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},
"code": "C93.1",
"name": "Хронический моноцитарный лейкоз",
"icd_name": "Хронический моноцитарный лейкоз",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "c93.1_hronicheskiy_monocitarnyy_leykoz",
"lead": "опухолевый процесс со значительным увеличением содержания моноцитарных клеток при нормальном или невысоком лейкоцитозе",
"description": "",
"etiology": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Причины хронического моноцитарного лейкоза неизвестны. </span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Единой теории, объясняющей возникновение опухолей системы крови, не существует. </span><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наиболее признанной в настоящее время является вирусно-генетическая теория. </span><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Согласно ей, особые вирусы (известно 15 видов таких вирусов) внедряются в организм человека и при воздействии предрасполагающих факторов, вызывающих срыв иммунитета, проникают внутрь незрелых клеток костного мозга. </span><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Это препятствует созреванию клеток и вызывает их частое деление.</span></p>\r\n<p><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Роль наследственности в возникновении опухолей системы крови не вызывает сомнений, так как эти заболевания чаще встречаются в некоторых семьях, а также у людей с нарушениями структуры хромосом (носители наследственной информации). </span></p>\r\n<p><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Предрасполагающие факторы.</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Физические: ионизирующая радиация, рентгеновское облучение (например, при нарушении техники безопасности на атомных электростанциях или при лечении рентгеновским облучением опухолей кожи).</span></p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Химические:</span></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;\">производственные – лаки, краски и др. (могут проникать в организм человека через кожу, при вдыхании или поступать с пищей и водой);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">лекарственные – длительное применение солей золота (при лечении заболеваний суставов), некоторых антибиотиков и др.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\">Биологические:</span></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;\">вирусы;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">кишечные инфекции;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">туберкулез (инфекционное заболевание человека и животных, вызываемое особым видом микроорганизмов – микобактериями – и поражающее преимущественно легкие, кости и почки);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">хирургические вмешательства;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">стрессы. </span></li>\r\n</ul>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В патогенезе хронического лимфолейкоза значимая роль принадлежит иммунологическим механизмам – об этом свидетельствует его частое сочетание с аутоиммунной гемолитической анемией и тромбоцитопенией, коллагенозами. Вместе с тем, у большинства больных хроническими лейкозами причинно значимых факторов выявить не удается.</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;\">Предполагаемый диагноз устанавливается на основании анализа гемограммы, с результатами которой пациент должен быть немедленно направлен к врачу-гематологу. Для подтверждения диагноза проводится:</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;\">Общий анализ крови. Типичные для хронического миелоидного лейкоза изменения включают: анемию, присутствие единичных миелобластов и гранулоцитов на разной стадии дифференцировки; в период бластного криза количество бластных клеток увеличивается более чем на 20%. При хроническом лимфолейкозе определяющими гематологическими признаками выступают выраженный лейкоцитоз и лимфоцитоз, наличие лимфобластов и клеток Боткина-Гумпрехта.</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;\">Пункции и биопсии. С целью определения морфологии опухолевого субстрата показано выполнение стернальной пункции, трепанобиопсии, биопсии лимфоузлов. В пунктате костного мозга при хроническом миелолейкозе увеличено количество миелокариоцитов за счет незрелых клеток гранулоцитарного ряда; в трепанобиоптате определяется замещение жировой ткани миелоидной. При хроническом лимфоидном лейкозе миелограмма характеризуется резким усилением лимфоцитарной метаплазии.</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;\">Инструментальные исследования. Для оценки выраженности лимфопролиферативного синдрома применяются УЗИ лимфатических узлов, селезенки, рентгенография грудной клетки, лимфосцинтиграфия, МСКТ брюшной полости и ряд других.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"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;\">На ранней доклинической стадии лечение неэффективно, поэтому больные подлежат динамическому наблюдению. Общережимные мероприятия предполагают исключение физических перегрузок, стрессов, инсоляции, электропроцедур и теплолечения; полноценное витаминизированное питание, длительные прогулки на свежем воздухе.</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;\">В развернутом периоде миелолейкоза назначается химиотерапевтическое лечение (бусульфан, митобронитол, гидроксимочевина и др.), при выраженной спленомегалии проводится облучение селезенки. Подобная тактика, хоть и не приводит к полному излечению, но существенно тормозит прогрессирование болезни и позволяет отсрочить наступление бластного криза. Кроме медикаментозной терапии, при хроническом миелоцитарном лейкозе используются процедуры лейкафереза. В ряде случаев излечение достигается с помощью трансплантации костного мозга.</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 переходе хронического миелолейкоза в терминальную стадию назначается высокодозная полихимиотерапия. В среднем после установления диагноза больные хроническим миелолейкозом живут 3-5 лет, в отдельных случаях – 10-15 лет. Также проводится цитостатическая терапия (хлорбутин, циклофосфамид), иногда в сочетании со стероидной терапией, облучением лимфоузлов, селезенки, кожи. При значительном увеличении селезенки выполняется спленэктомия. Применяется трансплантация стволовых клеток, однако ее эффективность еще требует подтверждения.</span></p>",
"prevention": "<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Первичная профилактика хронического моноцитарного лейкоза (то есть до возникновения заболевания):</span></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;\">соблюдение техники безопасности на производстве с целью снижения контакта с потенциально опасными химическими веществами (лаки, краски и др.) и источниками ионизирующего излучения (радиации);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">укрепление защитных сил организма для снижения заболеваемости простудными и прочими инфекционными заболеваниями (например, закаливание, прогулки на свежем воздухе, здоровое питание с достаточным содержанием овощей и фруктов и др.).</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Вторичная профилактика (то есть после возникновения заболевания) заключается в регулярных профилактических осмотрах населения с целью наиболее раннего выявления у них признаков заболевания.</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;\">Все симптомы хронического моноцитарного лейкоза объединены в несколько синдромов (устойчивая совокупность симптомов, объединенных единым развитием).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиперпластический, или пролиферативный (связанный с ростом опухоли):</span></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;\">боль и тяжесть в левой верхней части живота (увеличение селезенки) встречается у половины больных;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">увеличение лимфоузлов обычно незначительное или отсутствует;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боль и тяжесть в правой верхней части живота (увеличение печени) отмечается редко;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">боли в костях (разрастание костного мозга) выявляется при длительном течении заболевания.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-size: 7pt; white-space: pre-wrap;\"> Интоксикационный (отравление организма продуктами распада опухоли). Развивается при большой массе опухоли. Симптомы:</span></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;\">выраженная общая слабость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">утомляемость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">снижение массы тела;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">потливость;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">повышение температуры тела. </span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анемический (то есть за счет снижения уровня гемоглобина – особого вещества эритроцитов (красных клеток крови), переносящего кислород):</span></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;\">слабость, снижение работоспособности;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">головокружение;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">обморочные состояния;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">шум в ушах, мелькание «мушек» перед глазами;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">одышка (учащенное дыхание) и сердцебиение при незначительной физической нагрузке;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">колющие боли в грудной клетке.</span></li>\r\n</ul>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Геморрагический (наличие кровоизлияний и кровотечений за счет снижения количества тромбоцитов – кровяных пластинок, склеивание которых обеспечивает начальный этап свертывания крови):</span></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;\">подкожные и подслизистые (например, в полости рта) кровоизлияния;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">десневые, носовые и другие кровотечения.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Иммунодефицитный (синдром инфекционных осложнений). Присоединение любых инфекций связано с недостаточным образованием нормальных лейкоцитов (белых клеток крови), обеспечивающих защиту от микроорганизмов. </span></p>",
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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;\">Как правило, заболевание становится осложнением других бактериальных, грибковых или вирусных патологий. К предрасполагающим факторам относится нерациональный прием антибиотиков или кортикостероидов, переохлаждение, частое попадание воды в слуховой проход. В роли самостоятельной нозологии мирингит встречается крайне редко. Наиболее часто в роли пусковых факторов выступают:</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;\">Болезни наружного уха и барабанной полости. Являются основной причиной развития мирингита. Обычно его возникновение обусловлено распространением патологического процесса на барабанную перепонку при внешнем или среднем отите, тубоотите и пр.</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;\">Вирусные, бактериальные, грибковые заболевания. Мирингит может наблюдаться на фоне гриппа, кори, пневмонии или сепсиса. Поражение барабанной перепонки вызвано гематогенным или контактным распространением возбудителя из первичного очага.</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;\">Травматическое повреждение. Воспалительная реакция при травме обусловлена нарушением целостности эпидермиса, покрывающего наружный слой барабанной перепонки. В роли травмирующего фактора могут выступать механические, термические или химические агенты.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Полная программа обследования включает в себя следующие методы диагностики:</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;\">Сбор анамнеза и жалоб. При опросе пациента отоларинголог обращает внимание на дебют заболевания и наличие ранее диагностированных патологий. Врач уточняет динамику и последовательность развития имеющихся симптомов.</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;\">Отоскопия. При остром катаральном варианте присутствует отечность и гиперемия перепонки, сглаженность ее структур, небольшой объем серозного экссудата в полости слухового хода. Хроническая форма характеризуется утолщением стенки, мацерацией эпидермиса, наличием грануляций, большим количеством гнойных пузырьков. При геморрагическом мирингите буллы заполнены серозно-геморрагическим экссудатом. При герпетической этиологии они имеют небольшой диаметр, а крупные гнойники возникают при гриппе или парагриппе.</span></li>\r\n<li><span style=\"background-color: transparent; font-size: 7pt; font-family: Verdana; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Лабораторные анализы. Общий анализ крови позволяет выявить лейкоцитоз со сдвигом лейкоцитарной формулы влево, повышение СОЭ. При вирусной этиологии мирингита на 2-4 сутки от начала заболевания уровень лейкоцитов опускается ниже нормы, возникает относительный лимфоцитоз. При</span></li>\r\n<li>Тональная пороговая аудиометрия. Используется для определения характера развившейся тугоухости и выбора дальнейшей терапевтической тактики. При кондуктивной форме тугоухости наблюдается ухудшение воздушной проводимости при сохранении костного восприятия звука. Сенсоневральная тугоухость характеризуется нарушением работы как звукопроводящей, так и звуковоспринимающих систем.</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;\">Основной метод лечения – медикаментозный, комбинация препаратов определяется отоларингологом. В терапевтическую программу могут входить:</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;\">Антибактериальные или противовирусные средства. В зависимости от этиологического варианта мирингита, результатов бактериологического и вирусологического методов исследования назначаются антибиотики, противогрибковые или противовирусные препараты. Наиболее часто применяют цефалоспорины II-III поколения, макролиды, фторхинолоны, производные амантадина.</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;\">НПВС. Нестероидные противовоспалительные средства угнетают воспалительный процесс в барабанной перепонке. В сочетании с антибактериальной или противовирусной терапией они способны купировать болевой синдром.</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;\">Антисептические препараты. Растворы антисептиков используются для промывания слухового прохода. Это позволяет реализовать местное воздействие на пораженные ткани, способствует эвакуации гнойных или кровянистых масс. Обычно используется фурацилин и борная кислота.</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;\">Дезинтоксикационная терапия. Применяется при развитии выраженного интоксикационного синдрома. Основные препараты – физиологический раствор, 5% глюкоза, низкомолекулярные плазмозаменители.</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;\">Парацентез булл. При образовании крупных гнойников показано хирургическое удаление их геморрагического или гнойного содержимого с последующей обработкой антисептическими препаратами.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<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;\">Профилактика мирингита заключается в предотвращении травматических повреждений уха, соблюдении правил личной гигиены, полноценном своевременном лечении заболеваний, которые потенциально могут привести к поражению барабанной перепонки.</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;\">Хронический мирингит провоцирует хроническая экзема или диффузное воспаление слухового прохода. Поражение касается всей перепонки или отдельных ее участков.</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;\">Нередко выделяется гной с неприятным запахом. Освобожденная от гноя перепонка влажная, шероховатая, грязно-серого цвета. Симптомы хронического мирингита:</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;\">сильный, нестерпимый зуд в ухе;</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;\">выраженное притупление слуха;</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;\">ощущение тяжести в ухе.</span></li>\r\n</ul>",
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{
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"treatment": "<p>Используются средства местного и общего действия. Необходимо прекратить курение, не употреблять алкоголь, не перенапрягать голос, не есть очень горячую или холодную пищу, проводить лечение заболеваний носа и носоглотки, поскольку дыхание через рот вредно отражается на состоянии гортани. Используются ингаляционные процедуры типа щелочно-соляных и масляных ингаляций, инстилляций противовоспалительных средств (10 %-ный раствор иманина, химотрипсин, разведенный на изотоническом растворе хлорида натрия, гидрокортизон, сок каланхоэ), вяжущих средств (3 %-ный раствор колларгола, водно-глицериновый раствор танина). При атрофическом ларингите хроническом назначают йодоглицериновые или сероводородные ингаляции, сочетая с ними щелочные и масляные ингаляции. При выраженной сухости рекомендуются полоскания настойкой ромашки или липового цвета.</p>",
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"clinical_picture": "<p> При ларингите хроническом изменения происходят главным образом в области голосовых складок и межчерпаловидной области. Клинические проявления ларингита хронического выражаются в появлении хрипоты различной степени выраженности, ощущения упорного першения и неловкости в горле, кашля, стенозирования. Различают три основные формы ларингита хронического: катаральную, гипертрофическую и атрофическую.</p>",
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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;\">Основные причины хронического ларингита:</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;\">Профессиональные факторы (работа в условиях загазованности и с химическими веществами)</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;\">Вредные привычки (курение, употребление алкоголя)</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Аллергия</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;\">Воспалительные процессы в верхних дыхательных путях</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;\">Региональные особенности климата</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;\">Нарушения носового дыхания</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;\">Гормональные нарушения</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;\">Гастро-эзофагальный рефлюкс</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;\">Чрезмерные голосовые нагрузки</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;\">Травмы (в том числе, интубация)</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;\">Все это приводит к повреждению слизистой оболочки гортани, что способствует развитию хронического воспаления.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"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;\">Характерной патогенетической особенностью хронического ларингита является нарушение местного кровообращения в сочетании с метаплазией и классическими воспалительными изменениями покровного эпителия. Типичный для этой анатомической области цилиндрический эпителий замещается разновидностью плоского, затем разрыхляется и постепенно отторгается. Параллельно в подэпителиальных тканях возникает круглоклеточная инфильтрация.</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;\">Сочетание отека и клеточной пролиферации приводит к нарушению подвижности ресничек эпителия задней стенки гортани. В результате страдает одна из основных функций органа – дренаж слизи бронхиального дерева, из-за чего происходит ее скопление на голосовых складках.</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;\">Постановка диагноза производится на основании комплексного анализа жалоб пациента, результатов физикальных и лабораторных тестов. При сборе анамнеза врач-отоларинголог выясняет потенциальные этиологические факторы, в том числе условия работы и профессию больного, сопутствующие заболевания, ранее перенесенные операции и травмы, употребление спиртных напитков, курение. Дальнейшая диагностическая программа включает в себя:</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;\">Физикальный осмотр области шеи. При пальпации выявляются умеренно увеличенные передние и задние шейные группы лимфатических узлов. Во время разговора и при кашле определяется повышенная нагрузка на мускулатуру передней и боковой поверхности шеи.</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;\">Непрямую ларингоскопию. При осмотре полости гортани визуализируется общее утолщение и закругленность свободного края голосовых складок, выраженная гиперемия и расширение сосудов на их поверхности и на задней стенке глотки. Слизистая оболочка последней может быть суховатой или излишне влажной, на некоторых участках определяется скопление слизи.</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;\">Общие лабораторные тесты. В клиническом анализе крови присутствуют неспецифические воспалительные изменения: лейкоцитоз, сдвиг лейкоцитарной формулы в сторону палочкоядерных и юных нейтрофильных лейкоцитов, увеличение СОЭ.</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;\">Микробиологическое исследование. Назначается для идентификации патогенной микрофлоры с дальнейшим определением ее чувствительности к основным группам антибактериальных препаратов. В качестве материала для исследования используется отхаркиваемая при кашле мокрота или мазок, взятый со слизистой гортани.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Компьютерную томографию. КТ шеи показана при невозможности полноценно дифференцировать ларингит с нагноившимся ларингоцеле, злокачественными новообразованиями регионарных анатомических структур. При хроническом воспалении гортани на томограмме отображается диффузное утолщение мягких тканей, при других патологиях процесс зачастую имеет односторонний, ограниченный характер.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Используется комплексный терапевтический подход, включающий в себя местные и системные фармакологические средства, физиотерапевтические процедуры. Лечение начинается с устранения этиологического фактора, назначения голосового покоя и диеты из нераздражающих продуктов. Далее в зависимости от клинической ситуации применяются:</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;\">Системная терапия. Ведущую роль играют антибактериальные препараты широкого спектра действия. Группы выбора – пенициллины и макролиды. В последующем проводится коррекция антибиотикотерапии в соответствии с результатами микробиологического исследования. При необходимости назначаются муколитические средства, антациды и/или ингибиторы протоновой помпы, НПВС, обволакивающие препараты.</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;\">Местное лечение. Заключается в использовании компрессионных ингаляторов с симпатомиметиками, топическими глюкокортикоидами. Это позволяет купировать кашель, местную отечность слизистых. Дополнительно применяются масляные растворы, также обладающие обволакивающим эффектом, местные антисептики и антибиотики.</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;\">Физиотерапия. Показана только в период ремиссии. В амбулаторных условиях проводится фоноэлектрофорез по Крюкову-Подмазову с аугументином и преднизолоном. Эффективным считается санаторно-курортное лечение в условиях сухого прибрежного климата.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"prevention": "<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;\">Профилактика хронического ларингита заключается в своевременном лечении острого ларингита, гастроэзофагальной рефлюксной болезни (ГЭРБ), воспалительной патологии верхних и нижних дыхательных путей, отказа от курения и соблюдении голосового режима.</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;\">Наиболее распространенными симптомами хронического ларингита являются ощущение инородного тела в горле, хрипота и осиплость голоса.</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;\">К другим симптомам относятся:</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;\">ощущение чрезмерной сухости в горле;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">дискомфорт при глотании;</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;\">потеря голоса;</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;\">хронический кашель;</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;\">избыток в горле слизи, которая плохо отходит;</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;\">лихорадка.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": 6607,
"block_rubric": 103,
"standards": [
5367
]
}
]
}
