности носа и насморка, болей в горле, дискомфортных ощущений при глотании. Иногда они возникают уже после снижения температуры.</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;\">При остром воспалении у больного появляются следующие признаки ларинготрахеита:</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;\">боль за грудиной во время кашля;</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;\">сухой кашель (иногда «лающий») с более выраженными приступами утром и ночью, после глубокого вдоха;</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;\">дискомфортные ощущения в области гортани (сухость, жжение, щекотание, присутствие инородного тела);</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;\">охриплость и осиплость голоса (иногда до его полного пропадания);</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;\">признаки интоксикации: повышение температуры до 38-39 °С, общая слабость, головная боль и пр.</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;\">Со временем кашель становится влажным и сопровождается отделением небольшого количества вязкой мокроты слизистого характера. По мере прогрессирования воспаления она становится более обильной и жидкой, может содержать примеси гноя. В тяжелых случаях развивается приступ ложного крупа.</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;\">У больных появляются безболезненные и увеличенные лимфоузлы в области шейной группы. При прослушивании выявляется шумное дыхание. В зоне раздвоения трахеи иногда можно услышать сухие и влажные хрипы.</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;\">Острый ларинготрахеит длится несколько недель и заканчивается полным выздоровлением. При неблагоприятных сопутствующих факторах он может принять затяжное течение и перейти в хронический ларинготрахеит, который характеризуется длительным течением с периодами ремиссии и обострениями, чаще возникающими в осенне-зимний период.</span></p>",
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},
"code": "J04.0",
"name": "Острый ларингит",
"icd_name": "Острый ларингит",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0",
"4"
],
"periodicity": 1,
"slug": "j04.0_ostryy_laringit",
"lead": "воспалительный процесс в области слизистой оболочки гортани и связок, имеющий острое или хроническое течение",
"description": "<p><span id=\"docs-internal-guid-08095f19-7fff-3175-cdfc-842e4de89f35\"><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;\">Острый ларингит – это воспалительный процесс в области слизистой оболочки гортани и связок.</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;\">Острые ларингиты обычно развиваются не как самостоятельная патология, а как одно из проявлений различных инфекций. Признаки острого ларингита типичны для ряда вирусных заболеваний:</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;\">грипп;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">коклюш;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">корь;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">аденовирус;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">некоторые другие возбудители ОРВИ.</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;\">Иногда ларингиты возникают как проявление скарлатины, дифтерии – микробных инфекций.</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;\">Факторы риска для развития острых ларингитов – это переохлаждение как в области шеи, так и системного характера, пыльный воздух, гарь, курение, прием алкоголя, рефлюкс содержимого желудка в пищевод и глотку. Ларингиты чаще возникают при наличии атрофии мышц, изменений в голосовых связках, сухости слизистых, типичных для преклонного возраста.</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;\">Выделяют две формы ларингитов:</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;\">катаральный с поражением слизистого и подслизистого слоя, частично мышц гортани;</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;\">флегмонозный с гнойным воспалением в области слизистой, мышц и связочного аппарата гортани, частично с поражением хрящей.</span></li>\r\n</ul>\r\n<p> </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;\">Патогенез острого ларинготрахеита как синдрома ОРВИ связан с воздействием вирусов на слизистую оболочку дыхательных путей, в результате возникает ее отек и инфильтрация, спазм мышц гортани, скопление густого слизистого или слизисто-гнойного экссудата в просвете дыхательных путей. Это самые важные три звена патогенеза приводят к обструкции просвета гортани. Отек и инфильтрация слизистой оболочки подголосового отдела гортани приводят к его сужению. </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;\">С учетом причины заболевания и имеющихся симптомов врач может назначить следующие виды обследования:</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;\">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;\">исследование мокроты и смывов верхних дыхательных путей;</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;\">ларингоскопию;</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;\">эндоскопическое исследование</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\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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 ларингита направлено на устранение причины, вызвавшей ларингит.</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;\">Важно в течение недели соблюдать речевой покой (не напрягать голосовые связки), исключить курение, употребление алкогольных напитков, острых блюд. Также не следует находиться в прокуренном помещении, на холодном воздухе, на улице во время смога.</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;\">Назначаются паровые ингаляции при ларингите (15-20 минут через каждые 3 часа), полоскание горла отварами трав, согревающие компрессы на область гортани, горячие ножные ванночки.</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;\">Рекомендуется обильное теплое щелочное питье (молоко, боржоми).</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;\">Применяют противокашлевые препараты, а также физиотерапевтическое лечение (УВЧ, электрофорез на область гортани).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Антибиотики при ларингите следует принимать строго по назначению врача, если подтверждено бактериальное происхождение болезни.</span></p>",
"prevention": "<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;\">Основными методами профилактики острого ларингита являются: </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;\">своевременное лечение острых и хронических воспалительных процессов в горле;</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;\">бережное отношение к голосовому аппарату;</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;\">избегание резких перепадов температуры;</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;\">отказа от курения и алкоголя;</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;\">укрепление иммунитета.</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>",
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"code": "J00",
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"description": "Острый назофарингит - это ЛОР-заболевание, в основе которого лежит воспалительный процесс слизистой оболочки носоглотки, чаще всего инфекционного происхождения (вирусы, бактерии). ",
"etiology": "<p>Острый назофарингит имеет вирусную или, реже, бактериальную этиологию. </p>\r\n<p>В роли инфекционных агентов вирусной природы в основном выступают риновирусы, бактериальной природы - стрептококки, стафилококки, диплококки, пневмококки и другая микрофлора, обычно обнаруживаемая в носоглотке в непатогенной форме. </p>\r\n<p>Среди предрасполагающих факторов можно выделить следующие: </p>\r\n<ul>\r\n<li>ослабление иммунитета; </li>\r\n<li>переохлаждение; </li>\r\n<li>травмы слизистой носа; </li>\r\n<li>авитаминоз; </li>\r\n<li>тяжелые физические нагрузки; </li>\r\n<li>вдыхание задымленного, едкого воздуха. </li>\r\n</ul>",
"pathogenesis": "<p>Входными воротами инфекции служит слизистая оболочка носа и, возможно, верхних дыхательных путей. </p>\r\n<p>Их размножение реализуется в эпителиоцитах слизистой оболочки носа, что сопровождается разрушением клеток, развитием местной воспалительной реакции катарального характера с полнокровием и расширением сосудов, умеренной инфильтрацией, резким набуханием, отёчностью слизистой оболочки и обильной секрецией. </p>\r\n<p> </p>",
"diagnostics": "<p>Для постановки диагноза проводят анализ жалоб и сбор анамнеза. Необходимо грамотно провести объективный осмотр больного, особенно полости рта и глотки пациента. </p>\r\n<p>Выполняется общий анализ крови для оценки характера заболевания. </p>\r\n<p>При неясной картине заболевания проводят специальные инструментальные исследования: риноскопию и фарингоскопию. </p>\r\n<p>Риноскопия — информативный метод осмотра полости носа. </p>\r\n<p>Фарингоскопия — методика осмотра глотки при искусственном освещении с помощью шпателя и носоглоточного зеркала. Позволяет увидеть небные миндалины, язычок, заднюю стенку глотки. </p>\r\n<p>Для подбора эффективного лечения проводится микробиологическое исследование. Определяется характер возбудителя и наиболее эффективное антибактериальное средство. </p>\r\n<p> </p>",
"treatment": "<p>При повышенной температуре тела и нарушении общего состояния рекомендуется постельный режим, прием жаропонижающих средств. Больному необходимо обильное питье, особенно полезны для этого свежевыжатые разбавленные фруктовые соки, морсы, компоты, некрепкий чай с лимоном. </p>\r\n<p>Если заболевание вызвано бактериями, врач назначает антибиотики. Чаще всего, лекарственные препараты назначаются местно в виде капель или спрея. </p>\r\n<p>При нарушении носового дыхания применяют сосудосуживающие средства. Их длительное применение более недели приводит к пересыханию слизистой оболочки и еще более выраженному нарушению носового дыхания. </p>\r\n<p>Хорошие результаты дает применение физиотерапевтических процедур: кварц, УФО, УВЧ. </p>\r\n<p>Боли в горле облегчает полоскание отварами трав или растворами антисептиков. </p>",
"prevention": "<p>Комплекс профилактических мероприятий против назофарингита складывается из нескольких правил: </p>\r\n<ul>\r\n<li>Правильного и регулярного питания. Необходимо употреблять много овощей и фруктов, пить больше воды и принимать поливитамины. </li>\r\n<li>Соблюдать санитарные условия в доме, проветривать помещение, не допускать повышения влажности. </li>\r\n<li>Регулярно промывать носовую полость. </li>\r\n<li>Необходимо больше проводить времени на свежем воздухе. </li>\r\n<li>Соблюдать режим труда и отдыха, сна и бодрствования. </li>\r\n<li>Во время процветания болезни требуется избегать большого скопления народа.</li>\r\n</ul>",
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},
"code": "J06",
"name": "Острые инфекции верхних дыхательных путей",
"icd_name": "Острые инфекции верхних дыхательных путей множественной и неуточненной локализации",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
4,
5,
6,
9
],
"periodicity": 1,
"slug": "j06_ostrye_infekcii_verhnih_dyhatelnyh_putey",
"lead": "Группа заболеваний характеризующаяся вирусным поражением органов дыхания ",
"description": "ОРВИ - самые распространенные человеческие болезни - до 90% всех случаев инфекционных заболеваний. Ими болеют все - одни чаще, другие реже, но все. Зимой чаще (вирусы в это время намного активнее), летом - реже, но все равно болеют. ",
"etiology": "<p>Острую респираторную инфекцию (ОРВИ) помимо гриппа чаще вызывают представители 3-х семейств РНК-содержащих вирусов – парамиксовирусов (респираторно-синцитиальный вирус, метапневмовирус человека, вирусы парагриппа 1-4), коронавирусы и пикорнавирусы (риновирусы) и 2-х семейств ДНК-содержащих вирусов – аденовирусы (виды B, C, E), парвовирусы (бокавирус человека). Все вышеперечисленные вирусы, за исключением бокавируса человека, вызывают заболевания верхних и нижних дыхательных путей у всех возрастных групп, но наиболее тяжело протекают ОРВИ, вызванные респираторно-синцитиальным вирусом, метапневмовирусом, вирусами парагриппа и коронавирусами, у детей в возрасте до 5 лет, пожилых и у лиц с иммунодефицитом.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагностика ОРВИ не представляет особых трудностей в случае типичного течения заболевания. Для исключения возможных осложнений назначают флюорографию грудной клетки, общие анализы крови и мочи, если есть подозрения на бактериальную причину заболевания - может быть сделан посев, для определения возбудителя (бактерии). Иммунологические исследования для определения типа вируса, вызвавшего заболевание, имеют практическую ценность только при тяжелых формах заболеваний, серьезных затруднений в диагностике (и соответственно в лечении), в иных случаях эта ценность исключительно научная. Вирусную простуду можно спутать с начальной стадией гемофильной инфекции (спутать может даже врач, поскольку симптомы идентичны) и другими заболеваниями, поэтому при нарастании симптомов или при присоединение новых, более тяжелых симптомов, обратите на это внимание врача.</p>",
"treatment": "<p>На текущий день существует только симптоматическое лечение. Многие люди используют нерецептурные препараты, которые содержат антигистаминные средства, противоотечные, анальгетики или их комбинацию в качестве самостоятельного лечения простуды. Обзор 27 исследований с более чем 5000 участников показывает некоторую пользу в отношении общего восстановления и устранения симптомов. Сочетание антигистаминных и противоотечных средств является наиболее эффективным, но многие люди испытывают побочные эффекты, такие как <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>, <a href=\"/symptom/suhoy_rot/\" title=\"Перейти на страницу симптома Сухой рот \">сухость во рту</a>, <a href=\"/symptom/bessonnica/\" title=\"Перейти на страницу симптома Бессонница\">бессонница</a> и <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>. Нет никаких доказательств положительного эффекта у детей раннего возраста. Включенные испытания изучали очень разные популяции, процедуры и результаты, но в целом методологическое качество было приемлемым.</p>\r\n<p> </p>\r\n<p>Противовирусные препараты</p>\r\n<p>В подавляющем большинстве случаев (за исключением тяжелых форм болезни, особенно гриппа) применение противовирусных препаратов нецелесообразно. Это связано как с сомнительной эффективностью многих из них, так и с тем, что применение этой группы лекарств спустя 36 часов от появления первых признаков простуды не облегчает течение болезни и не ускоряет выздоровление.</p>\r\n<p>Отсутствие хорошей доказательной базы, демонстрирующей эффект против развития осложнений, соотносится с консервативными выводами FDA (US Food and Drug Administration – американская администрация по контролю за продуктами и лекарствами) относительно обоих препаратов. FDA одобрила лишь заявления об эффективности обоих препаратов для профилактики и лечения симптомов гриппа, но не в отношении других эффектов (включая блокировку передачи вируса от человека к человеку или предотвращение пневмонии). FDA описало общую эффективность обоих препаратов как «скромную».</p>\r\n<p>Эффективность других препаратов с точки зрения доказательной медицины не установлена. Так, нередко назначаемый препарат Арбидол по данным некоторым небольших исследований, обладает противовирусной активностью в отношении вируса гриппа, но масштабных испытаний его эффективности не проводилось.</p>\r\n<p>Препараты Римантадин (Ремантадин, Орвирем, Альгирем) и Амантадин (ПК-Мерц, Мидантан), по данным за 2011 год, <a href=\"/symptom/erektilnaya_disfunkciya/\" title=\"Перейти на страницу симптома Эректильная дисфункция\">не стоит</a> применять для лечения гриппа, поскольку устойчивость вирусов к ним высока. В то же время препарат эффективен у пациентов с аденовирусной инфекцией (при аденовирусном конъюнктивите).</p>\r\n<p>Оциллококцинум – гомеопатический препарат, который в последнее время стал набирать популярность у пациентов с простудными заболеваниями, и более того, даже рекомендован в России для применения с целью профилактики гриппа, с точки зрения доказательной медицины неэффективен.</p>\r\n<p> </p>\r\n<p>Жаропонижающие и противовоспалительные препараты</p>\r\n<p>Общее правило для всех инфекционных заболеваний: применять жаропонижающие препараты при повышении температуры выше 38,5 С. <a href=\"/symptom/erektilnaya_disfunkciya/\" title=\"Перейти на страницу симптома Эректильная дисфункция\">Не стоит</a> злоупотреблять жаропонижающими при небольшом повышении температуры, поскольку тем самым мы подавляем естественный защитный механизм.</p>\r\n<p> </p>\r\n<p>Витамины</p>\r\n<p>При ОРЗ показано применение витаминных комплексов (часто назначаются курсом в 1 месяц), а также аскорбиновой кислоты (витамина С) в дозе 1 г/сут. Доказано, что применение аскорбиновой кислоты позволяет облегчить течение простудных заболеваний.</p>\r\n<p> </p>\r\n<p>Отхаркивающие препараты</p>\r\n<p>Применяются только при непродуктивном кашле, когда отхождение мокроты затруднено.</p>\r\n<p> </p>\r\n<p>Препараты для улучшения носового дыхания</p>\r\n<p>Относятся к группе адреномиметиков. Оказывают сосудосуживающее действие на слизистую носа, тем самым уменьшая пропотевание жидкости из капилляров, а значит, и отделяемого из носа.</p>\r\n<p> </p>\r\n<p>Комбинированные противопростудные препараты</p>\r\n<p>Оказывают симптоматическое действие: уменьшают проявления заболевания, никак не влияя на длительность течения болезни и риск осложнений инфекции.</p>\r\n<ul>\r\n<li>Терафлю – содержит парацетмаол, фенилэфрин (сосудосуживающий препарат, используется для облегчения дыхания через нос) и хлорфенамин (антигистаминное — подавляющее <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> средство).</li>\r\n<li>Ринза – содержит те же компонетны, что Терафлю, и кофеин , оказывающий стимулирующее действие на нервную и сердечно-сосудистую систему.</li>\r\n<li>Антигриппин – содержит парацетамол, аскорбиновую кислоту и антигистаминное средство (подавляющее <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>).</li>\r\n<li>Колдакт – создан на основе хлорфенамина (антигистаминное) и фенилпропаноламина (сосудосуживающее), которые уменьшают отек слизистых носа и носовых пазух и <a href=\"/symptom/vypot/\" title=\"Перейти на страницу симптома Выпот\">отделяемое</a> из носа.</li>\r\n<li>Фервекс – содержит парацетамол, аскорбиновую кислоту и фенирамин (антигистаминное). Оказывает жаропонижающее, противовоспалительное действие.</li>\r\n</ul>\r\n<p> </p>\r\n<p>Диета и режим</p>\r\n<p>Во время болезни следует употреблять легкоусвояемую пищу. Поэтому нередко можно встретить рекомендации по применению растительно-молочной диеты.</p>\r\n<p>В период разгара болезни необходимо соблюдать постельный режим, отдыхать не менее 8 часов в сутки. Для борьбы с интоксикацией целесообразно обильное питье (2-3 литра жидкости в сутки)</p>",
"prevention": "<p>Мыть руки. Анализ 67 рандомизированных контролируемых исследований продемонстрировал, что мытье рук, самая обычная гигиеническая процедура, довольно эффективно спасает от того, чтобы подхватить вирус.</p>\r\n<p>Принимать пробиотики (препараты на основе полезных для здоровья микроорганизмов). Есть доказательства, что пробиотики могут предотвращать простуду, хотя точные комбинации и формы применения препаратов варьируют в разных работах.</p>",
"clinical_picture": "<p>Как бы ни назывался вирус, вызвавший простуду, в любом правильном (классическом) случае заболевания можно наблюдать общие признаки: сочетание так называемого «общеинфекционного» синдрома (<a href=\"/symptom/oznob/\" title=\"Перейти на страницу симптома Озноб\">озноб</a>, <a href=\"/symptom/bol_v_myshcah/\" title=\"Перейти на страницу симптома Боль в мышцах\">боль в мышцах</a>, <a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">повышение температуры</a> тела, <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/uvelichenie_limfaticheskih_uzlov/\" title=\"Перейти на страницу симптома Увеличение лимфатических узлов\">увеличение лимфатических узлов</a> на шее, под нижней челюстью, за ушами, на затылке) и поражения дыхательных путей. Имеют место также признаки отека слизистых – так называемые катаральные явления: заложенность и/или <a href=\"/symptom/vydeleniya_iz_vlagalischa/\" title=\"Перейти на страницу симптома Выделения из влагалища\">обильные выделения</a> из носа, <a href=\"/symptom/bol_v_gorle/\" title=\"Перейти на страницу симптома Боль в горле\">боль в горле</a>, резь в глазах, <a href=\"/symptom/slezotechenie/\" title=\"Перейти на страницу симптома Слезотечение\">слезотечение</a>, <a href=\"/symptom/kashel/\" title=\"Перейти на страницу симптома Кашель\">кашель</a>, который может быть сухим приступообразным, лающим; а может сопровождаться выделением мокроты (чаще всего светлой).</p>\r\n<p> </p>",
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},
"code": "J05",
"name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"icd_name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
2,
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],
"periodicity": 1,
"slug": "j05_ostryy_obstruktivnyy_laringit_krup_i_epiglottit",
"lead": "Нарушение здоровья, относящееся к группе острые респираторные инфекции верхних дыхательных путей",
"description": "Острый обструктивный ларингит (круп) - воспаление гортани и тканей подскладочного пространства с сужением просвета гортани. Ранее также использовался термин «стенозирующий ларинготрахеит» \r\n\r\nЭпиглоттит – это остро возникшее бактериальное воспаление надгортанника и окружающих тканей, которое может привести к быстрому жизнеугрожающему нарушению проходимости дыхательных путей. ",
"etiology": "<p>Наиболее часто причинно значимыми возбудителями острого обструктивного ларингита являются респираторные вирусы, причем до 80% случаев крупа обусловлено вирусом парагриппа. </p>\r\n<p>В числе прочих возбудителей болезни: вирусы гриппа А и В, аденовирусы, респираторно-синцитиальный вирус, риновирусы, энтеровирусы, бокавирус, коронавирус, метапневмовирус. В крайне редких случаях круп может быть обусловлен бактериальными возбудителями, например, микоплазмой пневмонии. </p>\r\n<p>Этиологическим фактором эпиглоттита в подавляющем большинстве случаев является гемофильная палочка типа b (>90%). В странах, где введена массовая иммунизация против гемофильной инфекции, у вакцинированных детей встречаются эпиглоттиты другой этиологии. В редких случаях эпиглоттит могут вызывать стрептококки, золотистый стафилококк, менингококк. </p>\r\n<p>Неинфекционные причины крупа и эпиглоттита: </p>\r\n<ul>\r\n<li>термические и химические повреждения вследствие приема горячей пищи или проглатывания препаратов бытовой химии; </li>\r\n<li>травмы, вызываемые слепым касанием пальца при попытке удалить инородное тело из глотки; </li>\r\n<li>отек Квинке; </li>\r\n<li>гемофагоцитарный лимфогистиоцитоз; </li>\r\n<li>острая лейкемия; раздражение при курении наркотиков (марихуана, крэк, кокаин); </li>\r\n<li>реакция на проводимую химиотерапию. </li>\r\n<li>лимфопролиферативные заболевания. </li>\r\n</ul>",
"pathogenesis": "<p>В основе механизма развития крупа лежит: </p>\r\n<ul>\r\n<li>Воспалительный отек с клеточной инфильтрацией голосовых связок и слизистой подскладочного пространства и трахеи и прилегающих тканей. </li>\r\n<li>Гиперсекреция слизистых желез, скопление в просвете дыхательных путей густой мокроты. </li>\r\n</ul>\r\n<p>Патогенез эпиглоттита </p>\r\n<p>При внедрении инфекции очень быстро развивается воспаление надгортанника и поддерживающей его черпаловидно-подгортанной складки. Надгортанник становится отечным и гиперемированным; его обычно твердая структура размягчается. Свисая и отклоняясь кзади, надгортанник закрывает вход в гортань, вызывая тяжелую обструкцию дыхательных путей. </p>\r\n<p>Выброс бактерий и их токсинов в кровь приводит к увеличению проницаемости микрососудов легкого, повышению гидростатического давления в малом круге кровообращения и скоплению жидкости в интерстициальном пространстве. Ухудшаются вентиляционно-перфузионные отношения, развиваются гипоксемия (снижение кислорода в крови), гиперкапния (повышение углекислого газа в крови), ацидоз (снижение рН крови). </p>",
"diagnostics": "<p>Диагноз обструктивного ларингита является клиническим и ставится, как правило, на основании анамнеза и симптомов осиплости голоса, лающего кашля, инспираторного стридора. </p>\r\n<p>Эпиглоттит диагностируется на основании характерных клинических признаков. </p>\r\n<p>Лабораторная диагностика включает общий анализ крови, определение уровня С-реактивного белка, при необходимости – уровень прокальцитонина (маркеры воспаления). </p>",
"treatment": "<p> Консервативное лечение крупа </p>\r\n<ul>\r\n<li>Согласно международному консенсусу, а также рекомендациям Всемирной организации здравоохранения, основу лечения острого обструктивного ларингита составляют ингаляционные и системные глюкокортикостероиды. </li>\r\n<li>При тяжелом крупе или отсутствии кортикостероидов возможно ингаляционное применение эпинефрина. </li>\r\n<li>При снижении сатурации крови кислородом ниже 92% показана оксигенотерапия. Стеноз гортани 3-й степени требует неотложной интубации. </li>\r\n</ul>\r\n<p> Консервативное лечение эпиглоттита </p>\r\n<ul>\r\n<li>Не рекомендуется укладывать ребенка, пациент должен находиться в положении сидя, в т.ч., при транспортировке в стационар. </li>\r\n<li>Рекомендована ранняя интубация для профилактики внезапной асфиксии (удушья). </li>\r\n<li>При эпиглоттите категорически не рекомендуется ингалировать, осуществлять седацию, провоцировать беспокойство. </li>\r\n<li>В обязательном порядке рекомендована антибактериальная терапия. Антибактериальная терапия должна быть продолжена до 7 – 10 дней. Начинают лечение обычно с парентерального (внутривенного) введения антибактериального препарата, после купирования лихорадки и нормализации состояния продолжают лечение пероральными антибиотиками. </li>\r\n<li>При асфиксии и невозможности проведения интубации проводится трахеотомия. </li>\r\n</ul>",
"prevention": "<p>Рекомендуется неспецифическая профилактика респираторных вирусных инфекций. </p>\r\n<p>В случае рецидивирования симптомов крупа у детей с гастроэзофагеальным рефлюксом рекомендовано соблюдение противорефлюксного режима с учащенными кормлениями меньшими порциями, а также проведение регулярных курсов противорефлюксной терапии. </p>\r\n<p>К мерам специфической профилактики следует отнести вакцинацию против гриппа, а также вакцинацию против гемофильной и пневмококковой инфекций для предупреждения развития эпиглоттита. </p>",
"clinical_picture": "<p>Обструктивный ларингит (круп) обычно начинается с неспецифических симптомов острой респираторной вирусной инфекции: появляются обильный насморк, першение в горле, кашель. </p>\r\n<p>Чаще протекает на фоне невысокой температуры, редко – на фоне фебрильной лихорадки. </p>\r\n<p>Как правило, симптомам стеноза гортани предшествуют признаки ларингита: осиплость голоса и/или сухой грубый кашель. При прогрессировании воспалительного процесса в гортани осиплость может усиливаться, кашель приобретает лающий характер, появляется шумное дыхание или шумный вдох (стридор). При нарастании степени стеноза гортани развивается инспираторная одышка (затрудненный вдох), которую можно заметить по втяжению яремной ямки на вдохе. </p>\r\n<p>Симптомы обструктивного ларингита обычно развиваются вечером, ночью, нередко в предутренние часы. </p>\r\n<p>I (стадия компенсации) - осиплость, грубый навязчивый кашель, умеренная одышка </p>\r\n<p>II (стадия неполной компенсации) - осиплость, грубый навязчивый кашель, выраженная одышка, возбуждение, дыхание с участием вспомогательной мускулатуры, втяжением податливых мест грудной клетки, раздуванием крыльев носа, цианоз (синюшность) носогубного треугольника, тахикардия </p>\r\n<p>III (стадия декомпенсации) - осиплость, грубый навязчивый кашель, беспокойство, страх, возможна апатия, резкая одышка с выраженным втяжением податливых мест грудной клетки, бледность, акроцианоз </p>\r\n<p>IV (терминальная стадия, асфиксия) - сознание отсутствует, резкая бледность и цианоз, гипотермия, возможны судороги, расширение зрачков, дыхание частое, поверхностное, артериальная гипотензия, нитевидный пульс. Эта стадия предшествует остановке дыхания и сердца. </p>\r\n<p>Эпиглоттит является тяжелой бактериальной инфекцией. </p>\r\n<ul>\r\n<li>заболевание обычно начинается остро с высокой температуры и нарушения общего состояния, </li>\r\n<li>характерны боль в горле, тризм (спазм жевательной мускулатуры), слюнотечение, нарушение глотания, поза «треножника», приоткрытый рот, </li>\r\n<li>быстрое развитие стридора, западение надгортанника в положении на спине. </li>\r\n</ul>\r\n<p>Типичного для крупа лающего кашля не отмечается. </p>",
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}
]
}
