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"name": "Гипертрихоз",
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"lead": "нарушение, при котором происходит избыточный рост волос на теле и на лице",
"description": "<p><span id=\"docs-internal-guid-116013dd-7fff-2d7b-3ec2-f756aad92126\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гипертрихоз – это избыточный рост волос на всех участках тела и головы, не зависящий от секреции стероидных половых гормонов и не связанный с вирилизацией (проявлением мужских черт у женщин)</span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Патология может возникнуть вследствие разных причин:</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;\">врождённой мутации (из-за неправильного течения беременности, инфекции, перенесённой матерью в первом триместре);</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;\">вследствие приёма рядах лекарств;</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;\">из-за нарушений работы эндокринной системы.</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;\">Также выделяется так называемый «симптоматический гипертрихоз». Он может сопутствовать некоторым заболеваниям и состояниям (истощение, нервная анорексия, алкогольный синдром, черепно-мозговая травма, порфирия и пр.).</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;\">Симптомы локального гипертрихоз может наблюдаться на месте повреждения кожи (например, ожога).</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;\">Кроме того, исследования показывают, что патология может появляется вследствие пробуждения волосяных фолликулов, вызванного различными онкологическими заболеваниями.</span></p>",
"pathogenesis": "",
"diagnostics": "<p><span id=\"docs-internal-guid-8285d8e2-7fff-f3eb-6d05-8261834a00af\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для точной постановки диагноза внешних проявлений заболевания в виде избыточной волосяной растительности недостаточно. Диагностика должна включать в себя полное и всестороннее обследование, в том числе:</span></span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">проведение анализов на изучение гормонального фона;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">МРТ;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">консультация и осмотр дерматолога, эндокринолога, онколога</span></li>\r\n</ul>\r\n<p><span id=\"docs-internal-guid-e41e7213-7fff-1373-6ded-450ed89fa755\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">После установления точной причины патологии врач подбирает схему и методику лечения гипертрихоза с обязательным учетом индивидуальных особенностей проявления.</span></span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Если чрезмерно беспокоит гипертрихоз, лечение необходимо проводить тогда, когда выявлены причины, вызвавшие развитие данной патологии. То есть, лечение должно быть направлено на избавление от основного заболевания. Если имеют место эндокринные нарушения, то проводить коррекцию нужно в этом направлении, так относительно каждого заболевания.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В том случае, когда нет возможности выявить проблему, решением может быть просто эпиляция. Зачастую именно она и является оптимальным выходом для данной проблемы – это своеобразный метод симптоматического лечения. При болезненной эпиляции используют анестезию. После такой процедуры может быть отек, который проходит через несколько дней. Но стоит помнить о том, что самостоятельно устранять волосы нельзя ни в коем случае.</span></p>\r\n<p> </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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Зачастую используют электроэпиляцию для разнообразных областей тела: грудной клетки, живота, лобка, лица. </span></p>\r\n<p> </p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Поскольку причины гипертрихоза окончательно не известны, то сложно говорить о полноценно профилактике гипертрихоза. Тем не менее, некоторые люди могут снизить риск развития некоторых видов приобретенного гипертрихоза, если будут избегать:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">некоторых иммунодепрессантов</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">андрогенных стероидов</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">препаратов для роста волос</span></li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гипертрихоз проявляется избыточным ростом волос в тех местах, где это не считается нормой с учетом возраста, пола и этнической принадлежности. Так, рост волос на ногах и бедрах у женщин средиземноморья является нормой. Но то же самое проявление у девочек и представительниц азиатских народностей уже проявления гипертрихоза.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">У мужчин гипертрихоз проявляется избыточным ростом волос на спине и плечах и является симптомом атавизма. В виде атавизма гипертрихоз проявляется сразу после рождения. У младенца присутствует большое количество длинных или пушковых волос. При этом лицо и ладони тоже могут быть покрыты волосами. Ранее таких детей убивали, сейчас же гипертрихоз достаточно успешно лечат.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">У детей гипертрихоз чаще диагностируют вместе с невусами. Ограниченный гипертрихоз у детей и у взрослых может проявляться в виде сращения бровей. У мужчин гипертрихоз проявляется в виде избыточного роста волос на лице, спине и ногах.</span></p>",
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},
"code": "I11",
"name": "Гипертензивная болезнь сердца [гипертоническая болезнь сердца с преимущественным поражением сердца]",
"icd_name": "Гипертензивная болезнь сердца [гипертоническая болезнь сердца с преимущественным поражением сердца]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "i11_gipertenzivnaya_bolezn_serdca_gipertonicheskaya_bolezn_serdca_s_preimuschestvennym_porazheniem_serdca",
"lead": "Нарушение здоровья, относящееся к группе болезни, характеризующиеся повышенным кровяным давлением",
"description": "Гипертоническая болезнь – хроническое заболевание, характеризующееся длительным и стойким повышением артериального давления выше 140/90 мм ртутного столба, вызванное нарушением работы сердца и регуляции тонуса сосудов и не связанное с заболеваниями внутренних органов.",
"etiology": "<p>К факторам, которые провоцируют развитие гипертонической болезни можно причислить следующие:</p>\r\n<ul>\r\n<li>избыточный вес (даже незначительные проблемы с лишним весом могут стать причиной проблем с сердцем и сосудами, на фоне которых разовьётся артериальная гипертония) вследствие нарушения обмена веществ, эндокринных заболеваний, сидячего образа жизни и т.д.;</li>\r\n<li>регулярные психические нагрузки, нахождение пациента в стрессовых ситуациях, депрессии, пережитые трагедии и т.д.;</li>\r\n<li>сильное эмоциональное напряжение, вызванное проблемами в семье, на работе, в бизнесе;</li>\r\n<li>перенесённые травмы головного мозга (аварии, падения, ушибы, переохлаждения);</li>\r\n<li>заболевания, которые оказывают негативное воздействие на сердечно-сосудистую систему;</li>\r\n<li>наследственная предрасположенность (по статистике, дети, родители которых страдали от артериальной гипертонии, часто наследуют эти проблемы и уже в молодом возрасте начинают наблюдать первые симптомы);</li>\r\n<li>вирусные и инфекционные заболевания, последствия которых могут проявиться в виде гипертонической болезни (менингит, фронтит, гайморит и т. д.);</li>\r\n<li>возрастные изменения сосудов; повышенный показатель холестерина, при котором на стенках сосудов образуются бляшки, мешающие нормальному кровообращению (в таких сосудах часто происходят спазмы, которые мешают поступлению крови к жизненно важным органам и могут спровоцировать инсульт или инфаркт);</li>\r\n<li>климактерическое состояние (во время существенной перестройки организма часто начинают прогрессировать скрытые заболевания, на фоне которых может развиться артериальная гипертония);</li>\r\n<li>атеросклероз;</li>\r\n<li>злоупотребление пагубными привычками (курение, употребление алкоголя в больших количествах, излишнее увлечение кофе);</li>\r\n<li>ежедневное употребление поваренной соли в больших количествах;</li>\r\n<li>резкое повышение адреналина в крови;</li>\r\n<li>провождение времени за компьютером;</li>\r\n<li>малоподвижный образ жизни;</li>\r\n<li>редкие прогулки на свежем воздухе и т.д</li>\r\n</ul>",
"pathogenesis": "<p>Непосредственные механизмы повышения АД у каждого больного отличаются в соответствии с сочетанием имеющихся ФР, которые через различные нейрогенные и гуморальные механизмы приводят к повышению и поддержанию на повышенном уровне АД. Большинство гемодинамических и гуморальных изменений, возникающих на начальной стадии заболевания, связаны с повышением активности симпатической нервной системы, нарушением функций почек и дисфункцией эндотелия. Значение органических изменений сосудов неуклонно возрастает по мере повышения АД и поддержания его на постоянно высоком уровне.</p>\r\n<p>В норме существуют механизмы ауторегуляции, поддерживающие равновесие между сердечным выбросом и периферическим сосудистым сопротивлением. Так, при увеличении сердечного выброса во время физической нагрузки общее периферическое сопротивление сосудов (ОПСС) снижается. Напротив, при повышении ОПСС происходит рефлекторное снижение сердечного выброса.</p>\r\n<p>При гипертонической болезни (ГБ) механизмы ауторегуляции нарушены. Возникает несоответствие между сердечным выбросом и ОПСС. На ранних стадиях ГБ обнаруживают повышение сердечного выброса, тогда как ОПСС может быть нормальным или лишь несколько повышенным. По мере прогрессирования заболевания, стабилизации системного АД на высоких уровнях ОПСС неуклонно повышается. Системное АД начинает повышаться при истощении антигипертензивных механизмов либо при усиленном спазме сосудов. В патогенезе ГБ большую роль также играет повышенная активность ренин-ангиотензин-альдостероновой системы.</p>\r\n<p>Вторичные артериальные гипертензии. Механизмы повышения АД зависят от изменений в организме, которые возникают при соответствующих заболеваниях. Изолированная систолическая артериальная гипертензия. Основная особенность патогенеза — возрастное снижение эластичности сосудов и атеросклероз.</p>",
"diagnostics": "<p>Диагностика гипертонии основывается на показателях измерения артериального давления. Для установления диагноза гипертонии необходимо провести как минимум три независимых измерения при разных встречах с медработником только ртутным тонометром по методу Н. С. Короткова, при которых получаются повышенные значения артериального давления. Для диагностики вторичных форм гипертонии, а также для определения поражений внутренних органов проводят дополнительно обследование: общий анализ крови, общий анализ мочи, специфические анализы крови и мочи, УЗИ сердца и внутренних органов, ЭКГ, различные пробы и пр.</p>\r\n<p>Суточное мониторирование АД — это метод исследования, заключающийся в одевании на пациента автоматизированного тонометра, фиксирующего артериальное давление в течение 24 часов, с интервалом, заданным программой, как правило, от 30—60 минут днем до 60—120 минут ночью. В результате за сутки получаются несколько десятков результатов. На основании этих данных можно судить о среднем давлении в течение суток, среднем давлении в течение ночи, среднем давлении в дневное время. Кроме самих цифр АД, можно получить данные, которые не прямым образом свидетельствуют в пользу диагноза гипертонической болезни. Например, о наличии или отсутствии именно гипертонической болезни можно судить по скорости и величине снижения артериального давления в ночное время или скорости его подъема в утренние часы.</p>",
"treatment": "<p>Основная цель лечения больных АГ состоит в максимальном снижении риска развития сердечно-сосудистых и других различных осложнений. Для достижения этой цели требуется не только снижения АД до нормального уровня, но и коррекция всех факторов риска: курения, дислипидемии, гипергликемии, ожирения, и лечение сопутствующих заболеваний. Лечение должно быть постоянным, в течение многих лет. </p>\r\n<p>Мероприятия по изменению образа жизни</p>\r\n<ul>\r\n<li>нормализация сна, режима труда и отдыха</li>\r\n<li>снижение потребления поваренной соли;</li>\r\n<li>снижение потребления алкогольных напитков, отказ от курения;</li>\r\n<li>увеличение физических нагрузок</li>\r\n<li>нормализация массы тела</li>\r\n<li>увеличение потребления растительной пищи, уменьшение потребления животных жиров, увеличение в рационе содержащихся в молочных продуктах, овощах, фруктах, зерновых калия, кальция, причём кальций должен поступать вместе с витамином D, и магния, содержащегося, как и кальций, в жёсткой воде, в минеральных магниевых водах, являющегося основным компонентом хлорофилла зелени, зелёных водорослей и т. д. ;</li>\r\n</ul>\r\n<p>Медикаментозная терапия</p>\r\n<p>В настоящее время для терапии АГ в России рекомендованы семь классов антигипертензивных препаратов</p>\r\n<ul>\r\n<li>диуретики(мочегонные средства);</li>\r\n<li>α и β-адреноблокаторы;</li>\r\n<li>антагонисты кальция;</li>\r\n<li>Ингибиторы АПФ;</li>\r\n<li>антагонисты рецепторов ангиотензина II;</li>\r\n<li>агонисты имидазолиновых рецепторов.</li>\r\n</ul>\r\n<p>Подбор препарата или комбинации препаратов должен осуществлять врач.</p>",
"prevention": "<p>Профилактика гипертонии включает в себя мероприятия по изменению образа жизни. Это нормализация сна, режима труда и отдыха, отказ от вредных привычек и алкоголя, правильное сбалансированное питание с ограничением поваренной соли, нормализация массы тела, адекватные физические нагрузки. прием медикаментозных препаратов, снижающих АД по рекомендации врача.</p>",
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},
"code": "I13",
"name": "Гипертензивная [гипертоническая] болезнь с преимущественным поражением сердца и почек",
"icd_name": "Гипертензивная [гипертоническая] болезнь с преимущественным поражением сердца и почек",
"gender": 0,
"age_min": 10,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "i13_gipertenzivnaya_gipertonicheskaya_bolezn_s_preimuschestvennym_porazheniem_serdca_i_pochek",
"lead": "Нарушение здоровья, относящееся к группе болезни, характеризующиеся повышенным кровяным давлением",
"description": "Гипертоническая болезнь (эссенциальная артериальная гипертензия, первичная артериальная гипертензия) – это хроническое заболевание, для которого характерно длительное стойкое повышение артериального давления.",
"etiology": "<p>Экзогенные факторы риска: </p>\r\n<ul>\r\n<li>сильное нервное перенапряжение – наиболее частая причина прогрессирования артериальной гипертензии; </li>\r\n<li>гиподинамия; </li>\r\n<li>нерациональное питание. Несоблюдение диеты и употребление в большом количестве жирной и жареной пищи; </li>\r\n<li>чрезмерное употребление алкогольных напитков; </li>\r\n<li>курение; </li>\r\n<li>употребление наркотических препаратов. </li>\r\n</ul>\r\n<p>Эндогенные факторы риска: </p>\r\n<ul>\r\n<li>отягощённая наследственность; </li>\r\n<li>ожирение; </li>\r\n<li> атеросклероз венечных сосудов сердца; </li>\r\n<li>повышенная вязкость крови (сердце не может полноценно перегонять её по сосудам); </li>\r\n<li>заболевания почек, такие как нефрит, гломерулонефрит, пиелонефрит; </li>\r\n<li> нарушение метаболизма; </li>\r\n<li> наличие эндокринных патологий; </li>\r\n<li> повышенная концентрация кальция в крови; </li>\r\n<li>действие адреналина на сердце во время стрессовых ситуаций; </li>\r\n<li>повышенная концентрация натрия в крови.</li>\r\n</ul>",
"pathogenesis": "<p>В основе патогенеза гипертонической болезни лежит увеличение объема минутного сердечного выброса и сопротивления периферического сосудистого русла. В ответ на воздействие стрессового фактора возникают нарушения регуляции тонуса периферических сосудов высшими центрами головного мозга (гипоталамусом и продолговатым мозгом). Возникает спазм артериол на периферии, в т. ч. почечных, что вызывает формирование дискинетичесного и дисциркуляторного синдромов. Увеличивается секреция нейрогормонов ренин-ангиотензин-альдостероновой системы. Альдостерон, участвующий в минеральном обмене, вызывает задержку воды и натрия в сосудистом русле, что еще более увеличивает объем циркулирующей в сосудах крови и повышает АД. </p>\r\n<p>При артериальной гипертензии увеличивается вязкость крови, что вызывает снижение скорости кровотока и обменных процессов в тканях. Инертные стенки сосудов утолщаются, их просвет сужается, что фиксирует высокий уровень общего периферического сопротивления сосудов и делает артериальную гипертензию необратимой. В дальнейшем в результате повышения проницаемости и плазматического пропитывания сосудистых стенок происходит развитие элластофиброза и артериолосклероза, что в конечном итоге ведет к вторичным изменениям в тканях органов: склерозу миокарда, гипертонической энцефалопатии, первичному нефроангиосклерозу. </p>\r\n<p>Степень поражения различных органов при гипертонической болезни может быть неодинаковой, поэтому выделяют несколько клинико-анатомических вариантов гипертонии с преимущественным поражением сосудов почек, сердца и мозга. </p>",
"diagnostics": "<p>Три основных метода диагностики, которые позволяют определить наличие гипертонии у человека, это: </p>\r\n<p>измерение артериального давления, </p>\r\n<p>физикальное обследование, </p>\r\n<p>электрокардиограмма. </p>\r\n<p>Медицинский анамнез </p>\r\n<p>Диагностика гипертонии заключается так же и в опросе больного врачом. Врач выясняет у больного, какими заболеваниями он ранее страдал, или страдает в настоящее время. Проводится оценка факторов риска (курение, повышенный уровень холестерина, сахарный диабет), а также т. н. наследственный анамнез, то есть, страдали ли гипертонией родители, дедушки-бабушки больного и другие близкие родственники. </p>\r\n<p>Физикальное обследование </p>\r\n<p>Физикальное обследование больного включает в себя прежде всего исследование сердца с помощью фонендоскопа. Этот метод позволяет выявить наличие шумов в сердце, изменения характерных тонов (усиление или, наоборот, ослабление), а также появление нехарактерных звуков. Эти данные, прежде всего, говорят об изменениях, происходящих в ткани сердца ввиду повышенного АД, а также о наличии пороков. </p>\r\n<p>Электрокардиограмма (ЭКГ) </p>\r\n<p>Электрокардиограмма (ЭКГ) — это метод, позволяющий регистрировать на специальной ленте изменение электрических потенциалов сердца во времени. Это незаменимый метод диагностики, прежде всего, различных нарушений ритма сердца. Кроме того, ЭКГ позволяет определить т. н. гипертрофию стенки левого желудочка, что характерно для артериальной гипертонии. </p>\r\n<p>Эхокардиография </p>\r\n<p>Кроме указанных методов диагностики, также применяются и другие методы, например, эхокардиография (ультразвуковое исследование сердца), которое позволяет определить наличие дефектов в строении сердца, изменения толщины его стенок и состояние клапанов. </p>\r\n<p>Артериография </p>\r\n<p>Артериография, в том числе аортография — это рентгенологический метод исследования состояния стенок артерий и их просвета. Данный метод позволяет выявить наличие атероматозных бляшек в стенке коронарных артерий (коронарография), наличие коарктации аорты (врожденное сужения аорты на определенном участке) и т. д. </p>\r\n<p>Допплерография </p>\r\n<p>Допплерография — это ультразвуковой метод диагностики состояния кровотока в сосудах, как в артериях, так и в венах. При артериальной гипертензии, прежде всего, врача интересует состояние сонных артерий и мозговых артерий. Для этого широко применяется именно ультразвук, так как он абсолютно безопасен в применении и не характеризуется осложнениями. </p>\r\n<p>Биохимический анализ крови </p>\r\n<p>Биохимический анализ крови также применяется в диагностике гипертонии. Прежде всего выясняется уровень холестерина и липопротеинов высокой, низкой и очень низкой плотности, так как они являются показателем склонности к атеросклерозу. Кроме того, определяется уровень сахара крови. </p>\r\n<p>В диагностике гипертонии также используется исследование состояния почек, для чего применяются такие методы, как общий анализ мочи, биохимический анализ крови (на уровень креатинина и мочевины), а также УЗИ почек и её сосудов. </p>\r\n<p>УЗИ щитовидной железы </p>\r\n<p>УЗИ щитовидной железы и анализ крови на гормоны щитовидной железы. Эти методы исследования помогают выявить роль щитовидной железы в возникновении повышения артериального давления. </p>",
"treatment": "<p>При лечении гипертонической болезни важно не только снижение АД, но также коррекция и максимально возможное снижение риска осложнений. Полностью излечить гипертоническую болезнь невозможно, но вполне реально остановить ее развитие и уменьшить частоту возникновения кризов. </p>\r\n<p>Гипертоническая болезнь требует объединения усилий пациента и врача для достижения общей цели. При любой стадии гипертонии необходимо: </p>\r\n<ul>\r\n<li>Соблюдать диету с повышенным потреблением калия и магния, ограничением потребления поваренной соли; </li>\r\n<li>Прекратить или резко ограничить прием алкоголя и курение; </li>\r\n<li>Избавиться от лишнего веса; </li>\r\n<li>Повысить физическую активность: полезно заниматься плаванием, лечебной физкультурой, совершать пешеходные прогулки; </li>\r\n<li>Систематически и длительно принимать назначенные препараты под контролем АД и динамическим наблюдением кардиолога. </li>\r\n</ul>\r\n<p>При гипертонической болезни назначают гипотензивные средства, угнетающие вазомоторную активность и тормозящие синтез норадреналина, диуретики, β-адреноблокаторы, дезагреганты, гиполипидемические и гипогликемические, седативные препараты. Подбор медикаментозной терапии осуществляют строго индивидуально с учетом всего спектра факторов риска, уровня АД, наличия сопутствующих заболеваний и поражения органов-мишеней. </p>\r\n<p>Критериями эффективности лечения гипертонической болезни является достижение: </p>\r\n<ul>\r\n<li>краткосрочных целей: максимального снижения АД до уровня хорошей переносимости; </li>\r\n<li>среденесрочных целей: предупреждения развития или прогрессирования изменений со стороны органов-мишеней; </li>\r\n<li>долгосрочных целей: профилактика сердечно-сосудистых и др. осложнений и продление жизни пациента. </li>\r\n</ul>",
"prevention": "<p>Для первичной профилактики гипертонической болезни необходимо исключение имеющихся факторов риска. Полезны умеренные физические нагрузки, низкосолевая и гипохолестериновая диета, психологическая разгрузка, отказ от вредных привычек. Важно раннее выявление гипертонической болезни путем контроля и самоконтроля АД, диспансерный учет пациентов, соблюдение индивидуальной гипотензивной терапии и поддержание оптимальных показателей АД. <br class=\"SCXW241713266\" /> </p>",
"clinical_picture": "<p>Клиническая картина гипертонической болезни варьирует в зависимости от длительности течения, степени повышения артериального давления, а также органов, вовлеченных в патологический процесс. Гипертоническая болезнь может в течение длительного времени ничем не проявляться клинически. Первые признаки заболевания в таких случаях возникают спустя несколько лет после начала патологического процесса при наличии выраженных изменений в сосудах и органах-мишенях. </p>\r\n<p>На доклинической стадии развивается транзиторная гипертензия (периодическое временное повышение артериального давления, обычно связанное с какой-либо внешней причиной – эмоциональными потрясениями, резкой переменой погоды, иными заболеваниями). Проявлениями гипертонической болезни являются головные боли, локализующиеся обычно в области затылка, носящие распирающий характер, ощущение тяжести и/или пульсации в голове, а также головокружение, шум в ушах, вялость, быстрая утомляемость, расстройства сна, сердцебиение, тошнота. На данной стадии поражения органов-мишеней не происходит. </p>\r\n<p>С прогрессированием патологического процесса у пациентов возникает одышка, которая может проявляться при физических нагрузках, беге, ходьбе, подъеме по лестнице. Больные предъявляют жалобы на повышенную потливость, гиперемию кожных покровов лица, онемение пальцев верхних и нижних конечностей, ознобоподобный тремор, продолжительные тупые боли в области сердца, носовые кровотечения. Артериальное давление устойчиво держится на уровне 140–160/90–95 мм рт. ст. В случае задержки жидкости в организме у пациента наблюдается отеки лица и рук, скованность движений. При спазме кровеносных сосудов сетчатки глаз могут появляться вспышки перед глазами, пелена, мелькание мушек, снижается острота зрения (в тяжелых случаях – вплоть до полной его потери при кровоизлиянии в сетчатку). На данной стадии заболевания у пациента проявляется микроальбуминурия (потеря альбуминов с мочей), протеинурия (потеря белка с мочой), гипертрофия левого желудочка, ангиопатия сетчатки глаза. </p>\r\n<p>Как на первой, так и на второй стадии заболевания возможно возникновение неосложненных кризов. </p>\r\n<p>Для поздней стадии гипертонической болезни характерно наличие вторичных изменений органов-мишеней, что обусловлено изменениями сосудов и нарушением внутриорганного кровотока. Проявляться это может хронической стенокардией (болями в сердце), острым нарушением мозгового кровообращения (геморрагический инсульт), гипертонической энцефалопатией. </p>\r\n<p>На поздней стадии заболевания развиваются осложненные кризы. Гипертонический криз – это внезапный, резкий подъем артериального давления, сопровождающийся ухудшением самочувствия, опасный осложнениями. </p>\r\n<p>Вследствие длительной повышенной нагрузки на сердечную мышцу происходит ее утолщение. При этом энергетическое обеспечение клеток сердечной мышцы ухудшается, нарушается поступление питательных веществ. У пациента развивается кислородное голодание миокарда, а затем и ишемическая болезнь сердца, повышается риск развития инфаркта миокарда, острой или хронической сердечной недостаточности, летального исхода. </p>\r\n<p>При прогрессировании гипертонической болезни происходит поражение почек. На начальных стадиях заболевания нарушения обратимы. Однако в отсутствие адекватного лечения протеинурия (потеря белка с мочой) нарастают, в моче повышается количество эритроцитов, нарушается азотовыделительная функция почек, развивается почечная недостаточность. </p>",
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}
]
}
