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},
"code": "R04",
"name": "Кровотечение из дыхательных путей",
"icd_name": "Кровотечение из дыхательных путей",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0,
1
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"periodicity": 1,
"slug": "r04_krovotechenie_iz_dyhatelnyh_putey",
"lead": "Нарушение здоровья, относящееся к группе симптомы и признаки, относящиеся к системам кровообращения и дыхания",
"description": "Кровотечение из верхних дыхательных путей— это опасное осложнение различных заболеваний органов дыхания. Сопровождается истечением крови из бронхиальных или легочных сосудов, сосудов полости носа и выделением ее из дыхательных путей.",
"etiology": "<p>Наиболее распространённые причины носового кровотечения:</p>\r\n<ul>\r\n<li>Травманоса;</li>\r\n<li>Инородные тела;</li>\r\n<li>Воспалительные процессы.</li>\r\n</ul>\r\n<p>Другие возможные причины:</p>\r\n<ul>\r\n<li>Анатомические деформации;</li>\r\n<li>Вдыхание наркотиков(особенно кокаина);</li>\r\n<li>Опухоли полости носа (назофарингеальная карциномаи др.);</li>\r\n<li>Низкая относительная влажность вдыхаемого воздуха;</li>\r\n<li>Применение носового кислородного катетера;</li>\r\n<li>Применение назального спрея;</li>\r\n<li>Баротравма;</li>\r\n<li>Оперативное вмешательство (пластика носовой перегородки и др.).</li>\r\n</ul>\r\n<p>Кровотечения из дыхательных путей могут вызывать также:</p>\r\n<ul>\r\n<li>болезни трахеи и бронхов: бронхоэктазия, бронхит, острый ларинготрахеит, опухоли; болезни легких: пневмонии, инфаркт легкого, туберкулез легкого, рак легкого, легочное нагноение, паразитарные болезни (эхинококкоз легкого, аскаридоз);</li>\r\n<li>профессиональные болезни легких; синдром Гудпасчера; идиопатический гемосидероз легких, эмфизема легких;</li>\r\n<li>травмы, груди, острое повышение внутригрудного давления; психоэмоциональное перенапряжение; перегревание под солнцем; проявление истерии;</li>\r\n<li>системные заболевания (красная волчанка, васкулиты, саркоидоз, лейкозы); уремия; холемия; передозировка антикоагулянтов, антиагрегантов;</li>\r\n<li>инфекционные заболевания: грипп, корь, коклюш, геморрагическая лихорадка, легкая форма чумы;</li>\r\n</ul>\r\n<p>Нарушение свертываемости крови при длительном и неадекватном приеме антикоагулянтов (препараты, разжижающие кровь).</p>\r\n<p> </p>",
"pathogenesis": "<p>Причинами кровотечений из дыхательных путей могут быть:</p>\r\n<ul>\r\n<li>повреждение кровеносного сосуда (в т.ч. при травме)</li>\r\n<li>разъедание стенки (аррозия) сосуда: бронхоэктазы, опухоли, каверны;</li>\r\n<li>разрыв сосуда (при артериовенозных аневризмах, телеангиэктазии);</li>\r\n<li>воспаление сосудов – артерииты;</li>\r\n<li>излияние крови в альвеолы из бронхиальной артерии (при инфаркте легкого);</li>\r\n<li>диапедезные кровотечения (тромбоцитопенический синдром, застойное полнокровие легочных сосудов).</li>\r\n</ul>",
"diagnostics": "<p>Для определения локализации источника носового кровотечения (переднее или заднее кровотечение) проводится осмотр пациента, фарингоскопия и передняя риноскопия.</p>\r\n<p>Локализацию источника кровотечения можно установить при рентгенологическом исследовании (по характеру поражения легких), более точно — при трахеобронхоскопии.</p>\r\n<p>Лабораторная диагностика включает: коагулограмму (исследование крови на ее способность к свертыванию); анализ мокроты (выявление микобактерий туберкулеза).</p>\r\n<p>Диагностика включает также:</p>\r\n<ul>\r\n<li>рентгенографию органов грудной клетки;</li>\r\n<li>компьютерную томографию (КТ) органов грудной клетки;</li>\r\n<li>ангиопульмонографию – исследование сосудов легких с помощью вводимого в сосуды контрастного вещества (выделяется на снимках при проведении рентгенографии и позволяет определить наличие патологических изменений в сосудах легких);</li>\r\n<li>биопсия – взятие кусочка легочной ткани для исследования на клеточный состав.</li>\r\n</ul>",
"treatment": "<p>При носовом кровотечении придать сидячее положение, успокоить больного. Прижать крылья носа к носовой перегородке на 10-15 мин, холод на переносицу. Ввести в носовые ходы турунды, смоченные 3% раствором перекиси водорода, можно использовать гемостатическую губку. При отсутствии эффекта проводится передняя тампонада носа.</p>\r\n<p>При легочном кровотечении проводится:</p>\r\n<ul>\r\n<li>Обеспечение больному полусидячего положения с опущенными вниз ногами.</li>\r\n<li>Удаление крови из дыхательных путей (отсасывание с помощью специальных аппаратов).</li>\r\n<li>Введение кровоостанавливающих препаратов.</li>\r\n<li>Лечебная бронхоскопия – метод, позволяющий осмотреть дыхательные пути изнутри, определить источник кровотечения и произвести манипуляции по остановке кровотечения: закупорка кровоточащего сосуда с помощью специальных средств. </li>\r\n<li>Оперативное лечение – открытая операция на легких с ушиванием кровоточащего сосуда или удалением части легкого.</li>\r\n<li>При большом объеме потерянной крови – переливание крови и ее компонентов, введение препаратов, восстанавливающих объем циркулирующей крови.</li>\r\n<li>Антибиотики – для профилактики присоединения инфекции.</li>\r\n<li>Лечение основного заболевания, приведшего к легочному кровотечению.</li>\r\n</ul>",
"prevention": "<p>Профилактические мероприятия включают:</p>\r\n<ul>\r\n<li>своевременное выявление и проведение адекватного лечения болезней дыхательной и сердечно-сосудистой систем, а также системных заболеваний;</li>\r\n<li>периодический контроль состояния свертывающей системы крови в случае применения антикоагулянтов (лекарственных препаратов, разжижающих кровь);</li>\r\n<li>избегание травм грудной клетки и носа.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Непосредственным признаком носового кровотечения является истечение крови из полости носа наружу или внутрь носоглотки. В последнем случае кровь стекает в ротоглотку, где и обнаруживается при фарингскопии.</p>\r\n<p>Могут возникнуть головокружение, шум в ушах, жажда, общая слабость, сердцебиение. В некоторых случаях может отмечаться незначительная бледность кожи.</p>\r\n<p>Кровопотеря средней степени тяжести сопровождается выраженным головокружением, падением артериального давления, акроцианозом, тахикардией и одышкой. При тяжелой кровопотере развивается геморрагический шок. Пациент заторможен, возможна потеря сознания. Во время осмотра выявляют нитевидный пульс, выраженную тахикардию, резкое падение АД.</p>\r\n<p>Симптомы легочного кровотечения:</p>\r\n<ul>\r\n<li>выделение при кашле алой крови или ее сгустков из дыхательных путей, часть выделенной крови пенистая;</li>\r\n<li>кожа покрывается холодным липким потом, бледная;</li>\r\n<li>одышка;</li>\r\n<li>учащенное сердцебиение;</li>\r\n<li>снижение артериального давления;</li>\r\n<li>чувство страха;</li>\r\n<li>шум в ушах;</li>\r\n<li>головокружение;</li>\r\n<li>при массивном кровотечении – обморок.</li>\r\n</ul>\r\n<p>При кровохарканьи наблюдается выделение (откашливание) из бронхов и легких крови в виде прожилок и примеси крови в мокроте, окрашенных кровью плевков. Объем выделяемой крови не превышает 50 мл в сутки.</p>",
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