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"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;\">Диагностической алгоритм аневризмы сонной артерии 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;\">анамнестические данные; </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;\">результаты физического осмотра (пальпируемая мешковидная опухоль в области шеи); УЗИ шеи. Это исследование служит для определения размера и расширения аневризмы; ангиографию – золотой стандарт диагностики аневризмы сонной артерии; </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;\">контрастная КТ – обладает такими преимуществами, как легкая и быстрая применимость; является минимально инвазивным методом, который дает возможность увидеть изменения сосудистой стенки, объемом менее 1 мм; </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;\">магнитно-резонансная ангиография – является неинвазивным методом, который может визуализировать сосудистые структуры без необходимости использования контрастной среды или рентгеновского излучения. МРА может показывать тромбированные части аневризмы и остаточные характеристики потока крови.</span></li>\r\n</ul>\r\n<p> </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;\">Неврологи назначают пациентам, у которых диагностирована аневризма сонной артерии, препараты, снижающие концентрацию липидов в крови (ловастатин, симвастин, аторвастин), антиагреганты (клопидогрель, дипиридамол). Больных консультирует сосудистый хирург.</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;\">Радикальный метод лечения аневризмы сонной артерии – хирургическое вмешательство. Сосудистые хирурги проводят следующие операции:</span></p>\r\n<p> </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;\">Эндартерэктомию сонной артерии и ветвей;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Востановление кровеносного сосуда головного мозга с помощью имплантата;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эндоваскулярное стентирование сонной артерии;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Клипирование аневризмы;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эмболизацию аневризмы.</span></li>\r\n</ul>",
"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;\">Чтобы предотвратить осложнения аневризмы сонной артерии, следует отказаться от курения, злоупотребления спиртных напитков, нормализовать массу тела. Лица старше пятидесяти лет должны ежегодно проходить скрининговые исследования.</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;\">Аневризма сонной артерии проявляется следующими неврологическими симптомами:</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;\">Цефальгией (головной болью);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Диплопией (двоением в глазах);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Птозом (опущение века);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анизокорией (сужением одного зрачка);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Снижением реакции зрачка на свет;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Выпадением полей зрения;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Периферическим парезом лицевого нерва (опущением нижнего века, нарушением выработки слезы, асимметрией лица).</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\"><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 зависимости от локализации аневризмы сонной артерии неврологи определяют следующие 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;\">Полный или частичный паралич одной половины тела;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Невозможность выполнить произвольные движения;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Речевые расстройства;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эмоциональную лабильность.</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;\">Медленно увеличивающаяся аневризма сонной артерии проявляется симптомами сдавления головного мозга. У пациентов развивается сосудисто-мозговая недостаточность.</span></p>",
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{
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{
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"code": "I71",
"name": "Аневризма и расслоение аорты",
"icd_name": "Аневризма и расслоение аорты",
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"cause": [
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"periodicity": 1,
"slug": "i71_anevrizma_i_rassloenie_aorty",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "Расслаивающаяся аневризма аорты – дефект внутренней оболочки аневризматически расширенной аорты, сопровождающийся образованием гематомы, продольно расслаивающей сосудистую стенку с формированием ложного канала. Расслаивающаяся аневризма аорты проявляется внезапной интенсивной болью, мигрирующей по ходу расслоения, подъемом артериального давления, признаками ишемии сердца, головного и спинного мозга, почек, внутреннего кровотечения.",
"etiology": "<p>К факторам, способствующим развитию аневризмы аорты и ее расслоению, относятся: </p>\r\n<ul>\r\n<li>атеросклероз со значительным изменением vasa vasorum (сосудов сосудов) аорты, ишемию стенки аорты; </li>\r\n<li>гипертоническую болезнь и резкие колебания артериального давления; </li>\r\n<li>сифилис; </li>\r\n<li>очаговые некрозы среднего слоя сосуда бактериально-эмболического происхождения при острых инфекционных заболеваниях; </li>\r\n<li>врожденные дефекты развития аорты (коарктация, двойная дуга, гипоплазия, незаращение боталлова протока, синдром Марфана); </li>\r\n<li>физическое и нервно-эмоциональное перенапряжение; </li>\r\n<li>повреждение аорты смежным процессом (спондилит, рак пищевода, пенетрация пептической язвы пищевода, двенадцатиперстной кишки) или инородным телом; </li>\r\n<li>закрытую травму грудной или брюшной полости. </li>\r\n</ul>",
"pathogenesis": "<p>Аорта имеет три наиболее уязвимых сегмента - корень, перешеек и диафрагму. Гемодинамическое напряжение указанных зон и их хроническая травматизация приводят к дегенеративным изменениям средней оболочки сосуда. Длительное повышение артериального давления всегда ведет к той или иной степени дилатации аорты. Известно также, что внутренняя оболочка по своей структуре менее растяжима, чем средняя и наружная оболочки, обладающие большей эластичностью. Именно поэтому при одном из очередных «критических» повышений артериального давления происходит разрыв внутренней оболочки. Однако гидравлический удар о стенку аорты и разрыв внутренней оболочки сами по себе могут привести лишь к развитию внутристеночной гематомы. Дальнейшее расслоение происходит лишь при наличии патологического процесса в средней оболочке аорты. Если расслоение прорывает стенку аорты полностью (все три слоя), то происходит быстрая массивная кровопотеря и гибель больного. </p>",
"diagnostics": "<p>В случае подозрения на появление расслаивающей аневризмы аорты требуется срочная диагностика, основными методами которой являются: </p>\r\n<ul>\r\n<li>рентгенография грудной клетки; </li>\r\n<li>УЗДГ; </li>\r\n<li>ЭхоКГ; </li>\r\n<li>компьютерная томография; </li>\r\n<li>магнитно-резонансная томография; </li>\r\n<li>аортография. </li>\r\n</ul>\r\n<p>Рентгенография грудной клетки позволяет определить признаки расслаивающей аневризмы: расширение аорты, плевральный выпот, отсутствие пульсации, деформацию контуров аорты. </p>\r\n<p>ЭхоКГ (УЗИ сердца) – более информативный и доступный метод, позволяющий обнаружить отслоившийся лоскут, определить истинный и ложный канал, оценить атеросклеротическое поражение, состояние аортального клапана, состояние грудной аорты. </p>\r\n<p>Аортография дает возможность определить место начального разрыва, протяженность и местонахождения расслоения, состояние аортального клапана, ветвей аорты, коронарных артерий. </p>\r\n<p>МРТ дает возможность точно определить локализацию разрыва и направление расслоения, оценить состояние ветвей аорты и клапана. </p>",
"treatment": "<p>Расслоение аорты требует неотложной медицинской помощи, немедленного лечения. Терапия может заключаться в проведении операции, употреблении лекарственных средств, а также в комбинированном лечении — схема зависит от области аорты, которая подверглась расслоению. </p>\r\n<p>Хирургическое вмешательство - хирурги удаляют как можно большую площадь, подвергшуюся расслоению, а затем реконструируют аорту при помощи синтетической трубки-трансплантата. Если в результате расслоения повреждаются аортальные клапаны, они так же могут быть заменены; </p>\r\n<p>Интенсивная терапия расслаивающейся аневризмы аорты направлена на купирование болевого синдрома (путем введения ненаркотических и наркотических анальгетиков), выведение из шокового состояния, снижение артериального давления. Лекарственные препараты, например, бета-блокаторы и нитропруссид, уменьшают частоту сердечных сокращений и нормализуют низкое кровяное давление, что предотвращает усугубление расслоения. </p>",
"prevention": "<p>Профилактика формирования расслаивающейся аневризмы аорты заключается в контроле за течением сердечно-сосудистых заболеваний. Предупреждение расслоения аорты включает наблюдение кардиолога, мониторинг артериального давления и уровня холестерина крови, периодическое ультразвуковая диагностика сердца и аорты. <br class=\"SCXW45342897\" /> <br class=\"SCXW45342897\" /> </p>",
"clinical_picture": "<p>Для расслаивающейся аневризмы аорты характерно внезапное начало с имитацией симптомов различных сердечно-сосудистых, неврологических, урологических заболеваний. Расслоение аорты проявляется резким нарастанием раздирающей, нестерпимой боли с широкой областью иррадиации (за грудиной, между лопатками и по ходу позвоночника, в эпигастральной области, пояснице), мигрирующей по ходу расслоения. </p>\r\n<p>Отмечается повышение артериального давления с последующим спадом, асимметрия пульса на верхних и нижних конечностях, обильное потоотделение, слабость, синюшность, двигательное беспокойство. Большая часть больных с расслаивающейся аневризмой аорты умирает от развития осложнений. </p>\r\n<p>Неврологическими проявлениями расслаивающейся аневризмы аорты могут служить ишемическое поражение головного или спинного мозга парезы, параличи), периферическая нейропатия, нарушения сознания(обморок, кома). </p>\r\n<p>Расслаивающаяся аневризма восходящей аорты может сопровождаться ишемией миокарда, сдавлением органов средостения (появлением охриплости, дисфагии, одышки, синдрома Горнера, синдрома верхней полой вены), гемоперикарда, тампонады сердца (скопление жидкости между листками околосердечной сумки). </p>\r\n<p>Расслаивающаяся аневризма нисходящей грудной и брюшной части аорты выражается развитием выраженного повышения давления в почечных сосудах и острой почечной недостаточности, острой ишемии органов пищеварения, ишемии кишечника, острой ишемии нижних конечностей. </p>",
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"description": "<p>Атеросклероз - это х<span style=\"color: #222328; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">роническое очаговое поражение артерий, характеризующееся отложением и накоплением во внутренней оболочке сосуда жиросодержащих белков и доставляемого ими холестерина.</span></p>",
"etiology": "<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Факторы, влияющие на развитие атеросклероза, разделяются на три группы: неустранимые, устранимые и потенциально устранимые. К неустранимым факторам относятся те, которые нельзя исключить с помощью волевого или медицинского воздействия. В их число входят:</span></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: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Возраст. С возрастом риск развития атеросклероза возрастает. Атеросклеротические изменения сосудов в той или иной мере наблюдаются у всех людей после 40-50 лет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Пол. У мужчин развитие атеросклероза происходит на десять лет раньше и превышает показатель заболеваемости атеросклерозом среди женщин в 4 раза. После 50-55 лет уровень заболеваемости атеросклерозом среди женщин и мужчин выравнивается. Это объясняется снижением продукции эстрогенов и их защитной функции у женщин в период </span><a style=\"text-decoration-line: none;\" href=\"https://www.krasotaimedicina.ru/diseases/zabolevanija_gynaecology/climax\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">менопаузы</span></a><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наследственность. Нередко атеросклероз развивается у пациентов, чьи родственники страдают этой болезнью. </span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Устранимыми факторами атеросклероза считаются те, которые могут быть исключены самим человеком посредством изменения привычного образа жизни. К ним относятся:</span></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: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Курение. Его влияние на развитие атеросклероза объясняется отрицательным воздействием никотина и смол на сосуды. Многолетнее курение в несколько раз увеличивает риск гиперлипидемии, артериальной гипертензии, ИБС.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Несбалансированное питание. Употребление в пищу большого количества жиров животного происхождения ускоряет развитие атеросклеротических изменений сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиподинамия. Ведение малоподвижного образа жизни способствует нарушению жирового обмена и развитию ожирения, сахарного диабета, атеросклероза сосудов.</span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">К потенциально и частично устранимым факторам риска относят те хронические нарушения и заболевания, которые возможно скорректировать посредством назначенного лечения. Они включают:</span></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: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Артериальную гипертонию. На фоне повышенного артериального давления создаются условия для повышенного пропитывания сосудистой стенки жирами, что способствует формированию атеросклеротической бляшки. С другой стороны, снижение эластичности артерий при атеросклерозе способствует поддержанию повышенного кровяного давления.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Дислипидимию. Нарушение жирового обмена в организме, проявляющееся повышенным содержанием холестерина, триглицеридов и липопротеидов, играет ведущую роль в развитии атеросклероза.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ожирение и сахарный диабет. Повышают вероятность атеросклероза в 5-7 раз. Это объясняется нарушением жирового обмена, лежащего в основе данных заболеваний и являющегося пусковым механизмом атеросклеротического поражения сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Инфекции и интоксикации. Инфекционные и токсические агенты оказывают повреждающее воздействие на сосудистые стенки, способствуя их атеросклеротическим изменениям.</span></p>\r\n</li>\r\n</ol>",
"pathogenesis": "<p>Атеросклеротическая бляшка — это образование, состоящее из смеси жиров (в первую очередь, холестерина) и кальция.</p>\r\n<p>Со временем бляшка становится непрочной, на ее поверхности возникают дефекты. В месте дефекта на внутренней оболочке сосуда начинает образовываться тромб — скопление клеток, в основном, тромбоцитов (элементы крови, участвующие в процессе свертывания) и белков крови.</p>",
"diagnostics": "<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на атеросклероз врач может назначить:</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: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови на холестерин и сахар;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенологическое исследование;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ангиографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">МРТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ультразвуковую допплерографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ аорты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; 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</ul>\r\n<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также при необходимости список обследований могут пополнить:</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: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">кардиологические стресс-тесты для определения критической нагрузки на сердце;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">коронарография;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">липидограмма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ органов брюшной полости.</span></p>\r\n</li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для лечения атеросклероза применяют комплексные меры, которые включают в себя:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">диету, назначаемую с целью снизить уровень холестерина в крови и нормализовать липидный баланс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отказ от вредных привычек: курения и чрезмерного употребления спиртных напитков;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">умеренную физическую нагрузку, подходящую по возрасту и особенностям организма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лекарственную терапию, которая: снижает выработку холестерина, выводит лишний холестерин из организма.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В рамках терапии обычно назначают:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">статины. Именно они существенно понижают уровень холестерина.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">средства, содержащие никотиновую кислоту. Она отвечает за нормализацию липидного уровня.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">фибраты. Благодаря им в организме уменьшается выработка жиров.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">секвестранты. Помогают кишечнику освободиться от желчных кислот.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эстрогены. В качестве ЗГТ для женщин в постменопаузу.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В некоторых случаях прибегают к хирургическому вмешательству посредством:</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: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ангиопластики;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эндарэктомии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">шунтирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">стентирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сосудистого протезирования.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p>С целью предупреждение атеросклероза необходим отказ от курения, исключение стрессового фактора, переход на нежирную и бедную холестерином пищу, систематическая физическая активность соразмерно возможностям и возрасту, нормализация веса.</p>\r\n<p>Целесообразно включение в рацион продуктов, содержащих клетчатку, растительных жиров (льняного и оливкового масел), растворяющих холестериновые отложения.</p>\r\n<p>Прогрессирование атеросклероза можно замедлить приемом холестеринснижающих лекарственных препаратов.</p>",
"clinical_picture": "<p align=\"justify\">При атеросклерозе чаще страдают грудной и брюшной отделы аорты, коронарные, мезентериальные, почечные сосуды, а также артерии нижних конечностей и головного мозга.</p>\r\n<p align=\"justify\">В развитии атеросклероза различают доклинический (бессимптомный) и клинический периоды. В бессимптомном периоде в крови обнаруживается повышенное содержание β-липопротеидов или холестерина при отсутствии симптомов заболевания.</p>\r\n<p align=\"justify\">Клинически атеросклероз начинает себя проявлять, когда происходит <a title=\"Перейти на страницу симптома стеноз\" href=\"/symptom/stenoz/\">сужение</a> артериального просвета на 50% и более. В течении клинического периода выделяют три стадии: ишемическую, тромбонекротическую и фиброзную.</p>\r\n<p align=\"justify\">В стадии ишемии развивается недостаточность кровоснабжения того или иного органа (например, ишемия миокарда вследствие атеросклероза коронарных сосудов проявляется стенокардией). В тромбонекротической стадии присоединяется тромбоз измененных артерий (так, течение атеросклероза коронарных сосудов может осложниться инфарктом миокарда). На стадии фиброзных изменений происходит разрастание соединительной ткани в плохо кровоснабжаемых органах (так, атеросклероз коронарных артерий приводит к развитию атеросклеротического кардиосклероза).</p>\r\n<p align=\"justify\">Клинические симптомы атеросклероза зависят от вида пораженных артерий. Проявлением атеросклероза коронарных сосудов служат стенокардия, инфаркт миокарда и кардиосклероз, последовательно отражающие стадии недостаточности кровообращения сердца.</p>\r\n<p align=\"justify\">Течение атеросклероза аорты длительное и долгое время бессимптомное, даже в тяжелых формах. Клинически атеросклероз грудной аорты проявляется аорталгией – давящими или жгучими болями за грудиной, иррадиирующими в руки, спину, шею, верх живота. В отличие от болей при стенокардии <a title=\"Перейти на страницу симптома Боль в груди \" href=\"/symptom/bol_v_grudi/\">аорталгия</a> может длиться по несколько часов и дней, периодически ослабевая или усиливаясь. Снижение эластичности стенок аорты вызывает усиление работы сердца, приводя к гипертрофии миокарда левого желудочка.</p>\r\n<p align=\"justify\">Атеросклеротическое поражение брюшной аорты проявляется болями в области живота различной локализации, метеоризмом, запорами. При атеросклерозе бифуркации брюшной аорты наблюдается <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и похолодание ног, отек и <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">гиперемия</a> стоп, некрозы и язвы пальцев ног, перемежающаяся <a title=\"Перейти на страницу симптома Нарушения походки\" href=\"/symptom/narusheniya_pohodki/\">хромота</a>.</p>\r\n<p align=\"justify\">Проявлениями атеросклероза мезентериальных артерий служат приступы «брюшной жабы» и нарушение пищеварительной функции вследствие недостаточности кровоснабжения кишечника. У пациентов отмечается появление резких болей спустя несколько часов после еды. Боли локализуются в области пупка или верхних отделах живота. Продолжительность болевого приступа от нескольких минут до 1-3 часов, иногда болевой синдром купируется приемом нитроглицерина. Появляются <a title=\"Перейти на страницу симптома Метеоризм\" href=\"/symptom/meteorizm/\">вздутие</a> живота, <a title=\"Перейти на страницу симптома Отрыжка\" href=\"/symptom/otryzhka/\">отрыжка</a>, <a title=\"Перейти на страницу симптома Запор\" href=\"/symptom/zapor/\">запор</a>, <a title=\"Перейти на страницу симптома Нарушение сердечного ритма\" href=\"/symptom/narushenie_serdechnogo_ritma/\">сердцебиение</a>, повышение артериального давления. Позднее присоединяются зловонные поносы с фрагментами непереваренной пищи и неусвоенным жиром.</p>\r\n<p align=\"justify\">Атеросклероз почечных артерий ведет к развитию вазоренальной симптоматической артериальной гипертензии. В моче определяются эритроциты, белок, цилиндры. При одностороннем атеросклеротическом поражении артерий отмечается медленное прогрессирование гипертонии, сопровождающееся стойкими изменениями в моче и стойко высокими цифрами АД. Двустороннее поражение почечных артерий вызывает злокачественную артериальную гипертонию.</p>\r\n<p align=\"justify\">При атеросклерозе сосудов головного мозга отмечается снижение памяти, умственной и физической работоспособности, внимания, интеллекта, <a title=\"Перейти на страницу симптома Головокружение\" href=\"/symptom/golovokruzhenie/\">головокружение</a>, нарушения сна. В случаях выраженного атеросклероза сосудов мозга изменяется поведение и психика пациента. Атеросклероз артерий мозга может осложняться острым нарушением мозгового кровообращения, тромбозами, кровоизлияниями.</p>\r\n<p align=\"justify\">Проявлениями облитерирующего атеросклероза артерий нижних конечностей служат <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a> и боли в икроножных мышцах голени, <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и зябкость ног. Характерно развитие синдрома «перемежающейся хромоты» (боли в икроножных мышцах возникают при ходьбе и стихают в покое). Отмечаются похолодание, бледность конечностей, трофические нарушения (<a title=\"Перейти на страницу симптома Шелушение кожи\" href=\"/symptom/shelushenie_kozhi/\">шелушение</a> и <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">сухость кожи</a>, развитие трофических язв и сухой гангрены).</p>",
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},
"code": "I70.0",
"name": "Атеросклероз аорты",
"icd_name": "Атеросклероз аорты",
"gender": 0,
"age_min": 30,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 3,
"slug": "i70.0_ateroskleroz_aorty",
"lead": "хроническое заболевание, при котором на стенке этого сосуда образуются холестериновые бляшки",
"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;\">Главной причиной развития атеросклероза является нарушение обмена липидов. Именно холестерин, а точнее, холестерин низкой плотности, откладывается на сосудистой стенке и постепенно образует бляшку. Ее формированию способствует нарушение целостности стенок артерии.</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;\">Повреждение сосудов провоцируется воздействием следующих факторов:</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;\">высокое артериальное давление – приводит к истончению артериальной стенки и утрате эластичности;</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;\">возраст – с годами стенки сосудов становятся ломкими;</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;\">повышенная концентрация холестерина и липопротеинов низкой плотности в крови;</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;\">курение – химические соединения табачного дыма повреждаются стенки;</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;\">лишний вес;</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 рационе жирной пищи;</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;\">генетическая предрасположенность – наличие у ближайших родственников атеросклероза;</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;\">малоподвижный образ жизни;</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;\">злоупотребление спиртным;</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;\">длительные стрессы;</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;\">хронические воспалительные заболевания;</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;\">прием некоторых лекарственных препаратов.</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;\">Гормональные нарушения и обменные патологии тоже способствует накоплению в организме опасного холестерина. Повышенное кровяное давление благоприятствуют тромбообразованию, что является предрасполагающим к атеросклерозу состоянием.</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;\">Начальную стадию аортального атеросклероза можно диагностировать только посредством инструментальных методов. На поздних этапах заболевания, когда уже проявились его симптомы, патологию можно определить по клиническим признакам. Тем не менее во избежание ошибочного диагноза необходима инструментальная и лабораторная диагностика, поскольку проявления заболевания достаточно разнообразны.</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;\">Схема обследования включает следующие диагностические мероприятия:</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 и биохимический анализы крови для определения концентрации липопротеинов низкой и высокой плотности, триглицеридов.</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;\">Ультразвуковое сканирование сосудов сердца (УЗ-сканирование);</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;\">Допплерография;</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;\">Компьютерная томография.</span></li>\r\n</ul>\r\n<p> </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;\">В зависимости от степени тяжести АА лечение может быть консервативным и хирургическим. Следует также понимать, что очень важно соблюдать специальную диету, без которой лечение не будет эффективным.</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;\">Медикаментозное</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;\">Чтобы остановить развитие атеросклероза, применяют несколько групп препаратов:</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;\">Статины (мевастатин, флувастатин, правастатин). Угнетают синтез холестерина, оказывают противовоспалительное действие, улучшают состояние внутренней стенки сосудов.</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;\">Фибраты (фенофибрат, гемфиброзил, безафибрат). Повышают активность липопротеинлипазы – фермента, расщепляющего липопротеины. Также ускоряют метаболизм холестерина в печени и обладает антитромботическим эффектом.</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;\">Секвестранты желчных кислот (колестипол, колестирамин). Замедляют всасывание желчных кислот в кишечнике, в результате чего уровень липопротеинов и общего холестерина в крови снижается на 10-20%.</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;\">Антиагреганты (тиклопидин и клопидогрел). Уменьшают склонность к тромбообразованию и снижают вязкость крови. Препараты этой группы применяют при лечении АА для предотвращения пристеночного тромбообразования.</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;\">Дополнительно врач может назначить симптоматическое лечение, направленное на нормализацию артериального давления и функции печени. При необходимости курс лечения может быть дополнен эфферентной терапией (энтеросорбция, гемосорбция, ЛПНП-иммуносорбция).</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;\">Хирургическое</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;\">В случаях, когда холестериновые бляшки разрастаются настолько, что повреждают внутреннюю оболочку аорты и создают ощутимое препятствие для нормального кровотока, прибегают к хирургическому лечению. Механическое препятствие (бляшка) удаляется вместе с пораженным участком внутренней оболочки аорты.</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;\">При необходимости расширения просвета аорты производится установка стента – упругой конструкции из пластика или инертных сплавов, повторяющей форму сосуда.</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;\">Профилактика предполагает строгое соблюдение диеты, нормализацию массы тела и отказ от вредных привычек (в первую очередь – от курения). Важно избегать малоподвижного образа жизни, однако и физические нагрузки должны быть дозированными. Для начала пациенту рекомендуют пешие прогулки не менее 30 минут в день, затем их продолжительность увеличивается по мере развития выносливости. Через несколько недель можно добавлять комплексы лечебной гимнастики или плавание в бассейне.</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;\">Важно избегать стрессов и свести к минимуму психоэмоциональное напряжение. Кроме того, необходимо внимательно следить за давлением – оно не должно превышать 130/85 мм рт. ст.</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;\">На ранних стадиях, когда повреждения сосуда незначительны, недуг протекает бессимптомно. Когда же бляшка перекрывает сосуд более, чем наполовину, у пациента проявляются признаки стенозирующего атеросклероза. Симптомы выраженного атеросклероза аорты различаются в зависимости от того, какой именно участок артерии поражен.</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;\">Поражения восходящего отдела и дуги аорты сопровождаются повышением артериального давления, головокружениями, головными болями.</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;\">Атеросклероз грудного отдела проявляется болевыми ощущениями, похожими на стенокардию. При этом боль зачастую продолжаться длительное время, но не имеет характер приступа.</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;\">Симптомы атеросклероза брюшного отдела аорты путают с проявлениями заболеваний. Болезнь проявляется в виде расстройств пищеварения, болей в области живота (после еды), потеря веса.</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;\">Атеросклеротические бляшки в зоне буфирикации (место, где аорта разделяется на 2 подвздошные артерии) вызывают типичные симптомы атеросклероза нижних конечностей: слабость и онемение в ногах, боли и хромота при ходьбе. У мужчин при этом наблюдается половая дисфункция.</span></li>\r\n</ul>\r\n<p> </p>",
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}
]
}
