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"lead": "врожденное аномальное развитие сердца, которое характеризуется развитием дефектов со стороны желудочков и аорты",
"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;\">Причинами аномалии считаются воздействия на плод в ранние сроки беременности (со второй по восьмую неделю):</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;\">инфекционные заболевания будущей матери (краснуха, корь, грипп, скарлатина);</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;\">прием алкоголя или наркотиков;</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;\">лечение гормональными препаратами, седативными и снотворными лекарствами;</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;\">токсическое действие никотина;</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;\">интоксикация промышленными ядовитыми веществами на вредных производствах;</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;\">возможна наследственная предрасположенность.</span></li>\r\n</ul>",
"pathogenesis": "",
"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;\">При объективном обследовании пациентов с тетрадой Фалло обращает внимание бледность или синюшность кожных покровов, утолщение пальцевых фаланг («барабанные палочки» и «часовые стекла), вынужденная поза, адинамия; реже - деформация грудной клетки (сердечный горб). Перкуторно обнаруживается незначительное расширение границ сердца в обе стороны. Типичными аускультативными признаками тетрады Фалло служат грубый систолический шум во II-III межреберье слева от грудины, ослабление II тона над легочной артерией и др. Полная аускультативная картина порока фиксируется с помощью фонокардиографии.</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;\">Рентгенография органов грудной клетки выявляет умеренную кардиомегалию, типичную форму сердца в виде башмачка, обеднение легочного рисунка. ЭКГ-картина характеризуется значительным отклонением ЭОС вправо, гипертрофическими изменениями миокарда правого желудочка, неполной блокадой правой ножки пучка Гиса.</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;\">С помощью УЗИ сердца непосредственно определяются все анатомические компоненты тетрады Фалло: степень ле­гочного стеноза, величина смещения аорты, размер ДМЖП и выраженность гипертрофии правого желудочка.</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;\">Зондирование полостей сердца позволяет выявить высокое давление в правом желудочке, снижение насыщения артериальной крови кислородом, прохождение катете­ра из правого желудочка в аорту. При проведении аортографии и легочной артериографии обнаруживается наличие коллатерального кровотока, ОАП, патологии легочной артерии. При необходимости выполняется левая вентрикулография, селективная коронарография, МСКТ и МРТ сердца.</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;\">Все пациенты с тетрадой Фалло подлежат хирургическому лечению. Медикаментозная терапия показана при развитии одышечно-цианотических приступов: ингаляции увлажненного кислорода, внутривенное введение реополиглюкина, натрия гидрокарбоната, глюкозы, эуфиллина. В случае неэффективности лекарственной терапии необходимо незамедлительное наложение аортолегочного анастомоза.</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;\">Способ оперативной коррекции тетрады Фалло зависит от тяжести течения порока, его анатомо-гемодинамического варианта, возраста пациента. Новорожденным и детям раннего возраста с тяжелой формой тетрады Фалло на первом этапе требуется проведение паллиатив­ных операций, которые позволили бы снизить степень риска осложнений при последующей радикальной коррекции порока.</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;\">К паллиативным (шунтирующим) типам операций при тетраде Фалло относятся: наложение подключично-легочного анастомоза Блелока-Тауссиг, внутриперикардиальное анастомозирование восходящей аорты и правой легочной артери­и, наложение центрального аорто-легочного анастомоза с помощью синтетического или биологического протеза, наложение анастомоза между нисходящей аортой и левой легочной арте­рией и др. Для уменьшения гипоксемии применяются операции открытой инфундибулопластики и баллонной вальвулопластики.</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;\">Радикальная коррекция тетрады Фалло предусматривает проведение пластики ДМЖП и устранения обструкции выходного отдела правого желудочка. Обычно она проводится в возрасте от полугода до 3-х лет.</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;\">Специфических методов профилактики тетрады Фалло не существует. Для предотвращения развития заболевания у ребенка беременной женщине рекомендуется:</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;\">своевременно встать на учет в женской консультации (до 12 недель беременности);</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;\">регулярно посещать акушера-гинеколога (1 раз в месяц в 1 триместре, 1 раз в 2-3 недели во 2 триместре и 1 раз в 7-10 дней в 3 триместре);</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;\">соблюдать режим дня, полноценно питаться;</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;\">исключить воздействие вредных факторов (радиоактивного излучения, контактов с ядовитыми веществами);</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;\">исключить курение (в том числе пассивное) и прием алкоголя;</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;\">принимать лекарственные средства под строгим контролем врача;</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;\">привиться от краснухи (инфекционное заболевание) как минимум за полгода до предполагаемой беременности;</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 наличии тяжелых заболеваний следует провести коррекцию своего состояния до беременности;</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 наличии порока сердца у женщины или близких родственников тщательно наблюдать за плодом для своевременного обнаружение порока сердца, при его возникновении своевременно лечить.</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>",
"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;\">Синдром Тетрада Фалло имеет характерные клинические проявления:</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;\">Синюшность кожных покровов, а также в области губ. Если ребенок плачет, кушает, плачет или натуживается, цианоз может становиться еще больше;</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;\">Задержка физического развития;</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;\">Одышка, слабость, судороги.</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;\">Пальцы утолщаются в виде барабанных палочек;</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 характерного сердечного горба;</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;\">Усиление сердечного ритма;</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;\">Подверженность к вирусным заболеваниям, а также патологиям со стороны дыхательной системы;</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;\">Головокружение, потеря сознания.</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;\">Одышечно-цианотические приступы;</span></li>\r\n</ul>",
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},
"code": "H74.0",
"name": "Тимпаносклероз",
"icd_name": "Тимпаносклероз",
"gender": 0,
"age_min": 20,
"age_max": 100,
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"slug": "h74.0_timpanoskleroz",
"lead": "фиброзирующая форма среднего отита, которая является исходом катарального воспаления слизистой оболочки среднего уха",
"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;\">Определяющими факторами развития тимпаносклероза являются острые или хронические катаральные или гнойные воспаления среднего уха.</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;\">Способствующими факторами являются:</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;\">периодические или постоянные обструкции слуховой трубы;</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;\">наличие хронической перитубарной инфекции в области лимфоаденоидной ткани;</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;\">индивидуальная склонность к преобразованию соединительной ткани в рубцово-склеротическую;</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 обмена веществ, ведущие к пансклерозу, увеличению содержания холестерина и мочевины в 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;\">аллергические реакции;</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 воспалительные заболевания верхних дыхательных путей.</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;\">Возникновение тугоухости обусловлено комбинацией нескольких причин: наличие перфорации барабанной перепонки, ограничение подвижности изменённой барабанной перепонки, дефекты оссикулярной цепи и, что наиболее характерно для данного заболевания, ограничение подвижности или полная фиксация слуховых косточек очагами ТС.</span></p>",
"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;\">Основным субстратом патологии является образование тимпаносклеротического комплекса или бляшки. Они состоят из гиалиновых масс, кальцинатов, оссифицированной ткани. Большая часть бляшек располагается на внутренней оболочке среднего уха или поражает барабанную перепонку. Слизистая теряет эластичность, становится более плотной. Постепенно нарушается способность барабанной перепонки к совершению колебательных движений, уплотняется кольцевидная связка стремечка.</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 барабанной полости формируются соединительнотканные спайки, нарушающие подвижность слуховых косточек. Патологический процесс в слизистой развивается неоднородно: очаги склерозирования сочетаются с очагами вялотекущего катарального воспаления. Фиброзирование может протекать двумя способами: по типу замещения дефекта в слизистой грануляционной тканью с последующим рубцовым перерождением или же путем формирования на его месте соединительной 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;\">Диагностика тимпаносклероза осуществляется на основании данных анамнеза, жалоб пациента, осмотра врача-отоларинголога, комплекса лабораторных и инструментальных исследований. При опросе больного особое внимание уделяется наличию в анамнезе перенесенного ранее отита различной давности или травм барабанной перепонки, а также уточняется время возникновения первых симптомов. Для диагностики заболевания используются:</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;\">Физикальное обследование. При осмотре выявляется истончение кожи в области слухового прохода, реже обнаруживаются серозные выделения. Отоскопическая картина характеризуется наличием дефекта в барабанной мембране или ее утолщением. В редких случаях обнаруживаются атрофические рубцы или наслоения гиалина.</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;\">Микроотоскопия. Тимпаносклеротические изменения среднего уха сопровождаются образованием бляшек на слизистой оболочке и в области барабанной перепонки. Они отграничены от окружающих тканей и плотно спаяны с ними, имеют белесоватый оттенок и различные размеры. Сама слизистая оболочка среднего уха истончена, на ней имеются единичные участки гиперемии. Визуализируется полный или частичный разрыв барабанной перепонки.</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;\">Инструментальные исследования. Магнитно-резонансная томография или КТ височной кости позволяют обнаружить разрушение слуховых косточек, повреждение барабанной полости. С помощью рентгенографии черепа можно определить положение отдельных кальцинатов в составе тимпаносклеротических комплексов.</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;\">Исследование функций органов слуха. С целью подтверждения тугоухости и определения ее степени применяют камертональные пробы. Для склеротита характерны кондуктивная тугоухость или смешанная форма с преобладанием кондуктивного компонента. Это связано с повреждением барабанной перепонки и нарушением проведения звуковой волны. Аудиометрия назначается с целью измерения остроты слуха, значительно снижающейся при заболевании.</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;\">Если заболевание имеет ограниченную форму, то возможно консервативное лечение, которое включает:</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;\">продувание слуховой трубы по Политцеру;</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;\">пневмомассаж барабанной перепонки;</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;\">парентеральное (внутримышечное) введение таких биостимуляторов как алоэ и стекловидное 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;\">транстубарное введение эмульсии гидрокортизона, химотрипсина (катетеризация слуховой трубы);</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 – УВЧ, электрофорез, сеансы лазеротерапии, массаж тубарных валиков с помощью ультразвука, сеансы виброакустической терапии, энауральный фонофорез рассасывающего препарата лидазы;</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;\">витамины группы В и кокарбоксилазы (витаминоподобный препарат).</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;\">Большинство авторов сходится во мнении, что хирургическое лечение является наиболее эффективным способом реабилитации больных, страдающих ТС, хотя отдалённые результаты не всегда являются удовлетворительными. Цель хирургического вмешательства - улучшение слуха и санация среднего уха. Успех операции и стабильность результатов во многом определяется выраженностью ТС процесса, локализацией и характером очагов, сохранностью и подвижностью элементов цепи слуховых косточек, а также состоянием слуховой трубы. Лечение может быть одноэтапным и многоэтапным. Хирургическое вмешательство включает удаление патологических образований из полости среднего уха, мобилизацию сохранных элементов звукопроводящей цепи, реконструкцию оссикулярной цепи и восстановление барабанной перепонки.</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;\">Основными вмешательствами при ТС являются следующие:</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;\">тимпанопластика (мирингопластика) – при очагах ТС не фиксирующих цепь слуховых косточек;</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;\">тимпанопластика (мирингопластика) с мобилизацией цепи слуховых косточек посредством удаления ТС комплексов;</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;\">тимпанопластика (мирингопластика) с оссикулопластикой дефектов слуховой цепи после удаления ТС комплексов;</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;\">стапедотомия и реконструкция звукопроводящей цепи при фиксации стремени.</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p><span id=\"docs-internal-guid-58803b3c-7fff-14f9-5545-fe44fc3f01fb\"><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;\">Профилактикой тимпаносклероза является своевременное и рациональное лечение отита среднего уха. </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;\">Для заболевания характерно медленное течение и постепенное нарастание симптомов. Большинство пациентов через несколько лет после перенесенного среднего отита отмечают периодическое появление шума в ушах, который усиливается во время физических нагрузок или психоэмоционального напряжения. Позже больные замечают постепенное снижение остроты слуха вплоть до полной его потери.</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;\">Около 46% людей отмечают наличие слизистых выделений из наружного слухового прохода, не связанных с каким-либо заболеванием. При длительном течении процесса пациенты предъявляют жалобы на диффузную головную боль без четкой локализации. Если на фоне тимпаносклероза происходит обострение хронического отита, могут возникать характерные клинические проявления в виде болевого синдрома или гнойных выделений из уха.</span></p>",
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"code": "E06",
"name": "Тиреоидит",
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"age_min": 25,
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"slug": "e06_tireoidit",
"lead": "Воспаление неизмененной щитовидной железы.",
"description": "<p>Тиреоидит представляет собой большую категорию новообразований в щитовидной железе, сопровождающихся воспалительными процессами. Наиболее частным видом тиреоидита является хроническое течение.</p>",
"etiology": "<p>Острый гнойный тиреоидит развивается на фоне острого или хронического инфекционного процесса (тонзиллит, пневмония, сепсис и др.).</p>\r\n<p> </p>\r\n<p>Острый негнойный тиреоидит может развиться после травмы, кровоизлияния в щитовидную железу, лучевой терапии.</p>\r\n<p> </p>\r\n<p>Подострый тиреоидит развивается после вирусных инфекций (ОРВИ, Коксаки, инфекционный паротит и др.). Заболевают чаще женщины в возрасте 30-50 лет.</p>\r\n<p> </p>\r\n<p>Аутоиммунный хронический тиреоидит заболевание, в основе которого лежит аутоиммунное поражение щитовидной железы, образуются антитела к различным компонентам щитовидной железы (в норме антитела в организме человека вырабатываются только на чужеродное вещество). Это наиболее часто встречающееся воспалительное заболевание щитовидной железы. Чаще всего аутоиммунный тиреоидит встречается у пациентов от 40 до 50 лет, причем у женщин в десять раз чаще, чем у мужчин. И в последнее время аутоиммунным тиреоидитом страдает все больше пациентов молодого возраста и детей.</p>\r\n<p> Причина хронического фиброзного тиреоидита неизвестна. Есть версия о том, что зоб Риделя это конечная стадия аутоиммунного тиреоидита. Риск развития заболевания имеют люди, у которых наблюдались базедова болезнь или любые формы эндемического зоба.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p>Лабораторная и инструментальная диагностика.</p>",
"treatment": "<p>Острый тиреоидит требует приема антибиотиков, препаратов с витамином C и витаминами группы B, а так же лекарств, которые устраняют симптоматическое проявление болезни. Если имеется абсцесс острого гнойного тиреодита, то неизбежно оперативное вмешательство с целью удаления гнойного накопления. В процессе операции абсцесс вскрывается и из него удаляется весь гной. После этого воспаленное место обрабатывается антибиотиком и закрывается повязкой.</p>\r\n<p>Хронический фиброзный тиреоидит, сопровождающийся возникновением гипотиреоза, требует назначения заместительной терапии препаратами синтетических гормонов щитовидной железы. При обнаружении сдавливания дыхательной трахеи пациенту проводится хирургическая операция.</p>\r\n<p>Подострый тиреоидит лечится длительным приемом препаратов категории «кортикостероиды», лекарств салицилового комплекса при снижении дозы кортикостероидных лекарств. При обнаружении гипертиреоза назначаются медикаменты, которые способны уменьшить количество тиреоидных гормонов в крови больного. При выявлении гипотиреоза назначаются препараты, содержащие тиреоидные гормоны.</p>\r\n<p>Хронический аутоиммунный тиреоидит требует применения препаратов с содержанием тиреоидных гормонов. Если узловой зоб не уменьшается при проведении заместительной терапии в течение 4-х месяцев, то врач может назначить сильные гормональные препараты типа преднизолон, который необходимо принимать не менее 3-х месяцев. Только после этого периода можно снижать ежедневную дозу и постепенно полностью отказываться от препарата. При динамично развивающемся заболевании с болезненными проявлениями и быстрым ростом опухоли требуется незамедлительное хирургическое вмешательство с целью отсечения больной ткани щитовидной железы.</p>",
"prevention": "",
"clinical_picture": "<p>Острый гнойный тиреоидит: боль в области передней поверхности шеи, отдающая в затылок, нижнюю и верхнюю челюсть, усиливающаяся при движении головы, глотании. Увеличение шейных лимфатических узлов. Повышение температуры тела, озноб.</p>\r\n<p> Острый негнойный тиреоидит: проявления менее выражены, чем при остром гнойном воспалении щитовидной железы.</p>\r\n<p> Подострый тиреоидит: боль в области шеи, отдающая в затылочную область, нижнюю челюсть, уши, височную область, головная боль, слабость, снижение двигательной активности, повышение температуры тела. В начале заболевания (гипертиреоидная, острая стадия) могут наблюдаться симптомы тиреотоксикоза: учащение сердечных сокращений, потливость, похудание, тремор рук. В крови - повышенные уровни гормонов щитовидной железы. При длительном течении могут развиться симптомы гипотиреоза (гипотиреоидная стадия), сонливость, вялость, заторможенность, зябкость, отечность лица, сухость кожи, урежение сердечных сокращений, запоры. Щитовидная железа увеличена (часто только правая доля), плотная, болезненная. В крови - низкое содержание гормонов щитовидной железы. <br />В стадии выздоровления исчезает болезненность щитовидной железы, уровни гормонов щитовидной железы.</p>\r\n<p> Заболевание склонно к рецидивированию (возврату), особенно при повторных вирусных инфекциях, переохлаждении.</p>\r\n<p> Хронический фиброзный тиреоидит: диффузное (распространенное), реже очаговое увеличение щитовидной железы. Железа очень плотная, неподвижная, не смещается при глотании.</p>\r\n<p> Прогрессирование и распространение процесса на всю железу сопровождается развитием гипотиреоза. При больших размерах железы наблюдаются симптомы сдавления органов шеи: осиплость голоса, затруднение глотания, дыхания.</p>\r\n<p> Аутоиммунный хронический тиреоидит: в течение первых лет заболевания жалобы и симптомы, как правило, отсутствуют. В дальнейшем, диффузное, иногда неравномерное увеличение щитовидной железы, плотная, подвижная. При больших размерах железы появляются симптомы сдавления органов шеи. По мере развития заболевания изменения, разрушающие щитовидную железу, приводят к нарушению функции железы - вначале явлениям гипертиреоза вследствие поступления в кровь большого количества ранее выработанных гормонов, в дальнейшем (или минуя гипертиреоидную фазу) - к гипотиреозу. Содержание тиреоидных гормонов в крови снижено. В диагностике большое значение имеют определение титра антитиреоидных антител антител против собственной щитовидной железы.</p>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 41,
"published": 1,
"parent": null,
"block_rubric": 45,
"standards": [
5015,
5094,
5097,
5400,
5433,
5434
]
}
]
}
