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},
"code": "P36",
"name": "Бактериальный сепсис новорожденного",
"icd_name": "Бактериальный сепсис новорожденного",
"gender": 0,
"age_min": 0,
"age_max": 39,
"cause": [
4,
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],
"periodicity": 2,
"slug": "p36_bakterialnyy_sepsis_novorozhdennogo",
"lead": "Нарушение здоровья, относящееся к группе инфекционные болезни, специфичные для перинатального периода",
"description": "Сепсис новорожденных – это тяжелое инфекционное заболевание, возникающее у детей первого месяца жизни. При нем образуются: гнойное воспаление одного или нескольких органов, полиорганная недостаточность (нарушение функций всех органов), циркуляция бактерий в крови (бактериемия). Сепсис — одна из основных причин смерти новорожденных.",
"etiology": "<p>Неонатальный сепсис вызывается условнопатогенной бактериальной микрофлорой. Наиболее частой причиной инфицирования в период внутриутробного развития плода и чаще в интранатальный период является S. Agalacticae — представитель стрептококков группы А. Реже сепсис вызывает E. Coli и другая кишечная грамотрицательная флора. </p>\r\n<p>Большую роль играют острые и хронические инфекционные заболевания у матери, различные акушерские вмешательства, длительный безводный период,эндометрит, наличие других гнойно-воспалительных очагов у матери (гнойный мастит и др. ).</p>\r\n<p>Предрасполагающими факторами являются внутриутробная гипоксия, внутричерепная родовая травма, незрелость новорожденного, повреждение кожи новорожденного во время акушерских операций и такие манипуляции, как интубация, катетеризация подключичных и пупочных вен и др. </p>",
"pathogenesis": "<p>Входными воротами чаще бывают раневая поверхность на коже, слизистых оболочках, пупочная рана и пупочные сосуды, а также неповрежденная кожа и слизистые оболочки верхних дыхательных путей, желудочно-кишечного тракта. При внутриутробном сепсисе очаг инфекции обычно локализуется в плацента или каком-либо органе беременной. Нередко входные ворота и первичный септический очаг определить не удается. </p>\r\n<p>Возбудитель проникает в кровеносную систему, вызывая бактериемию, токсинемию и антигенную стимуляцию продуктами жизнедеятельности и распада. В ответ на инфекцию организм отвечает системной воспалительной реакцией, проявляющейся выбросом провоспалительных цитокинов и активацией нейтрофилов, системы комплемента, свертывания крови и агрегацией тромбоцитов. Чрезмерный системный ответ, наряду с токсическим и антигенным воздействием возбудителя, приводит к повреждающему действию на органы и системы организма. Нарушается микроциркуляция, проницаемость и функции эндотелия капилляров, развивается синдром внутрисосудистого свертывания. В дальнейшем возникает полиорганная недостаточность. </p>",
"diagnostics": "<p>Клинический анализ крови: повышение количества лейкоцитов (клетки крови, отвечающие за иммунитет) либо их резкое снижение. </p>\r\n<p>Повышение уровня С-реактивного белка и прокальцитонина в крови (показатели острого воспалительного процесса в организме). </p>\r\n<p>Посев крови для выделения возбудителя и определения чувствительности к антибиотикам (какие антибиотики действуют на данного возбудителя в данном случае). </p>\r\n<p>Посев спинномозговой жидкости либо мочи, либо гнойного отделяемого с кожи (в зависимости от входных ворот инфекции (например, гноя с пуповинного остатка, если первично возникло его поражение). Взятый материал сеют на питательную среду и через определенное время анализируют, какие возбудители размножились. </p>",
"treatment": "<p>Лечение включает: </p>\r\n<ul>\r\n<li>Нахождение ребенка в кувезе (специальном аппарате для выхаживания новорожденных, в котором поддерживается оптимальная температура и влажность воздуха). </li>\r\n<li>Вскармливание предпочтительно грудное. В тяжелых случаях — парентеральтное (введение питательных растворов внутривенно). </li>\r\n<li>Антибактериальная терапия (действует непосредственно на причину болезни, то есть на бактерии) является кардинальным направлением в лечении сепсиса. Антибиотики сначала назначаются исходя из предположения о наиболее вероятных возбудителях инфекции у данного больного. После получения результатов посева крови с определением чувствительности данных возбудителей к антибиотикам возможна коррекция терапии. </li>\r\n<li>Инфузионная терапия (внутривенное введение растворов). </li>\r\n<li>Иммунокорригирующая терапия — внутривенное введение иммуноглобулинов, интерферонов. </li>\r\n<li>Переливание крови и плазмы крови (проводят для восполнения клеточного состава крови, факторов свертывания крови, плазма – для плазмофереза, то есть очищения жидкого компонента крови). </li>\r\n<li>С целью местного лечения гнойных очагов производится вскрытие фурункулов и абсцессов, перевязки с антибактериальными и ферментными препаратами; назначается УВЧ, СВЧ, электрофорез. </li>\r\n</ul>",
"prevention": "<p>Профилактика сепсиса новорожденных включает выявление и санацию инфекций мочеполовой сферы у беременной, соблюдение противоэпидемических мероприятий медперсоналом родильных домов и отделений новорожденных, тщательный гигиенических уход за новорожденным, естественное вскармливание. Вопрос о сроках вакцинации новорожденных с сепсисом против туберкулеза и против гепатита В , проводимой в первые дни жизни, решается в индивидуальном порядке.</p>",
"clinical_picture": "<p>Предвестниками сепсиса новорожденных могут выступать вялость или беспокойство, снижение аппетита, обильные частые срыгивания, плохая прибавка в весе. </p>\r\n<p>В период разгара развивается температурная реакция (повышение или снижение температуры тела), отечный синдром или обезвоживание, снижение массы тела. Характерным признаком сепсиса новорожденных является грязновато-серый (землистый) оттенок кожных покровов, желтушность, мраморность кожи, сыпь. </p>\r\n<p>Вследствие токсического поражения различных органов возникают увеличение печени и селезенки, поражение легких (учащение дыхания, синюшность, дыхательная недостаточность), поражение сердца (тахикардия или брадикардия, артериальная гипотензия), диспепсия, мочевой синдром (снижение диуреза, острая почечная недостаточность), кровотечения, надпочечниковая недостаточность. Чаще всего септицемия осложняется присоединением пневмонии (воспаления легких), которая выступает как самостоятельное интеркуррентное заболевание. </p>\r\n<p>Септикопиемия или сепсис новорожденных с гнойными очагами характеризуется возникновением на фоне интоксикации вторичных очагов отсева в мозговых оболочках, легких, костях, печени, других органах. Чаще всего септикопиемия протекает с развитием гнойного менингита, абсцедирующей пневмонии, остеомиелита; реже – с формированием абсцесса печени, гнойного артрита, поражения глаз, желудка или кишечника. </p>\r\n<p>В восстановительном периоде происходит опорожнение гнойных очагов, стихание интоксикации, постепенное восстановление нарушенных функций. </p>\r\n<p>Молниеносная форма сепсиса новорожденных протекает с развитием септического шока: стремительным ухудшением состояния ребенка, снижением температуры тела, брадикардией, кровоточивостью, отеком легких, острой почечной недостаточностью. Летальный исход при молниеносном течении сепсиса новорожденных наступает в течение 3-5 суток. </p>",
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{
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}
]
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