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"lead": "нарушение функций работы подкожной жировой клетчатки и ее замещение соединительной тканью, которое имеет воспалительный, разрушающий жировые клетки, характер",
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"etiology": "<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;\">Примерно половина случаев панникулита приходится на спонтанную (идиопатическую) форму заболевания, которая чаще встречается у женщин в возрасте от 20 до 50 лет. Остальные 50% — это случаи вторичного панникулита, развивающегося на фоне системных и кожных заболеваний, иммунологических нарушений, действия различных провоцирующих факторов (холод, некоторые медикаменты). Известно, что в основе развития панникулита лежит нарушение перекисного окисления жиров. Но, несмотря на многочисленные исследования в области этиологии и патогенеза этого заболевания, дерматология до сих пор не имеет четкого представления о механизме его возникновения.</span></p>",
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"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;\">Диагностику панникулита дерматолог проводит совместно с ревматологом, нефрологом и гастроэнтерологом. Пациенту назначают биохимический анализ крови и мочи, печеночные пробы, исследование панкреатических ферментов, пробу Реберга. Выявление узлов висцерального панникулита осуществляют с помощью УЗИ органов брюшной полости, УЗИ почек. поджелудочной железы и УЗИ печени. Посев крови на стерильность позволяет исключить септический характер заболевания. Для дифференцировки инфильтративного варианта панникулита от абсцесса проводят бактериологическое исследование отделяемого вскрывшегося узла.</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;\">Точный диагноз панникулита устанавливают по результатам биопсии узла. При гистологическом исследовании выявляют воспалительную инфильтрацию, некроз жировых клеток и их замещение соединительной тканью.</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;\">В зависимости от его формы и течения. Для лечения узлового панникулита с хроническим течением назначают нестероидные противовоспалительные (напроксен, диклофенак) и антиоксиданты (витамин Е, аскорбиновая кислота), проводят обкалывание единичных узловых образований глюкокортикоидами. Эффективны физиопроцедуры: УВЧ, фонофорез гидрокортизона, магнитотерапия, озокерит, ультразвук, лазеротерапия.</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 бляшечной и инфильтративной форме, подостром течении панникулита применяют глюкокортикостероиды (гидрокортизон, преднизолон) и цитостатики (циклофосфан, метотрексат). Для улучшения функции печени целесообразно назначение гепатопротекторов. Лечение вторичных форм панникулита обязательно включает терапию фонового заболевания: панкреатита, СКВ, васкулита, подагры.</span></p>",
"prevention": "",
"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;\">Основным проявлением спонтанного панникулита являются узловые образования, расположенные в подкожно-жировой клетчатке на различной глубине. Чаще всего они появляются на ногах и руках, реже — в области живота, груди или на лице. После разрешения узлов панникулита остаются очаги атрофии жировой клетчатки, которые выглядят как округлые участки западения кожи.</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;\">Узловой вариант панникулита характеризуется появлением в подкожной клетчатке типичных отдельно расположенных узлов размером от 3-4 мм до 5 см. Кожа над узлами может иметь окраску от обычной до ярко-розовой.</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;\">Бляшечный вариант панникулита представляет собой отдельные скопления узлов, которые, срастаясь, образуют бугристые конгломераты. Цвет кожи над такими образованиями бывает розовый, бардовый или бардово-синюшний. В некоторых случаях конгломераты узлов распространяются на всю </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;\">клетчатку голени, плеча или бедра, сдавливая при этом сосудистые и нервные пучки, что обуславливает выраженную болезненность и отек конечности, приводит к лимфостазу.</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;\">Инфильтративный вариант панникулита протекает с расплавлением узлов или их конгломератов. При этом в области узла или бляшки, как правило, ярко красного или бардового оттенка, появляется флюктуация, типичная для абсцесса или флегмоны. Однако при вскрытии узлов из них выходит не гной, а маслянистая масса желтого цвета. На месте вскрывшегося узла образуется длительно не заживающее изъязвление.</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;\">Смешанный вариант панникулита — встречается редко и представляет собой переход узловой формы в бляшечную, а затем в инфильтративную.</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;\">Изменения со стороны подкожной жировой клетчатки в случае спонтанного панникулита могут не сопровождаться нарушением общего состояния пациента. Но чаще в начале заболевания наблюдается симптоматика, схожая с проявлениями острых инфекций (ОРВИ, гриппа, кори, краснухи и др): головная боль, общая слабость, повышение температуры, артралгии, боли в мышцах, тошнота.</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;\">Висцеральная форма панникулита характеризуется системным поражением жировых клеток по всему организму с развитием панкреатита, гепатита, нефрита, образованием характерных узлов в забрюшинной клетчатке и сальнике.</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;\">По своему течению панникулит может быть острым, подострым и рецидивирующим, длиться от 2-3 недель до нескольких лет. Острая форма панникулита характеризуется выраженным изменением общего состояния с высокой температурой, миалгиями, болями в суставах, нарушением функции почек и печени. Несмотря на проводимое лечение, состояние пациента прогрессивно ухудшается, изредка бывают непродолжительные ремиссии, но в течение года заболевание заканчивается летальным исходом.</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;\">Подострое течение панникулита более сглаженное. Для него типично нарушение общего состояния, лихорадка, изменения функциональных проб печени, резистентность к проводимому лечению. Наиболее благоприятно рецидивирующее или хроническое течение панникулита. 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},
"code": "B66.4",
"name": "Парагонимоз",
"icd_name": "Парагонимоз",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"7"
],
"periodicity": 3,
"slug": "b66.4_paragonimoz",
"lead": "паразитарное заболевание из группы трематодозов, вызываемое лёгочным сосальщиком",
"description": "<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;\">Парагонимоз — это хронически протекающее инфекционное заболевание, имеющее паразитарную природу. Возбудителями данного патологического процесса являются плоские гельминты, называющиеся легочными сосальщиками. </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;\">Парагонимоз вызывается легочными сосальщиками, включающими несколько близких видов трематод рода Paragonimus. </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;\">Сложный цикл развития трематод проходит со сменой хозяев: основными являются человек и животные (свиньи, собаки, кошки, ондатры, выдры, крысы), первыми промежуточными служат пресноводные моллюски; дополнительными – пресноводные крабы, раки и креветки. Парагонимоз имеет фекально-оральный механизм передачи. Яйца трематод выделяются из организма основного хозяина в окружающую среду с испражнениями, реже с мокротой и дозревают в воде. Вылупившиеся личинки (мирацидии) активно внедряются в ткани моллюсков и последовательно проходят через стадии спороцисты, редии и церкарии. Церкарии способны активно или пассивно проникать в тела крабов и раков, инцистироваться в мышцах и внутренних органах, развиваясь там до инвазионных метацеркарий.</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;\">В патогенезе парагонимоза ведущую роль играют токсико-аллергические реакции и механическое воздействие гельминтов и их яиц на ткани. Во время миграции личинок паразитов в легкие через диафрагму и другие органы (печень, поджелудочную железу, почки) в них отмечаются кровоизлияния, а иногда и некрозы. В легких (особенно в нижних долях) помимо кровоизлияний образуются эозинофильные инфильтраты и скопления экссудата. Позднее вокруг паразитов формируются фиброзные кисты размером от 0,1 до 10 см. Они заполнены массой серо-белого, шоколадного или темно-красного цвета, содержат слизь, эозинофилы и другие лейкоциты, кристаллы Шарко-Лейдена, а также одного или нескольких паразитов. Кисты часто сообщаются с разветвлениями бронхов После гибели паразита или выхода его из кисты полость ее зарубцовывается. При нарушении стенки кисты паразиты или их яйца иногда заносятся в головной мозг, мезентериальные лимфатические узлы, предстательную железу, печень, кожу и другие органы и ткани.</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 диагностике парагонимоза используются данные эпидемиологического анамнеза, клинической картины, лабораторных (общего анализа крови, микроскопии мокроты, копроовоскопии) и инструментальных исследований (рентгенографии, КТ и МРТ легких, КТ черепа, биопсии кисты, лапароскопии), результаты аллергопробы с антигенами пангонимусов. В острой стадии парагонимоз диагностируется редко, характерным признаком может служить сочетание изменений в легких с неврологической симптоматикой.</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;\">Диагноз парагонимоза подтверждается обнаружением овальных золотисто-коричневых яиц паразита в мокроте и кале больного. В первые 2-3 месяца после заражения более информативны серологические методы (ИФА), выявляющие специфические антитела к антигенам гельминта. В крови при парагонимозе определяется эозинофилия, лимфоцитоз, гипохромная анемия. На рентгенограмме легких парагонимозные кисты представлены в виде размытых кольцевидных затемнений с ровными гладкими границами в одном или нескольких легочных сегментах. При рентгенографии черепа видны кальцификаты в форме «мыльных пузырей». При лапароскопии в брюшной полости обнаруживается выпот геморрагического, фибринозного или фибринозно-гнойного характера, в котором можно выявить незрелых гельминтов.</span></p>",
"treatment": "<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 ранней стадии парагонимоза проводится десенсибилизирующая терапия антигистаминными препаратами, при тяжелых органных поражениях – короткий курс кортикостероидов. Специфическое лечение парагонимоза включает прием противогельминтных средств (празиквантел, битионол), принимаемых после стихания острых аллергических реакций. При поражении ЦНС лечение парагонимоза проводится только в стационаре. Применяются противосудорожные, мочегонные препараты. При хроническом парагонимозе показаны общеукрепляющие и сердечно-сосудистые средства. В случае неэффективности консервативной тактики проводится резекция легкого, удаление кист легких и мозга.</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 парагонимоза в очагах сводится к исключению из пищи сырого мяса ракообразных, кипячению питьевой воды, охране водоемов от фекального загрязнения.</span></p>\r\n<p><span id=\"docs-internal-guid-0983e3c4-7fff-4080-2d36-512feb6921e6\"> </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;\">Инкубационный период парагонимоза длится 2-3 недели, при массивной инвазии может сокращаться до нескольких дней.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В остром периоде болезни развиваются первые симптомы парагонимоза вследствие тяжелого энтерита, гепатита и доброкачественного асептического перитонита, сопровождающиеся признаками «острого живота». Затем возникают лихорадка, боли в груди, одышка, кашель с гнойной мокротой, имеющей иногда примесь крови. При физикальном и рентгенологическом исследованиях выявляются экссудативные инфильтраты, а иногда и признаки экссудативного плеврита.</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;\">Через 2-3 месяца болезнь переходит в хроническую стадию, характеризующуюся периодами ремиссий и обострений, во время которых возникают типичные симптомы парагонимоза: температура повышается до 38-40 °С, усиливаются боли в груди, головные боли, появляются одышка, кашель с выделением ржавой мокроты, в которой содержатся яйца гельминта. Нередко отмечается кровохарканье. При рентгенологическом исследовании легких определяются слабо выраженные округлые тени диаметром от 5 до 40 мм с отходящими от них радиальными линейными затемнениями. По мере формирования фиброзных кист внутри теней просматриваются светлые вакуоли с четкими и гладкими очертаниями величиной 2-4 мм.</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;\">Через 2-4 года клинические симптомы парагонимоза постепенно исчезают. После исчезновения симптомов болезни при рентгенологическом исследовании в легких обнаруживаются небольшие изолированные очаги фиброза и единичные или множественные очаги кальцификации диаметром 2-5 мм.</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;\">При интенсивной инвазии и многолетнем течении болезни может развиться пневмосклероз и синдром «легочного сердца».</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;\">Попадание парагонимусов в ЦНС вызывает развитие симптомов менингита, повышается внутричерепное давление. Возможно развитие атрофии зрительного нерва, парезов, параличей, нарушений чувствительности, эпилепсии. На рентгенограммах головного мозга у таких больных выявляются кальцинированные округлые образования, содержащие погибших гельминтов.</span></p>",
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"lead": "Область медицины, включающая в себя лечение 284 заболеваний. В 37 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 2214 заболеваний. В 886 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 515 заболеваний. В 980 клиниках России оказывается помощь по этому направлению медицины.",
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"lead": "Область медицины, включающая в себя лечение 851 заболевания. В 696 клиниках России оказывается помощь по этому направлению медицины.",
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},
"code": "H49",
"name": "Паралитическое косоглазие",
"icd_name": "Паралитическое косоглазие",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
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"slug": "h49_paraliticheskoe_kosoglazie",
"lead": "Нарушение здоровья, относящееся к группе болезни мышц глаза, нарушения содружественного движения глаз, аккомодации и рефракции",
"description": "Паралитическое косоглазие обусловлено параличом или парезом одной или нескольких\r\nглазодвигательных мышц, вызванным различными причинами: травмой, инфекциями,\r\nновообразованиями и др. Оно характеризуется прежде всего ограничением или отсутствием\r\nподвижности косящего глаза в сторону действия парализованной мышцы. При взгляде в эту\r\nсторону возникает двоение, или диплопия.",
"etiology": "<p>Выделяют следующие причины паралитического косоглазия:<br /> кровоизлияние в головной мозг (вследствие инсульта);</p>\r\n<p> прогрессирующий паралич зрительных нервов;</p>\r\n<p> наличие новообразований в головном мозге;<br /> травмы черепа;<br /> множественный склероз сосудов;<br /> нейросифилис;<br /> переломы основания черепа;<br /> менингит;<br /> неврит инфекционной или токсической природы;<br /> опухоль глазницы;<br /> ранения глаза;<br /> миозит;<br /> периостит.<br />Врожденное паралитическое косоглазие у детей может возникнуть внутриутробно из-за<br />неправильного образа жизни матери, наличия в организме женщины опасных инфекций и т.д.</p>",
"pathogenesis": "<p>Поражение ядер или стволов глазодвигательного, блокового и отводящего нервов, поражение нервов или самих мышц приводят к параличу или парезу глазодвигательных мышц. Больной при этом поворачивает голову в сторону действия пораженной мышцы, что компенсирует ее функциональную недостаточность.</p>",
"diagnostics": "<p><strong></strong></p>\r\n<p>Физикальное обследование </p>\r\n<ul>\r\n<li>Исследование положения глаз и степени девиации (угла косоглазия) в различных позициях взора. </li>\r\n<li>Определение величины отклонения глаз от срединной позиции (по Гиршбергу). </li>\r\n<li>Исследование подвижности глаз. </li>\r\n<li>Исследование объёма движений глаз проводят, предъявляя пациенту движущийся объект фиксации (например, конец карандаша) в различных позициях взора: вверх, вниз, направо, влево, вверх-вправо, вниз-вправо, вверх-влево, вниз-влево. </li>\r\n</ul>\r\n<p>Метод коордиметрии позволяет определить поле взора каждого глаза и выявить его ограничения в зоне действия той или иной мышцы. Метод основан на разделении полей взора правого и левого глаза при помощи красного и зелёного фильтров, окрашенных в дополнительные цвета. При наложении этих цветов друг на друга возникает эффект гашения изображения. Метод учитывает характер локализации в пространстве изображений обоих глаз при косоглазии. </p>\r\n<p>Особое внимание при обследовании пациентов необходимо уделять характеру вынужденного положения головы. Поворот головы имеет целью вывести глаз из области двоения и действия парализованной мышцы, то есть пациент поворачивает голову в сторону действия поражённой мышцы</p>",
"treatment": "<p>Немедикаментозное лечение </p>\r\n<ul>\r\n<li>Мышечная гимнастика. </li>\r\n<li>Упражнения на слияние двойных изображений. </li>\r\n<li>Физиотерапевтическое лечение (магнито-, электрофорез: электростимуляция </li>\r\n<li>глазодвигательных мышц; рефлексотерапия).</li>\r\n</ul>\r\n<p>Хирургическое лечение </p>\r\n<ul>\r\n<li>Операции по усилению или ослаблению заинтересованных мышц. </li>\r\n<li>Пластика глазодвигательных мышц по О’Коннору, Аветисову с пересадкой волокон </li>\r\n<li>действующих мышц (например, вертикальных к парализованной горизонтальной мышце). </li>\r\n</ul>",
"prevention": "<p>Профилактика паралитического косоглазия включает:</p>\r\n<ul>\r\n<li>профилактику травматизма на производстве и в быту;</li>\r\n<li>предупреждение родовых травм;</li>\r\n<li>ранняя диагностика и лечение заболеваний, предшествующих косоглазию.</li>\r\n</ul>",
"clinical_picture": "<p>При паралитическом косоглазии отмечаются:</p>\r\n<ul>\r\n<li>отклонение глазного яблока в ту или иную сторону (в случаях изолированного поражения одной из мышц больной глаз отклоняется в сторону, противоположную парализованной мышце);</li>\r\n<li>неравенство первичного и вторичного углов отклонения. При фиксации какого-либо предмета парализованным глазом отклоняется здоровый глаз, причем на значительно больший угол, чем тот, на который был отклонен больной глаз (угол вторичного отклонения больше угла первичного отклонения);</li>\r\n<li>двоение - диплопия, поскольку изображение одного и того же предмета падает на диспаратные отделы сетчаток обоих глаз;</li>\r\n<li>расстройство глубинного или стереоскопического зрения;</li>\r\n<li>головокружение вследствие двоения, а главное, в связи с постоянным изменением пространственных отношений истинных и мнимых изображений при поворотах глазных яблок в ту или иную сторону у больного создается впечатление, что все предметы, окружающие его, находятся в непрерывном движении;</li>\r\n<li>вынужденное положение головы (глазной тортиколис), что избавляет больного от двоения. Поворот или наклон головы при этом должен быть направлен в сторону действия парализованной мышцы.</li>\r\n</ul>\r\n<p>При одновременном параличе всех глазных нервов наступает полная офтальмоплегия, которая характеризуется неподвижностью глаза, птозом и расширением зрачка.</p>",
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"parent": null,
"block_rubric": 83,
"standards": [
4988
]
}
]
}
