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},
{
"name": "боль в сердце при вдохе"
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{
"name": "боль в сердце у детей"
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{
"name": "Боль выше пупка"
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"name": "Боль ниже пупка"
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"name": "Острые боли в животе"
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"name": "Боль в области живота "
},
{
"name": "Боль в области пупка"
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{
"name": "Боль в правой жасти живота"
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"name": "Пупок тянет"
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"name": "Болит пупок"
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{
"name": "Болит живот сверху"
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{
"name": "Боль в животе у ребенка"
},
{
"name": "У ребенка болит живот"
},
{
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"code": "G90",
"name": "Расстройства вегетативной [автономной] нервной системы",
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"lead": "Нарушение здоровья, относящееся к группе другие нарушения нервной системы",
"description": "Синдром, характеризующийся нарушениями вегетативной регуляции внутренних органов - сердечно-сосудистой системы, желудочно-кишечного тракта, органов дыхания, желез внутренней секреции.",
"etiology": "<p>Нарушение деятельности внутренних систем человека происходит из-за сбоев в процессе нервной регуляции. Причинами могут быть:</p>\r\n<p> </p>\r\n<ul>\r\n<li>Нарушения в эндокринной систем (ожирение, сахарный диабет);</li>\r\n<li>гормональные сбои или возрастные гормональные изменения в организме (беременность, менструальный цикл, климакс, пубертатный период);</li>\r\n<li>Наследственная предрасположенность;</li>\r\n<li>травмы, ранения, хирургические операции</li>\r\n<li>хронический стресс, мнительность;</li>\r\n<li>Курение, употребления алкоголя и наркотических препаратов;</li>\r\n<li>Несоблюдение правил правильного питания;</li>\r\n<li>Хронические инфекции по типу кариозных образований и тонзиллита;</li>\r\n<li>Аллергическая реакция;</li>\r\n<li>Интоксикация;</li>\r\n<li>Влияние производственных факторов (вибрация, облучение)</li>\r\n<li>Инфекционное поражение периферической вегетативной нервной системы (СПИД, герпес, сифилис, лепра)</li>\r\n</ul>\r\n<p>У детей 1 года жизни заболевания вегетативной нервной системы возникают из-за гипоксии плода (нехватки кислорода при внутриутробном развитии), а также из-за перенесенных стрессов. У детей психика не настолько устойчива, как у взрослых, поэтому для них любая проблема может вызвать психическую травму.</p>",
"pathogenesis": "<p>Основную роль в патогенезе вегетативной дистонии играет нарушение вегетативной регуляции и развитие вегетативного дисбаланса. Отношения между симпатической и парасимпатической вегетативными нервными системами соответствуют принципу «качающегося равновесия»: повышение тонуса одной системы влечет за собой возрастание тонуса другой. Такая форма вегетативного обеспечения позволяет поддерживать постоянство внутренней среды и создавать условия для повышенной лабильности физиологических функций. Клинико-экспериментальные исследования обнаружили эту лабильность практически во всех системах – вариации ритма сердца, артериального давления, температуры тела и других показателей. Выход этих колебаний за пределы нормального диапазона повышает уязвимость системы вегетативной регуляции для повреждающих факторов. В таких условиях экзогенные либо эндогенные стимулы могут приводить к предельному напряжению регуляторных систем, а затем к их «поломке» с клинической манифестацией в виде расстройства вегетативной нервной системы.</p>",
"diagnostics": "<p class=\"txt\">Диагностика вегетативной дистонии преимущественно клиническая. Лабораторные и инструментальные методы требуются для исключения соматических заболеваний, имеющих сходную клиническую картину.</p>\r\n<p class=\"txt\">Дифференциальную диагностику проводят с заболеваниями эндокринных органов (гипо- и гипертиреоз, сахарный диабет, феохромоцитома), сердечно-сосудистой системы (пароксизмы нарушений сердечного ритма и проводимости, сопровождающиеся обмороками), неврологическими заболеваниями (эпилепсия).</p>\r\n<p>Основные (обязательные) диагностические обследования, проводимые на амбулаторном уровне:</p>\r\n<ul>\r\n<li>измерение АД, ЧСС, ЧД в покое, при физической, умственной и эмоциональной нагрузках;</li>\r\n<li>ортостатическая проба – используется для анализа работы сердечно-сосудистой системы при вставании и помогает определить как функционирует симпатический отдел вегетативной нервной системы;</li>\r\n<li>общий анализ крови;</li>\r\n<li>определение натрия, кальция, калия в сыворотке крови;</li>\r\n<li>определение глюкозы в сыворотке крови;</li>\r\n<li>общий анализ мочи;</li>\r\n<li>электрокардиографическое исследование (в 12 отведениях);</li>\r\n</ul>\r\n<p>Основные (обязательные) диагностические обследования, проводимые на стационарном уровне:</p>\r\n<ul>\r\n<li>холтеровское (суточное) мониторирование электрокардиограммы;</li>\r\n<li>суточное мониторирование АД;</li>\r\n<li>тест на толерантность к глюкозе;</li>\r\n<li>ЭЭГ-видеомониторинг.</li>\r\n</ul>\r\n<p>Дополнительные диагностические обследования, проводимые на стационарном уровне:</p>\r\n<ul>\r\n<li>Коагулология;</li>\r\n<li>определение гормонов щитовидной железы ИФА-методом;</li>\r\n<li>МРТ головного мозга;</li>\r\n<li>УЗДГ сосудов головы;</li>\r\n<li>Ультразвуковая диагностика комплексная;</li>\r\n<li>Рентгенография обзорная органов грудной клетки;</li>\r\n<li>Люмбальная пункция;</li>\r\n<li>Исследование спиномозговой жидкости.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>",
"treatment": "<p><strong>Немедикаментозное лечение </strong></p>\r\n<p>Включает соблюдение режима труда и отдыха, освобождение от дополнительных нагрузок.</p>\r\n<p>При вторичных нарушениях вегетативной нервной системы необходима диетотерапия, согласно протокола основного заболевания (сахарный диабет, онкологические заболевания, заболевания ЖКТ и т.д.)</p>\r\n<p>Для детей старше пяти лет можно применять иглорефлексотерапию</p>\r\n<p>Показана ранняя реабилитация (массаж, водные процедуры, игротерапия, музыкотерапия, индивидуальная или групповая психотерапия, ЛФК).</p>\r\n<p><strong> Медикаментозное лечение </strong></p>\r\n<p>Назначается только в случае неэффективности немедикаментозных мероприятий или в сочетании с ними.</p>\r\n<p>В случае преобладания активности симпатического отдела нервной системы назначают седативные средства. По показаниям - бензодиазепиновые производные альфа- и бета-адреноблокаторы.</p>\r\n<p>При преобладании тонуса парасимпатической системы используют средства, повышающие АД, холинолитики центрального и периферического воздействие.</p>\r\n<p>В связи с частым сочетанием вегетативных и эмоциональных нарушений применяют антидепрессанты, противотревожные (анксиолитики) и снотворные препараты. Лечение следует проводить с участием психотерапевта или психиатра.</p>",
"prevention": "<p>Профилактику следует начинать с немедикаментозных мероприятий – нормализации режима дня, питания, прогулки на свежем воздухе, водные процедуры. Профилактика нарушений вегетативной нервной системы возможна лишь при ранней их диагностике, определяемых задолго до появления жалоб. В основе профилактики лежит здоровый образ жизни. Оптимизация физической активности и сбалансированное рациональное питание с низкой калорийностью и антисклеротической направленностью – главные составляющие профилактики заболеваний нервной и сердечно-сосудистой систем.</p>",
"clinical_picture": "<p>В клинике расстройств вегетативной нервной системы выделяют гипотензивный и гипертензивный варианты, ведущим проявлением которых являются изменения артериального давления (АД), а также кардиологический вариант с преобладанием болей в области сердца.</p>\r\n<p>Гипотензивный тип устанавливают в случаях, когда величина систолического АД колеблется в пределах 110-80 мм рт. ст., а диастолического 45-60 мм рт. ст. и имеются клинические признаки хронической сосудистой недостаточности.</p>\r\n<p>Жалобы больных, наиболее значимых для диагноза, - зябкость кистей, стоп и склонность к ортостатическим расстройствам (головокружение при перемене положения тела, резком повороте головы, туловища), непереносимость транспорта. Наблюдаются проявления астеновегетативного синдрома: быстрая истощаемость умственной и физической активности, снижение памяти, концентрации внимания, слабость, повышенная утомляемость. Свойственны лабильность настроения, высокая тревожность, склонность к ипохондрии.</p>\r\n<p>При осмотре определяют астеническое телосложение, бледность кожных покровов, мраморность, пастозность тканей, снижение температуры кожи конечностей, влажность ладоней и стоп, учащенное сердцебиение. Нередко выявляется снижение аппетита, тошнота, не связанная с приемом пищи, периодические боли в животе, запоры, головные боли.</p>\r\n<p>Гипертензивный тип характеризуется транзиторным повышением АД и связанные с ним головные боли, боли в области сердца, головокружения, сердцебиения, мелькание мушек перед глазами, чувство жара, приливов к голове и шее. Головная боль возникает преимущественно при психоэмоциональных и физических перегрузках, носит ноющий, иногда пульсирующий характер с преимущественной локализацией в затылке. Отмечается эмоциональная лабильность, повышенная утомляемость, раздражительность, нарушения сна, ипохондрию, метеозависимость.</p>\r\n<p>Кардиалгический тип устанавливают, если нет изменений АД, но есть жалобы на сердцебиение или перебои в сердце, боли в области сердца, одышку. Объективно выявляется тахикардия, выраженная синусовая аритмия или экстрасистолия.</p>\r\n<p>В крайней степени выраженности заболевание может проявляться вегетативными кризами, нейрорефлекторными синкопальными состояниями, перманентными вегетативными нарушениями. Вегетативные кризы могут быть симпатическими, парасимпатическими и смешанными. </p>\r\n<p>При преобладании тонуса симпатической нервной системы (симпатикотония) возникают типичные вегетативные кризы (панические атаки). При осмотре выявляются тахикардия, побледнение кожных покровов, повышение АД, ослабление перистальтики кишечника, расширение зрачков, озноб, ощущение нехватки воздуха, одышка. Важно присутствие тревоги, беспокойства, ощущение страха, который может носить витальную окраску (больной опасается за свою жизнь, хотя видимой угрозы не существует). Возможен страх сойти с ума, совершить неконтролируемое действие, нанести увечья себе или близким.</p>\r\n<p>Гипервентиляционный криз также включает в себя сочетание вегетативных и аффективных нарушений. У больного наблюдаются усиленное, учащенное дыхание, ощущение нехватки воздуха с преимущественным затруднением вдоха. Возможно появление чувства кома в горле, «мурашек» на коже, похолодания рук и ног, неустойчивости походки. Появляется страх потерять сознание, умереть. Вследствие преходящей гипокалиемии возможно развитие гипервентиляционной тетании с напряжением мышц предплечий и кисти («рука акушера»), голеней и стоп (карпопедальные спазмы). Кисти и стопы становятся влажными, холодными на ощупь. Приступ может закончиться обмороком.</p>\r\n<p>Ваготонические кризы сопровождаются брадикардией, затруднением дыхания, покраснением кожи лица, потливостью, саливацией, понижением АД, желудочно-кишечными дискинезиями. Возможно снижение уровня глюкозы в крови. Приступ также может заканчиваться кратковременной утратой сознания. У отдельных больных возможны аллергические явления в виде крапивницы или отека Квинке. Такие кризы могут провоцироваться пребыванием в душном помещении, несвоевременным приемом пищи («голодный обморок»), интенсивными нагрузками, волнением.</p>\r\n<p>Смешанные кризы проявляются сочетанием симптомов, типичных для преобладания тонуса симпатической или парасимпатической нервной системы, либо поочередным их появлением.</p>",
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"code": "G90.2",
"name": "Синдром Горнера",
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"lead": "симптомокомплекс, обусловленный поражением симпатической нервной системы, проявляющийся офтальмологическими нарушениями, расстройствами потовыделения и тонуса сосудов на стороне поражения",
"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;\">Различают врождённую или приобретённую форму заболевания. Врожденный вариант возникает вследствие родовой травмы. Описаны случаи наследования окулосимпатического синдрома по аутосомно-доминантному типу, при этом признаки вовлечения в патологический процесс вегетативной нервной системы могут отсутствовать. Основные причины развития приобретенного варианта:</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;\">Ятрогенное вмешательство. Синдром Горнера – частое осложнение неправильной постановки дренажа по Бюлау. Симптомы также появляются после пересечения нервных волокон, блокады шейного сплетения или звездчатого ганглия в области грудной клетки или шеи.</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;\">Травматические повреждения. Заболевание нередко обусловлено тупой травмой основания шеи с поражением грудной или шейной симпатической нервной цепи. Клинические проявления наблюдаются на стороне, противоположной от зоны повреждения.</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;\">Отогенные патологии. Болезнь может возникать в результате распространения инфекции из полости среднего уха при отите. Этому способствует перфорация барабанной перепонки и лабиринтит в анамнезе.</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;\">Злокачественные новообразования. Сдавливание опухолью нервных волокон приводит к появлению клинической симптоматики синдрома Горнера. Наиболее частыми причинами являются опухоль Панкоста или бронхогенная карцинома верхушки лёгкого.</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;\">Неврологические болезни. Развитие патологии может быть связано с латеральным медуллярным синдромом, параличом Дежерин-Клюмпке или рассеянным склерозом. Реже этиологическим фактором становится сирингомиелия.</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;\">Сосудистые патологии. Распространённая причина синдрома Горнера – аневризма аорты. Локальные изменения на уровне артерий, кровоснабжающих зону поражения, также могут выступать в роле триггера.</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;\">Болезни щитовидной железы. Окулосимпатический синдром может возникать на фоне щитовидно-шейной венозной дилатации или зоба. Часто прослеживается взаимосвязь между проявлениями болезни и гиперплазией щитовидной железы.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"pathogenesis": "<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;\">В основе развития заболевания лежит центральное, пре- или постганглионарное поражение симпатических нервных волокон. Из-за нарушения иннервации верхней тарзальной мышцы или мышцы Мюллера возникает классическое опущение верхних век или перевёрнутый птоз. Выраженность цилиоспинального рефлекса снижается. Патологическая пигментация меланоцитов, формирующих основу радужки, приводит к гетерохромии. Конъюнктива выглядит гиперемированной, что обусловлено расширением сосудов при параличе гладких мышц или патологии симпатической вазоконстрикторной реакции. Паралич или парез орбитальной мышцы глаза ведет к энофтальму. Симптоматика болезни развивается с противоположной стороны от зоны поражения.</span></p>",
"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;\">Постановка диагноза базируется на результатах физикального осмотра и специальных методов исследования. При осмотре выявляется миоз, гетерохромия и западение глазного яблока на пораженной стороне. Реакция зрачков на свет вялая или не определяется. Основные методы диагностики:</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;\">Тест с оксамфетамином. Используется для установления причины миоза. Если третий нейрон не задействован, применение амфетамина ведёт к появлению стойкого мидриаза. В заключении указывают, на каком промежутке поврежден нервный путь.</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;\">Биомикроскопия глаза. Отмечается инъекция сосудов конъюнктивы. Прозрачность оптических сред глаза не снижена, структура радужки неоднородна. Может наблюдаться неравномерное распределение пигмента.</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;\">Тест на определение задержки расширения зрачка. При болезни Горнера птоз сочетается с суженным зрачковым отверстием. При поражении глазодвигательного нерва в результате исследования выявляется сочетание опущения века с мидриазом.</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;\">КТ орбит. Исследование осуществляется для определения этиологии болезни. Компьютерная томография дает возможность визуализировать объемные образования глазницы и травматические повреждения органа зрения.</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>",
"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;\">Лечение синдром Горнера происходит:</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;\">Посредством нейростимуляции – к пораженным мышцам или же участкам прикрепляются электроды, и короткими электрическими импульсами происходит стимуляция пораженных областей. Это приводит к лучшему их кровообращению и дальнейшему частичному или полному восстановлению.</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;\">Средствами пластической хирургии – проводится хирургическое вмешательство в пораженные области с целью пластической коррекции дискомфортных зон.</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;\">Медикаментозно – происходит деликатный подбор специализированных препаратов, предназначенных для стимуляции пораженных тканей лица. Данные медикаменты являются очень специфическими, и их подбор проводится исключительно специалистами. Поэтому самолечение не приведет к излечению от данной болезни. Нужно обращаться исключительно к компетентному лицу.</span></li>\r\n<li><span id=\"docs-internal-guid-4a186071-7fff-f07f-8924-7d0a111f4d18\"><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;\">Кинезотерапия — вид лечебных физических нагрузок. Данная методика использует различные массажи, позволяющие стимулировать пораженные участки посредством непосредственного физического контакта. Благодаря этому области получают должное кровообращение.</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>",
"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;\">Специфические превентивные меры не разработаны. Неспецифическая профилактика сводится к своевременной диагностике и лечению заболеваний ЛОР-органов и щитовидной железы, коррекции гормонального фона. Если клиническая картина болезни связана с объемными образованиями глазницы, пациенты должны состоять на диспансерном учете у офтальмолога. </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;\">Выделяют клиническую триаду характерную для синдрома Горнера: птоз – опущение верхнего века, миоз – сужение зрачка и энофтальм – западение глазного яблока. Все симптомы возникают только на стороне поражения. Помимо характерной триады у пациентов с синдромом Горнера возникают следующие симптомы:</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;\">Иногда можно заметить, что нижнее веко несколько приподнятое.</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;\">Гетерохромия – цвет радужной оболочки на обоих глазах разный. Также бывают случаи неравномерного окрашивания райдужки пораженного глаза.</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;\">Синдром сухого глаза на пораженной стороне.</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;\">Пациент может отмечать уменьшение потоотделения на стороне патологического процесса.</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;\">Гиперемия лица с пораженной стороны.</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;\">Инъекция сосудов склеры на пораженном глазе.</span></li>\r\n</ul>\r\n<p> </p>",
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{
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{
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{
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}
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"code": "G90",
"name": "Расстройства вегетативной [автономной] нервной системы",
"icd_name": "Расстройства вегетативной [автономной] нервной системы",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "g90_rasstroystva_vegetativnoy_avtonomnoy_nervnoy_sistemy",
"lead": "Нарушение здоровья, относящееся к группе другие нарушения нервной системы",
"description": "Синдром, характеризующийся нарушениями вегетативной регуляции внутренних органов - сердечно-сосудистой системы, желудочно-кишечного тракта, органов дыхания, желез внутренней секреции.",
"etiology": "<p>Нарушение деятельности внутренних систем человека происходит из-за сбоев в процессе нервной регуляции. Причинами могут быть:</p>\r\n<p> </p>\r\n<ul>\r\n<li>Нарушения в эндокринной систем (ожирение, сахарный диабет);</li>\r\n<li>гормональные сбои или возрастные гормональные изменения в организме (беременность, менструальный цикл, климакс, пубертатный период);</li>\r\n<li>Наследственная предрасположенность;</li>\r\n<li>травмы, ранения, хирургические операции</li>\r\n<li>хронический стресс, мнительность;</li>\r\n<li>Курение, употребления алкоголя и наркотических препаратов;</li>\r\n<li>Несоблюдение правил правильного питания;</li>\r\n<li>Хронические инфекции по типу кариозных образований и тонзиллита;</li>\r\n<li>Аллергическая реакция;</li>\r\n<li>Интоксикация;</li>\r\n<li>Влияние производственных факторов (вибрация, облучение)</li>\r\n<li>Инфекционное поражение периферической вегетативной нервной системы (СПИД, герпес, сифилис, лепра)</li>\r\n</ul>\r\n<p>У детей 1 года жизни заболевания вегетативной нервной системы возникают из-за гипоксии плода (нехватки кислорода при внутриутробном развитии), а также из-за перенесенных стрессов. У детей психика не настолько устойчива, как у взрослых, поэтому для них любая проблема может вызвать психическую травму.</p>",
"pathogenesis": "<p>Основную роль в патогенезе вегетативной дистонии играет нарушение вегетативной регуляции и развитие вегетативного дисбаланса. Отношения между симпатической и парасимпатической вегетативными нервными системами соответствуют принципу «качающегося равновесия»: повышение тонуса одной системы влечет за собой возрастание тонуса другой. Такая форма вегетативного обеспечения позволяет поддерживать постоянство внутренней среды и создавать условия для повышенной лабильности физиологических функций. Клинико-экспериментальные исследования обнаружили эту лабильность практически во всех системах – вариации ритма сердца, артериального давления, температуры тела и других показателей. Выход этих колебаний за пределы нормального диапазона повышает уязвимость системы вегетативной регуляции для повреждающих факторов. В таких условиях экзогенные либо эндогенные стимулы могут приводить к предельному напряжению регуляторных систем, а затем к их «поломке» с клинической манифестацией в виде расстройства вегетативной нервной системы.</p>",
"diagnostics": "<p class=\"txt\">Диагностика вегетативной дистонии преимущественно клиническая. Лабораторные и инструментальные методы требуются для исключения соматических заболеваний, имеющих сходную клиническую картину.</p>\r\n<p class=\"txt\">Дифференциальную диагностику проводят с заболеваниями эндокринных органов (гипо- и гипертиреоз, сахарный диабет, феохромоцитома), сердечно-сосудистой системы (пароксизмы нарушений сердечного ритма и проводимости, сопровождающиеся обмороками), неврологическими заболеваниями (эпилепсия).</p>\r\n<p>Основные (обязательные) диагностические обследования, проводимые на амбулаторном уровне:</p>\r\n<ul>\r\n<li>измерение АД, ЧСС, ЧД в покое, при физической, умственной и эмоциональной нагрузках;</li>\r\n<li>ортостатическая проба – используется для анализа работы сердечно-сосудистой системы при вставании и помогает определить как функционирует симпатический отдел вегетативной нервной системы;</li>\r\n<li>общий анализ крови;</li>\r\n<li>определение натрия, кальция, калия в сыворотке крови;</li>\r\n<li>определение глюкозы в сыворотке крови;</li>\r\n<li>общий анализ мочи;</li>\r\n<li>электрокардиографическое исследование (в 12 отведениях);</li>\r\n</ul>\r\n<p>Основные (обязательные) диагностические обследования, проводимые на стационарном уровне:</p>\r\n<ul>\r\n<li>холтеровское (суточное) мониторирование электрокардиограммы;</li>\r\n<li>суточное мониторирование АД;</li>\r\n<li>тест на толерантность к глюкозе;</li>\r\n<li>ЭЭГ-видеомониторинг.</li>\r\n</ul>\r\n<p>Дополнительные диагностические обследования, проводимые на стационарном уровне:</p>\r\n<ul>\r\n<li>Коагулология;</li>\r\n<li>определение гормонов щитовидной железы ИФА-методом;</li>\r\n<li>МРТ головного мозга;</li>\r\n<li>УЗДГ сосудов головы;</li>\r\n<li>Ультразвуковая диагностика комплексная;</li>\r\n<li>Рентгенография обзорная органов грудной клетки;</li>\r\n<li>Люмбальная пункция;</li>\r\n<li>Исследование спиномозговой жидкости.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>",
"treatment": "<p><strong>Немедикаментозное лечение </strong></p>\r\n<p>Включает соблюдение режима труда и отдыха, освобождение от дополнительных нагрузок.</p>\r\n<p>При вторичных нарушениях вегетативной нервной системы необходима диетотерапия, согласно протокола основного заболевания (сахарный диабет, онкологические заболевания, заболевания ЖКТ и т.д.)</p>\r\n<p>Для детей старше пяти лет можно применять иглорефлексотерапию</p>\r\n<p>Показана ранняя реабилитация (массаж, водные процедуры, игротерапия, музыкотерапия, индивидуальная или групповая психотерапия, ЛФК).</p>\r\n<p><strong> Медикаментозное лечение </strong></p>\r\n<p>Назначается только в случае неэффективности немедикаментозных мероприятий или в сочетании с ними.</p>\r\n<p>В случае преобладания активности симпатического отдела нервной системы назначают седативные средства. По показаниям - бензодиазепиновые производные альфа- и бета-адреноблокаторы.</p>\r\n<p>При преобладании тонуса парасимпатической системы используют средства, повышающие АД, холинолитики центрального и периферического воздействие.</p>\r\n<p>В связи с частым сочетанием вегетативных и эмоциональных нарушений применяют антидепрессанты, противотревожные (анксиолитики) и снотворные препараты. Лечение следует проводить с участием психотерапевта или психиатра.</p>",
"prevention": "<p>Профилактику следует начинать с немедикаментозных мероприятий – нормализации режима дня, питания, прогулки на свежем воздухе, водные процедуры. Профилактика нарушений вегетативной нервной системы возможна лишь при ранней их диагностике, определяемых задолго до появления жалоб. В основе профилактики лежит здоровый образ жизни. Оптимизация физической активности и сбалансированное рациональное питание с низкой калорийностью и антисклеротической направленностью – главные составляющие профилактики заболеваний нервной и сердечно-сосудистой систем.</p>",
"clinical_picture": "<p>В клинике расстройств вегетативной нервной системы выделяют гипотензивный и гипертензивный варианты, ведущим проявлением которых являются изменения артериального давления (АД), а также кардиологический вариант с преобладанием болей в области сердца.</p>\r\n<p>Гипотензивный тип устанавливают в случаях, когда величина систолического АД колеблется в пределах 110-80 мм рт. ст., а диастолического 45-60 мм рт. ст. и имеются клинические признаки хронической сосудистой недостаточности.</p>\r\n<p>Жалобы больных, наиболее значимых для диагноза, - зябкость кистей, стоп и склонность к ортостатическим расстройствам (головокружение при перемене положения тела, резком повороте головы, туловища), непереносимость транспорта. Наблюдаются проявления астеновегетативного синдрома: быстрая истощаемость умственной и физической активности, снижение памяти, концентрации внимания, слабость, повышенная утомляемость. Свойственны лабильность настроения, высокая тревожность, склонность к ипохондрии.</p>\r\n<p>При осмотре определяют астеническое телосложение, бледность кожных покровов, мраморность, пастозность тканей, снижение температуры кожи конечностей, влажность ладоней и стоп, учащенное сердцебиение. Нередко выявляется снижение аппетита, тошнота, не связанная с приемом пищи, периодические боли в животе, запоры, головные боли.</p>\r\n<p>Гипертензивный тип характеризуется транзиторным повышением АД и связанные с ним головные боли, боли в области сердца, головокружения, сердцебиения, мелькание мушек перед глазами, чувство жара, приливов к голове и шее. Головная боль возникает преимущественно при психоэмоциональных и физических перегрузках, носит ноющий, иногда пульсирующий характер с преимущественной локализацией в затылке. Отмечается эмоциональная лабильность, повышенная утомляемость, раздражительность, нарушения сна, ипохондрию, метеозависимость.</p>\r\n<p>Кардиалгический тип устанавливают, если нет изменений АД, но есть жалобы на сердцебиение или перебои в сердце, боли в области сердца, одышку. Объективно выявляется тахикардия, выраженная синусовая аритмия или экстрасистолия.</p>\r\n<p>В крайней степени выраженности заболевание может проявляться вегетативными кризами, нейрорефлекторными синкопальными состояниями, перманентными вегетативными нарушениями. Вегетативные кризы могут быть симпатическими, парасимпатическими и смешанными. </p>\r\n<p>При преобладании тонуса симпатической нервной системы (симпатикотония) возникают типичные вегетативные кризы (панические атаки). При осмотре выявляются тахикардия, побледнение кожных покровов, повышение АД, ослабление перистальтики кишечника, расширение зрачков, озноб, ощущение нехватки воздуха, одышка. Важно присутствие тревоги, беспокойства, ощущение страха, который может носить витальную окраску (больной опасается за свою жизнь, хотя видимой угрозы не существует). Возможен страх сойти с ума, совершить неконтролируемое действие, нанести увечья себе или близким.</p>\r\n<p>Гипервентиляционный криз также включает в себя сочетание вегетативных и аффективных нарушений. У больного наблюдаются усиленное, учащенное дыхание, ощущение нехватки воздуха с преимущественным затруднением вдоха. Возможно появление чувства кома в горле, «мурашек» на коже, похолодания рук и ног, неустойчивости походки. Появляется страх потерять сознание, умереть. Вследствие преходящей гипокалиемии возможно развитие гипервентиляционной тетании с напряжением мышц предплечий и кисти («рука акушера»), голеней и стоп (карпопедальные спазмы). Кисти и стопы становятся влажными, холодными на ощупь. Приступ может закончиться обмороком.</p>\r\n<p>Ваготонические кризы сопровождаются брадикардией, затруднением дыхания, покраснением кожи лица, потливостью, саливацией, понижением АД, желудочно-кишечными дискинезиями. Возможно снижение уровня глюкозы в крови. Приступ также может заканчиваться кратковременной утратой сознания. У отдельных больных возможны аллергические явления в виде крапивницы или отека Квинке. Такие кризы могут провоцироваться пребыванием в душном помещении, несвоевременным приемом пищи («голодный обморок»), интенсивными нагрузками, волнением.</p>\r\n<p>Смешанные кризы проявляются сочетанием симптомов, типичных для преобладания тонуса симпатической или парасимпатической нервной системы, либо поочередным их появлением.</p>",
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"code": "G90.2",
"name": "Синдром Горнера",
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"lead": "симптомокомплекс, обусловленный поражением симпатической нервной системы, проявляющийся офтальмологическими нарушениями, расстройствами потовыделения и тонуса сосудов на стороне поражения",
"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;\">Различают врождённую или приобретённую форму заболевания. Врожденный вариант возникает вследствие родовой травмы. Описаны случаи наследования окулосимпатического синдрома по аутосомно-доминантному типу, при этом признаки вовлечения в патологический процесс вегетативной нервной системы могут отсутствовать. Основные причины развития приобретенного варианта:</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;\">Ятрогенное вмешательство. Синдром Горнера – частое осложнение неправильной постановки дренажа по Бюлау. Симптомы также появляются после пересечения нервных волокон, блокады шейного сплетения или звездчатого ганглия в области грудной клетки или шеи.</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;\">Травматические повреждения. Заболевание нередко обусловлено тупой травмой основания шеи с поражением грудной или шейной симпатической нервной цепи. Клинические проявления наблюдаются на стороне, противоположной от зоны повреждения.</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;\">Отогенные патологии. Болезнь может возникать в результате распространения инфекции из полости среднего уха при отите. Этому способствует перфорация барабанной перепонки и лабиринтит в анамнезе.</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;\">Злокачественные новообразования. Сдавливание опухолью нервных волокон приводит к появлению клинической симптоматики синдрома Горнера. Наиболее частыми причинами являются опухоль Панкоста или бронхогенная карцинома верхушки лёгкого.</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;\">Неврологические болезни. Развитие патологии может быть связано с латеральным медуллярным синдромом, параличом Дежерин-Клюмпке или рассеянным склерозом. Реже этиологическим фактором становится сирингомиелия.</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;\">Сосудистые патологии. Распространённая причина синдрома Горнера – аневризма аорты. Локальные изменения на уровне артерий, кровоснабжающих зону поражения, также могут выступать в роле триггера.</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;\">Болезни щитовидной железы. Окулосимпатический синдром может возникать на фоне щитовидно-шейной венозной дилатации или зоба. Часто прослеживается взаимосвязь между проявлениями болезни и гиперплазией щитовидной железы.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"pathogenesis": "<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;\">В основе развития заболевания лежит центральное, пре- или постганглионарное поражение симпатических нервных волокон. Из-за нарушения иннервации верхней тарзальной мышцы или мышцы Мюллера возникает классическое опущение верхних век или перевёрнутый птоз. Выраженность цилиоспинального рефлекса снижается. Патологическая пигментация меланоцитов, формирующих основу радужки, приводит к гетерохромии. Конъюнктива выглядит гиперемированной, что обусловлено расширением сосудов при параличе гладких мышц или патологии симпатической вазоконстрикторной реакции. Паралич или парез орбитальной мышцы глаза ведет к энофтальму. Симптоматика болезни развивается с противоположной стороны от зоны поражения.</span></p>",
"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;\">Постановка диагноза базируется на результатах физикального осмотра и специальных методов исследования. При осмотре выявляется миоз, гетерохромия и западение глазного яблока на пораженной стороне. Реакция зрачков на свет вялая или не определяется. Основные методы диагностики:</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;\">Тест с оксамфетамином. Используется для установления причины миоза. Если третий нейрон не задействован, применение амфетамина ведёт к появлению стойкого мидриаза. В заключении указывают, на каком промежутке поврежден нервный путь.</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;\">Биомикроскопия глаза. Отмечается инъекция сосудов конъюнктивы. Прозрачность оптических сред глаза не снижена, структура радужки неоднородна. Может наблюдаться неравномерное распределение пигмента.</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;\">Тест на определение задержки расширения зрачка. При болезни Горнера птоз сочетается с суженным зрачковым отверстием. При поражении глазодвигательного нерва в результате исследования выявляется сочетание опущения века с мидриазом.</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;\">КТ орбит. Исследование осуществляется для определения этиологии болезни. Компьютерная томография дает возможность визуализировать объемные образования глазницы и травматические повреждения органа зрения.</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>",
"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;\">Лечение синдром Горнера происходит:</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;\">Посредством нейростимуляции – к пораженным мышцам или же участкам прикрепляются электроды, и короткими электрическими импульсами происходит стимуляция пораженных областей. Это приводит к лучшему их кровообращению и дальнейшему частичному или полному восстановлению.</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;\">Средствами пластической хирургии – проводится хирургическое вмешательство в пораженные области с целью пластической коррекции дискомфортных зон.</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;\">Медикаментозно – происходит деликатный подбор специализированных препаратов, предназначенных для стимуляции пораженных тканей лица. Данные медикаменты являются очень специфическими, и их подбор проводится исключительно специалистами. Поэтому самолечение не приведет к излечению от данной болезни. Нужно обращаться исключительно к компетентному лицу.</span></li>\r\n<li><span id=\"docs-internal-guid-4a186071-7fff-f07f-8924-7d0a111f4d18\"><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;\">Кинезотерапия — вид лечебных физических нагрузок. Данная методика использует различные массажи, позволяющие стимулировать пораженные участки посредством непосредственного физического контакта. Благодаря этому области получают должное кровообращение.</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>",
"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;\">Специфические превентивные меры не разработаны. Неспецифическая профилактика сводится к своевременной диагностике и лечению заболеваний ЛОР-органов и щитовидной железы, коррекции гормонального фона. Если клиническая картина болезни связана с объемными образованиями глазницы, пациенты должны состоять на диспансерном учете у офтальмолога. </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;\">Выделяют клиническую триаду характерную для синдрома Горнера: птоз – опущение верхнего века, миоз – сужение зрачка и энофтальм – западение глазного яблока. Все симптомы возникают только на стороне поражения. Помимо характерной триады у пациентов с синдромом Горнера возникают следующие симптомы:</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;\">Иногда можно заметить, что нижнее веко несколько приподнятое.</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;\">Гетерохромия – цвет радужной оболочки на обоих глазах разный. Также бывают случаи неравномерного окрашивания райдужки пораженного глаза.</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;\">Синдром сухого глаза на пораженной стороне.</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;\">Пациент может отмечать уменьшение потоотделения на стороне патологического процесса.</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;\">Гиперемия лица с пораженной стороны.</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;\">Инъекция сосудов склеры на пораженном глазе.</span></li>\r\n</ul>\r\n<p> </p>",
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"code": "J35",
"name": "Хронические болезни миндалин и аденоидов",
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"lead": "Нарушение здоровья, относящееся к группе другие болезни верхних дыхательных путей",
"description": "Хронические болезни миндалин и аденоидов бывают воспалительного и невоспалительного характера. При этом к воспалительным относят хронические тонзиллиты (поражение небных миндалин) и аденоидит (поражение глоточной миндалины), к невоспалительным – патологическая гипертрофия небных и трубной (аденоиды) миндалин.",
"etiology": "<p>Хронический тонзиллит может быть вызван различными инфекциями. Среди патогенов при хроническом тонзиллите наиболее часто обнаруживают стафилококки, стрептококки, пневмококки, гемофильную палочку, моракселлу, аденовирусы, вирус Эпштейна — Барр, вирусы Коксаки, вирус герпеса, различные анаэробы, микоплазмы, хламидии, грибы.</p>\r\n<p>Основным этиологическим фактором в развитии хронического тонзиллита является бета-гемолитический стрептококк группы А. У большинства больных хроническим тонзиллитом бета-гемолитические стрептококки встречаются в ассоциации с золотистым стафилококком.</p>\r\n<p>Существует наследственная предрасположенность к разрастанию небной и носоглоточной миндалин, обусловленная отклонением в строении эндокринной и лимфатической системы (лимфатико-гипопластический диатез). Располагающими к гипертрофии лимфоидной ткани факторами могут быть возрастная несовершенность иммунологических процессов, воспалительные заболевания глотки, различные детские инфекционные заболевания и повышенная аллергизация детского организма в связи с частыми острыми респираторно-вирусными заболеваниями, эндокринные нарушения, гиповитаминозы, аномалии конституции, грибковая инвазия, неблагоприятные социальные и бытовые условия, радиационное и другие виды воздействия, снижающие реактивность организма.</p>",
"pathogenesis": "<p>Общепринятой теории патогенеза хронического тонзиллита и хронического аденоидита не существует. Основное значение имеет наличие патогенной микрофлоры в лакунах небных миндалин (Streptococcus pyogenes группы А, Haemophilus influenzae, Streptococcus pneumonia и аденовирусов). Особенности строения небных миндалин, имеющих глубокие извитые лакуны, проникающие в толщу паренхимы, создают условия для длительного контакта ткани миндалин с чужеродными белками и токсинами патогенных микроорганизмов. После перенесенных ангин возникают спайки и сращения, которые перекрывают просвет лакун и препятствуют удалению их содержимого — остатков пищи, слущенного эпителия и микроорганизмов. На фоне изменений иммунной реактивности организма это приводит к стойкой воспалительной реакции в небных миндалинах, хронической интоксикации и сенсибилизации (аллергия к антигенам S. pyogenes группы А выявляется у 83% больных хроническим тонзиллитом), вызывающей развитие системных инфекционно-аллергических заболеваний с поражением сердца, сосудов, суставов, почек и др.</p>\r\n<p>В основе механизма развития аденоидов лежит повторное усиление функциональной активности глоточной миндалины под влиянием часто повторяющихся местных воспалительных изменений при различных инфекционных заболеваниях, особенно протекающих на фоне аллергии и при несовершенстве иммунологических процессов у детей младшего возраста.</p>",
"diagnostics": "<p>Диагностика тонзиллита проводится с помощью следующих методов:</p>\r\n<ul>\r\n<li>осмотр ЛОР-врача, сбор анамнеза заболевания;</li>\r\n<li>мазок из глотки на флору с определением чувствительности к антибиотикам и бактериофагам;</li>\r\n<li>общий анализ крови, общий анализ мочи;</li>\r\n<li>анализ крови на антистрептолизин -О, ревматоидный фактор, С-реактивный белок;</li>\r\n<li>ЭКГ;</li>\r\n<li>По показаниям, УЗИ почек, Эхо-КГ, консультация кардиолога, уролога.</li>\r\n</ul>\r\n<p>Диагностика аденоидов:</p>\r\n<p>Ребенка с гипертрофированной глоточной миндалиной узнают по характерному внешнему виду. Размеры и консистенцию аденоидов определяют при задней риноскопии, фиброэндоскопии и с помощью пальцевого исследования носоглотки. Степень аденоидных разрастаний уточняют при боковой рентгенографии полости носа и носоглотки.</p>\r\n<p>Непосредственный детальный осмотр носоглотки проводят методом задней риноскопии, при которой аденоидные вегетации визуализируются как образования неправильной формы с широким основанием, расположенные на своде носоглотки Видно слизистое отделяемое, заполняющее носоглотку и носовые ходы, набухание или гипертрофия носовых раковин. После анемизации слизистой оболочки полости носа, во время фонации при передней риноскопии можно увидеть, как аденоидные разрастания перемещаются по задней стенке глотки. Характерно ограничение подвижности мягкого неба.</p>\r\n<p>Эндоскопический метод — «золотой стандарт» в диагностике аденоидов, проводится как через нос —так и через полость рта.</p>\r\n<p>Диагностика гипертрофии небных миндалин</p>\r\n<p>Диагноз «гипертрофия небных миндалин» ставится на основании жалоб пациента и фарингоскопии или УЗИ области глотки. При фарингоскопии видно, что миндалины увеличены, бледно-розового цвета, мягкие, но воспаления нет. Также делают общий анализ крови.</p>",
"treatment": "<p><strong>Лечение хронического тонзиллита включает:</strong></p>\r\n<p>Консервативную терапию с сохранением самой лимфоидной ткани миндалин как иммунного органа. Терапия включает промывание миндалин и орошение горла растворами антисептиков, ингаляции, системную антибактериальную терапию и иммуностимуляцию. При выборе антибактериального препарата первостепенное значение имеет чувствительность к нему типичных возбудителей. Растущая резистентность различных микроорганизмов ко многим основным антибиотикам является главной проблемой при лечении бактериальных инфекций.</p>\r\n<p>Курсы консервативного лечения обычно проводят 2 раза в год, лучше весной и осенью. При частых рецидивах ангин число курсов консервативного лечения может быть доведено до четырех в год.</p>\r\n<p>Хирургическое лечение: радикальный метод лечения хронического тонзиллита. Характеризуется полным или частичным удаление миндалин, назначается в случае неэффективности консервативного лечения либо при наличии серьезных осложнений со стороны внутренних органов либо при переходе тонзиллита в декомпенсированную форму, когда миндалины перестают выполнять свои функции и превращаются исключительно в хронический очаг инфекции.</p>\r\n<p><strong>Лечение аденоидов</strong></p>\r\n<p>Консервативный способ лечения аденоидов у детей:</p>\r\n<p>Консервативное лечение назначается ребёнку с аденоидитами (с хроническим воспалением аденоидов). Детям с предрасположенностью к разрастанию аденоидов прописывается:</p>\r\n<ul>\r\n<li>промывания носа и носоглотки;</li>\r\n<li>особая диета;</li>\r\n<li>особый климат;</li>\r\n<li>лечение различными фитосборами;</li>\r\n<li>ароматерапия;</li>\r\n<li>массаж различных зон, связанных с данной особенностью;</li>\r\n<li>занятия дыхательной гимнастикой</li>\r\n<li>местные глюкокортикоиды в нос</li>\r\n</ul>\r\n<p>Если данные способ лечения неэффективен, то врач назначает хирургическое лечение</p>\r\n<p>Хирургическое лечение:</p>\r\n<p>Причиной для удаления аденоидов является увеличение более второй степени (если они закрывают просвет носоглотки больше чем на две трети) и связанное с этим нарушение носового дыхания, а также искривление перегородки носа, воспалительный или аллергический отёк слизистой оболочки носовых раковин (наиболее частые), полипоз, новообразования полости носа (более редкие).</p>\r\n<p>Кроме того, аденоиды удаляют при закрытии ими выводного соустья евстахиевых труб и связанного с этим нарушения дренажной функции евстахиевой трубы. При этом из среднего уха не выходит слизь, которая там в норме образуется, и скопление этой слизи нарушает проведение звуков, в результате чего нарушается слух.</p>\r\n<p> <strong>Лечение гипертрофии небных миндалин</strong></p>\r\n<p>При начальных формах гипертрофии достаточно полосканий горла, прижиганий, санаторно-курортного лечения, климатотерапии. Особенно хорошо действует на миндалины морской и горный воздух. Часто назначают кислородные коктейли и физиотерапию: УВЧ на подчелюстные узлы, электрофорез грязевых растворов на подчелюстную область.</p>\r\n<p>При II и III стадиях заболевания, если у ребенка есть трудности с дыханием и глотанием пищи, проводят тонзилэктомию (частичное удаление миндалин). Операцию проводят амбулаторно, под местным обезболиванием.</p>",
"prevention": "<p>Профилактика обострений хронического тонзиллита:</p>\r\n<ul>\r\n<li>Общегигиенические мероприятия;</li>\r\n<li>Закаливание;</li>\r\n<li>Рациональное питание;</li>\r\n<li>Соблюдение правил гигиены жилища и рабочих помещений;</li>\r\n<li>Устранение запылённости, загазованности воздуха;</li>\r\n<li>Санационные мероприятия: выявление и лечение заболеваний дёсен и зубов, синуситов, отитов, нарушений носового дыхания.</li>\r\n</ul>\r\n<p> В качестве профилактики гипертрофии небных миндалин и аденоидов можно порекомендовать закаливание детей, правильное рациональное питание, активный образ жизни. Детям с первой стадией заболевания нужно периодически проходить осмотр у оториноларинголога.</p>",
"clinical_picture": "<p>Для хронического тонзиллита характерно: </p>\r\n<ul>\r\n<li>покраснение и валикообразное утолщение краёв нёбных дужек.</li>\r\n<li>рубцовые спайки между миндалинами и небными дужками.</li>\r\n<li>разрыхленные или рубцово-измененные и уплотненные миндалины.</li>\r\n<li>творожисто-гнойные пробкиили жидкий гной в лакунах миндалин.</li>\r\n<li>увеличение и болезненность поднижнечелюстных (чаще) и шейных лимфоузлов;</li>\r\n<li>боль в горле;</li>\r\n<li>неприятные ощущения в глотке, боль при глотании;</li>\r\n<li>боль в мышцах, суставах;</li>\r\n<li>слабость, вялость, быстрая утомляемость;</li>\r\n<li>субфебрильная температура.</li>\r\n</ul>\r\n<p>Для гипертрофии небных миндалин характерно:</p>\r\n<ul>\r\n<li>затруднение дыхания, глотания;</li>\r\n<li>затруднение речи;</li>\r\n<li>храп ночью;</li>\r\n<li>частые простудные заболевания;</li>\r\n<li>рефлекторный кашель.</li>\r\n</ul>\r\n<p>Для аденоидов характерно:</p>\r\n<ul>\r\n<li>заложенность носа; </li>\r\n<li>затруднение носового дыхания, глотания; </li>\r\n<li>постоянные насморки; </li>\r\n<li>гнусавость;</li>\r\n<li>храп ночью;</li>\r\n<li>обструктивная остановка дыхания во сне;</li>\r\n<li>частые простудные заболевания;</li>\r\n<li>быстрая утомляемость;</li>\r\n<li>частые отиты;</li>\r\n<li>снижение слуха.</li>\r\n</ul>",
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"description": "<p><span id=\"docs-internal-guid-9d447e01-7fff-5e57-e46d-344747f7660e\"><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;\">Хронический тонзиллит – это воспаление миндалин, сопровождающееся болью в горле и увеличением шейных лимфоузлов. </span></span></p>",
"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;\">Развитие хронического тонзиллита возможно по 2 сценариям:</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;\">в результате ангины (острого тонзиллита), которая неправильно лечилась или лечение проведено не до конца;</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;\">в результате снижения иммунной защиты и постоянного воздействия агрессивных факторов (это безангинный вариант).</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 качестве агрессивных раздражителей выступают:</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;\">вдыхание табачного дыма;</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;\">неправильное питание;</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 спиртными напитками;</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;\">кариозные зубы;</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;\">воспалительные процессы в околоносовых пазухах (гайморит, фронтит и т.д.);</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;\">нарушение носового дыхания, происходящее при искривлении перегородки носа, полипы или гипертрофия нижних раковин носа. В таких условиях слизистая ротовой полости пересыхает и нарушается образование иммуноглобулина А, что снижает иммунную защиту лор-органов.</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\"> </p>",
"pathogenesis": "<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;\">Небные миндалины вместе с другими лимфоидными образованиями глоточного кольца защищают организм от болезнетворных микробов, проникающих вместе с воздухом, водой и пищей. При определенных условиях бактерии вызывают в миндалинах острое воспаление – ангину. В результате повторяющихся ангин может развиться хронический тонзиллит. В отдельных случаях (около 3% от всего количества больных) хронический тонзиллит является первично хроническим заболеванием, то есть возникает без предшествующих ангин.</span></p>",
"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;\">Диагноз хронического тонзиллита выставляется на основании характерного анамнеза (повторяющиеся ангины), данных объективного осмотра отоларинголога и дополнительных исследований.</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;\">На фарингоскопии выявляется гиперемия, утолщение краев и отечность небных дужек. Возможно сращение небных дужек с треугольной складкой и миндалинами. Нередко наблюдается разрыхление миндалин (особенно у детей). В лакунах миндалин содержится гной, иногда – с неприятным запахом. Часто выявляется увеличение регионарных лимфоузлов.</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 токсико-аллергической форме хронического тонзиллита проводится всестороннее обследование больного, направленное на выявление сопряженных заболеваний и оценку выраженности патологии.</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;\">Лечение хронического тонзиллита проводят и консервативными, и оперативными методами.</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;\">Консервативные методики – это:</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;\">антибиотики, которые назначают и местно (полоскания горла), и системно (таблетированные или инъекционные формы);</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;\">непосредственное промывание лакун и введение в них препаратов антибактериальной и противовоспалительной направленности;</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;\">физиотерапевтические процедуры (галлотерапия, магнитно-лазерное воздействие на лимфоузлы, фонофорез и УФО небных миндалин).</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;\">Оперативные методы лечения:</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;\">Тонзиллэктомия – удаление миндалин вместе с капсулой (инструментальная и бескровная методика).</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;\">Разрушение лимфоидной ткани в миндалине (радиоволновая абляция, криодеструкция).</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;\">Криптолизис («запаивание» небных лакун).</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p><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;\"> </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 направлена на снижение частоты обострений и осложнений. Очень важно вести здоровый образ жизни, не употреблять спиртное, исключить курение. Употребление пищи должно быть сбалансированным и содержать достаточное количество витаминов. Допустимо применение БАДов, направленных на улучшение защитных качеств иммунитета.</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;\">В осенне-весенний период необходимо избегать переохлаждений, а жаркое летнее время - резких перепадов температур.</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;\">Симптомы хронического тонзиллита:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Регулярное или непроходящее першение в горле, боль или дискомфорт во время еды или утром после сна, ощущение инородного предмета в горле.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Воспаление, увеличение, болезненность лимфоузлов.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Белый налет или желтоватые комочки в горле, гнойники и др.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Частый кашель, частые (от трех раз в год) ангины.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Повышение температуры тела при отсутствии других заболеваний, особенно если она повышается только ближе к вечеру.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Раздражительность, утомляемость, сонливость, вялость и другие признаки снижения иммунитета.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Одышка, нарушение сердечного ритма.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Неприятный запах изо рта. Такое действие оказывают скапливающиеся бактерии.</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Другие патологии. Паразитирующие микроорганизмы легко могут проникнуть в организм и вызвать поражение других тканей и органов, поэтому пациенты часто жалуются на боль и «ломоту» в суставах, боль в почках, непроходящую аллергию и кожные заболевания, покалывание и боли в сердце.</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
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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;\">длительное переохлаждение;</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;\">авитаминоз;</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;\">воздействие радиоактивного излучения;</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;\">несбалансированный рацион;</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;\">стрессовые ситуации, постоянное нервное напряжение;</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;\">чрезмерные физические нагрузки;</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;\">крайне нeблагоприятные условия.</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;\">Что касается непосредственно заболеваний, то гипертрофия миндалин может быть обусловлена следующими патологическими процессами:</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;\">корь, скарлатина;</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;\">патологические процессы лимфатической системы;</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;\">туберкулез;</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;\">аллергия;</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;\">заболевания эндокринной системы;</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;\">нарушения в работе гормонального фона.</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;\">В группе риска находятся люди, которые имеют ослабленную на фоне хронических заболеваний иммунную систему, системные патологии, хронические заболевания верхних дыхательных путей с частыми рецидивами.</span></p>",
"pathogenesis": "<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;\">Для детей в возрасте до 3-4 лет свойственна недостаточность клеточного иммунитета в виде дефицита Т-хелперов. Это, в свою очередь, препятствует трансформации В-лимфоцитов в плазматические клетки и выработке антител. Постоянный контакт с бактериальными и вирусными антигенами приводит к чрезмерной продукции функционально незрелых Т-лимфоцитов лимфоидными фолликулами миндалин и их гиперплазии. Инфекционные и воспалительные заболевания носоглотки сопровождаются усиленной продукцией слизи. Она, стекая по задней стенке глотки, оказывает раздражающее действие на небные миндалины, вызывая их гипертрофию. При лимфатико-гипопластическом диатезе, помимо стойкой гиперплазии всей лимфоидной ткани организма, наблюдается ее функциональная недостаточность, что обуславливает повышенную склонность к аллергии и инфекционным заболеваниям. Важную роль в патогенезе заболевания играют аллергические реакции, которые вызывают дегрануляцию мастоцитов, скопление в паренхиме небных миндалин большого количества эозинофилов.</span></p>",
"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;\">В первую очередь проводится физикальный осмотр, в ходе которого врач определяет клиническую картину, личный и семейный анамнез, изучает историю болезни пациента.</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;\">Диагностическая программа включает в себя следующие 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 анализ 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;\">общий анализ 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;\">бактериологическое исследование мазка из миндалин;</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;\">эндоскопия;</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;\">фарингоскопия;</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 глотки.</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;\">Чаще всего устранить патологический процесс можно при помощи консервативных терапевтических мероприятий, которые основываются на приеме медикаментов и проведении физиотерапевтических процедур.</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;\">Медикаментозная терапия 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;\">растворы для полоскания ротовой полости;</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;\">кортикостероиды;</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;\">иммуностимулирующие препараты;</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;\">раствор азотнокислого серебра;</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;\">антибиотики.</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;\">Физиотерапия основывается на проведении следующих процедур:</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;\">УВЧ;</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;\">озонотерапия;</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;\">грязелечение;</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;\">ультразвуковой массаж.</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p><span id=\"docs-internal-guid-5101d264-7fff-63d3-a00a-0d8ff82c4791\"><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;\">Специфические превентивные меры отсутствуют. Неспецифическая профилактика основывается на своевременном лечении воспалительных и инфекционных заболеваний, коррекции эндокринных нарушений, минимизации контактов с аллергенами, санаторно-курортном оздоровлении и рациональной витаминотерапии.</span></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;\">Гипертрофия миндалин приводит к тому, что нарушается работа верхних дыхательных путей. На фоне этого у человека появляются приступы апноэ и храпа. По мере усугубления патологического процесса приступы будут учащаться и становиться более длительными по времени.</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;\">Клиническая картина такого заболевания характеризуется следующими симптомами:</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;\">неприятное ощущение в горле при глотании, першение и боль;</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;\">ощущение, что в горле есть инородное тело;</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;\">затрудненное носовое дыхание, особенно во время сна, что и приводит к храпу;</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;\">одышка, поверхностное дыхание, особенно явными эти симптомы становятся после физической активности;</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;\">непривычное положение во время сна;</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;\">проблемы с речью;</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;\">трудности при глотании;</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">головные боли;</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;\">нарушение концентрации внимания, снижение работоспособности.</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;\">При гипертрофии язычной миндалины симптоматический комплекс будет включать в себя следующие клинические 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;\">ларингоспазм;</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;\">кашель без выделения мокроты;</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;\">потеря аппетита;</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;\">ощущение кома в горле;</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;\">при кашле может выделяться кровь.</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;\">При поражении глоточной миндалины симптоматика характеризуется следующим образом:</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;\">храп;</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 слуха;</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;\">головные боли, головокружение;</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;\">изменение строения лица;</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;\">частые риниты, трахеиты;</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;\">гнусавость;</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;\">бледность кожных покровов;</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 концентрации внимания, памяти, ухудшение когнитивных функций.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><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;\"> </span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 39,
"published": 1,
"parent": 6605,
"block_rubric": 103,
"standards": []
},
{
"id": 11423,
"symptoms": [],
"alternative_names": [],
"complications": [],
"medicine_branches": [],
"who": [
{
"id": 15109,
"gender": 2,
"diseased": 9115856,
"deaths": 0,
"danger": 0.0,
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