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"name": "Обморок [синкопе] и коллапс",
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"description": "Обморок - потеря сознания, возникающая в результате недостаточности кровообращения головного мозга. \r\nКоллапс - остро развивающаяся недостаточность сосудов, сопровождающаяся снижением артериального давления, при этом больной не теряет сознание.",
"etiology": "<p>Острая сосудистая недостаточность способна провоцировать обморок и коллапс может развиваться из-за ряда факторов: </p>\r\n<ul>\r\n<li>потеря большого количества крови из-за внутренних разрывов, серьезных внешних повреждений; </li>\r\n<li>быстрая смена положения лежачего пациента; </li>\r\n<li>время полового созревания у девушек; </li>\r\n<li>перенесение всевозможных инфекционных болезней (дизентерии, ОРВИ, вирусного гепатита, пневмонии); </li>\r\n<li>отравление организма от злоупотребления лекарственными препаратами или же пищевая интоксикация; </li>\r\n<li>сбой сердечного ритма: ИМ, тромбоз, миокардит; </li>\r\n<li>поражение электрическим током; </li>\r\n<li>сильно повышенная внешняя температура: тепловой шок. </li>\r\n</ul>",
"pathogenesis": "<p>В основе патогенеза острой сосудистой недостаточности лежит снижение тонуса гладкой мускулатуры сосудистой стенки, приводящее к нарушению адекватного соотношения между объемом циркулирующей крови и емкостью сосудистого русла. В результате развивается гипоксия головного мозга и угнетение жизненно важных функций организма. </p>",
"diagnostics": "<p>В диагностике важно определить наличие и характер продромальных явлений, состояние вне обморока и коллапса, наличие заболевания сердца, нарушения ритма и проводимости. Может быть полезной электрокардиография, исследование крови на сахар. При повторяющихся коллапсах применяются ортостатическая проба, суточное мониторирование АД и ЭКГ. </p>",
"treatment": "<p>Обморок часто не нуждается в медикаментозном лечении. Достаточно уложить больного, лучше приподнять ноги, расстегнуть стесняющую грудь и шею одежду. Можно сбрызнуть лицо водой, похлопать по щекам, поднести ватку, смоченную нашатырным спиртом. Если это не помогает, можно сделать инъекции сосудосуживающих препаратов. </p>\r\n<p>Лечение коллапса направлено на устранения причин его возникновения. Его проводят в условиях стационара. Больного необходимо уложить, приподнять ноги, согреть. Перед транспортировкой делают инъекцию сосудосуживающего препарата. </p>\r\n<p>В условиях стационара назначают лекарственные вещества, действующие как на механизмы возникновения острой сосудистой недостаточности, так и на устранение причины, вызвавшей ее развитие. </p>\r\n<ul>\r\n<li>Препараты, возбуждающие сосудистый и дыхательный центры. Повышают тонус сосудов, увеличивают ударный объем сердца. </li>\r\n<li>Сосудосуживающие вещества. Внутривенное капельное введение адреналина, норадреналина допамина или других гормонов. </li>\r\n<li>Дезинтоксикационная терапия. Включает введение антидотов и детоксикационных растворов. Они обязательны при отравлениях и инфекционных заболеваниях. </li>\r\n<li>Кровь и кровезаменители. Применяют при кровопотере и анемии. При введении необходимо провести пробу на совместимость с кровью больного, а то это может привести к развитию геморрагического шока. </li>\r\n<li>Противовоспалительные средства. Антибиотики назначаются при инфекционных заболеваниях. </li>\r\n<li>Оксигенотерапия. Назначается с целью улучшения обмена веществ и насыщения крови кислородом. </li>\r\n<li>Восстановление объема крови. Вводятся коллоидные растворы, плазма и солесодержащие препараты. </li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p>Лучшей профилактикой недостаточности функции сосудов является предупреждение заболеваний, которые могут ее вызывать. Рекомендуется следить за состоянием сосудов, употреблять меньше холестерина, проходить регулярные обследования системы кровоснабжения и сердца. В отдельных случаях гипотоникам назначают профилактический курс поддерживающих давление препаратов.</p>",
"clinical_picture": "<p>Обмороки проявляются внезапной слабостью, дурнотой, головокружением, онемением рук и ног с последующей кратковременной полной или частичной потерей сознания. Кожа бледная, конечности холодные, дыхание редкое, поверхностное, зрачки узкие, реакция на свет сохранена, пульс малый, артериальное давление низкое, мышцы расслаблены. Продолжается несколько минут, после чего обычно проходит самостоятельно. </p>\r\n<p>Симптомы коллапса: </p>\r\n<p>беспричинный приступ слабости и усталости, головокружение, бледность кожи, озноб, ледяные конечности, холодный липкий пот, пульс сбивчивый, учащенный, цианоз, резкое снижение АД, обморок, судороги. </p>",
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"code": "R55",
"name": "Обморок [синкопе] и коллапс",
"icd_name": "Обморок [синкопе] и коллапс",
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"age_min": 0,
"age_max": 100,
"cause": [
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"slug": "r55_obmorok_sinkope_i_kollaps",
"lead": "Нарушение здоровья, относящееся к группе общие симптомы и признаки",
"description": "Обморок - потеря сознания, возникающая в результате недостаточности кровообращения головного мозга. \r\nКоллапс - остро развивающаяся недостаточность сосудов, сопровождающаяся снижением артериального давления, при этом больной не теряет сознание.",
"etiology": "<p>Острая сосудистая недостаточность способна провоцировать обморок и коллапс может развиваться из-за ряда факторов: </p>\r\n<ul>\r\n<li>потеря большого количества крови из-за внутренних разрывов, серьезных внешних повреждений; </li>\r\n<li>быстрая смена положения лежачего пациента; </li>\r\n<li>время полового созревания у девушек; </li>\r\n<li>перенесение всевозможных инфекционных болезней (дизентерии, ОРВИ, вирусного гепатита, пневмонии); </li>\r\n<li>отравление организма от злоупотребления лекарственными препаратами или же пищевая интоксикация; </li>\r\n<li>сбой сердечного ритма: ИМ, тромбоз, миокардит; </li>\r\n<li>поражение электрическим током; </li>\r\n<li>сильно повышенная внешняя температура: тепловой шок. </li>\r\n</ul>",
"pathogenesis": "<p>В основе патогенеза острой сосудистой недостаточности лежит снижение тонуса гладкой мускулатуры сосудистой стенки, приводящее к нарушению адекватного соотношения между объемом циркулирующей крови и емкостью сосудистого русла. В результате развивается гипоксия головного мозга и угнетение жизненно важных функций организма. </p>",
"diagnostics": "<p>В диагностике важно определить наличие и характер продромальных явлений, состояние вне обморока и коллапса, наличие заболевания сердца, нарушения ритма и проводимости. Может быть полезной электрокардиография, исследование крови на сахар. При повторяющихся коллапсах применяются ортостатическая проба, суточное мониторирование АД и ЭКГ. </p>",
"treatment": "<p>Обморок часто не нуждается в медикаментозном лечении. Достаточно уложить больного, лучше приподнять ноги, расстегнуть стесняющую грудь и шею одежду. Можно сбрызнуть лицо водой, похлопать по щекам, поднести ватку, смоченную нашатырным спиртом. Если это не помогает, можно сделать инъекции сосудосуживающих препаратов. </p>\r\n<p>Лечение коллапса направлено на устранения причин его возникновения. Его проводят в условиях стационара. Больного необходимо уложить, приподнять ноги, согреть. Перед транспортировкой делают инъекцию сосудосуживающего препарата. </p>\r\n<p>В условиях стационара назначают лекарственные вещества, действующие как на механизмы возникновения острой сосудистой недостаточности, так и на устранение причины, вызвавшей ее развитие. </p>\r\n<ul>\r\n<li>Препараты, возбуждающие сосудистый и дыхательный центры. Повышают тонус сосудов, увеличивают ударный объем сердца. </li>\r\n<li>Сосудосуживающие вещества. Внутривенное капельное введение адреналина, норадреналина допамина или других гормонов. </li>\r\n<li>Дезинтоксикационная терапия. Включает введение антидотов и детоксикационных растворов. Они обязательны при отравлениях и инфекционных заболеваниях. </li>\r\n<li>Кровь и кровезаменители. Применяют при кровопотере и анемии. При введении необходимо провести пробу на совместимость с кровью больного, а то это может привести к развитию геморрагического шока. </li>\r\n<li>Противовоспалительные средства. Антибиотики назначаются при инфекционных заболеваниях. </li>\r\n<li>Оксигенотерапия. Назначается с целью улучшения обмена веществ и насыщения крови кислородом. </li>\r\n<li>Восстановление объема крови. Вводятся коллоидные растворы, плазма и солесодержащие препараты. </li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p>Лучшей профилактикой недостаточности функции сосудов является предупреждение заболеваний, которые могут ее вызывать. Рекомендуется следить за состоянием сосудов, употреблять меньше холестерина, проходить регулярные обследования системы кровоснабжения и сердца. В отдельных случаях гипотоникам назначают профилактический курс поддерживающих давление препаратов.</p>",
"clinical_picture": "<p>Обмороки проявляются внезапной слабостью, дурнотой, головокружением, онемением рук и ног с последующей кратковременной полной или частичной потерей сознания. Кожа бледная, конечности холодные, дыхание редкое, поверхностное, зрачки узкие, реакция на свет сохранена, пульс малый, артериальное давление низкое, мышцы расслаблены. Продолжается несколько минут, после чего обычно проходит самостоятельно. </p>\r\n<p>Симптомы коллапса: </p>\r\n<p>беспричинный приступ слабости и усталости, головокружение, бледность кожи, озноб, ледяные конечности, холодный липкий пот, пульс сбивчивый, учащенный, цианоз, резкое снижение АД, обморок, судороги. </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 194,
"standards": [
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},
{
"id": 6378,
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"id": 2941,
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"name": "астеническое состояние"
},
{
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{
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},
{
"name": "упадок сил"
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{
"name": "бессилие"
}
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"code": "G12",
"name": "Спинальная мышечная атрофия и родственные синдромы",
"icd_name": "Спинальная мышечная атрофия и родственные синдромы",
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"cause": [
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"slug": "g12_spinalnaya_myshechnaya_atrofiya_i_rodstvennye_sindromy",
"lead": "Нарушение здоровья, относящееся к группе системные атрофии, поражающие преимущественно центральную нервную систему",
"description": "Термин “спинальная мышечная атрофия” (СМА), или “спинальная амиотрофия”, является широким понятием, объединяющим группу заболеваний, сопровождающихся дегенерацией двигательных нейронов в спинном мозге и (или) стволе головного мозга и характеризующихся преимущественно аутосомно-рецессивным типом наследования. ",
"etiology": "<p>В большинство случаев СМА обусловлена дефицитом протеина мотонейронов, именуемым SMN (протеин выживаемости мотонейронов) </p>\r\n<p>Этот протеин, как следует из его названия, необходим для нормального функционирования мотонейронов. </p>\r\n<p>SMN – связанная СМА обычно подразделяется на 3 категории. Тип 1 — наиболее тяжелый, с самым ранним началом, а тип 3 — наименее тяжелый, с наиболее поздним возрастом начала. Некоторые специалисты выделяют еще тип 4 для обозначения умеренной или мягкой СМА с дебютом во взрослом возрасте </p>\r\n<p>Все эти типы связаны с генетическими поломками (мутациями) на хромосоме 5, что влияет на количество синтезируемого SMN – протеина. Более высокие уровни протеина снижают тяжесть СМА. </p>\r\n<p>Существуют также формы СМА, не связанные с протеином SMN и не являющиеся результатом мутаций на хромосоме 5. </p>",
"pathogenesis": "<p>СМА вызвана мутацией в гене SMN1, который в норме производит белок SMN.</p>\r\n<p>Из-за мутации гена, у людей с СМА производится меньшее количество белка SMN, что приводит к потере моторных нейронов.</p>",
"diagnostics": "<p>При подозрении — консультация невролога и генетика. </p>\r\n<p>Биохимия крови: креатинкиназа — в норме при СМА тип I, в норме или незначительно повышена при других типах. </p>\r\n<p>Генетическое обследование: пренатально или постнатально. Тест ДНК путем определения выпадения гена SMN1. </p>\r\n<p>Электронейромиография — показывает снижение нервных импульсов, помогает дифференцировать СМА от других нервно-мышечных болезней. Сенсорная нервная проводимость обычно нормальная. </p>\r\n<p>Биопсия мышц — гистологические признаки атрофии мышечных волокон, помогает дифференцировать СМА от других нервно-мышечных болезней. </p>",
"treatment": "<p>Специального лечения пока не разработано. </p>\r\n<p>Необходимы мультипрофессиональный подход и паллиативная помощь для улучшения качества жизни. </p>\r\n<ol>\r\n<li>Помощь в передвижении и самообслуживании. </li>\r\n<li>Фиксация корпуса и конечностей (корсеты, туторы и др.). </li>\r\n<li>Физиотерапия, эрготерапия (восстановлением утраченных двигательных навыков), физическая терапия и специальные сиденья могут уменьшить развитие контрактур суставов и сколиоза. </li>\r\n<li>Дыхательные упражнения. </li>\r\n<li>Респираторная поддержка, в том числе ИВЛ (неинвазивная через маску или инвазивная через трахеостому), может понадобиться на дому при прогрессировании болезни. </li>\r\n<li>Кормление через гастростому необходимо при прогрессировании проблем с глотанием. </li>\r\n</ol>",
"prevention": "<p>Возможна только пассивная профилактика — консультирование родителей с риском СМА о возможных последствиях и пренатальная ДНК-диагностика во время беременности через биопсию ворсин хориона для принятия решения о рождении или прерывании беременности. </p>",
"clinical_picture": "<p>Наиболее тяжёлой формой является I тип спинальной мышечной атрофии (синдром Верднига-Гоффмана), манифестирующий в раннем детстве (в первые 6 месяцев). Характерен синдром «вялого ребёнка» (слабый крик, сниженная двигательная активность, вялое сосание, потеря массы тела, сниженные глотательный, сосательный и кашлевой рефлексы). Такие дети неспособны удерживать головку, переворачиваться и сидеть, отстают в моторном развитии (грубая задержка). Могут развиваться деформации суставов и конечностей, контрактуры, дыхательные и бульбарные нарушения (расстройство глотания (дисфагия), нарушение артикуляции (дизартрия) и звучности речи (дисфония). Средняя продолжительность жизни таких детей – 2 года. Причиной смерти, как правило, становится тяжёлая дыхательная недостаточность или развитие пневмонии. </p>\r\n<p>Для II типа спинальной амиотрофии характерны более поздняя манифестация (6-18 месяцев) и хронически прогрессирующее течение. У таких детей наблюдается отставание в моторном развитии, тремор пальцев, прогрессирование слабости кашлевого рефлекса, поверхностного диафрагмального дыхания и межрёберных мышц. В начале дети с данной формой заболевания могут ползать, сидеть без поддержки, а некоторые и стоять при поддержке, но эти способности утрачиваются по мере роста и увеличения массы тела. Формируются скелетные и мышечные деформации (в том числе сколиоз, деформации грудной клетки и псевдогипертрофия икроножной мышцы), контрактуры, а также возникают нарушения дыхания (вплоть до развития дыхательной недостаточности). </p>\r\n<p>Наиболее лёгкое течение из детских форм характерно для III типа спинальной мышечной атрофии (синдрома Кугельберга-Веландера). Первые проявления, как правило, обнаруживаются у детей после 1,5 лет и характеризуются сложностями с комплексными двигательными навыками (бег, подъём по ступенькам и т.п.). Симптоматика прогрессирует медленно, нарушения глотания и жевания развиваются значительно позже. </p>\r\n<p>Взрослая форма (тип IV) имеет мягкое течение, при котором наиболее часто первыми поражаются мышцы плечевого пояса. </p>",
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"code": "G12",
"name": "Спинальная мышечная атрофия и родственные синдромы",
"icd_name": "Спинальная мышечная атрофия и родственные синдромы",
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"cause": [
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"slug": "g12_spinalnaya_myshechnaya_atrofiya_i_rodstvennye_sindromy",
"lead": "Нарушение здоровья, относящееся к группе системные атрофии, поражающие преимущественно центральную нервную систему",
"description": "Термин “спинальная мышечная атрофия” (СМА), или “спинальная амиотрофия”, является широким понятием, объединяющим группу заболеваний, сопровождающихся дегенерацией двигательных нейронов в спинном мозге и (или) стволе головного мозга и характеризующихся преимущественно аутосомно-рецессивным типом наследования. ",
"etiology": "<p>В большинство случаев СМА обусловлена дефицитом протеина мотонейронов, именуемым SMN (протеин выживаемости мотонейронов) </p>\r\n<p>Этот протеин, как следует из его названия, необходим для нормального функционирования мотонейронов. </p>\r\n<p>SMN – связанная СМА обычно подразделяется на 3 категории. Тип 1 — наиболее тяжелый, с самым ранним началом, а тип 3 — наименее тяжелый, с наиболее поздним возрастом начала. Некоторые специалисты выделяют еще тип 4 для обозначения умеренной или мягкой СМА с дебютом во взрослом возрасте </p>\r\n<p>Все эти типы связаны с генетическими поломками (мутациями) на хромосоме 5, что влияет на количество синтезируемого SMN – протеина. Более высокие уровни протеина снижают тяжесть СМА. </p>\r\n<p>Существуют также формы СМА, не связанные с протеином SMN и не являющиеся результатом мутаций на хромосоме 5. </p>",
"pathogenesis": "<p>СМА вызвана мутацией в гене SMN1, который в норме производит белок SMN.</p>\r\n<p>Из-за мутации гена, у людей с СМА производится меньшее количество белка SMN, что приводит к потере моторных нейронов.</p>",
"diagnostics": "<p>При подозрении — консультация невролога и генетика. </p>\r\n<p>Биохимия крови: креатинкиназа — в норме при СМА тип I, в норме или незначительно повышена при других типах. </p>\r\n<p>Генетическое обследование: пренатально или постнатально. Тест ДНК путем определения выпадения гена SMN1. </p>\r\n<p>Электронейромиография — показывает снижение нервных импульсов, помогает дифференцировать СМА от других нервно-мышечных болезней. Сенсорная нервная проводимость обычно нормальная. </p>\r\n<p>Биопсия мышц — гистологические признаки атрофии мышечных волокон, помогает дифференцировать СМА от других нервно-мышечных болезней. </p>",
"treatment": "<p>Специального лечения пока не разработано. </p>\r\n<p>Необходимы мультипрофессиональный подход и паллиативная помощь для улучшения качества жизни. </p>\r\n<ol>\r\n<li>Помощь в передвижении и самообслуживании. </li>\r\n<li>Фиксация корпуса и конечностей (корсеты, туторы и др.). </li>\r\n<li>Физиотерапия, эрготерапия (восстановлением утраченных двигательных навыков), физическая терапия и специальные сиденья могут уменьшить развитие контрактур суставов и сколиоза. </li>\r\n<li>Дыхательные упражнения. </li>\r\n<li>Респираторная поддержка, в том числе ИВЛ (неинвазивная через маску или инвазивная через трахеостому), может понадобиться на дому при прогрессировании болезни. </li>\r\n<li>Кормление через гастростому необходимо при прогрессировании проблем с глотанием. </li>\r\n</ol>",
"prevention": "<p>Возможна только пассивная профилактика — консультирование родителей с риском СМА о возможных последствиях и пренатальная ДНК-диагностика во время беременности через биопсию ворсин хориона для принятия решения о рождении или прерывании беременности. </p>",
"clinical_picture": "<p>Наиболее тяжёлой формой является I тип спинальной мышечной атрофии (синдром Верднига-Гоффмана), манифестирующий в раннем детстве (в первые 6 месяцев). Характерен синдром «вялого ребёнка» (слабый крик, сниженная двигательная активность, вялое сосание, потеря массы тела, сниженные глотательный, сосательный и кашлевой рефлексы). Такие дети неспособны удерживать головку, переворачиваться и сидеть, отстают в моторном развитии (грубая задержка). Могут развиваться деформации суставов и конечностей, контрактуры, дыхательные и бульбарные нарушения (расстройство глотания (дисфагия), нарушение артикуляции (дизартрия) и звучности речи (дисфония). Средняя продолжительность жизни таких детей – 2 года. Причиной смерти, как правило, становится тяжёлая дыхательная недостаточность или развитие пневмонии. </p>\r\n<p>Для II типа спинальной амиотрофии характерны более поздняя манифестация (6-18 месяцев) и хронически прогрессирующее течение. У таких детей наблюдается отставание в моторном развитии, тремор пальцев, прогрессирование слабости кашлевого рефлекса, поверхностного диафрагмального дыхания и межрёберных мышц. В начале дети с данной формой заболевания могут ползать, сидеть без поддержки, а некоторые и стоять при поддержке, но эти способности утрачиваются по мере роста и увеличения массы тела. Формируются скелетные и мышечные деформации (в том числе сколиоз, деформации грудной клетки и псевдогипертрофия икроножной мышцы), контрактуры, а также возникают нарушения дыхания (вплоть до развития дыхательной недостаточности). </p>\r\n<p>Наиболее лёгкое течение из детских форм характерно для III типа спинальной мышечной атрофии (синдрома Кугельберга-Веландера). Первые проявления, как правило, обнаруживаются у детей после 1,5 лет и характеризуются сложностями с комплексными двигательными навыками (бег, подъём по ступенькам и т.п.). Симптоматика прогрессирует медленно, нарушения глотания и жевания развиваются значительно позже. </p>\r\n<p>Взрослая форма (тип IV) имеет мягкое течение, при котором наиболее часто первыми поражаются мышцы плечевого пояса. </p>",
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