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},
"code": "I74",
"name": "Эмболия и тромбоз артерий",
"icd_name": "Эмболия и тромбоз артерий",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "i74_emboliya_i_tromboz_arteriy",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "\r\nТромбозы и эмболии артерий – это патология, возникающая при острой закупорке просвета артерий тромбом или эмболом, приводящее к нарушению кровотока в тканях. При этом дальнейшее поступление крови по сосуду прекращается, ткани испытывают гипоксию (кислородное голодание).\r\n",
"etiology": "<p>К причинам возникновения артериальных тромбозов относятся:</p>\r\n<ul>\r\n<li>Сердечно-сосудистые заболевания, облитерирующий атеросклероз, тромбангиит;</li>\r\n<li>Сахарный диабет;</li>\r\n<li>Повреждения стенок артерий при ушибах мягких тканей, вывихах и переломах костей конечностей, компрессия сосудистого пучка опухолью или гематомой;</li>\r\n<li>Предшествующие ангиографические исследования, эндоваскулярные вмешательства, реконструктивные операции на сосудах и другие интервенционные процедуры;</li>\r\n<li>Гематологические заболевания (эритроцитоз);</li>\r\n<li>Инфекционные заболевания (сыпной тиф, сепсис, грипп и т.д.).</li>\r\n</ul>\r\n<p>К причинам возникновения артериальных эмболий относятся:</p>\r\n<ul>\r\n<li>В 92-95% случаев – сердечно-сосудистые заболевания, в первую очередь инфаркт миокарда (особенно в первые 2-3 нед заболевания), осложненный тяжелыми нарушениями ритма сердца, острой или хронической аневризмой левого желудочка;</li>\r\n<li>Внутрипредсердный тромбоз;</li>\r\n<li>Тромбы, образующиеся в аневризмах брюшной аорты и крупных магистральных артерий;</li>\r\n<li>Атероматозные язвы аорты.</li>\r\n</ul>",
"pathogenesis": "<p>Непременными условиями возникновения артериальных тромбозов являются нарушение целостности сосудистой стенки, изменение системы гемостаза и замедление кровотока. Во всех указанных случаях ответной реакцией на повреждения внутренней стенки сосуда является прилипание тромбоцитов, склеивание их между собой и дальнейший рост, что связано с воздействием биологически активных веществ, вырабатываемых в организме. В то же время под действием биологически активных веществ происходит активация свертывающей системы крови и снижение способности растворять тромбы. В результате на поверхности агрегата адсорбируются нити фибрина, образующие сетчатую структуру, которая, задерживая форменные элементы крови, способствует образованию кровяного свертка - тромба.</p>\r\n<p>Эмболия - закупорка просвета кровеносного сосуда эмболом, который обычно представлен частью тромба или бляшки, \"оторвавшейся\" от сосудистой стенки, мигрирующих с током крови по кровеносному руслу. Эти тромбы отрываются от мест прикрепления и, переносясь током крови, застревают в местах анатомических сужений артерий или их разделения на ветви. После закупорки сосуда происходит его рефлекторный спазм ниже эмбола. Сам эмбол стимулирует образование и рост тромба, который иногда достигает очень больших размеров.</p>\r\n<p>Тромбоз и эмболия приводят к полному обескровливанию конечности ниже закупорки. Артериальная ишемия в подавляющем большинстве случаев приводит к гангрене.</p>",
"diagnostics": "<p>Диагностика включает в себя сбор жалоб, анамнеза заболевания и жизни; физикальное обследование.</p>\r\n<p>Лабораторные методы исследования: коагулограмма (обнаруживается повышение свертываемости крови).</p>\r\n<p>Инструментальные методы:</p>\r\n<ol>\r\n<li>Ультразвуковое ангиосканирование аорты и артерий:</li>\r\n</ol>\r\n<ul>\r\n<li>увеличение скорости кровотока в местах препятствия току крови – стеноз (выше уровня тромбоза);</li>\r\n<li>отсутствие кровотока в аорте или артерии на уровне тромбоза (эмболии);</li>\r\n<li>кровоток отсутствует или коллатеральный ниже уровня тромбоза (эмболии);</li>\r\n<li>утолщение стенки артерии, выявление атеросклеротических бляшек.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Ангиография проводится на операционном столе для уточнения воспринимающего сосудистого русла и позволяет определить характер хирургического вмешательства.</li>\r\n</ol>\r\n<ol start=\"3\">\r\n<li>Мультиспиральная компьютерная томография проводится при наличии времени для детальной диагностики и позволяет очень точно выявить характер поражений и определить лечебную тактику.</li>\r\n</ol>",
"treatment": "<p>Тактика лечения зависит от давности начала заболевания, уровня поражения сосуда, степени нарушения артериального кровообращения, от наличия сопутствующих заболеваний. </p>\r\n<p>Консервативную терапию следует проводить в течение 2 – 4 часов при субкомпенсации кровообращения конечности. Если наступает улучшение кровообращения конечности, то следует продолжить консервативную терапию до ликвидации ишемических проявлений конечности. Если за это время улучшения не наступает, следует ставить вопрос о немедленном оперативном лечении.</p>\r\n<p> Немедикаментозное лечение:</p>\r\n<ul>\r\n<li>Режим I, II, III.</li>\r\n<li>Диета №10.</li>\r\n</ul>\r\n<p> Медикаментозное лечение:</p>\r\n<ul>\r\n<li>Назначается тромболитическая терапия, направленная на восстановление кровотока в в сосуде за счет лизиса тромба внутри сосудистого русла.</li>\r\n<li>С целю профилактики восходящего и нисходящего вторичного тромбоза применяется антикоагулянтные препараты прямого действия.</li>\r\n<li>Для улучшения реологических свойств кров применяются антиагрегантные препараты.</li>\r\n<li>Спазмолитическая терапия показана для снижения периферического артериоспазма и улучшения кровотока по пораженной конечности за счет расширения коллатерального кровотока. Для лизиса эмбола или тромба применяют препараты, повышающие фибринолитическую активность крови.</li>\r\n</ul>\r\n<p>Хирургическое лечение острых артериальных эмболии заключается в удалении эмбола и тромботических масс из просвета артерии с помощью катетера.</p>\r\n<p>При тяжелой ишемии, сопровождающейся отеком мышц или мышечной контрактурой с целью декомпрессии и улучшения тканевого кровотока показана фасциотомия (рассечение мышечной фасции (оболочки)).</p>\r\n<p>При остром тромбозе, развившемся на фоне органического поражения артериальной стенки, простое удаление тромба обычно неэффективно, так как быстро наступает повторный тромбоз сосуда. Поэтому должна проводиться реконструктивная операцией.</p>\r\n<p>При развитии гангрены конечности показана ампутация.</p>",
"prevention": "<p>Профилактика тромбозов и эмболий артерий включает здоровое питание, подвижный образ жизни, отказ от курения, нормализация индекса массы тела, своевременное и полноценное лечение сердечно-сосудистых и инфекционных заболеваний.</p>\r\n<p> </p>",
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"description": "<p>Атеросклероз - это х<span style=\"color: #222328; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">роническое очаговое поражение артерий, характеризующееся отложением и накоплением во внутренней оболочке сосуда жиросодержащих белков и доставляемого ими холестерина.</span></p>",
"etiology": "<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Факторы, влияющие на развитие атеросклероза, разделяются на три группы: неустранимые, устранимые и потенциально устранимые. К неустранимым факторам относятся те, которые нельзя исключить с помощью волевого или медицинского воздействия. В их число входят:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Возраст. С возрастом риск развития атеросклероза возрастает. Атеросклеротические изменения сосудов в той или иной мере наблюдаются у всех людей после 40-50 лет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Пол. У мужчин развитие атеросклероза происходит на десять лет раньше и превышает показатель заболеваемости атеросклерозом среди женщин в 4 раза. После 50-55 лет уровень заболеваемости атеросклерозом среди женщин и мужчин выравнивается. Это объясняется снижением продукции эстрогенов и их защитной функции у женщин в период </span><a style=\"text-decoration-line: none;\" href=\"https://www.krasotaimedicina.ru/diseases/zabolevanija_gynaecology/climax\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">менопаузы</span></a><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наследственность. Нередко атеросклероз развивается у пациентов, чьи родственники страдают этой болезнью. </span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Устранимыми факторами атеросклероза считаются те, которые могут быть исключены самим человеком посредством изменения привычного образа жизни. К ним относятся:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Курение. Его влияние на развитие атеросклероза объясняется отрицательным воздействием никотина и смол на сосуды. Многолетнее курение в несколько раз увеличивает риск гиперлипидемии, артериальной гипертензии, ИБС.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Несбалансированное питание. Употребление в пищу большого количества жиров животного происхождения ускоряет развитие атеросклеротических изменений сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиподинамия. Ведение малоподвижного образа жизни способствует нарушению жирового обмена и развитию ожирения, сахарного диабета, атеросклероза сосудов.</span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">К потенциально и частично устранимым факторам риска относят те хронические нарушения и заболевания, которые возможно скорректировать посредством назначенного лечения. Они включают:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Артериальную гипертонию. На фоне повышенного артериального давления создаются условия для повышенного пропитывания сосудистой стенки жирами, что способствует формированию атеросклеротической бляшки. С другой стороны, снижение эластичности артерий при атеросклерозе способствует поддержанию повышенного кровяного давления.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Дислипидимию. Нарушение жирового обмена в организме, проявляющееся повышенным содержанием холестерина, триглицеридов и липопротеидов, играет ведущую роль в развитии атеросклероза.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ожирение и сахарный диабет. Повышают вероятность атеросклероза в 5-7 раз. Это объясняется нарушением жирового обмена, лежащего в основе данных заболеваний и являющегося пусковым механизмом атеросклеротического поражения сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Инфекции и интоксикации. Инфекционные и токсические агенты оказывают повреждающее воздействие на сосудистые стенки, способствуя их атеросклеротическим изменениям.</span></p>\r\n</li>\r\n</ol>",
"pathogenesis": "<p>Атеросклеротическая бляшка — это образование, состоящее из смеси жиров (в первую очередь, холестерина) и кальция.</p>\r\n<p>Со временем бляшка становится непрочной, на ее поверхности возникают дефекты. В месте дефекта на внутренней оболочке сосуда начинает образовываться тромб — скопление клеток, в основном, тромбоцитов (элементы крови, участвующие в процессе свертывания) и белков крови.</p>",
"diagnostics": "<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на атеросклероз врач может назначить:</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: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови на холестерин и сахар;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенологическое исследование;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ангиографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">МРТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ультразвуковую допплерографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ аорты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭКГ.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также при необходимости список обследований могут пополнить:</span></p>\r\n<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: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">кардиологические стресс-тесты для определения критической нагрузки на сердце;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">коронарография;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">липидограмма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ органов брюшной полости.</span></p>\r\n</li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для лечения атеросклероза применяют комплексные меры, которые включают в себя:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">диету, назначаемую с целью снизить уровень холестерина в крови и нормализовать липидный баланс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отказ от вредных привычек: курения и чрезмерного употребления спиртных напитков;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">умеренную физическую нагрузку, подходящую по возрасту и особенностям организма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лекарственную терапию, которая: снижает выработку холестерина, выводит лишний холестерин из организма.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В рамках терапии обычно назначают:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">статины. Именно они существенно понижают уровень холестерина.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">средства, содержащие никотиновую кислоту. Она отвечает за нормализацию липидного уровня.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">фибраты. Благодаря им в организме уменьшается выработка жиров.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">секвестранты. Помогают кишечнику освободиться от желчных кислот.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эстрогены. В качестве ЗГТ для женщин в постменопаузу.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В некоторых случаях прибегают к хирургическому вмешательству посредством:</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: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ангиопластики;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эндарэктомии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">шунтирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">стентирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сосудистого протезирования.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p>С целью предупреждение атеросклероза необходим отказ от курения, исключение стрессового фактора, переход на нежирную и бедную холестерином пищу, систематическая физическая активность соразмерно возможностям и возрасту, нормализация веса.</p>\r\n<p>Целесообразно включение в рацион продуктов, содержащих клетчатку, растительных жиров (льняного и оливкового масел), растворяющих холестериновые отложения.</p>\r\n<p>Прогрессирование атеросклероза можно замедлить приемом холестеринснижающих лекарственных препаратов.</p>",
"clinical_picture": "<p align=\"justify\">При атеросклерозе чаще страдают грудной и брюшной отделы аорты, коронарные, мезентериальные, почечные сосуды, а также артерии нижних конечностей и головного мозга.</p>\r\n<p align=\"justify\">В развитии атеросклероза различают доклинический (бессимптомный) и клинический периоды. В бессимптомном периоде в крови обнаруживается повышенное содержание β-липопротеидов или холестерина при отсутствии симптомов заболевания.</p>\r\n<p align=\"justify\">Клинически атеросклероз начинает себя проявлять, когда происходит <a title=\"Перейти на страницу симптома стеноз\" href=\"/symptom/stenoz/\">сужение</a> артериального просвета на 50% и более. В течении клинического периода выделяют три стадии: ишемическую, тромбонекротическую и фиброзную.</p>\r\n<p align=\"justify\">В стадии ишемии развивается недостаточность кровоснабжения того или иного органа (например, ишемия миокарда вследствие атеросклероза коронарных сосудов проявляется стенокардией). В тромбонекротической стадии присоединяется тромбоз измененных артерий (так, течение атеросклероза коронарных сосудов может осложниться инфарктом миокарда). На стадии фиброзных изменений происходит разрастание соединительной ткани в плохо кровоснабжаемых органах (так, атеросклероз коронарных артерий приводит к развитию атеросклеротического кардиосклероза).</p>\r\n<p align=\"justify\">Клинические симптомы атеросклероза зависят от вида пораженных артерий. Проявлением атеросклероза коронарных сосудов служат стенокардия, инфаркт миокарда и кардиосклероз, последовательно отражающие стадии недостаточности кровообращения сердца.</p>\r\n<p align=\"justify\">Течение атеросклероза аорты длительное и долгое время бессимптомное, даже в тяжелых формах. Клинически атеросклероз грудной аорты проявляется аорталгией – давящими или жгучими болями за грудиной, иррадиирующими в руки, спину, шею, верх живота. В отличие от болей при стенокардии <a title=\"Перейти на страницу симптома Боль в груди \" href=\"/symptom/bol_v_grudi/\">аорталгия</a> может длиться по несколько часов и дней, периодически ослабевая или усиливаясь. Снижение эластичности стенок аорты вызывает усиление работы сердца, приводя к гипертрофии миокарда левого желудочка.</p>\r\n<p align=\"justify\">Атеросклеротическое поражение брюшной аорты проявляется болями в области живота различной локализации, метеоризмом, запорами. При атеросклерозе бифуркации брюшной аорты наблюдается <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и похолодание ног, отек и <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">гиперемия</a> стоп, некрозы и язвы пальцев ног, перемежающаяся <a title=\"Перейти на страницу симптома Нарушения походки\" href=\"/symptom/narusheniya_pohodki/\">хромота</a>.</p>\r\n<p align=\"justify\">Проявлениями атеросклероза мезентериальных артерий служат приступы «брюшной жабы» и нарушение пищеварительной функции вследствие недостаточности кровоснабжения кишечника. У пациентов отмечается появление резких болей спустя несколько часов после еды. Боли локализуются в области пупка или верхних отделах живота. Продолжительность болевого приступа от нескольких минут до 1-3 часов, иногда болевой синдром купируется приемом нитроглицерина. Появляются <a title=\"Перейти на страницу симптома Метеоризм\" href=\"/symptom/meteorizm/\">вздутие</a> живота, <a title=\"Перейти на страницу симптома Отрыжка\" href=\"/symptom/otryzhka/\">отрыжка</a>, <a title=\"Перейти на страницу симптома Запор\" href=\"/symptom/zapor/\">запор</a>, <a title=\"Перейти на страницу симптома Нарушение сердечного ритма\" href=\"/symptom/narushenie_serdechnogo_ritma/\">сердцебиение</a>, повышение артериального давления. Позднее присоединяются зловонные поносы с фрагментами непереваренной пищи и неусвоенным жиром.</p>\r\n<p align=\"justify\">Атеросклероз почечных артерий ведет к развитию вазоренальной симптоматической артериальной гипертензии. В моче определяются эритроциты, белок, цилиндры. При одностороннем атеросклеротическом поражении артерий отмечается медленное прогрессирование гипертонии, сопровождающееся стойкими изменениями в моче и стойко высокими цифрами АД. Двустороннее поражение почечных артерий вызывает злокачественную артериальную гипертонию.</p>\r\n<p align=\"justify\">При атеросклерозе сосудов головного мозга отмечается снижение памяти, умственной и физической работоспособности, внимания, интеллекта, <a title=\"Перейти на страницу симптома Головокружение\" href=\"/symptom/golovokruzhenie/\">головокружение</a>, нарушения сна. В случаях выраженного атеросклероза сосудов мозга изменяется поведение и психика пациента. Атеросклероз артерий мозга может осложняться острым нарушением мозгового кровообращения, тромбозами, кровоизлияниями.</p>\r\n<p align=\"justify\">Проявлениями облитерирующего атеросклероза артерий нижних конечностей служат <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a> и боли в икроножных мышцах голени, <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и зябкость ног. Характерно развитие синдрома «перемежающейся хромоты» (боли в икроножных мышцах возникают при ходьбе и стихают в покое). Отмечаются похолодание, бледность конечностей, трофические нарушения (<a title=\"Перейти на страницу симптома Шелушение кожи\" href=\"/symptom/shelushenie_kozhi/\">шелушение</a> и <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">сухость кожи</a>, развитие трофических язв и сухой гангрены).</p>",
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},
"code": "I73.1",
"name": "Облитерирующий тромбоангиит [болезнь Бергера]",
"icd_name": "Облитерирующий тромбоангиит [болезнь Бергера]",
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"age_min": 30,
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"cause": [
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],
"periodicity": 1,
"slug": "i73.1_obliteriruyuschiy_tromboangiit_bolezn_bergera",
"lead": "воспалительное поражение кровеносных сосудов",
"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;\">Облитерирующий тромбангиит - воспалительный тромбоз мелких артерий, среднего размера артерий и некоторых поверхностных вен, вызывающий артериальную ишемию дистальных отделов конечностей и поверхностный тромбофлебит. Главный фактор риска - курение.</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;\">До настоящего времени причины данного заболевания так до конца и не выяснены. Но на основании многолетних наблюдений за пациентами с облитерирующим тромбангиитом удалось выявить некоторые причинно-следственные связи. К ним можно отнести:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наследственность, т. е. если данное заболевание наблюдалось хотя бы у одного из кровных родственников (у бабушки, дедушки, мамы, папы или кого-то из братьев и сестёр).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Аутоиммунный механизм повреждения сосудов циркулирующими иммунными комплексами. В этом случае иммунная система человека вместе защиты организма человека от внешних воздействий, таких как вирусы, бактерии, паразиты и др. возбудители инфекций, начинает повреждать собственные клетки, \"считая\" их врагами. По каким причинам это происходит, к сожалению, медицине до сих пор точно неизвестно.</span></li>\r\n<li style=\"list-style-type: none; font-size: 8pt; font-family: Verdana; color: #181d21; 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;\">Самая главная причина, без которой заболевание не развивается, даже если у человека есть наследственная предрасположенность и аутоиммунная настроенность организма — это табакокурение. В настоящее время выяснено, что 98 % больных облитерирующим тромбангиитом, а по некоторым данным 100 %, являются злостными курильщиками. Именно в связи с этим заболевание еще называют болезнью молодых курильщиков.</span></p>\r\n</li>\r\n</ul>",
"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;\">Первичными в звене патогенеза облитерирующего тромбангиита считаются наследственность и генетическая предрасположенность. В последние годы признаётся важная роль собственных антигенов гистосовместимости (совместимости тканей) в осуществлении ряда основных функций иммунитета человека. Это создаёт предпосылки для понимания механизмов взаимосвязи между антигенами совместимости тканей (они ещё называются HLA-антигены, или human leukocyte antigens) и болезнями. Считается, что эти гены регулируют иммунный ответ и являются посредниками в различных иммунологических реакциях, в том числе патологических (вызывающих заболевание). Однако даже наличие наследственности и генетической предрасположенности не приводит к развитию заболевания без внешних провоцирующих факторов, основным из которых является табакокурение.</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;\">Важно знать, что для развития заболевания не нужен большой стаж курения и не нужно выкуривать по несколько пачек сигарет, достаточно 1-2 сигарет в сутки и через промежуток времени от месяца до года могут возникнуть симптомы заболевания. Но только в том случае, если у пациента имеется генетическая предрасположенность.</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;\">Итак, когда необходимые звенья патогенеза собрались в цепь и были запущены курением, в сосудах мелкого и среднего калибра поэтапно начинают развиваться патологические изменения.</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;\">Никотин, содержащийся в табаке, попадает в кровь и начинает воздействовать на внутреннюю поверхность сосудов — эндотелий. В результате нормальный эндотелий становится изменённым и организм начинает воспринимать его как чужеродный, опасный для себя. При этом запускается механизм выработки циркулирующих иммунных комплексов (это специальные защитники нашего организма для борьбы с чужеродными клетками). Иммунные комплексы в крови взаимодействуют с эндотелием сосудов и начинают атаковать его. В результате в стенке артерии или вены возникает множество повреждённых участков, стенки сосудов воспаляются и утолщаются.</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;\">В таком воспалённом сосуде происходит стаз кровотока (замедление, сгущение) и образуются тромбы. Эти сгустки крови перекрывают просвет сосуда, кровоснабжения тканей ухудшается, что, в свою очередь, является причиной нарушения трофики (клеточного питания) и возникновения клинических симптомов заболевания.</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 общем и биохимическом анализах крови выявляются неспецифические изменения: лейкоцитоз, рост СОЭ, увеличение фибрина, серомукоида, гаптоглобина, сиаловых кислот, γ-глобулинов. При иммунологическом исследовании определяются антигены HLA В5, А9, DR4. Коагулограмма при облитерирующем тромбангиите выявляет повышенную свертываемость крови и агрегацию тромбоцитов.</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 проведении кожной термографии и теплометрии определяются зоны пониженной температуры, свидетельствующие о нарушении кровообращения в дистальных отделах конечностей. Степень микроциркуляторных нарушений уточняется в ходе радиоизотопного сканирования (сцинтиграфии), УЗДГ, реовазографии, рентгеноконтрастной ангиографии периферических сосудов. При ЭКГ обнаруживаются ишемические изменения в сердце.</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;\">Медикаментозное лечение включает прием ангиоспазмолитических препаратов (ксантинола никотината, дротаверина, кислоты никотиновой, циннаризина, алпростадила); нестероидных анальгетиков; средств, улучшающих реологические показатели крови (пентоксифиллина, ацетилсалициловой к-ты, дипиридамола) и трофику тканей (витаминов группы В, никотиновой кислоты, аденозинмонофосфата, пирикарбата, даларгина).</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;\">Пациентам с облитерирующим тромбангиитом назначается тренировочная ходьба, фотогемотерапия (УФОК, ВЛОК), плазмаферез, гемосорбция, гипербарическая оксигенация, санаторное лечение.</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 неэффективности консервативной терапии пациенту необходима консультация сосудистого хирурга. Хирургическое лечение облитерирующего тромбангиита может заключаться в проведении поясничная симпатэктомии, операции обходного шунтирования пораженных сосудов, баллонной ангиопластики или ампутации конечности.</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;\">Профилактика заболевания заключается в соблюдении правил здорового образа жизни:</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;\">категорическом отказе от курения;</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;\">правильном питании;</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;\">активном двигательном режиме (ежедневная ходьба, лёгкий бег, скандинавская ходьба, катание на велосипеде, плавание);</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;\">соблюдении режима сна и бодрствования (необходим полноценный ночной сон длительностью 6-8 часов в сутки).</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;\">Также для профилактики заболевания важно регулярно проходить плановые медицинские осмотры.</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;\">Поражение периферических артериальных путей при облитерирующем тромбангиите носит двусторонний характер с заинтересованностью обеих верхних либо нижних конечностей от дистальных до проксимальных отделов. Облитерирующий тромбангиит отличается триадой признаков: перемежающейся хромотой, синдромом Рейно и поверхностным мигрирующим тромбофлебитом дистальных участков конечностей.</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;\">Клинические проявления перемежающейся хромоты включают боли в стопе и икроножных мышцах во время ходьбы; при поражении верхних конечностей в процессе выполнения действий руками боли возникают в кистях и предплечьях. Отмечается бледность и цианотичность пальцев, повышение чувствительности стоп и кистей к холоду, появление кровоизлияний и болезненных узелков на коже подушечек пальцев. Тяжелые ишемические поражения конечностей при облитерирующем тромбангиите проявляются болями в покое, отсутствием пульсации на артериях стопы и рук, изъязвлениями, трофическими нарушениями и гангреной пальцев вплоть до самоампутации некротизированных зон.</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;\">Вовлеченность венечных артерий выражается развитием стенокардии и инфаркта миокарда. При поражении брыжеечных артерий возникают резкие боли в животе, кровотечения из пищеварительного тракта, язвы и некрозы стенки кишки. При заинтересованности сосудов мозга возможно развитие инсульта, ишемического неврита зрительных нервов. Тромбозы почечных артерий ведут к инфарктным изменениям паренхимы почки.</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;\">Обострения облитерирующего тромбангиита провоцируются холодом и частым курением, возможно развитие вторичного инфицирования мягких тканей конечностей.</span></p>",
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"name": "парестазия кожи"
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},
"code": "I73.0",
"name": "Синдром Рейно",
"icd_name": "Синдром Рейно",
"gender": 0,
"age_min": 20,
"age_max": 50,
"cause": [
"0"
],
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"slug": "i73.0_sindrom_reyno",
"lead": "спазм сосудов кистей или стоп в ответ на холод или эмоциональный стресс",
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"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;\">Синдром Рейно бывает первичным и вторичным:</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;\">первичный синдром (идиопатический, или болезнь Рейно) развивается как самостоятельное заболевание и встречается более чем в 80 % случаев;</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;\">вторичный синдром — это проявление или осложнение других патологий.</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;\">Причины синдрома Рейно</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;\">Первичный синдром связан с нарушениями в работе автономной нервной системы, но причины этих нарушений до конца не ясны.</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;\">Возможные причины вторичного синдрома:</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;\">системные заболевания соединительной ткани: системная склеродермия (синдром Рейно присутствует в 95 % случаев этого заболевания), системная красная волчанка, синдром Шёгрена, дерматомиозит, полимиозит и др.;</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;\">васкулиты: гранулематоз с полиангиитом (гранулематоз Вегенера), узелковый полиартериит, синдром Чёрджа — Стросса, гигантоклеточный артериит и др.;</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;\">другие сосудистые заболевания: атеросклероз, артериовенозная фистула, синдром вибрации руки, синдром канала Гийона и др.;</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;\">гематологические нарушения: множественная миелома, полицитемия, криоглобулинемия, антифосфолипидный синдром и др.;</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;\">злокачественные опухоли: рак лёгких, кишечника, женских половых органов, предстательной железы и др.;</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;\">болезни нервной системы и нейровегетативные расстройства: идиопатическая периферическая нейропатия, синдром запястного канала, рефлекторная симпатическая дистрофия и др.;</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;\">эндокринные заболевания: гипотиреоз, сахарный диабет, акромегалия, феохромоцитома и др.;</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;\">воздействие лекарственных средств и токсических веществ: химиотерапии, Циклоспорина, симпатомиметиков, наркотиков, никотина, мышьяка, органических растворителей и др.</span></li>\r\n</ul>\r\n<p><span id=\"docs-internal-guid-651b7ff6-7fff-9b60-e056-fd4229301b9a\"> </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;\">Как правило, диагностика болезни Рейно не представляет для профессионалов особой сложности, но комплексное обследование все равно требуется. После осмотра, холодовых проб и сбора анамнеза пациентам назначают:</span></p>\r\n<p> </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;\">биохимию 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;\">гемограмму; </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;\">коагулограмму; </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;\">общий анализ мочи; </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;\">иммунограмму; </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;\">УЗИ – исследование внутренних органов; </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;\">томографию позвоночника; </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;\">допплерографию сосудов, а также некоторые другие исследования.</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;\">Первым принципом терапии синдрома Рейно служит исключение провоцирующих моментов – курения, охлаждения, вибрации и других бытовых и производственных факторов. Проводится выявление и лечение первичного заболевания, обусловившего развитие синдрома Рейно. Среди вазодилататоров при синдроме Рейно эффективно назначение антагонистов кальция - нифедипина, алпростадила, селективных блокаторов кальциевых каналов - верапамила, никардипина дилтиазема. При необходимости применяются ингибиторы АПФ (каптоприл), селективные блокаторы HS2-серотониновых рецепторов (кетансерин).</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 синдроме Рейно производится назначение антиагрегантных препаратов - дипиридамола, пентоксифиллина, низкомолекулярных декстранов (реополиглюкина). Прогрессирование и резистентность синдрома Рейно к лекарственной терапии служит показанием к проведению хирургической симпатэктомии или ганглиэктомии. При развившемся ишемическом приступе неотложными мерами является согревание конечности в теплой воде, массирование с помощью шерстяной ткани, предложение пациенту горячего питья. При затяжном приступе назначают инъекционные формы спазмолитиков (дротаверина, платифиллина), диазепама, блокады.</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;\">При синдроме Рейно используются немедикаментозные методики - психотерапия, рефлексотерапия, физиотерапия, гипербарическая оксигенация. При синдроме Рейно, обусловленном системными коллагенозами, показано проведение сеансов экстракорпоральной гемокоррекции. Новым словом в лечении синдрома Рейно является терапия с использованием стволовых клеток, направленная на нормализацию периферического кровотока. Стволовые клетки способствуют открытию новых коллатералей в сосудистом русле, стимулируют регенерацию поврежденных нервных клеток, что в итоге ведет к прекращению пароксизмов вазоконстрикции.</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;\">Первичной профилактики, которая позволила бы предотвратить развитие болезни, на сегодняшний день не существует. Однако можно уменьшить количество приступов, для этого нужно избегать факторов риска сосудистого спазма:</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;\">отказаться от курения, употребления алкоголя, кофе и кофеинсодержащих напитков;</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;\">ограничить время пребывания на холоде, в том числе в холодных и влажных помещениях, по возможности переехать в местность с мягким и тёплым климатом;</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;\">носить рукавицы вместо перчаток, теплосберегающее бельё, тёплые шапки;</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;\">отказаться от работы, связанной с локальным или местным переохлаждением, вибрацией или перенапряжением кистей рук;</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;\">не принимать препараты, которые могут вызвать уменьшение просвета сосудов (симпатомиметиков, Клонидина и др.);</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;\">избегать эмоциональных перегрузок, при необходимости принимать седативные средства (Реланиум, Элениум, Сибазон и др.), использовать психотерапию, гипноз, аутотренинг.</span></li>\r\n</ul>\r\n<p> </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;\">Симптоматика синдрома Рейно обусловлена пароксизмальным вазоспазмом и развивающимися вследствие этого повреждениями тканей. В типичных случаях при синдроме Рейно поражаются IV и II пальцы стоп и кистей, иногда – подбородок, уши и нос. Приступы ишемии вначале кратковременны, редки; возникают под воздействием холодовых агентов, вследствие волнения, курения и т. д. Внезапно развивается парестезия, похолодание пальцев, кожа становится алебастро-белого цвета. Онемение сменяется жжением, ломящей болью, чувством распирания. Приступ завершается резкой гиперемией кожи и ощущением жара.</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;\">Прогрессирование синдрома Рейно приводит к удлинению времени приступов до одного часа, их учащению, спонтанному возникновению без видимых провокаций. После высоты пароксизма наступает цианотическая фаза, появляется незначительная отечность тканей. В промежутки между приступами стопы и кисти остаются холодными, цианотичными, влажными. Для пароксизмов ишемии при синдроме Рейно характерно симметричное и последовательное развитие проявлений: сначала на пальцах кистей, затем - стоп. Последствиями ишемии тканей в случае длительного и тяжелого течения синдрома Рейно могут стать трофические изменения в виде плохо заживающих трофических язв, участков некрозов, дистрофических поражений ногтевых пластин, остеолиза и деформации фаланг, гангрены.</span></p>",
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