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},
"code": "N41.0",
"name": "Острый простатит",
"icd_name": "Острый простатит",
"gender": 1,
"age_min": 30,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "n41.0_ostryy_prostatit",
"lead": "болезненное воспаление в предстательной железе, которое обычно сопровождается наличием признаков недавней или продолжающейся инфекции",
"description": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Простатит — это воспалительный процесс ткани предстательной железы, сопровождающийся болевыми ощущениями в пояснице, промежности или тазовой области, а также нарушениями в работе нижних мочевыводящих путей.</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;\">Причиной острого простатита всегда является инфекция. Существуют различные способы попадания бактерий в предстательную железу:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><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;\">через кровеносную систему: патогенные бактерии могут “передвигаться” по кровеносным сосудам при наличии сепсиса или инфекционно-воспалительных очагов в других отделах организма;</span></li>\r\n<li><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;\">через мочевыводящие пути: частицы инфицированной мочи могут проникнуть в выводные протоки предстательной железы;</span></li>\r\n<li><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;\">через лимфатические узлы;</span></li>\r\n<li><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;\">заражение в результате некачественного медицинского вмешательства (ятрогенная инфекция) - при операциях на половых органах, неудачно взятой биопсии, различного рода манипуляциях на предстательной железе.</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;\">В большинстве случаев возбудителями острого простатита являются бактерии Escherichia coli. Реже причиной острых воспалительных процессов в предстательной железе становятся штаммы Enterobacter, Klebsiella, Proteus и Pseudomonas.</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;\">К дополнительным факторам, которые могут спровоцировать инфицирование, относятся:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><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;\">незащищенные половые контакты и частая смена партнеров;</span></li>\r\n<li><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;\">наличие очагов инфекций других органов в организме;</span></li>\r\n<li><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;\">сниженный иммунитет;</span></li>\r\n<li><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;\">частые переохлаждения;</span></li>\r\n<li><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;\">сидячий образ жизни;</span></li>\r\n<li><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;\">малая физическая активность;</span></li>\r\n<li><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;\">операции на органах малого таза.</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 результате попадания микроорганизмов в ткань простаты развивается неспецифическая воспалительная реакция, основным проявлением которой становится отек ткани, обильное привлечение клеток иммунной системы в очаг воспаления, увеличение органа в объеме, сдавление нервных окончаний соседних органов (мочевой пузырь, прямая кишка) и появление боли. На фоне этого будут отмечаться и общие реакции в ответ на воспалительный процесс.</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;\">Учитывая ярко выраженную симптоматическую картину острого простатита, такой первичный диагноз ставится врачами-урологами довольно часто. Однако для его подтверждения и определения причины воспаления необходимо комплексное обследование. Так как ректальный осмотр противопоказан из-за сильной болезненности, пациенту назначаются анализы и инструментальные исследования. На острое воспаление указывает увеличенное число лейкоцитов в секрете простаты. По бакпосеву мочи определяется возбудитель патологии и подбирается курс антибиотиков.</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;\">Другие методы диагностики при остром простатите:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">урофлоуметрия</span></li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #354a54; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">допплерометрия</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #354a54; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ПЦР-тест на наличие ЗППП</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #354a54; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ предстательной железы</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #354a54; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">исследование мазков из уретры и секрета простаты</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #354a54; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ на концентрацию СПА в крови</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #354a54; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пункция при подозрении на абсцесс или гнойную инфекцию</span></p>\r\n</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;\">Если болевой синдром умеренный, в процессе диагностики простатита делается трансректальное УЗИ (через прямую кишку). В других случаях врач прибегает к абдоминальному способу (через брюшную стенку). Результаты позволяют оценить форму, размер простаты, выявить диффузные или очаговые изменения, а также определить стадию острого воспалительного процесса.</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;\">Острый простатит требует постельного режима, специальной, бессолевой диеты, полового покоя.</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;\">Методы курсового лечения:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Самой результативной в лечении простатита является этиотропная терапия. Если в основе простатита – инфекция, приоритетен курс антимикробных средств, который снимает проявления воспаления.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Болевой синдром купируют анальгетиками, спазмолитиками, ректальными свечами, микроклизмами с тёплыми растворами обезболивающих препаратов. Возможно применение НПВП.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Доказали свою эффективность иммуностимуляторы, иммуномодуляторы, энзимы, витаминные комплексы, сочетание микроэлементов.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Физиотерапевтические методы возможны только в подострой стадии заболевания. Они улучшают микроциркуляцию, повышают иммунитет: УВЧ, СВЧ, электрофорез, лазер, магнитотерапия.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Массаж – ещё один эффективный метод воздействия на простату. Он открывает протоки, нормализуют кровообращение органов мошонки, малого таза.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Острую задержку фильтрата почек можно скорректировать катетеризацией, троакарной цистостомой.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гнойный процесс подразумевает хирургическое вмешательство.</span></li>\r\n</ul>",
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"code": "A80",
"name": "Острый полиомиелит",
"icd_name": "Острый полиомиелит",
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"slug": "a80_ostryy_poliomielit",
"lead": "Нарушение здоровья, относящееся к группе вирусные инфекции центральной нервной системы",
"description": "Полиомиелит - острое вирусное заболевание, характеризующееся поражением нервной системы (преимущественно серого вещества спинного мозга), а также воспалительными изменениями слизистой оболочки кишечника и носоглотки. ",
"etiology": "<p>Возбудитель относится к семейству пикорнавирусов, к группе энтеровирусов (кишечным вирусам), куда входят также Коксаки- и ЕСНО-вирусы и существует в виде 3 независимых типов (I, II и III). Наиболее часто встречается 1 тип. </p>\r\n<p>Вирус устойчив во внешней среде (в воде сохраняется до 100 суток, в испражнениях — до 6 мес), хорошо переносит замораживание. Не разрушается пищеварительными соками. Разрушается при нагревании до 50 градусов Цельсия в течение 30 минут. Быстро погибает при кипячении, под действием ультрафиолетового облучения и при высушивании. Даже незначительные концентрации хлора инактивируют вирус. Источник инфекции — человек (больной или переносящий заражение бессимптомно); возбудитель выделяется через рот (несколько суток), а затем с испражнениями (несколько недель, а иногда и месяцев). Заражение может произойти воздушно-капельным путём, но чаще — при попадании в рот активного вируса (через загрязнённые руки, пищу). Механическим переносчиком вируса могут быть мухи. </p>\r\n<p>Заболеваемость полиомиелитом преобладает в летне-осенние месяцы. Чаще болеют дети от 6 месяцев до 5 лет. Большинство заболеваний связано с вирусом типа I. </p>",
"pathogenesis": "<p>Кишечная фаза </p>\r\n<p>Входными воротами для инфекции является слизистая оболочка носоглотки и тонкой кишки, в эпителии и лимфатических образованиях которых происходит первичная репродукция вируса. Затем вирус проникает в ток крови и обусловливает вирусемию. </p>\r\n<p>Фаза вирусемии </p>\r\n<p>Эта фаза характеризуется проникновением вируса во многие органы и ткани, такие как лимфатические узлы, селезенка, печень, легкие, сердечная мышца, жировая ткань, особенно бурый жир. </p>\r\n<p>Невральная фаза </p>\r\n<p>Следующим этапом развития патогенеза полиомиелита является проникновение вируса в различные органы, в частности в ЦНС. В ЦНС в патологический процесс чаще всего вовлекаются мотонейроны передних рогов спинного мозга, двигательные клетки черепных нервов. В тяжелых случаях могут поражаться нейроны задних рогов, клетки спинальных ганглиев и даже проксимальные отделы периферических нервов. В головном мозге повреждаются ретикулярная формация, вестибулярные ядра, глубинные структуры. </p>\r\n<p>Вирус действует на эндотелий сосудов, повышая их проницаемость. В результате чего происходит сдавление, отек здоровых участков нервной ткани, возникает клеточная инфильтрация, тигролиз - все это является морфологическим субстратом полиомиелита. Распространение вируса в организме человека может закончиться на любом этапе, что и определяет развитие той или иной формы полиомиелита. </p>",
"diagnostics": "<p>Лабораторные исследования: пробы крови для серологических исследований, общий анализ крови и мочи. </p>\r\n<p>Инструментальные исследования: </p>\r\n<ul>\r\n<li>Электромиография. При помощи ЭМГ регистрируются биоэлектрические потенциалы, возникающие на нервно-мышечной периферии. Поражение двигательных клеток в передних рогах спинного мозга выражается, прежде всего, четкими изменениями ритма. Это обусловлено тем, что пораженные мотонейроны возбуждаются одновременно (синхронно), что приводит с урежению колебаний потенциалов. Существует отчетливая связь между тяжестью поражения мышц и изменениями электромиограммы. ЭМГ тяжело пораженных мышц характеризуется «биоэлектрическим молчанием». </li>\r\n<li>Рентгенография конечностей для исключения вывихов, подвывихов, остеопороза.. </li>\r\n<li>Магниторезонансная томография спинного мозга - признаки атрофического процесса в передних рогах спинного мозга. </li>\r\n</ul>",
"treatment": "<p>Немедикаментозное лечение </p>\r\n<ul>\r\n<li>Лечебная физкультура занимает одно из ведущих мест в лечении больных с паралитическими формами полиомиелита. К ней необходимо приступить в раннем восстановительном периоде, то есть сразу после появления первых признаков движений в пораженных мышцах. Основная задача лечебных упражнений в раннем восстановительном периоде - тренировка основных параметров двигательной системы, которая заключается в постепенном и дозированном увеличении силы мышечного сокращения, амплитуды. На этом этапе лечения больному необходима помощь в овладении простыми движениями, а затем элементами утраченного сложного двигательного навыка. У больных с глубокими парезами при мышечной силе в пределах 1-0 балла, помимо лечения положением, применяют пассивные и пассивно-активные упражнения с переходом к активным упражнениям. </li>\r\n<li>Стимулирующий массаж пораженных конечностей, мышц спины. </li>\r\n<li>Физиолечение - магнитотерапия, биоптрон, УВЧ на пораженные сегменты спинного мозга, электростимуляция паретичных мышц импульсным током, озокеритовые или парафиновые аппликации на область паретичных мышц, суставы; электрофорез галантамина, прозерина по Вермелю. </li>\r\n<li>Иглорефлексотерапия. </li>\r\n<li>Ортопедическая профилактика паретичных конечностей с использованием шин, лонгет, валиков, мешков с песком, разработка контрактур. </li>\r\n</ul>\r\n<p> Медикаментозное лечение </p>\r\n<ul>\r\n<li>Стимулирующая терапия: антихолинэстеразные препараты - прозерин, галантамин. </li>\r\n<li>Витаминотерапия: аскорбиновая кислота, витамины группы В - В1, В6, В12. </li>\r\n<li>Последние годы в лечении полиомиелита используются анаболические стероиды (нерабол, ретаболил, метандростеналон). </li>\r\n<li>Лечение препаратами, действующими на сосудистую систему, улучшающими реологические свойства крови и микроциркуляцию, проводится в виде последовательных курсов, каждый из них длительностью 2-3 недели. </li>\r\n<li>Спазмолитическим, сосудорасширяющим, стимулирующим влиянием на спинной мозг обладает дибазол. Лечение продолжается в течение 3-4 недель, показаны повторные курсы лечения. </li>\r\n<li>Препараты, улучшающие метаболизм (ноотропы). </li>\r\n<li>Метаболические средства - фолиевая кислота, аевит, оротат калия. </li>\r\n</ul>",
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"clinical_picture": "<p>Инкубационный период при различных формах полиомиелита в среднем составляет 8–12 дней. </p>\r\n<p>Инаппарантная форма полиомиелита представляет собой носительство вируса, которое никак не проявляется клинически и может быть обнаружено только лабораторным путем. </p>\r\n<p>Абортивная (висцеральная) форма полиомиелита составляет более 80% всех случаев болезни. Клинические проявления неспецифичны; среди них преобладают общеинфекционные симптомы – лихорадка, интоксикация, головная боль, умеренные катаральные явления, боли в животе, диарея. Болезнь заканчивается через 3-7 дней полным выздоровлением; остаточных неврологических симптомов не отмечается. </p>\r\n<p>Менингеальная форма полиомиелита протекает по типу доброкачественного серозного менингита. При этом отмечается двухволновая лихорадка, головные боли, умеренно выраженные менингеальные симптомы (Брудзинского, Кернига, ригидность затылочных мышц). Через 3-4 недели наступает выздоровление. </p>\r\n<p>Паралитическая форма полиомиелита имеет наиболее тяжелое течение и исходы. В препаралитическом периоде преобладает общеинфекционная симптоматика: повышение температуры, диспепсия, ринит, фарингит, трахеит и др. Вторая волна лихорадки сопровождается менингеальными явлениями, болью в мышцах, болями в позвоночнике и конечностях, выраженной болевой чувствительностью, потливостью, спутанностью сознания и судорогами. </p>\r\n<p>Примерно на 3-6 день заболевание вступает в паралитическую фазу, характеризующуюся внезапным развитием парезов и параличей чаще нижних конечностей при сохранной чувствительности. Для параличей при полиомиелите характерны асимметричность, неравномерность, преимущественное поражение проксимальных отделов конечностей. Несколько реже при полиомиелите развиваются парезы и параличи верхних конечностей, лица, мышц туловища. Через 10-14 дней наблюдаются первые признаки мышечной атрофии. Поражение жизненно важных центров продолговатого мозга может вызвать паралич дыхательных мышц и диафрагмы и послужить причиной гибели ребенка от острой дыхательной недостаточности. </p>\r\n<p>В восстановительном периоде полиомиелита, который длится до 1 года, происходит постепенная активизация сухожильных рефлексов, восстанавливаются движения в отдельных мышечных группах. Мозаичность поражения и неравномерность восстановления обусловливает развитие атрофии и мышечных контрактур, отставание пораженной конечности в росте, формирование остеопороза и атрофии костной ткани. </p>\r\n<p>В резидуальном периоде отмечаются остаточные явления полиомиелита – стойкие вялые параличи, контрактуры, паралитическая косолапость, укорочение и деформации конечностей, вальгусная деформация стоп, кифосколиозы и пр. </p>",
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},
"code": "I30",
"name": "Острый перикардит",
"icd_name": "Острый перикардит",
"gender": 0,
"age_min": 15,
"age_max": 100,
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"lead": "воспалительное заболевание тканевой оболочки сердца (перикарда)",
"description": "<p>Перикардит - <span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">это воспаление перикарда (эластичная двухслойная оболочка, покрывающая сердце), которое начинается постепенно, существует длительно и приводит к накоплению жидкости в полости перикарда или утолщению перикарда.</span></p>",
"etiology": "<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К инфекционным причинам относят – ревматические, туберкулезные, бактериальные, Кроме того перикардит может иметь грибковую или вирусную этиологию, например, при гриппе.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К асептическим причинам можно отнести аллергию, диффузные заболевания соединительной ткани, гематологические заболевания, злокачественные процессы, травмы, радиационное облучение, гиповитаминоз.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также может развиться идиопатический перикардит, причины которого установить не удается. Именно эти патологии чаще всего склонны к рецидивам.</span></p>\r\n</li>\r\n</ol>\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 развитии перикардита играет большую роль изменение состава или количества перикардиальной жидкости под влиянием вышеперечисленных факторов.</span></p>",
"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;\">Патогенез часто аллергический или аутоиммунный, при инфекционном перикардите инфекция может быть пусковым механизмом; не исключается и прямое повреждение оболочек сердца бактериальным или другими агентами.</span></p>",
"diagnostics": "<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови (клинический, биохимический, иммунологический) – есть ли в крови признаки воспаления;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭХО КГ (УЗИ сердца) - видно количество жидкости в перикардиальной полости;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭКГ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенография;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">КТ грудной клетки;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">в некоторых случаях диагностическая пункция или биопсия перикарда.</span></p>\r\n</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;\">При острой форме пациенту необходимо соблюдать постельный режим. В хронической форме — ограничить физическую активность и соблюдать специальную диету.</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;\">Перечень лекарственных препаратов определяется врачом, и может включать:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">противовоспалительные средства;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анальгетики для снижения болевого синдрома;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">витаминные комплексы и калий;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">антибиотики или противовирусные препараты.</span></p>\r\n</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;\">В некоторых случаях требуется дренирование перикарда.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактические меры по возникновения вторичного перикарда включают регулярное наблюдение у кардиолога, обследование сердца, своевременное лечение инфекций.</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 качестве поддерживающих мер показана умеренная физическая активность, сбалансированная диета и здоровый образ жизни в целом.</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;\">Самой ранней и частой жалобой больных с острым перикардитом является боль в области сердца, локализующаяся на верхушке сердца или внизу грудины, иррадиирующая в левую руку, под левую лопатку, шею, может в эпигастрии. Боль напоминает картину инфаркта миокарда или плеврита. По характеру, как правило, она сильная, иногда ноющая, тупая.</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;\">Больные жалуются на неприятное ощущение и тяжесть в области сердца. Сердечные боли являются главным симптомом сухого перикардита. Появление экссудата и быстрое его накопление в полости перикарда вызывает выраженную одышку у больных. Больной отмечает усиление одышки в горизонтальном положении, лежа на постели, поэтому он вынужден принять положение ортопноэ (положение сидя); иногда стараются облегчить состояние, наклоняя туловище вперед. Одышка обычно сопровождается сухим кашлем.</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;\">Клиническая картина и течение заболевания зависит от основного заболевания.</span></p>\r\n<p> </p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Неспецифический перикардит чаще сопровождается частыми рецидивами. Наиболее частая причина его возникновения – осложнения после вирусных инфекций или облучения. Возникает после вирусной инфекции верхних дыхательных путей, инсоляции. Без своевременного лечения может перерасти в экссудативную или констриктивную форму.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При гнойном перикардите при аппаратном или пункциональномобследовании обнаруживается умеренное накопление гноя в сердечной сумке.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ревматический перикардит является признаком активного ревматизма и зачастую возникает на фоневоспаления стенок сердца - ревматического кардита.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; 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;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Метастатическим перикардит может быть первым признаком рака легких или молочной железы. Первичная опухоль перикарда, которая также вызывает перикардит –мезотелиома – встречается редко.</span></p>\r\n</li>\r\n</ol>",
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},
"code": "K05.2",
"name": "Острый пародонтит",
"icd_name": "Острый пародонтит",
"gender": 0,
"age_min": 40,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "k05.2_ostryy_parodontit",
"lead": "инфекционно-воспалительное заболевание пародонта",
"description": "",
"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;\">Выделяют местные факторы, вызывающие развитие патологии:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">специфические бактерии, которые содержатся в зубных отложениях;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">анатомически неправильное расположение зубов;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">аномалии прикуса;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">повышенный тонус мышц, задействованных при жевании.</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;\">Среди общих причин отмечают наличие соматических заболеваний (сахарного диабета, иммунодефицитных состояний, патологий крови, органов пищеварения и других систем).</span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Первый этап диагностики – внешний осмотр ротовой полости. Специалист проводит зондирование (пародонтальную пробу) – процедуру, которая определит глубину образовавшегося зубного кармана. Это необходимо для установки степени тяжести пародонтита. Дополнительно назначаются следующие исследования:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #465a63; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">бензидиновая проба. Позволяет выявить гной в пародонтальных карманах без проведения микроскопического исследования. Для этого в карман вводят турунду, смоченную в растворе, состоящем из бензидина, уксусной кислоты и полиэтиленгликоля. Если гной отсутствует, то цвет турунды не меняется, а при его наличии она становится голубой, зеленой или голубовато-зеленой;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #465a63; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">проба Шиллера-Писарева. Направлена на выявление в десне гликогена – вещества, количество которого резко возрастает при воспалении. Десна смазывают видоизмененным раствором Люголя, после чего оценивают окраску. Она меняется от светло-коричневого до темно-бурого;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #465a63; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенография. На снимке специалист определяет, насколько сильно патологическим процессом поражена костная ткань;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #465a63; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">мазок из зубного кармана. Исследование проводится с целью определить возбудителя заболевания, который вызвал воспалительный процесс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #465a63; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">панорамная томография. Такая процедура позволяет получить полный вид пораженной челюсти. Исследование чаще проводится при подозрении на генерализованный пародонтит.</span></p>\r\n</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;\">После внимательной диагностики и определения тяжести заболевания стоматолог назначает терапию, которая включает комплекс препаратов для применения внутрь и наружно. Среди них обезболивающие, антибактериальные, противовоспалительные, иммуномодулирующие средства.</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;\">При остром пародонтите на первом этапе устраняют источник инфицирования. Для этого проводят санацию ротовой полости и профессиональную чистку зубов. Если удаление отложений в виде налета и камней не приносит желаемого результата, производят кюретаж околозубных карманов. Оперативное уменьшение карманов снижает подвижность зубов и позволяет закрыть оголенные корни.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В тяжелых случаях острого пародонтита, когда происходит деструкция костных тканей, потребуется хирургическое вмешательство для внедрения синтетического или собственного материала пациента. Одновременно выполняют шинирование подвижных зубов. Дентальные единицы, не подлежащие восстановлению, удаляются.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эффективная профилактика пародонтита заключается в следовании ряду простых правил:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ежедневная чистка зубов (лучше дважды в день);</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">применение зубной нити после каждой трапезы;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">равномерное использование всех зубов в жевательном процессе;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">включение в рацион твердой растительной пищи;</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">осмотр у стоматолога 1–2 раз в год.</span></li>\r\n</ul>",
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"description": "Острый панкреатит — стремительно развивающееся воспаление поджелудочной железы, обусловленное поражением органа собственными ферментами, заболевание без лечения может угрожать жизни пациента. Заболевание возникает чаще в возрасте 30—60 лет, причем у женщин в 2 раза чаще, чем у мужчин.",
"etiology": "<p>Факторы, способствующие возникновению острого панкреатита:</p>\r\n<ul>\r\n<li>злоупотребление алкоголем (в 70% случаев), вредные пищевые привычки (жирная, острая пища);</li>\r\n<li>заболевания желчевыводящих путей, в том числе желчнокаменная болезнь (в 25-30% случаев);</li>\r\n<li>вирусные (эпидемический паротит, вирус Коксаки) или бактериальные инфекции;</li>\r\n<li>травмы поджелудочной железы;</li>\r\n<li>хирургические вмешательствапо поводу других патологий поджелудочной железы и желчевыводящих путей;</li>\r\n<li>прием эстрогенов, кортикостероидов, тиазидных диуретиков, азатиоприна, других лекарственных средств с выраженным патологическим действием на поджелудочную железу (медикаментозный панкреатит);</li>\r\n<li>врожденные аномалии развития железы, генетическая предрасположенность, муковисцидоз;</li>\r\n<li>воспалительные заболевании органов пищеварения (холецистит, гепатит, гастродуоденит).</li>\r\n</ul>",
"pathogenesis": "<p>В развитии острого воспаления поджелудочной железы основным фактором выступает повреждение клеток преждевременно активированными ферментами самой железы. В нормальных условиях пищеварительные ферменты вырабатываются поджелудочной железой в неактивной форме и активизируются уже в пищеварительном тракте. Под воздействием внешних и внутренних патологических факторов механизм выработки нарушается, ферменты (фосфолипаза А и липаза) активизируются в поджелудочной железе и начинают переваривание ее собственной ткани. Вследствие этого развивается воспаление, отек ткани, поражаются сосуды паренхимы железы.</p>\r\n<p>Патологический процесс при остром панкреатите может распространяться на близлежащие ткани: забрюшинную клетчатку, сальниковую сумку, брюшину, сальник, брыжейку кишечника и связки печении ДПК. Тяжелая форма острого панкреатита способствует резкому повышению уровня различных биологически активных веществ в крови, что ведет к выраженным общим нарушениям жизнедеятельности.</p>\r\n<p> </p>",
"diagnostics": "<p>Лабораторная диагностика:</p>\r\n<p>При исследовании крови в общем анализе отмечаются признаки воспаления (ускорена СОЭ, повышено содержание лейкоцитов), в биохимическом анализе крови обнаруживают повышение активности панкреатических ферментов (амилаза, липаза), возможна гипергликемия и гипокальциемия. Также проводят определение концентрации ферментов в моче. Может отмечаться билирубинемия и повышения активности печеночных ферментов.</p>\r\n<p>При диагностировании острого панкреатита берут биохимический анализ мочи и определяют активность амилазы мочи.</p>\r\n<p>Инструментальная диагностика:</p>\r\n<p>При ультразвуковом исследовании обнаруживают снижение эхогенности паренхимы железы и появление отсутствующего в норме просвета сальниковой сумки за счёт скопления в ней выпота</p>\r\n<p>Рентгеновское исследование брюшной полости обычно малоинформативно, однако иногда позволяет выявить как косвенные признаки воспалительного процесса в поджелудочной железе</p>\r\n<p>КТ имеет преимущество перед ультразвуковым исследованием, так как обеспечивает лучшую специфическую визуализацию ткани поджелудочной железы.</p>\r\n<p>МРТ позволяет оценить уровень тканевого метаболизма, наличие ишемии, некроз панкреатоцитов. Это важно при оценке течения заболевания до развития тяжёлых состояний и осложнений.</p>\r\n<p>Ангиография позволяет установить нарушения кровообращения в поджелудочной железе и окружающих тканях и органах. Эти данные позволяют определиться с прогнозом и тактикой хирургического вмешательства.</p>\r\n<p>ЭГДС относится к дополнительным методам инструментального исследования острого панкреатита.</p>\r\n<p> </p>",
"treatment": "<p>Тактика лечения больных с острым панкреатитом определяется клинико-морфологической формой заболевания в соответствии с фазой развития воспалительного и некротического процесса и степенью тяжести состояния больного. Оптимальным видом лечения ОП в доинфекционной фазе является интенсивная консервативная терапия, а при появлений инфекционных (септических) осложнении – оперативное лечение.</p>\r\n<p>Немедикаментозное лечение: Голод в течение 2-3 суток, постоянное назогастралъное зондирование и аспирация, местная гипотермия (холод на живот). </p>\r\n<p> Для лечения нетяжёлого панкреатита достаточно проведения базисного лечебного комплекса: - анальгетики; - спазмолитики; - инфузионная</p>\r\n<p>Базисную терапию целесообразно усиливать антисекреторной и антиферментной.</p>\r\n<p>При отсутствии эффекта от проводимой базисной терапии в течение 6 часов и наличии хотя бы одного из признаков тяжёлого панкреатита следует констатировать тяжёлый панкреатит и перевести больного в отделение реанимации и интенсивной терапии и проводить лечение, соответствующее тяжёлому острому панкреатиту.</p>\r\n<p>Протокол интенсивной терапии тяжёлого панкреатита</p>\r\n<p>Основной вид лечения - интенсивная консервативная терапия. Приведенный выше базисный лечебный комплекс при тяжёлом ОП является недостаточно эффективным и должен быть дополнен специализированным лечебным комплексом. Эффективность последнего максимальна при раннем начале лечения (первые 12 часов от начала заболевания). Хирургическое вмешательство в виде лапаротомии показано лишь при развитии осложнений хирургического профиля, которые невозможно устранить эндоскопическими методами (деструктивный холецистит, желудочно-кишечное кровотечение, острая кишечная непроходимость и др.).</p>\r\n<p>Специализированное лечение. 1) Антисекреторная терапия (оптимальный срок - первые трое суток заболевания); 2) Антикоагулянты; 3) Возмещение плазмопотери (коррекция водно-электролитных, белковых потерь и др.; 4) Антиферментная, антиоксидантная и антигипоксантная терапия. 5) Детоксикация – при тяжёлом ОП показаны экстракорпоральные методы детоксикации, из которых наиболее эффективным является серийный лечебный плазмаферез. 6) Антибиотикотерапия широкого спектра действия (цефалоспорины III-IV поколений или фторхинолоны II-III поколений в сочетании с метронидазолом).</p>\r\n<p>Хирургическое лечение показано в случае выявления:</p>\r\n<p>камней в желчных протоках; скоплений жидкости в железе или вокруг нее; участков панкреатического некроза, кист, абсцессов.</p>\r\n<p>К операциям, проводимым при остром панкреатите с образованием кист или абсцессов, относятся: эндоскопическое дренирование, марсупиализация кисты, цистогастростомия и др. При образовании участков некроза, в зависимости от их размера, проводят некрэктомию или резекцию поджелудочной железы. Наличие камней является показанием к операциям на протоке поджелудочной железы.</p>\r\n<p>К хирургическому вмешательству могут прибегать и в случае сомнений в диагностики и вероятности пропустить другое хирургическое заболевание, требующее хирургического лечения.</p>",
"prevention": "<p>Первичной профилактикой панкреатита является рациональное здоровое питание, исключение алкоголя, острой, жирной обильной пищи, отказ от курения. Острый панкреатит может развиться не только у лиц, регулярно злоупотребляющих алкоголем, но и как следствие однократного приема спиртосодержащих напитков под жирную, жареную и острую закуску в больших количествах.</p>",
"clinical_picture": "<p>Характерные симптомы острого панкреатита.</p>\r\n<ul>\r\n<li>Болевой синдром. Боль может локализоваться в эпигастрии, левом подреберье, нередко носит опоясывающий характер, может отдавать под левую лопатку. Боль носит выраженный постоянный характер, в положении лежа на спине усиливается. Усиление боли происходит и после приема пищи, особенно – жирной, острой, жареной, алкоголя.</li>\r\n<li>Тошнота, рвота. Рвота может быть неукротимой, содержит желчь, не приносит облегчения. Как правило, из-за интоксикации и рвоты наступает нарушение водно-электролитного баланса, обезвоживание, которое играет важную роль в патогенезезаболевания.</li>\r\n<li>Повышение температуры тела.</li>\r\n<li>Умеренно выраженная желтушность склер. Редко – легкая желтуха кожных покровов.</li>\r\n</ul>\r\n<p>Кроме того, острый панкреатит может сопровождаться диспепсическими симптомами (вздутие живота, метеоризм, изжога), кожными проявлениями (синюшные пятна на левой боковой стенке живота, иногда с желтоватым оттенком, кровоизлияния в области пупка).</p>",
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},
"code": "J05",
"name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"icd_name": "Острый обструктивный ларингит [круп] и эпиглоттит",
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2,
4,
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7
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"lead": "Нарушение здоровья, относящееся к группе острые респираторные инфекции верхних дыхательных путей",
"description": "Острый обструктивный ларингит (круп) - воспаление гортани и тканей подскладочного пространства с сужением просвета гортани. Ранее также использовался термин «стенозирующий ларинготрахеит» \r\n\r\nЭпиглоттит – это остро возникшее бактериальное воспаление надгортанника и окружающих тканей, которое может привести к быстрому жизнеугрожающему нарушению проходимости дыхательных путей. ",
"etiology": "<p>Наиболее часто причинно значимыми возбудителями острого обструктивного ларингита являются респираторные вирусы, причем до 80% случаев крупа обусловлено вирусом парагриппа. </p>\r\n<p>В числе прочих возбудителей болезни: вирусы гриппа А и В, аденовирусы, респираторно-синцитиальный вирус, риновирусы, энтеровирусы, бокавирус, коронавирус, метапневмовирус. В крайне редких случаях круп может быть обусловлен бактериальными возбудителями, например, микоплазмой пневмонии. </p>\r\n<p>Этиологическим фактором эпиглоттита в подавляющем большинстве случаев является гемофильная палочка типа b (>90%). В странах, где введена массовая иммунизация против гемофильной инфекции, у вакцинированных детей встречаются эпиглоттиты другой этиологии. В редких случаях эпиглоттит могут вызывать стрептококки, золотистый стафилококк, менингококк. </p>\r\n<p>Неинфекционные причины крупа и эпиглоттита: </p>\r\n<ul>\r\n<li>термические и химические повреждения вследствие приема горячей пищи или проглатывания препаратов бытовой химии; </li>\r\n<li>травмы, вызываемые слепым касанием пальца при попытке удалить инородное тело из глотки; </li>\r\n<li>отек Квинке; </li>\r\n<li>гемофагоцитарный лимфогистиоцитоз; </li>\r\n<li>острая лейкемия; раздражение при курении наркотиков (марихуана, крэк, кокаин); </li>\r\n<li>реакция на проводимую химиотерапию. </li>\r\n<li>лимфопролиферативные заболевания. </li>\r\n</ul>",
"pathogenesis": "<p>В основе механизма развития крупа лежит: </p>\r\n<ul>\r\n<li>Воспалительный отек с клеточной инфильтрацией голосовых связок и слизистой подскладочного пространства и трахеи и прилегающих тканей. </li>\r\n<li>Гиперсекреция слизистых желез, скопление в просвете дыхательных путей густой мокроты. </li>\r\n</ul>\r\n<p>Патогенез эпиглоттита </p>\r\n<p>При внедрении инфекции очень быстро развивается воспаление надгортанника и поддерживающей его черпаловидно-подгортанной складки. Надгортанник становится отечным и гиперемированным; его обычно твердая структура размягчается. Свисая и отклоняясь кзади, надгортанник закрывает вход в гортань, вызывая тяжелую обструкцию дыхательных путей. </p>\r\n<p>Выброс бактерий и их токсинов в кровь приводит к увеличению проницаемости микрососудов легкого, повышению гидростатического давления в малом круге кровообращения и скоплению жидкости в интерстициальном пространстве. Ухудшаются вентиляционно-перфузионные отношения, развиваются гипоксемия (снижение кислорода в крови), гиперкапния (повышение углекислого газа в крови), ацидоз (снижение рН крови). </p>",
"diagnostics": "<p>Диагноз обструктивного ларингита является клиническим и ставится, как правило, на основании анамнеза и симптомов осиплости голоса, лающего кашля, инспираторного стридора. </p>\r\n<p>Эпиглоттит диагностируется на основании характерных клинических признаков. </p>\r\n<p>Лабораторная диагностика включает общий анализ крови, определение уровня С-реактивного белка, при необходимости – уровень прокальцитонина (маркеры воспаления). </p>",
"treatment": "<p> Консервативное лечение крупа </p>\r\n<ul>\r\n<li>Согласно международному консенсусу, а также рекомендациям Всемирной организации здравоохранения, основу лечения острого обструктивного ларингита составляют ингаляционные и системные глюкокортикостероиды. </li>\r\n<li>При тяжелом крупе или отсутствии кортикостероидов возможно ингаляционное применение эпинефрина. </li>\r\n<li>При снижении сатурации крови кислородом ниже 92% показана оксигенотерапия. Стеноз гортани 3-й степени требует неотложной интубации. </li>\r\n</ul>\r\n<p> Консервативное лечение эпиглоттита </p>\r\n<ul>\r\n<li>Не рекомендуется укладывать ребенка, пациент должен находиться в положении сидя, в т.ч., при транспортировке в стационар. </li>\r\n<li>Рекомендована ранняя интубация для профилактики внезапной асфиксии (удушья). </li>\r\n<li>При эпиглоттите категорически не рекомендуется ингалировать, осуществлять седацию, провоцировать беспокойство. </li>\r\n<li>В обязательном порядке рекомендована антибактериальная терапия. Антибактериальная терапия должна быть продолжена до 7 – 10 дней. Начинают лечение обычно с парентерального (внутривенного) введения антибактериального препарата, после купирования лихорадки и нормализации состояния продолжают лечение пероральными антибиотиками. </li>\r\n<li>При асфиксии и невозможности проведения интубации проводится трахеотомия. </li>\r\n</ul>",
"prevention": "<p>Рекомендуется неспецифическая профилактика респираторных вирусных инфекций. </p>\r\n<p>В случае рецидивирования симптомов крупа у детей с гастроэзофагеальным рефлюксом рекомендовано соблюдение противорефлюксного режима с учащенными кормлениями меньшими порциями, а также проведение регулярных курсов противорефлюксной терапии. </p>\r\n<p>К мерам специфической профилактики следует отнести вакцинацию против гриппа, а также вакцинацию против гемофильной и пневмококковой инфекций для предупреждения развития эпиглоттита. </p>",
"clinical_picture": "<p>Обструктивный ларингит (круп) обычно начинается с неспецифических симптомов острой респираторной вирусной инфекции: появляются обильный насморк, першение в горле, кашель. </p>\r\n<p>Чаще протекает на фоне невысокой температуры, редко – на фоне фебрильной лихорадки. </p>\r\n<p>Как правило, симптомам стеноза гортани предшествуют признаки ларингита: осиплость голоса и/или сухой грубый кашель. При прогрессировании воспалительного процесса в гортани осиплость может усиливаться, кашель приобретает лающий характер, появляется шумное дыхание или шумный вдох (стридор). При нарастании степени стеноза гортани развивается инспираторная одышка (затрудненный вдох), которую можно заметить по втяжению яремной ямки на вдохе. </p>\r\n<p>Симптомы обструктивного ларингита обычно развиваются вечером, ночью, нередко в предутренние часы. </p>\r\n<p>I (стадия компенсации) - осиплость, грубый навязчивый кашель, умеренная одышка </p>\r\n<p>II (стадия неполной компенсации) - осиплость, грубый навязчивый кашель, выраженная одышка, возбуждение, дыхание с участием вспомогательной мускулатуры, втяжением податливых мест грудной клетки, раздуванием крыльев носа, цианоз (синюшность) носогубного треугольника, тахикардия </p>\r\n<p>III (стадия декомпенсации) - осиплость, грубый навязчивый кашель, беспокойство, страх, возможна апатия, резкая одышка с выраженным втяжением податливых мест грудной клетки, бледность, акроцианоз </p>\r\n<p>IV (терминальная стадия, асфиксия) - сознание отсутствует, резкая бледность и цианоз, гипотермия, возможны судороги, расширение зрачков, дыхание частое, поверхностное, артериальная гипотензия, нитевидный пульс. Эта стадия предшествует остановке дыхания и сердца. </p>\r\n<p>Эпиглоттит является тяжелой бактериальной инфекцией. </p>\r\n<ul>\r\n<li>заболевание обычно начинается остро с высокой температуры и нарушения общего состояния, </li>\r\n<li>характерны боль в горле, тризм (спазм жевательной мускулатуры), слюнотечение, нарушение глотания, поза «треножника», приоткрытый рот, </li>\r\n<li>быстрое развитие стридора, западение надгортанника в положении на спине. </li>\r\n</ul>\r\n<p>Типичного для крупа лающего кашля не отмечается. </p>",
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