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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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{
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},
"code": "J22",
"name": "Острая респираторная инфекция нижних дыхательных путей неуточненная",
"icd_name": "Острая респираторная инфекция нижних дыхательных путей неуточненная",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
2,
4
],
"periodicity": 3,
"slug": "j22_ostraya_respiratornaya_infekciya_nizhnih_dyhatelnyh_putey_neutochnennaya",
"lead": "Нарушение здоровья, относящееся к группе другие острые респираторные инфекции нижних дыхательных путей",
"description": "Инфекция дыхательных путей – это острое инфекционное заболевания, возникающие вследствие попадания инфекционных агентов с помощью аэрогенного механизма заражения, то есть являющиеся контагиозными, поражающие отделы дыхательной системы как первично, так и вторично, сопровождающиеся воспалительными явлениями и характерными клиническими симптомами. ",
"etiology": "<p>Возбудители инфекций органов дыхания делятся на группы по этиологическому фактору:</p>\r\n<p>1) Бактериальные причины (пневмококки и другие стрептококки, стафилококки, микоплазмы, коклюшная палочка, менингококк, возбудитель дифтерии, микобактерии и другие).<br />2) Вирусные причины (вирусы гриппа, парагриппа, аденовирусы, энтеровирусы, риновирусы, ротавирусы, герпетические вирусы, вирус кори, эпидемического паротита и другие).<br />3) Грибковые причины (грибы рода Candida, аспергиллы, актиномицеты).</p>",
"pathogenesis": "<p>Источник инфекции – больной человек или носитель инфекционного агента. Заразный период при инфекциях дыхательных путей чаще всего начинается с момента появления симптомов заболевания.</p>\r\n<p>Механизм заражения аэрогенный, включающий в себя воздушно-капельный путь (заражение при контакте с больным посредством вдыхания частичек аэрозоля при чихании и кашле), воздушно-пылевой (вдыхание пылевых частиц с содержащимися в ней инфекционными возбудителями). При некоторых инфекциях органов дыхания в силу устойчивости возбудителя во внешней среде имеют значения факторы передачи – предметы обихода, на которые попадают выделения больного при кашле и чихании (мебель, платки, полотенца, посуда, игрушки, руки и другие</p>",
"diagnostics": "<p>Общий дифференциальный диагностический поиск сводится к разделению вирусных инфекций дыхательных путей и бактериальных. Итак, для вирусных инфекций органов дыхания характерны следующие симптомы:</p>\r\n<p>• острое начало и быстрый подъем температуры до фебрильных цифр в зависимости от <br />формы тяжести, выраженные симптомы интоксикации – миалгии, недомогание, разбитость;<br />• развитие ринита, фарингита, ларингита, трахеита с выделениями слизистого характера, <br />прозрачными, водянистыми, ангина без наложений;<br />• при объективном осмотре нередко выявляется инъекция сосудов склер, точечные <br />геморрагические элементы на слизистых зева, глаз, кожи, пастозность лица, при аускультации – жесткое дыхание и отсутствие хрипов. Наличие хрипов, как правило, сопровождает присоединение вторичной бактериальной инфекции.</p>\r\n<p>При бактериальной природе инфекций дыхательных путей встречается:<br />• подострое или постепенное начало заболевания, нерезкий подъем температуры до 380, редко <br />выше, несильно выраженные симптомы интоксикации (слабость, утомляемость);<br />• выделения при бактериальной инфекции становятся густыми, вязкими, приобретают <br />окраску от желтоватого до буро-зеленого цвета, кашель с мокротой различного количества;<br />• объективный осмотр показывает гнойные наложения на миндалинах, при аускультации <br />сухие или разнокалиберные влажные хрипы.</p>\r\n<full></full>\r\n<p>) Общий анализ крови изменяется при любой острой инфекции дыхательных путей: увеличиваются лейкоциты, СОЭ, <br />для бактериальной инфекции характерно повышение количества нейтрофилов, прием палочкоядерный воспалительный сдвиг влево (увеличение палочек по отношению к сегментоядерным нейтрофилам), лимфопения; для вирусных же инфекций сдвиги в лейкоформуле носят характер лимфоцитоза и моноцитоза (увеличение лимфоцитов и моноцитов). Степень нарушений клеточного состава зависит от формы тяжести и течения инфекции органов дыхания. <br />2) Специфические анализы на выявление возбудителя заболевания: анализ слизи носа и зева на <br />вирусы, а также на флору с определением чувствительности к определенным препаратам; анализ мокроты на флору и антибиотикочувствительность; бакпосев слизи зева на BL (бацилла Леффлера – возбудитель дифтерии) и другие.<br />3) При подозрении на специфические инфекции взятие крови на серологические анализы для <br />определения антител и их титров, которые обычно берут в динамике.<br />4) Инструментальные методы обследования: ларингоскопия (определение характера воспаления <br />слизистой гортани, трахеи), бронхоскопия, рентгенологическое исследование легких (выявление характера процесса при бронхите, пневмонии, степени распространения воспаления, динамики лечения). </p>",
"treatment": "<p>1) Этиотропная терапия направлена на возбудитель, вызвавший заболевание и имеет своей целью <br />прекращение его дальнейшего размножения. Именно от правильной диагностики причин развития инфекций дыхательных путей и зависит тактика этиотропного лечения. Вирусная природа инфекций требует раннего назначения противовирусных средств (изопринозин, арбидол, кагоцел, ремантадин, тамифлю, реленза и другие), которые оказываются совершенно неэффективными при ОРЗ бактериального происхождения. При бактериальной природе инфекции доктором назначаются антибактериальные препараты с учетом локализации процесса, сроков болезни, тфжести проявлений, возраста пациента. При ангине это могут быть макролиды (эритромицин, азитромицин, кларитромицин), бетта-лактамы (амоксициллин, аугментин, амоксиклав), при бронхите и пневмонии это могут быть как макролиды и бетта-лактамы, так и препараты фторхинолонового ряда (офлоксацин, левофлоксацин, ломефлоксацин) и другие. Назначение антибиотиков детям имеет серьезные для этого показания, которых придерживается только врач (возрастные моменты, клиническая картина). </p>\r\n<p>2) Патогенетическое лечение основано на прерывании инфекционного процесса с целью <br />облегчения течения инфекции и укорочение сроков выздоровления. К препаратам данной группы относятся иммуномодуляторы для вирусных инфекций – циклоферон, анаферон, гриппферон, лавомакс или амиксин, виферон, неовир, полиоксидоний, при бактериальных инфекциях – бронхомунал, иммудон, ИРС-19 и другие. Также в эту группу могут относится противовоспалительные комбинированные препараты (эреспал, например), нестероидные противовоспалительные средства при наличии показаний.</p>\r\n<p>3) Симптоматическая терапия включает в себя средства, облегчающие качество жизни для <br />пациентов: при рините (назол, пинасол, тизин и многие другие препараты), при ангине (фарингосепт, фалиминт, гексорал, йокс, тантум верде и другие), при кашле – отхаркивающие (препараты термопсиса, солодки, алтея, чабреца, мукалтин, пертуссин), муколитики (ацетилцистеин, АЦЦ, мукобене, карбоцистеин (мукодин, бронхкатар), бромгексин, амброксол, амброгексал, лазолван, бронхосан), комбинированные препараты (бронхолитин, геделикс, бронхоцин, аскорил, стоптуссин), противокашлевые (синекод, глаувент, глауцин, туссин, тусупрекс, либексин, фалиминт, битиодин).</p>\r\n<p>4) Ингаляционная терапия (паровые ингаляции, использование ультразвукового и струйного <br />ингалятора или небулайзера).</p>",
"prevention": "<p>Специфическая профилактика включает вакцинацию при ряде инфекций (пневмококковая <br />инфекция, грипп – сезонная профилактика, детские инфекции – корь, краснуха, менингококковая инфекция).</p>",
"clinical_picture": "<p>Больных беспокоят симптомы интоксикации (температура, общая слабость и недомогание), саднящая боль в верхней части груди за грудиной, появление сухого ночного и утреннего кашля, а в течение дня провоцирование кашля раздражителями – разговором, смехом, холодным воздухом, глубоким вдохом и выдохом.Иногда голос может осипнуть. Чаще кашель сухой, но при присоединении бронхита может быть и с отхождением мокроты тягучего характера как слизистой (вирусная природа), так и гнойной (бактериальный процесс).</p>\r\n<p> </p>\r\n<p> </p>",
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}
]
}
