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"description": "Натуральная оспа представляет собой инфекционное заболевание человека, относящееся к особо опасным инфекциям, вызываемое вирусом Orthopoxvirus variola, характеризующееся лихорадкой, интоксикацией и специфическими высыпаниями на коже и слизистых оболочках. Распространение натуральной оспы происходит аэрозольным путем, при этом возбудитель настолько устойчив в воздушной среде, что может вызывать заражение людей, находящихся не только в одной комнате с больным, но и в соседних помещениях. В середине 70-х годов ХХ века полная ликвидация натуральной оспы в развитых странах привела к отмене профилактической вакцинации против этого заболевания.",
"etiology": "<p align=\"justify\" style=\"\">Натуральной оспой болеют только люди, экспериментальное заражение лабораторных животных удается с трудом. Возбудителем натуральной оспы является фильтрующийся вирус, антигенно родственный вакцинии, вирусу коровьей оспы, тонкое строение и закономерности размножения которого хорошо изучены. Инкубационный период при натуральной оспе продолжается от 8 до 14 дней, чаще ок. 11–12. Больные заразны для окружающих в течение всего периода и, по-видимому, даже за несколько дней до появления сыпи, в общей сложности около трех недель. Вирус выделяется из разрывающихся и подсыхающих пузырьков на коже, из ротовой полости и обнаруживается в моче и кале больного. Возбудитель инфекции передается путем непосредственных контактов, воздушно-капельным способом, от здоровых носителей и животных, и может сохранять жизнеспособность на одежде и постельном белье. Все невакцинированные люди восприимчивы к заражению; естественного иммунитета к натуральной оспе не бывает. Хотя заболевание возможно в любом возрасте, дети до четырех лет особенно уязвимы.</p><p align=\"justify\">Возбудитель оспы относится к вирусам семейства Poxviridae, подсемейства Chordopoxviridae, рода Orthopoxvirus; содержит ДНК, имеет размеры 200-350 нм, размножается в цитоплазме с образованием включений. Вирус натуральной оспы имеет антигенное родство с эритроцитами группы А крови человека, что обусловливает слабый иммунитет, высокую заболеваемость и смертность соответствующей группы лиц. Он устойчив к воздействию внешней среды, особенно к высушиванию и низким температурам. Он может длительное время, в течение ряда месяцев, сохраняться в корочках и чешуйках, взятых с оспин на коже больных, в замороженном и лиофилизированном состоянии остается жизнеспособным несколько лет.</p>",
"pathogenesis": "<p>При вдыхании зараженного воздуха вирусы попадают в респираторный тракт. Возможно заражение через кожу при вариоляции и трансплацентарно. Вирус поступает в ближайшие лимфатические узлы и далее в кровь, что приводит к виремии. Гематогенно инфицируется эпителий, здесь происходит размножение вируса, с чем связано появление энантемы и экзантемы. Ослабление иммунитета ведет к активации вторичной флоры и превращению везикул в . Вследствие гибели росткового слоя эпидермиса, глубоких нагноительных и деструктивных процессов формируются рубцы. Может развиться инфекционно-токсический . Для тяжелых форм характерно развитие геморрагического синдрома.</p>",
"diagnostics": "<p>Диагностика оспы подразумевает под собой учет характерных для заболевания клинических проявлений (в частности речь идет о сыпи), которые используются для последующего проведения клинических исследований. Так, диагностирование заболевания основывается на анализах содержимого образуемых кожных элементов в той или иной их стадии (везикула, пустула, пузырек, корочка), также исследуется кровь и мазок слизи, взятой из полости рта. Наличие во взятых образцах вируса оспы определяется посредством проведения микропреципитации, ПЦР, электронной микроскопии. Получение предварительного результата происходит в период 24 часов, за счет проведения дальнейших, более основательных исследований образцов, происходит уже выделение вируса и его идентификация.<br></p>",
"treatment": "<p><span style=\"text-align: justify;\">Лечение натуральной оспы заключается в назначении противовирусных препаратов (метисазон), введении иммуноглобулинов. Кожу, пораженную оспенной сыпью, обрабатывают антисептическими средствами. Дополнительно (ввиду гнойного характера инфекции) назначается антибиотикотерапия: применяют антибиотики групп полусинтетических пенициллинов, макролидов и цефалоспорины. Симптоматическая терапия заключается в активной дезинтоксикации с помощью внутривенной инфузии растворов глюкозы, гемодеза. Иногда в терапию включают глюкокортикоиды.</span><br></p>",
"prevention": "<p style=\"padding-bottom: 19px;\" align=\"justify\">В настоящее время специфическая профилактика оспы производится с целью не допустить ее завоза из эпидемически опасных регионов. Ликвидация оспы в развитых странах достигнута благодаря массовой вакцинации и ревакцинации населения на протяжении нескольких поколений, в настоящее время плановая всеобщая вакцинация нецелесообразна.</p>\r\n<p style=\"padding-bottom: 19px;\" align=\"justify\">В случае выявления больного натуральной оспой, осуществляют его изоляцию, а так же производят карантинные мероприятия в отношении всех, имевших контакт с больным. В очаге инфекции производят тщательную дезинфекцию, контактных лиц вакцинируют в течение первых трех дней с момента контакта.</p>",
"clinical_picture": "<p>При типичном течении оспы инкубационный период длится 8-12 дней. Начальный период характеризуется ознобом, повышением температуры тела, сильными рвущими болями в пояснице, крестце и конечностях, сильной жаждой, головокружением, головной болью, рвотой. Иногда начало болезни мягкое. На 2-4-й день на высоте лихорадки появляется инициальная на коже либо в виде участков гиперемии (кореподобная, розеолезная, эритематозная), либо геморрагическая по обеим сторонам грудной клетки в области грудных мышц до подмышечных впадин, а также ниже пупка в области паховых складок и внутренних поверхностей бедер (\"треугольник Симона\"); кровоизлияния выглядят как пурпура и даже как экхимозы. Пятнистая держится несколько часов, геморрагическая - более продолжительное время.</p>\r\n<full></full>\r\n<p>На 4-й день наблюдается снижение температуры тела, ослабляются клинические симптомы начального периода, но появляются типичные на коже головы, лица, туловища и конечностей, которые проходят стадии пятна, , пузырька, , образования корочек, отторжения последних и образования рубца. Одновременно появляются на слизистой оболочке носа, ротоглотки, гортани, трахеи, бронхах, конъюнктивах, прямой кишке, женских половых органов, мочеиспускательного канала. Они вскоре превращаются в .</p>\r\n<p>На 8-9-й дни болезни в стадии нагноения пузырьков вновь ухудшается самочувствие больных, возникают признаки токсической энцефалопатии (нарушение сознания, , возбуждение, у детей - судороги). Период подсыхания и отпадения корок занимает около 1-2 нед. На лице и волосистой части головы образуются многочисленные рубцы. Изменение крови характеризуется лейкоцитозом, при тяжелых формах имеется резкий сдвиг влево с выходом в кровь миелоцитов и юных клеток.</p>\r\n<p>К тяжелым формам относятся сливная форма (Variola confluens), пустулезно-геморрагическая (Variola haemorrhagica pustulesa) и оспенная пурпура (Purpura variolosae).</p>\r\n<p>У привитых противооспенной вакциной оспа протекает легко (Varioloid). Основными ее особенностями являются продолжительный инкубационный период (15-17 дней), умеренные явления недомогания и других признаков интоксикации; истинная оспенная необильная, не образуются, рубцов на коже не остается, выздоровление наступает через 2 нед.</p>\r\n<p>Встречаются легкие формы с кратковременной лихорадкой без сыпи и выраженных расстройств самочувствия (Variola sine exanthemate) или только в виде необильной сыпи (Variola afebris).</p>",
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},
"code": "I46",
"name": "Остановка сердца",
"icd_name": "Остановка сердца",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
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"periodicity": 1,
"slug": "i46_ostanovka_serdca",
"lead": "Нарушение здоровья, относящееся к группе другие болезни сердца",
"description": "Остановка сердца — внезапное и полное прекращение эффективной деятельности сердца с наличием или отсутствием биоэлектрической активности. Внезапная сердечная смерть – неожидаемая смерть от сердечных причин, произошедшая в течение 1 часа от появления симптомов у больного с известным заболеванием сердца или без него. \r\n\r\n",
"etiology": "<p>К наиболее частым причинам развития остановки сердца относят:</p>\r\n<ul>\r\n<li>Фибрилляция желудочков— около 90% всех случаев остановки сердца;</li>\r\n<li>Асистолияжелудочков — около 5% всех случаев остановки сердца;</li>\r\n<li>Желудочковая пароксизмальная тахикардия с отсутствием пульса на крупных сосудах;</li>\r\n<li>Электромеханическая диссоциация— электрическая активность в виде ритмичных комплексов QRS без соответствующих сокращений желудочков.</li>\r\n</ul>\r\n<p>К дополнительным факторам относят заболевания сердца (миокардиты, кардиомиопатии), острые нарушения кровообращения, гиповолемию, ишемию (в т.ч. инфаркт миокарда), метаболические нарушения (острая гиперкальциемия), гипотермию, анафилактический шок, геморрагический шок (возникающий вследствие острой массивной кровопотери); гипоксию, асфиксию, пневмоторакс и др.</p>\r\n<p>К причинам, косвенно влияющим на возникновение остановки сердца относят возраст, пагубные привычки (курение, злоупотребление алкоголем), чрезмерные нагрузки на сердце, генетическая предрасположенность</p>\r\n<p> </p>",
"pathogenesis": "<p>Различают два вида прекращения сердечной деятельности:</p>\r\n<p>1) асистолию;</p>\r\n<p>2) фибриллляцию желудочков.</p>\r\n<p>Под асистолией понимают полное прекращение сокращений желудочков. Произойти она может внезапно (рефлекторно), при сохранившемся тонусе миокарда, или постепенно — при развитии его атонии. Фибилляция желудочков – некоординированные сокращения мышечных волокон сердца. При сохранившемся тонусе миокарда наблюдаются энергичные фибриллярные сокращения, а при атонии — вялые.</p>\r\n<p>Первая группа нарушений проводимости сердца представляет собой нарушение проведения возбуждений между различными отделами сердца при сохранении возбудимости и сократимости, миокарда внутри каждого отдела сердца. К этой группе относят: а) асистолию всего сердца в результате нарушений и полной блокады проводимости между синусовым узлом и предсердиями; б) асистолию желудочков вследствие полной поперечной блокады; в) резко выраженную желудочковую брадикардию (менее 30 сокращений в минуту) при неполной блокаде проводимости между предсердиями и желудочками.</p>\r\n<p>Вторая группа нарушений проводимости сердца представляет собой нарушение проведения возбуждения внутри проводящей системы желудочков, в результате чего нарушается координированность сокращений миокарда желудочков. К этой группе относят: а) фибрилляцию и трепетание желудочков и б) пароксизмальную тахикардию, связанную с нарушением внутрижелудочковой или внутрипредсердной проводимости.</p>\r\n<p>Фибрилляция и трепетание желудочков поддерживаются круговой циркуляцией возбуждения по проводящей системе, в результате чего отдельные группы мышечных волокон миокарда сокращаются разрозненно и неодновременно и эффективная работа сердца прекращается. Фибрилляция желудочков может наступить от тех же причин, от которых происходит остановка сердца в состоянии асистолии, а также при заболеваниях сердца — спазме венечных сосудов, инфаркте миокарда.</p>\r\n<p>Пароксизмальная тахикардия желудочкового и наджелудочкового происхождения связана с нарушением проводимости и круговой циркуляцией возбуждения. Хотя при этом координация сокращений миокарда не нарушена, но при высокой частоте сокращения желудочков могут стать недостаточно эффективными для поддержания необходимого уровня артериального давления.</p>\r\n<p>Третья группа нарушений проводимости сердца представляет собой наиболее глубокое нарушение проводимости, распространяющееся на все конечные разветвления проводящей системы внутри миокарда. Последний теряет при этом способность отвечать не только на импульсы, поступающие из очагов автоматии но и на искусственные механические или электрические раздражения. Это состояние сердца, при котором полностью теряется возбудимость и сократимость, характеризуется потерей мышечного тонуса — атонией миокарда.</p>\r\n<p>Атония миокарда является последней стадией любого вида остановки сердца в случае, если своевременно не приняты меры для восстановления кровообращения.</p>",
"diagnostics": "<p>Остановка сердца — экстренное состояние, поэтому диагностика должна быть выполнена в течение нескольких минут. </p>\r\n<p>Проводится физикальный осмотр – установливается отсутствия сознания, дыхания, отсутствие пульсации в общей сонной или бедренной артерии. Отмечаются расширенные зрачки, бледный, синюшный цвет кожи.</p>\r\n<p>Электрокардиография (ЭКГ) – подтверждает отсутствие активности сердца, а также используется для определения эффективности лечения.</p>\r\n<p> </p>",
"treatment": "<p>Первая помощь включает наружный массаж сердца и искусственное дыхание (два вдувания через каждые 30 нажатий)[1]. При большинстве остановок сердца имеет место фибрилляция желудочков, которая может быть купирована электрической дефибрилляцией (электрическая импульсная терапия для восстановления ритма сердца). </p>\r\n<p>Врачебная помощь включает:</p>\r\n<ul>\r\n<li>Непрямой массаж сердца;</li>\r\n<li>Дефибрилляция.</li>\r\n<li>Искусственная вентиляция легких (аппаратное дыхание). </li>\r\n<li>100% кислород при помощи маски или через эндотрахеальную (трубка, вставленная в трахею) трубку. </li>\r\n</ul>\r\n<p>Неотложная лекарственная терапия:</p>\r\n<ul>\r\n<li>Адреномиметики (препараты, улучшающие проводимость электрического импульса по сердцу и увеличивающие число сердечных сокращений).</li>\r\n<li>Антиаритмические препараты (препараты, восстанавливающие нормальный ритм сердечных сокращений).</li>\r\n<li>М-холиноблокаторы (препараты, увеличивающие число сердечных сокращений и облегчающие проводимость электрических импульсов по сердцу).</li>\r\n</ul>\r\n<p>Хирургическое лечение:</p>\r\n<ul>\r\n<li>Перикардиоцентез (забор жидкости из околосердечной сумки с помощью иглы) при тампонаде сердца (скопление жидкости в околосердечной сумке).</li>\r\n<li>Пункция плевральной полости (во II межреберье по среднеключичной линии) и ее дренирование (введение катетера (дренажа) в полость) для лечения напряженного пневмоторакса (накопление воздуха в полости, образованной двумя оболочками, покрывающими легкие и стенки грудной клетки).</li>\r\n</ul>",
"prevention": "<p>Профилактика остановки сердца включает своевременную диагностику и лечение сердечно-сосудистых заболеваний, контроль артериального давления и уровня холестерина крови, отказ от пагубных привычек (курения и алкоголя), рациональное и сбалансированное питание, умеренные физические нагрузки, исключение переохлаждений, электротравм, профилактика травматизма (в том числе дорожно-транспортного), контроль приема лекарственных средств.</p>\r\n<p> </p>",
"clinical_picture": "<p>При остановке сердца наблюдается:</p>\r\n<ul>\r\n<li>потеря сознания (развивается спустя 10-20 секунд от начала острой ситуации);</li>\r\n<li>отсутствие пульса на крупных артериях;</li>\r\n<li>шумное редкое агональное (предсмертное) дыхание с остановкой через 2 минуты;</li>\r\n<li>быстро нарастающие изменения окраски кожных покровов, посинение и бледность;</li>\r\n<li>возможно появление судорог через 15–30 секунд после утраты сознания;</li>\r\n<li>расширение зрачков через 2 минуты с утратой реакции на свет.</li>\r\n</ul>\r\n<p>После потери сознания и остановки дыхания наступает клиническая смерть, развивается гипоксия в органах и тканях. </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 95,
"standards": [
5121
]
}
]
}
