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},
"code": "I74",
"name": "Эмболия и тромбоз артерий",
"icd_name": "Эмболия и тромбоз артерий",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "i74_emboliya_i_tromboz_arteriy",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "\r\nТромбозы и эмболии артерий – это патология, возникающая при острой закупорке просвета артерий тромбом или эмболом, приводящее к нарушению кровотока в тканях. При этом дальнейшее поступление крови по сосуду прекращается, ткани испытывают гипоксию (кислородное голодание).\r\n",
"etiology": "<p>К причинам возникновения артериальных тромбозов относятся:</p>\r\n<ul>\r\n<li>Сердечно-сосудистые заболевания, облитерирующий атеросклероз, тромбангиит;</li>\r\n<li>Сахарный диабет;</li>\r\n<li>Повреждения стенок артерий при ушибах мягких тканей, вывихах и переломах костей конечностей, компрессия сосудистого пучка опухолью или гематомой;</li>\r\n<li>Предшествующие ангиографические исследования, эндоваскулярные вмешательства, реконструктивные операции на сосудах и другие интервенционные процедуры;</li>\r\n<li>Гематологические заболевания (эритроцитоз);</li>\r\n<li>Инфекционные заболевания (сыпной тиф, сепсис, грипп и т.д.).</li>\r\n</ul>\r\n<p>К причинам возникновения артериальных эмболий относятся:</p>\r\n<ul>\r\n<li>В 92-95% случаев – сердечно-сосудистые заболевания, в первую очередь инфаркт миокарда (особенно в первые 2-3 нед заболевания), осложненный тяжелыми нарушениями ритма сердца, острой или хронической аневризмой левого желудочка;</li>\r\n<li>Внутрипредсердный тромбоз;</li>\r\n<li>Тромбы, образующиеся в аневризмах брюшной аорты и крупных магистральных артерий;</li>\r\n<li>Атероматозные язвы аорты.</li>\r\n</ul>",
"pathogenesis": "<p>Непременными условиями возникновения артериальных тромбозов являются нарушение целостности сосудистой стенки, изменение системы гемостаза и замедление кровотока. Во всех указанных случаях ответной реакцией на повреждения внутренней стенки сосуда является прилипание тромбоцитов, склеивание их между собой и дальнейший рост, что связано с воздействием биологически активных веществ, вырабатываемых в организме. В то же время под действием биологически активных веществ происходит активация свертывающей системы крови и снижение способности растворять тромбы. В результате на поверхности агрегата адсорбируются нити фибрина, образующие сетчатую структуру, которая, задерживая форменные элементы крови, способствует образованию кровяного свертка - тромба.</p>\r\n<p>Эмболия - закупорка просвета кровеносного сосуда эмболом, который обычно представлен частью тромба или бляшки, \"оторвавшейся\" от сосудистой стенки, мигрирующих с током крови по кровеносному руслу. Эти тромбы отрываются от мест прикрепления и, переносясь током крови, застревают в местах анатомических сужений артерий или их разделения на ветви. После закупорки сосуда происходит его рефлекторный спазм ниже эмбола. Сам эмбол стимулирует образование и рост тромба, который иногда достигает очень больших размеров.</p>\r\n<p>Тромбоз и эмболия приводят к полному обескровливанию конечности ниже закупорки. Артериальная ишемия в подавляющем большинстве случаев приводит к гангрене.</p>",
"diagnostics": "<p>Диагностика включает в себя сбор жалоб, анамнеза заболевания и жизни; физикальное обследование.</p>\r\n<p>Лабораторные методы исследования: коагулограмма (обнаруживается повышение свертываемости крови).</p>\r\n<p>Инструментальные методы:</p>\r\n<ol>\r\n<li>Ультразвуковое ангиосканирование аорты и артерий:</li>\r\n</ol>\r\n<ul>\r\n<li>увеличение скорости кровотока в местах препятствия току крови – стеноз (выше уровня тромбоза);</li>\r\n<li>отсутствие кровотока в аорте или артерии на уровне тромбоза (эмболии);</li>\r\n<li>кровоток отсутствует или коллатеральный ниже уровня тромбоза (эмболии);</li>\r\n<li>утолщение стенки артерии, выявление атеросклеротических бляшек.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Ангиография проводится на операционном столе для уточнения воспринимающего сосудистого русла и позволяет определить характер хирургического вмешательства.</li>\r\n</ol>\r\n<ol start=\"3\">\r\n<li>Мультиспиральная компьютерная томография проводится при наличии времени для детальной диагностики и позволяет очень точно выявить характер поражений и определить лечебную тактику.</li>\r\n</ol>",
"treatment": "<p>Тактика лечения зависит от давности начала заболевания, уровня поражения сосуда, степени нарушения артериального кровообращения, от наличия сопутствующих заболеваний. </p>\r\n<p>Консервативную терапию следует проводить в течение 2 – 4 часов при субкомпенсации кровообращения конечности. Если наступает улучшение кровообращения конечности, то следует продолжить консервативную терапию до ликвидации ишемических проявлений конечности. Если за это время улучшения не наступает, следует ставить вопрос о немедленном оперативном лечении.</p>\r\n<p> Немедикаментозное лечение:</p>\r\n<ul>\r\n<li>Режим I, II, III.</li>\r\n<li>Диета №10.</li>\r\n</ul>\r\n<p> Медикаментозное лечение:</p>\r\n<ul>\r\n<li>Назначается тромболитическая терапия, направленная на восстановление кровотока в в сосуде за счет лизиса тромба внутри сосудистого русла.</li>\r\n<li>С целю профилактики восходящего и нисходящего вторичного тромбоза применяется антикоагулянтные препараты прямого действия.</li>\r\n<li>Для улучшения реологических свойств кров применяются антиагрегантные препараты.</li>\r\n<li>Спазмолитическая терапия показана для снижения периферического артериоспазма и улучшения кровотока по пораженной конечности за счет расширения коллатерального кровотока. Для лизиса эмбола или тромба применяют препараты, повышающие фибринолитическую активность крови.</li>\r\n</ul>\r\n<p>Хирургическое лечение острых артериальных эмболии заключается в удалении эмбола и тромботических масс из просвета артерии с помощью катетера.</p>\r\n<p>При тяжелой ишемии, сопровождающейся отеком мышц или мышечной контрактурой с целью декомпрессии и улучшения тканевого кровотока показана фасциотомия (рассечение мышечной фасции (оболочки)).</p>\r\n<p>При остром тромбозе, развившемся на фоне органического поражения артериальной стенки, простое удаление тромба обычно неэффективно, так как быстро наступает повторный тромбоз сосуда. Поэтому должна проводиться реконструктивная операцией.</p>\r\n<p>При развитии гангрены конечности показана ампутация.</p>",
"prevention": "<p>Профилактика тромбозов и эмболий артерий включает здоровое питание, подвижный образ жизни, отказ от курения, нормализация индекса массы тела, своевременное и полноценное лечение сердечно-сосудистых и инфекционных заболеваний.</p>\r\n<p> </p>",
"clinical_picture": "<p>Тромбозы и эмболии развиваются внезапно, на фоне относительного благополучия. При закупорке артерий конечности возникает острая сильная боль, затем появляются и нарастают чувство онемения, похолодания и потеря чувствительности. Вместе с этим возникает полная обездвиженность. Сначала движения становятся невозможными из-за сильных болей, а затем — из-за наступившей ишемии конечности и окоченения мышц.</p>\r\n<p>При обследовании больного часто отмечается аритмичный пульс. Конечность более бледная и холодная на ощупь, чем контралатеральная, мраморность окраски кожи. Пульсация периферических артерий ниже места эмболии не определяется. Болевая и тактильная чувствительность снижена или отсутствует. Больной продолжает страдать от сильных болей в конечности.</p>\r\n<p>Закупорка брыжеечной артерии вызывает геморрагический (кровяной) инфакркт и даже гангрену соответствующего участка кишки с жалобами и объективными признаками острого живота – резкими болями в животе, напряжением брюшной стенки, вздутием живота, тошнотой, рвотой, явлениями шока, легким повышением температуры, иногда диареей.</p>\r\n<p>Закупорка брюшной аорты вызывает резкую боль в средней части живота или в спине, а также в обеих ногах, побледнение, потерю чувствительности, а затем движений в ногах, явления шока. Исчезает пульс на сосудах нижних конечностей, развивается гангрена.</p>",
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"description": "<p>Красный плоский лишай – хроническое воспалительное заболевание, которое характеризуется мономорфными высыпаниями папул (узелков) на коже и видимых слизистых оболочках, чаще на слизистой оболочке рта и красной кайме губ, сопровождающимися зудом различной тяжести.</p>",
"etiology": "<p>Этиология дерматоза не выяснена. Выявлено комплексное участие следующих факторов: инфекционных (вирусных), нейроэндокринных, генетических, иммунных (реакция «трансплантат против хозяина» при пересадке донорского органа), токсико-аллергических (токсического действия лекарственных средств – препаратов золота, мышьяка, ртути, хинина и его производных, фтивазида, ПАСК, тетрациклина и др.), аутоинтоксикации, обусловленной заболеваниями желудочно-кишечного тракта, сахарным диабетом, нарушением функции печени, включая хронический гепатит С (у 55% пациентов с красным плоским лишаем обнаруживаются положительные лабораторные маркеры на вирусный гепатит С).</p>",
"pathogenesis": "<p>До сих пор неизвестен точный механизм и причины возникновения красного плоского лишая. На сегодняшний день красный плоский лишай считается многопричинным заболеванием, возникающим при воздействии различных внешних и внутренних факторов, приводящих к нарушениям в иммунных и метаболических процессах, в результате чего в ответ на действие провоцирующего фактора развивается неадекватная тканевая реакция.</p>\r\n<p>Отмечены случаи красного плоского лишая в результате действия нервно-психологических факторов и вегетативных расстройств. Хронический стресс, повышенная возбудимость, утомление и другие психогенные расстройства часто предшествуют возникновению заболевания и влияют на его течение.</p>\r\n<p>Эндокринная теория основана на обнаружении дисфункции коры надпочечников, повышения экскреции катехоламинов, предполагается, что нервные и эндокринные расстройства являются скорее факторами патогенетическими, чем этиологическими.</p>\r\n<p>Инфекционно-аллергическая теория исходит из того, что поражение вирусом клеток эпидермиса провоцирует образование антител к собственным клеткам и развитие аутоаллергических реакций, приводящих к повреждению с формированием клеточных инфильтратов в дерме.</p>\r\n<p>Определенную роль в развитии патологии играет местная травма. Положительный изоморфный феномен, когда неспецифический раздражитель вызывает характерные для КПЛ элементы поражения (реакция Кэбнера). Исследования показали, что местная травма слизистой оболочки способствует проявлению заболевания, так как высыпания появляются в зоне повреждения и в ответ на него.</p>\r\n<p>Определенное значение придается наследственному предрасположению. Допускается также возможность провоцирующей роли аутоинтоксикации из желудочно-кишечного тракта, некоторых медикаментов, профессиональных вредностей, изменения реактивности организма и прочие.</p>",
"diagnostics": "<p>Диагноз красного плоского лишая в типичных случаях не вызывает затруднений. Характерная окраска элементов с сиреневато-перламутровым оттенком, полигональное очертание плоских папул с пупкообразным вдавлением в центре, наличие сетки Уикхема, локализация очагов поражения на сгибательной поверхности предплечий и нередко на слизистой оболочке полости рта, половых органов – все это почти безошибочно позволяет поставить диагноз красного плоского лишая, даже не прибегая к гистологическому исследованию.</p>\r\n<p>В сомнительных случаях красного плоского лишая для подтверждения диагноза необходимо проведение биопсии с последующим гистологическим исследованием.</p>",
"treatment": "<p> Лечение красного плоского лишая определяется в зависимости от клинической формы заболевания, распространенности патологического процесса, локализации очагов поражения.</p>\r\n<p>Варианты лечения красного плоского лишая:</p>\r\n<p>1) терапия антималярийными препаратами;</p>\r\n<p>2) терапия ароматическими ретиноидами (производное витамина А) – уменьшают интенсивность воспалительной реакции, влияют на состояние клеточных мембран и нормализуют процессы пролиферации;</p>\r\n<p>3) ПУВА-терапия (при распространенных формах) - метод лечения, который включает использование фотоактивного вещества совместно с облучением кожи длинноволновым ультрафиолетовым излучением;</p>\r\n<p>4) кортикостероидная терапия (короткие курсы при острых генерализованных формах);</p>\r\n<p>5) терапия цитостатиками (при резистентных к другим вариантам терапии и генерализованных формах);</p>\r\n<p>6) лечение антидепрессантами, транквилизаторами, анксиолитиками;</p>\r\n<p>7) гипосенсибилизирующая терапия препаратами кальция и антигистаминными (противоаллергическими) средствами;</p>\r\n<p>8) лечение сопутствующих заболеваний, осложняющих течение дерматоза.</p>\r\n<p>Наружно назначают противозудные взбалтываемые смеси с ментолом и анестезином, кортикостероидные кремы и мази (возможно под окклюзионную повязку). Крупные и бородавчатые очаги обкалывают антималярийными препаратами либо кортикостероидами, в ряде случаев проводят криодеструкиию или лазеротерапию. При тяжелом поражении слизистой оболочки полости рта назначают полоскания раствором кортикостероида.</p>\r\n<p> </p>",
"prevention": "<p>Профилактика красного плоского лищая включает санацию очагов фокальной инфекции, своевременное лечение выявленных сопутствующих заболеваний, предотвращение приема ряда медикаметозных препаратов, способных спровоцировать развитие заболевания, общие оздоровительные мероприятия, санаторно-курортное лечение.</p>",
"clinical_picture": "<p>Типичные высыпания красного плоского лишая обычно локализуются на сгибательных поверхностях предплечий и лучезапястных суставов, передних поверхностях голеней, в области крестца, у мужчин – на половом члене. Одновременно с поражением кожи, реже изолированно, у 40-60% больных может развиться поражение слизистых оболочек полости рта: внутренней поверхности щек, языка, десен, твердого и мягкого неба, миндалин. Вначале появляются мелкие (милиарные) папулы, хорошо заметные на розовом фоне непораженной слизистой оболочки благодаря серовато-белому цвету, которые, затем сливаясь, формируют небольшого размера бляшки, напоминающие по форме сетку, лист папоротника. Вследствие мацерации в полости рта элементы серо-белого цвета и без характерного блеска. Инфильтрат этих папул бывает выражен незначительно, и элементы почти не возвышаются.</p>\r\n<p>На красной кайме губ (чаше на нижней) образуются небольшие, слегка шелушащиеся, фиолетового цвета бляшки, на поверхности которых выявляется серовато-белая сетка.</p>\r\n<p>Изменение ногтевых пластинок при красном плоском лишае характеризуется образованием борозд, углублений, участков помутнения; ногти могут истончаться и даже частично или полностью разрушаться. Чаще всего страдают ногтевые пластинки больших пальцев ног.</p>\r\n<p>Помимо классической формы описано множество атипичных форм красного плоского лишая. К атипичным формам заболевания относятся:</p>\r\n<ul>\r\n<li>кольцевидная (высыпания в форме колец);</li>\r\n<li>бородавчатая - характеризуется появлением значительно возвышающихся над уровнем здоровой кожи бляшек фиолетового или буровато-красного цвета, с неровной поверхностью, покрытых массивными роговыми наслоениями. По периферии бляшек можно обнаружить отдельные типичные папулы красного плоского лишая. Отличительными особенностями этой формы являются: интенсивный зуд, длительное существование элементов, склонных к склерозированию, необычная резистентность к терапии;</li>\r\n<li>буллезная - характеризуется появлением пузырей на папулах и бляшках, а также на эритематозных участках и неизмененной коже. После разрешения высыпаний могут оставаться атрофия и гиперпигментация. При локализации элементов на волосистой части головы возможно развитие рубцовой алопеции (облысение);</li>\r\n<li>атрофическая - после разрешения типичных для заболевания высыпаний развивается атрофия;</li>\r\n<li>эрозивно-язвенная - характерно образование на слизистой оболочке рта (шеки, десны, красная кайма губ) или на коже голеней эрозивно-язвенных дефектов;</li>\r\n<li>Остроконечная - локализуется преимущественно на коже шеи, лопаток и нижних конечностей. Ее элементы представляет собой остроконечные папулы. В центре каждой папулы расположен участок гиперкератоза, выступающий кверху в виде рогового шипика.</li>\r\n</ul>",
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