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"code": "K05.4",
"name": "Пародонтоз",
"icd_name": "Пародонтоз",
"gender": 0,
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"slug": "k05.4_parodontoz",
"lead": "системное поражение тканей пародонта, возникающее из-за нарушения обмена веществ и кровоснабжения в деснах",
"description": "<p><span id=\"docs-internal-guid-b359ecbc-7fff-fbf2-9572-8645d33dace6\"><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;\">Пародонтоз – это заболевание десен, в основе которого лежит процесс склерозирования сосудов, что приводит к уменьшению поступления кислорода и питательных веществ, и как следствие – происходит медленная дистрофия всех тканей пародонта.</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;\">Причины развития пародонтоза точно не установлены, но считается, что важную роль в этом процессе играет нарушение питания костной ткани челюсти со снижением минерального обмена и обновления ткани.</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;\">Определенное место в формировании пародонтоза занимают патогенные микроорганизмы, присутствующие в зубном налете. В результате их жизнедеятельности ткань десны становится рыхлой, разрушается зубодесневое соединение, зубной налет проникает глубже и после затвердевания повреждает десну и зубную эмаль.</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;\">Основополагающими факторами, приводящими к развитию пародонтоза, являются:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">наследственная предрасположенность;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">системные заболевания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">эндокринные заболевания, включая, сахарный диабет и др.;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">хронические заболевания внутренних органов, пищеварительного тракта;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">заболевания сердечно-сосудистой системы атеросклеротического характера (атеросклероз, артериальная гипертония, вегетососудистая дистония);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">поражения костей (остеопении);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">гиповитаминоз;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">аномалии развития зубочелюстной системы (патологии прикуса, аномальное расположение зубов);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">воздействие хронического стресса;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #13353f; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">функциональная недостаточность пародонта.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<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 пародонтозе изменения затрагивают невидимую для глаз человека часть — костную ткань челюсти. Изменения, которые происходят в ней, приводят к подвижности зубов и как результат — их удалению. На уровне кости изменения затрагивают процесс образования костной ткани: новая ткань на фоне разрушения не успевает восстановиться с помощью специальных клеток, строящих ее. Ткань кости челюсти постепенно убывает. Этот процесс виден только на рентгенограмме челюстей.</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 пародонтозе появляются нарушения в кровеносных сосудах, питающих кость: сужается их просвет за счет утолщения и изменения стенок сосудов. На поверхности десны нарушается обмен белка на клеточном уровне, в более глубоких слоях слизистой оболочки десен происходит разрушение волокон соединительной ткани, которые создают поддержку зубов в челюсти.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><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;\">На фоне этих нарушений страдает обмен питательных веществ в деснах и возникает их недостаток — дистрофия.</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;\">Диагностика пародонтоза осуществляется комплексно, и необходимость тех или иных методов исследования определяет врач.</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;\">Анамнез. Обязательным является опрос самого пациента. Специалист должен быть осведомлен:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\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;\">о перенесенных пациентом в прошлом заболеваниях полости рта и других систем организма;</span></li>\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;\">о наличии пародонтоза у родственников;</span></li>\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;\">об имеющихся у пациента жалобах в данный момент времени.</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;\">Осмотр полости рта. Врачом в обязательном порядке проводится осмотр ротовой полости. Для точной диагностики ему необходимо оценить:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\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;\">положение и внешний вид десен (болезненность, чувствительность, оттенок);</span></li>\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;\">степень оголения шейки зуба;</span></li>\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;\">качество зубной эмали (цвет, плотность, чувствительность).</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;\">Общий анализ крови. Исследование общеклиническое. При подозрении на пародонтоз основное внимание уделяется показателям скорости оседания эритроцитов в крови.</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;\">Рентгенография. Рентгеновские снимки позволяют выявить изменения в костной ткани, ширину щелей между зубами, изменения границ зубных лунок.</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;\">Также может потребоваться диагностика с помощью лазера и ультразвука - исследуется ток крови в пародонте, содержание в ней кислорода и состояние самих тканей.</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 проводится врачом-пародонтологом и должно быть направлено на восстановление десневого соединения, при этом во время терапии пародонтоза нужно учитывать индивидуальные особенности пациента, сопутствующие заболевание и возраст. Так, в группе пациентов старшего возраста с пародонтозом часто присутствуют патологии сердечно-сосудистой системы, эндокринные заболевания и нарушения обмена веществ.</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;\">Лечение пародонтоза должно быть направлено на активизацию местного кровообращения, что достигается массажами и физиотерапией. Важно своевременно удалять зубной камень и зубной налет, поэтому при пародонтозе показана профессиональная гигиена полости рта и ультразвуковая чистка зубов.</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;\">Фиксация подвижных зубов проводится путем вантового шинирования или шинирования флекс-дугами. Если пародонтоз сопровождается выпадением зубов, то показана консультация ортопеда для решения вопроса зубопротезирования. Замещение образовавшихся дефектов зубного ряда возможно и путем имплантации зубов. Параллельно проводят курс витаминотерапии и коррекцию заболеваний, которые могли спровоцировать развитие пародонтоза.</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;\">Профилактические мероприятия сводятся к следующему:</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;\">поддержание на высоком уровне гигиены полости рта;</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;\">регулярное посещение стоматолога для профессиональной чистки зубов от камней и мягких отложений;</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;\">правильное питание, в котором важное место отводится свежим фруктам и овощам, а также продуктам, богатым кальцием, фтором и фосфором;</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;\">отказ от курения;</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;\">лечение внутренних болезней, особенно тех, которые сопровождаются гормональными сбоями, нарушениями кровообращения и обмена веществ, дисфункцией нервной системы.</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;\">Профилактика пародонтоза должна быть комплексной. Только так можно устранить максимальное количество предрасполагающих факторов, способных привести к развитию болезни.</span></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>",
"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 пародонтоза появляются медленно, годами и даже десятилетиями. Длительное время болезнь может себя никак не проявлять. Если пациент заметил, что у него появилась проблема с зубами и деснами, значит, от начала заболевания прошло не менее 10 лет.</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;\">Первые признаки</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;\">В начале болезни больные практически не предъявляют жалоб, поэтому к врачу не обращаются. Среди наиболее типичных жалоб на первое место выходят:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\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;\">зуд или жжение в деснах;</span></li>\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;\">повышенная чувствительность зуба;</span></li>\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;\">появление некариозных повреждений – клиновидных дефектов и эрозий эмали, особенно в области клыков.</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;\">Основные симптомы</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;\">По мере прогрессирования процесса появляются изменения в состоянии зубов и десен:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\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;\">десна бледная, плотная, не блестящая, может быть исчезновение межзубных сосочков, утолщение края десны в виде валика;</span></li>\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;\">наблюдается рецессия (снижение высоты) десны, вследствие чего корни зубов обнажены, чувствительны к температурным и химическим раздражителям;</span></li>\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;\">клиновидные дефекты постепенно углубляются и в тяжелых случаях могут доходить пульповой камеры (развивается пульпит);</span></li>\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;\">увеличение расстояния между зубами (тремы, диастемы), веерообразное их расхождение (касается передних зубов);</span></li>\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;\">постепенное смещение зубов и появление их подвижности (характерно для поздних стадий);</span></li>\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;\">может выявляться незначительное количество наддесневых твердых, пигментированных зубных отложений.</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;\">У молодых людей пародонтозу часто сопутствует вегетососудистая дистония, а у людей старшего возраста – гипертония и атеросклероз. Именно эти заболевания являются ведущими в механизме развития пародонтоза. Вследствие нарушения микроциркуляции наблюдается спазм и следующее за ним кислородное голодание тканей. Следствием этого становится ухудшение доставки питательных веществ, и изменение структуры кости.</span></p>",
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},
"code": "I47",
"name": "Пароксизмальная тахикардия",
"icd_name": "Пароксизмальная тахикардия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "i47_paroksizmalnaya_tahikardiya",
"lead": "Нарушение здоровья, относящееся к группе другие болезни сердца",
"description": "вид аритмии, для которого характерны приступы сердцебиения (пароксизмы) с частотой сердечных сокращений от 140 до 220 и более в минуту, возникающие под влиянием эктопических импульсов, которые приводят к замещению нормального синусового ритма. Обычно приступ начинается внезапно и также внезапно заканчивается. Длительность приступа от нескольких секунд до нескольких часов и суток.",
"etiology": "<p>Частой причиной, вызывающей приступы являются стрессовые реакции — психические или физические. Известно, что стрессовые реакции сопровождаются увеличением содержания адреналина и норадреналина в крови, к которым повышена чувствительность эктопических водителей ритма. этот процесс является одним из патогенетических механизмов пароксизмальной тахикардии.</p>\r\n<p>Возникновение пароксизмальных тахикардий, особенно суправентрикулярных ее форм, связывают также с состоянием нервной системы. Например, хорошо известны случаи пароксизмальной тахикардии с синдромом Вольфа-Паркинсона-Уайта при отсутствии заболеваний сердца. Приступы тахикардии возникали после контузии, а также примерно в одной трети случаев при неврастении и вегетативной дистонии.</p>\r\n<p>Пароксизмальная тахикардия может быть вызвана нервно-рефлекторным путем. В клинике нередко удается установить связь между возникновением приступов пароксизмальной тахикардии и заболеваниями пищеварительного аппарата, диафрагмы, желчного пузыря и почек. Гораздо реже рефлекторные раздражения исходят из других органов — легких и плевры, средостения, позвоночного столба, поджелудочной железы, половых органов.</p>\r\n<p>Желудочковая форма пароксизмальной тахикардии наблюдается чаще при тяжелых органических поражениях сердца. Развитию ишемии в различных областях не только миокарда, но также в специализированной ткани проводниковой системы может способствовать коронарный атеросклероз. Это приводит к возникновению эктопического очага возбуждения в миокарде с высокой степенью автоматизма.<br />У 20 % больных, перенесших инфаркт миокарда выявляется желудочковая тахикардия. Патология может наблюдаться и при других формах ишемической болезни сердца (стенокардия, хроническая коронарная недостаточность, атеросклеротический и постинфарктный кардиосклероз), гипертонической болезни, миокардите, врожденных и приобретенных пороках сердца, тяжелых инфекциях. При тиреотоксикозе и аллергических заболеваниях эта аритмия обнаруживается реже.</p>\r\n<p>Факторы, провоцирующие возникновение аритмии:<br />- эмоциональный стресс;<br />- прием алкоголя;<br />- курение;<br />- гипертонический криз;<br />- прием некоторых медицинских препаратов (сердечных гликозидов).</p>",
"pathogenesis": "<p>Патогенез пароксизмальной тахикардии не до конца изучен. Наибольшее признание получили две теории механизма ее развития — экстрасистолическая и теория «кругового движения».<br /><br />Предполагается, что, как и при экстрасистолии, причиной развития приступа пароксизмальной тахикардии может служить локальное усиление волны возбуждения, приобретающее более устойчивый характер. С этих позиций тахикардия рассматривается как приступ частой непрерывной экстрасистолии.</p>\r\n<p>Возникновение такого рода потологии может возникать вследствие наличия дополнительных путей проведения импульса. Особенно значимыми являются пучок Кента (между предсердием и желудочком) и пучок Джеймса (соединяющий синоатриальный и атриовентрикулярный узлы). При наличии дополнительных пучков происходит как бы «сброс» электрического сигнала ранее, чем это должно происходить в норме, в результате желудочки сокращаются преждевременно. но в большинстве случае этот сигнал возвращается обратно, циркулируя между основным и дополнительным пучком. Это приведет к возникновению наджелудочковой тахикардии. В целом такое состояние называется синдромом предвозбуждения желудочков. Различают два синдрома – Вольфа – Паркинсона – Уайта и Клерка – Леви – Кристеско (синдром укороченного PQ). Таким образом, эти два синдрома могут приводить к развитию суправентрикулярной тахикардии.</p>\r\n<p>Биохимической основой пароксизмальной тахикардии является, прежде всего, нарушение электролитного обмена. При органическом поражении миокарда это нарушение связано, вероятно, с различным содержанием электролитов в пораженной и непораженной части мышцы сердца.</p>",
"diagnostics": "<p>Пароксизмальная тахикардия выявляется по типичности приступа с внезапным началом и окончанием, а также путем исследования частоты сердечных сокращений. Так, при желудочковой форме тахикардии ЧСС обычно не превышает 180 ударов в минуту. При суправентрикулярной тахикардии ЧСС достигает 220-250 уд. в минуту, купирование такого приступа возможно с помощью вагусного маневра.</p>\r\n<p>При регистрации ЭКГ во время приступа определяются характерные изменения формы и полярности зубца Р, а также его расположения относительно желудочкового комплекса QRS, позволяющие различить форму пароксизмальной тахикардии. Для предсердной формы типично расположение зубца Р перед комплексом QRS. При пароксизме, исходящем из предсердно-желудочкового соединения, регистрируется отрицательный зубец Р, расположенный позади комплекса QRS или сливающийся с ним. Для желудочковой формы характерна деформация и расширение комплекса QRS, напоминающего желудочковые экстрасистолы; может регистрироваться обычный, неизмененный зубец Р.</p>\r\n<p>При невозможности зарегистрировать приступ на ЭКГ проводится суточное мониторирование ЭКГ, регистрирующего короткие эпизоды тахикардии, не ощущаемые пациентами. В ряде случаев при пароксизмальной тахикардии проводится запись эндокардиальной электрокардиограммы путем внутрисердечного введения электродов. Для исключения органической патологии проводят УЗИ сердца, МРТ или МСКТ сердца.</p>",
"treatment": "<p>Вопрос о тактике лечения пациентов с пароксизмальной тахикардией решается с учетом формы аритмии, ее этиологии, частоты и длительности приступов, наличия или отсутствия осложнений во время пароксизмов (сердечной или сердечно-сосудистой недостаточности). <br />Большинство случаев желудочковой пароксизмальной тахикардии требуют экстренной госпитализации в отделение кардиологии.<br />До приезда бригады скорой медицинской помощи можно облегчить состояние больного. Для этого в начале приступа необходимо усадить больного, расстегнуть стесняющую одежду, обеспечить доступ свежего воздуха, принять нитроглицерин.</p>\r\n<p><br /><strong>Неотложная помощь при пароксизме включает:</strong></p>\r\n<p><br />Вагусные пробы – приемы, оказывающие механическое воздействие на блуждающий нерв:<br />- проба Вальсальвы (попытка энергичного выдоха при закрытых носовой щели и ротовой полости);<br />- проба Ашнера (равномерное и умеренное надавливание на верхний внутренний угол глазного яблока);<br />- проба Чермака-Геринга (надавливание на область одного или обоих каротидных синусов в области сонной артерии); <br />- попытка вызвать рвотный рефлекс путем раздражения корня языка; обтирание холодной водой и др.<br /> <br />Вагусные пробы направлены на стимуляцию блуждающего нерва, что способствует урежению ритма сердца. Они носят вспомогательный характер, доступны самим пациентам и их родным, но не всегда устраняют аритмию, поэтому введение медикаментов — обязательное условие лечения пароксизма ПТ.<br />Пробы проводят только до момента восстановления ритма, иначе создаются условия для брадикардии и остановки сердца. Массаж каротидного синуса противопоказан пожилым людям с диагностированным атеросклерозом сонных артерий.<br />Медикаментозное лечение. Для купировани приступов аритмии применяются препараты антиаритмики. В стенке клеток миокарда и проводящей системы сердца имеется большое число ионных каналов. Через них идет движение ионов калия, натрия, хлора и других внутрь клетки и из нее. Движение заряженных частиц формирует потенциал действия, то есть электрический сигнал. Механизм действия антиаритмических препаратов заключается в блокаде тех или иных ионных каналов. В результате прекращается течение ионов,и подавляется выработка патологических импульсов, вызывающих аритмию.<br />В ряде случаев при невозможности купировать приступы с помощью лекарственных препаратов используется электрическая кардиоверсия (выполняется при помощи дефибриллятора).</p>\r\n<p>К хирургическому лечению прибегают при особо тяжелом течении пароксизмальной тахикардии и неэффективности противорецидивной терапии. Операция заключается в разрушении дополнительных путей проведения импульса или эктопических очагов самостоятельных сокращений сердца или вживлении электрокардиостимулятора (прибор, поддерживающий или навязывающий оптимальную частоту сердечных сокращений).</p>",
"prevention": "<p>Предупреждение приступов пароксизмальной тахикардии должно проводиться с учетом ее формы, частоты и причины возникновения. При редких приступах (один за несколько месяцев или лет) больному рекомендуется вести здоровый образ жизни (без курения и алкоголя) с исключением физических и психических нагрузок. При частых приступах для их профилактики применяются антиаритмические и седативные лекарственных средства.</p>",
"clinical_picture": "<p>Пароксизмальная тахикардия возникает внезапно, возможно — под влиянием провоцирующих факторов или же среди полного благополучия. Больной замечает четкое время начала пароксизма и хорошо ощущает его завершение. На начало приступа указывает толчок в области сердца, переходящий в усиленное сердцебие. Частота сердечных сокращений во время пароксизма достигает 140-220 и более в минуту при сохраненном правильном ритме. В редких случаях аритмии предшествует аура — начинает кружиться голова, ощущается шум в ушах, сжимающие боли в сердце.</p>\r\n<p><br />Симптомы приступа пароксизмальной тахикардии:</p>\r\n<ul>\r\n<li>Головокружение, обмороки при продолжительном пароксизме;</li>\r\n<li>Слабость, шум в голове;</li>\r\n<li>Одышка;</li>\r\n<li>Сжимающее чувство в сердце;</li>\r\n<li>Неврологические проявления — нарушение речи, чувствительности, гемипарезы, афазия;</li>\r\n<li>Вегетативные расстройства — потливость, тошнота, метеоризм, незначительное увеличение температуры, избыточное выделение мочи низкой плотности.</li>\r\n</ul>\r\n<p>Когда приступ заканчивается, больной испытывает значительное облегчение, становится легко дышать, учащенное сердцебиение прекращается толчком либо чувством замирания в груди.</p>",
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