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"code": "R95",
"name": "Внезапная смерть грудного ребенка",
"icd_name": "Внезапная смерть грудного ребенка",
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"slug": "r95_vnezapnaya_smert_grudnogo_rebenka",
"lead": "Нарушение здоровья, относящееся к группе неточно обозначенные и неизвестные причины смерти r95-r99",
"description": " Синдром внезапной детской смерти – понятие, применяемое в отношении неожиданной смерти ребенка первого года, наступившей во сне без установленных причин.",
"etiology": "<p>Точные причины СВДС пока не установлены. </p>\r\n<p>К факторам риска развития СВДС относят: </p>\r\n<ul>\r\n<li>сон ребенка на животе; </li>\r\n<li>использование для ребенка мягких постельных принадлежностей: матраса, подушки, одеяла; </li>\r\n<li>перегревание ребенка (использование ватных одеял или чрезмерное отопление в комнате); </li>\r\n<li>недоношенность; </li>\r\n<li>Малый вес ребенка при рождении; </li>\r\n<li>многоплодная беременность; </li>\r\n<li>большое число беременностей у матери и короткие промежутки между ними; </li>\r\n<li>случаи СВДС или мертворождение ранее родившихся детей у этих родителей; </li>\r\n<li>позднее начало или отсутствие врачебного наблюдения в период беременности; </li>\r\n<li>анемия и гипоксия плода; </li>\r\n<li>недавно перенесенное ребенком заболевание; </li>\r\n<li>возраст матери моложе 17 лет; </li>\r\n<li>курение, употребление наркотических веществ или алкоголя матерью; </li>\r\n<li>плохие экономические или социальные условия в семье (скученность в квартире, отсутствие регулярного проветривания, курение членов семьи, безработные родители, отсутствие знаний по уходу за младенцем); </li>\r\n<li>рождение ребенка у матери-одиночки; </li>\r\n<li>депрессия у матери в послеродовом периоде. </li>\r\n</ul>",
"pathogenesis": "<p>Существует несколько теорий, объясняющих механизм возникновения СВДС</p>\r\n<p>Нарушение функции дыхания </p>\r\n<p>Во время сна в норме периодически возникает нарушение функции дыхания, и дыхание на короткое время прекращается. В результате такой остановки дыхательной деятельности в крови образуется недостаточное количество кислорода (гипоксемия), что в норме вызывает пробуждение и восстановление дыхания. Если же восстановление дыхания не происходит, ребенок умирает. </p>\r\n<p>Нарушение сердечной деятельности </p>\r\n<p>Некоторые ученые считают ведущим фактором при СВДС нарушение ритма сердечной деятельности, остановку сердца (асистолию). Факторами риска эти ученые называют нарушения ритма сердца по типу экстрасистол и блокад на электрокардиограмме, снижение числа сердечных сокращений менее 70 в 1 минуту (брадикардия), часто меняющуюся частоту сердечных сокращений. </p>\r\n<p>Стресс. </p>\r\n<p>Это такие изменения, как: мелкие кровоизлияния в вилочковой железе, легких, иногда в наружной оболочке сердца, следы изъязвления слизистой пищеварительного тракта, сморщенные лимфоидные образования, снижение вязкости крови. Все эти явления – симптомы неспецифического синдрома стресса. </p>\r\n<p>Иммунная теория и инфекционный механизм возникновения СВДС </p>\r\n<p>У большей части детей, умерших внезапно, в течение недели или в последний день жизни имели место проявления какой-либо инфекции. </p>\r\n<p>Сторонники этой теории считают, что микроорганизмы выделяют токсины или цитокинины, которые вызывают нарушение механизмов защиты в организме. В итоге наличие факторов риска при возникновении инфекции усугубляется. Токсины микроорганизмов (чаще всего посмертно выделяли золотистый стафилококк) провоцируют и усиливают воспалительную реакцию. А организм младенца еще не в состоянии регулировать собственные защитные реакции. </p>",
"diagnostics": "<p>Детям, перенесшим абортивный синдром внезапной детской смерти, необходимо проведение комплексного обследования. </p>\r\n<p>Из инструментальных исследований наибольшее диагностическое значение могут представлять электроэнцефалографию, исследование сна, УЗИ головы, ЭКГ, УЗИ сердца ребенку, холтеровский мониторинг ЭКГ, рентгенография грудной клетки. </p>\r\n<p>Лабораторные методы могут включать инфекционную диагностику (ИФА, ПЦР, микробиологическое исследование), определение кислотно-основного состояния крови, биохимический анализ крови и др. </p>",
"treatment": "<p>При возникновении очевидного жизнеугрожающего эпизода необходимо взять ребенка на руки, потормошить, энергично помассировать кисти рук, ступни, мочки ушей, спину вдоль позвоночника. Обычно этих действий бывает достаточно, чтобы ребенок снова задышал. Если дыхание не восстановилось, необходимо срочно вызывать «скорую помощь» и начинать проведение искусственного дыхания и закрытого массажа сердца. </p>\r\n<p> </p>",
"prevention": "<p>Считается достаточно эффективным для профилактики СВСМ выполнение родителями следующих общих рекомендаций: </p>\r\n<ul>\r\n<li>Головка ребенка должна быть открыта во время сна </li>\r\n<li>Ребенка нельзя туго пеленать, оставлять в постели с соской </li>\r\n<li>Ограничить или не использовать в кроватке пуховые одеяла, подушки, думки, мягкие игрушки и мягкие бортики </li>\r\n<li>Рекомендуется укладывать спать ребенка на спине или на боку с валиком, мешающим ему перевернуться и оказаться лежащим вниз лицом </li>\r\n<li>Использовать жесткий, пригнанный матрас </li>\r\n<li>Необходимо оградить младенца от пассивного курения </li>\r\n<li>Обязательно регулярно проветривать комнаты </li>\r\n<li>Исключить шум, громкую музыку и т.п. </li>\r\n<li>Проводить тактильную стимуляцию.</li>\r\n</ul>",
"clinical_picture": "<p>Клиническими проявлениями этого синдрома являются такие признаки, как насморк, выделения из глаз; увеличение миндалин, печени и селезенки; сыпь; потеря веса. Эти симптомы отмечаются за 2-3 недели до СВДС у 90 % детей. </p>\r\n<p>В отношении младенцев, переживших в грудном возрасте очевидный жизнеугрожающий эпизод и выжившим, используется понятие абортивный синдром внезапной детской смерти или near-miss СВДС. </p>\r\n<p>Предвестником синдрома внезапной смерти у детей можно быть апноэ. При задержке дыхания у младенца может быть резкая слабость, посинение кожных покровов, состояние «замирания», снижение тонуса мышц. </p>\r\n<p>В 50-70% случаях у таких детей удается выявить корреляцию очевидного жизнеугрожающего эпизода с каким-либо патологическим состоянием: судорожным синдромом, миопатией, инфекциями дыхательных путей, гастроэзофагеальной рефлюксной болезнью, врожденными аномалиями развития, заболеваниями обмена веществ и пр. </p>",
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},
"code": "S53",
"name": "Вывих локтевого сустава",
"icd_name": "Вывих, растяжение и перенапряжение капсульно-связочного аппарата локтевого сустава",
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"age_min": 0,
"age_max": 100,
"cause": [
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],
"periodicity": 1,
"slug": "s53_vyvih_loktevogo_sustava",
"lead": "группа вывихов, которые характеризуются смещением суставных поверхностей плечевой, локтевой и лучевой костей",
"description": "<p>Вывих, растяжение и перенапряжение капсульно-связочного аппарата локтевого сустава включает в себя:</p>\r\n<ul>\r\n<li>вывих обеих костей предплечья (локтевой и лучевой);</li>\r\n<li>изолированный вывих лучевой кости или подвывих головки лучевой кости;</li>\r\n<li>изолированный вывих локтевой кости;</li>\r\n<li>вывих костей предплечья с переломом шейки лучевой кости и смещением головки, или эпифизеолиз;</li>\r\n<li>перелом локтевого отростка в сочетании с вывихом. </li>\r\n</ul>",
"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;\">Причины возникновения вывиха локтя:</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;\">Получение удара. Во время серьезной физической нагрузки, при ДТП или драке — человек может получить такую травму. А также вывих может произойти и при нанесении удара пациентов по твердой поверхности.</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;\">Падение. Падающий человек интуитивно выставляет вперед руки для смягчения падения. На кисть приходится высокая нагрузка. На травму оказывает влияние угол, под которым человек выставляет верхние конечности, его масса тела и скорость падения.</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;\">Резкий рывок. Вывих локтевого сустава со смещением может произойти, если сильно дернуть человека за руку. Обычно такая травма может произойти во время тренировки по дзюдо или самбо.</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;\">Травма на производстве. Подобные повреждения человек обычно получает на работе, связанной с тяжелым физическим трудом. Представители рабочих профессий чаще всего травмируются во время работы.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Травматолог, перед определением метода лечения, обязательно проводит тщательную диагностику, чтобы отличить проблему от других. Например, от закрытого перелома или локтевого бурсита.</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 первую очередь врач проводит сбор анамнеза, узнает, что предшествовало травме, затем проводит тщательный осмотр и пальпацию, определяет чувствительность в поврежденной конечности.</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;\">Возможно направление пациента на следующие анализы: </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;\">рентген;</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;\">УЗИ 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;\">общие анализы крови, мочи;</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;\">биопсия внутрисуставного вещества.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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 проводят забор анализов на выявление сопутствующих хронических патологий, которые определят методику лечения.</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;\">Травматолог после сбора анамнеза скорее всего прибегнет к вправлению сустава. Перед этим пациенту показан прием обезболивающих, возможна блокада сустава анестетиками, следует также внутримышечно ввести миорелаксанты, направленные на расслабление мышечных волокон. Вправлять пораженный сустав должен только профессионал.</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 зависимости от степени и вида поражения врач выберет определенный метод вправления.</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;\">Далее для облегчения состояния пациента необходима качественная иммобилизация в течение 2 недель. При вывихе локтя у ребенка, симптомы которого значительно ярче, правильная ликвидация любых движений в суставе приведет к быстрому восстановлению.</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 период лечения пациенту необходим прием медикаментов:</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;\">обезболивающих;</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;\">противовоспалительных;</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;\">миорелаксантов;</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;\">ангиопротекторов;</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;\">витаминных комплексов.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">Целесообразность терапии определенных лекарственных групп и курс лечения выбирает травматолог в зависимости от возрастных особенностей пациента, сложности травмы.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чтобы снизить вероятность появления травмы, рекомендуется регулярно делать упражнения, направленные на укрепление дельтовидную мышцы. Если есть заболевания, связанные с суставами, следует их лечить. Также нужно стараться избегать ситуаций, когда возможно травмирование рук. Не стоит совершать резких движений, важно стараться аккуратно ходить.</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;\">При вывихе локтя характерными симптомами считаются следующие признаки:</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;\">Изменение формы сустава. Внешне будет заметно, что локоть выглядит не так, как раньше.</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;\">Сильная боль. Пациент может ощущать в области локтя сильную боль, и при попытке двигать рукой — движения будут трудными и болезненными. В состоянии покоя пациент не будет чувствовать облегчение. Болевые ощущения могут охватывать плечо и предплечье.</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;\">Ограниченность в движениях. У пациента с вывихом локтя наблюдается частичная или даже полная ограниченность при попытке шевелить и двигать рукой. Если все же были приложены усилия, чтобы согнуть руку — это заканчивается резкой болью в области поражения.</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;\">Отечность. Область локтя опухает, и отек не спадает сразу после вправления, отек спадает постепенно.</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;\">Цвет. Ввиду воспаления, кожа на месте вывиха и по всей конечности становится красного или лилового цвета.</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;\">Снижение чувствительности. При таком виде травмы может неметь рука.</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;\">Спазмы. Из-за повреждения сосудов, связок и мышц часто появляются спазмы в травмированной руке.</span></li>\r\n<li><span id=\"docs-internal-guid-af3887ed-7fff-3d14-a7b0-9aeac95da86f\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ухудшение самочувствия. Из-за травмы больной будет испытывать общее недомогание, выражающееся в повышении температуры, жаре или ознобе. Пульс может быть учащенным или, наоборот, замедленным.</span></span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
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"code": "S84",
"name": "Травма нервов на уровне голени",
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}
]
}
