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},
"code": "D73.0",
"name": "Гипоспленизм",
"icd_name": "Гипоспленизм",
"gender": 0,
"age_min": 30,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "d73.0_giposplenizm",
"lead": "временная или постоянная гипофункция селезенки, вызванная отсутствием, атрофией либо функциональной несостоятельностью ее паренхимы",
"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;\">Гипоспленизмом называют снижение функциональных способностей селезенки. Чаще всего причина кроется в повреждении селезенки в ходе травм, операций или любых сторонних вмешательств. Гипоспления опасна тем, что может вызвать эритроцитоз — патологическое увеличение в крови количества эритроцитов, а также кровяных телец с избытком железа, сидероцитов.</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 гипоспленизма:</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: 6.5pt; font-family: Verdana; color: #252525; 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;\">оперативное удаление селезенки, например, при тяжелой травме селезенки, кистах, опухолях брюшной полости;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">функциональный гипоспленизм, вызванный талассемией, серповидно-клеточной анемией, тромбоцитемией и лимфопролиферативными заболеваниями, в частности лимфомой Ходжкина и неходжкинской лимфомой;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">раковые заболевания (хронический лимфолейкоз);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">воспалительные заболевания кишечника;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">целиакия;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">пересадка костного мозга;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">облучение селезенки или отказ организма принимать донорские органы.</span></p>\r\n</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;\">Гипоспленизм бывает и врожденным, связанным с сердечными аномалиями и билиарной атрезией (непроходимостью желчевыводящих путей).</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;\">При разных причинах гипоспленизма существует общий механизм развития гипофункционального состояния, основанный на выпадении основных функций селезенки. Несмотря на то, что орган обладает высоким функциональным и регенерационным резервом, при сохранении менее 30% объема активной ткани нарушается антиген-зависимая пролиферация и дифференцировка Т-лимфоцитов, снижается продукция опсонинов (в первую очередь — тафцина, обладающего иммуногенным и противоопухолевым эффектом), угнетается фагоцитарная реакция, что в конечном итоге приводит к развитию выраженной иммунной недостаточности.</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;\">Из-за нарушений фильтрующей функции страдает утилизация стареющих элементов крови и опосредованно — обмен пигментов, железа, продукция желчи клетками печени. Поскольку при возникновении гипоспленизма селезенка перестает справляться с функцией депонирования кровяных элементов, увеличивается их содержание в периферической крови.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постановка диагноза при гипоспленизме обычно затруднена только в тех случаях, когда развитие заболевания не связано с удалением селезенки. Это обусловлено скудностью ранних клинических проявлений нехирургической селезеночной гипофункции и отсутствием патогномоничных признаков расстройства. Диагностический поиск предполагает не только оценку структурно-функционального состояния органа, но и комплексное обследование пациента для выявления возможных осложнений. Наиболее информативными являются такие лабораторные и инструментальные методы, как:</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;\">Клинический анализ крови. При гипоспленизме обнаруживают увеличение количества эритроцитов и тромбоцитов. Характерным признаком заболевания считается повышение числа аномальных клеток (мишеневидных эритроцитов, шистоцитов, сидероцитов), появление патологических включений — телец Хауэлла-Джолли (представляют собой остатки клеточного ядра) и телец Папенхайма.</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;\">Эхография. УЗИ селезенки - неинвазивный метод обследования позволяет получить информацию о топографии и размерах органа, подтвердить наличие воспалительных или дегенеративных процессов, визуализировать кисты, новообразования. Сонография всегда проводится при подозрении на закрытые повреждения паренхимы, не сопровождающиеся разрывом органа, которые часто приводят к гипоспленизму.</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;\">Эзофагогастродуоденоскопия. ЭГДС производится при наличии стойких диспепсических симптомов с целью исключения патологии ЖКТ. Метод позволяет визуализировать состояние слизистой верхних отделов пищеварительного тракта, выявить эрозии, язвы, новообразования. Дополнительно осуществляется биопсия для гистологического анализа.</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;\">Также при гипоспленизме рекомендованы анализы крови на содержание витамина В12 и фолиевой кислоты (обычно наблюдается снижение показателей). При изучении коагулограммы зачастую обнаруживается повышение свертывающей способности крови. Для оценки состояния сердечно-сосудистой системы назначают ЭКГ или эхокардиографию. При недостаточной информативности ультразвукового исследования выполняют КТ и МРТ селезенки, позволяющие детально исследовать внутреннюю структуру органа, оценить состояние перфузии, провести денситометрический анализ. Достаточно чувствительным методом является радиосцинтиграфия, ценность которой особо значима для выявления остатков селезеночной паренхимы (спленоза) у прооперированных пациентов.</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>",
"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;\">Терапевтическая тактика зависит от причин, вызвавших развитие селезеночной недостаточности. Основными задачами являются полное или частичное восстановление функций органа при его анатомической сохранности, предупреждение тяжелых инфекционных осложнений. Пациенту рекомендовано соблюдение режима дня, исключение стрессов и значительной физической нагрузки, достаточная двигательная активность, полноценное питание, прием фолиевой кислоты и других витаминов.</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;\">Если гипоспленизм обусловлен не онкологическими заболеваниями, а другой соматической или эндокринной патологией, этиопатогенетическое лечение основного патологического процесса часто сопровождается уменьшением селезеночной гипофункции. Медикаментозная терапия для профилактики генерализованных инфекций предусматривает применение таких препаратов, как:</span></p>\r\n<p> </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: #000000; 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;\">Антибиотики. Рекомендованы антибактериальные средства широкого спектра действия — β-лактамные пенициллины, производные клавулановой кислоты, диаминопиримидины, цефалоспорины II поколения. При постоперационном гипоспленизме антибиотикотерапия начинается сразу после хирургического вмешательства и может продолжаться до 2 лет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #000000; 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;\">Иммунобиологические препараты. Для иммунизации используют поливалентную пневмококковую вакцину, полисахаридную менингококковую вакцину в конъюгации с дифтерийным анатоксином, гемофильную конъюгированную вакцину типа B. Вакцинация выполняется с 8 по 14 день после экстренной спленэктомии, за 2 недели до плановой, ревакцинация — каждые 3-6 лет.</span></p>\r\n</li>\r\n</ul>",
"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 болезни заключается в выполнении органосохраняющих операций на селезенке, аутотрансплантации селезеночной паренхимы при невозможности сохранить орган, своевременном выявлении и лечении предрасполагающих состояний: талассемии, тромбоцитемии, серповидно-клеточной анемии, непереносимости глютена, лимфопролиферативных заболеваний.</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;\">Для предупреждения инфекционных осложнений гипоспленизма рекомендовано информирование спленэктомированных пациентов о повышенной восприимчивости к инфекциям, проведение вакцинации. Больным необходимо избегать посещения стран с высокой распространенностью малярии.</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;\">Поскольку клетки селезенки важны для атаки болезнетворных бактерий и их уничтожения, снижение селезеночной функции приводит к появлению таких симптомов:</span></p>\r\n<p> </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: 6.5pt; font-family: Verdana; color: #252525; 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;\">повышенная восприимчивость к любым инфекциям;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">развитие пневмококковой септицемии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">хронический дефицит фолиевой кислоты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">нарушения работы ЖКТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">разрушение слизистой оболочки ЖКТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #252525; 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;\">расстройства пищеварения.</span></p>\r\n</li>\r\n</ul>",
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},
"code": "I95",
"name": "Гипотензия",
"icd_name": "Гипотензия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "i95_gipotenziya",
"lead": "низкий уровень артериального давления при показателях ниже, чем 90/60 это только результат измерения, но не болезнь и не является жизнеугрожающим состоянием ",
"description": "У лиц с пониженным артериальным давлением (артериальная гипотензия) также могут быть жалобы, причиняющие выраженный дискомфорт. В частности, гипотензия в некоторых случаях проявляется приступами головокружения, снижением внимания и повышенной утомляемостью. Пониженное артериальное давление может оказывать неблагоприятное влияние на умственную деятельность. У здоровых людей на фоне гипотензии возможно замедление реакции и угнетение способности к сосредоточению.",
"etiology": "<p>Постоянная <a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">артериальная гипотензия</a> может носить характер наследственной. Так называемая эссенциальная гипотензия (первичная гипотензия) является наиболее распространенной формой снижения артериального давления. Первичная гипотензия встречается в основном у молодых женщин с пониженной массой тела, чаще в тех случаях, когда существует семейная предрасположенность. В настоящее время отсутствует четкое объяснение причины стойкой гипотензии. Так или иначе, предрасположенность к низкому уровню артериального давления может переходить из поколения в поколение. Например, гипотензия часто наблюдается в одной семье у матери и у дочери. Если жалобы, связанные с низким уровнем артериального давления, отсутствуют, то эссенциальная гипотензия не причинит вреда организму. Более того, гипотензия способна предупреждать развитие заболеваний, связанных с повышенным уровнем артериального давления. Для лиц с гипотензией характерен меньший риск формирования склероза кровеносных сосудов (артериосклероз), а также его последствий, таких как ишемическая болезнь сердца, инфаркт миокарда, инсульт и облитерирующий артериит.</p>\r\n<p>Вторичной гипотензией называется снижение артериального давления вследствие заболевания или действия лекарственного препарата.</p>\r\n<p>Причиной развития гипотензии могут быть следующие заболевания:</p>\r\n<ul>\r\n<li>Гипофункция щитовидной железы (гипотиреоз)</li>\r\n<li>Гипофункция коры надпочечников (болезнь Аддисона)</li>\r\n<li>Гипофункция гипофиза (недостаточность передней доли гипофиза)</li>\r\n<li>Патология сердца (например, сердечная недостаточность, нарушения сердечного ритма, перикардит)</li>\r\n<li>Длительный постельный режим</li>\r\n<li>Дефицит жидкости (гиповолемия)</li>\r\n<li>Дефицит соли (гипонатриемия)</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>Опасение должна вызывать не сама гипотензия, а причины низкого давления. Следует выявить истинные причины такого состояния и обратить на них пристальное внимание, чтобы не допустить развития серьезных заболеваний сердечно-сосудистой и нервной систем.</p>\r\n<p><a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">Артериальная гипотензия</a> чаще всего является физиологическим состоянием организма и опасности не представляет. Наоборот, легче сказать, чем не опасна <a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">гипотония</a>. Гипотоникам не страшна самая коварная болезнь современности, порождающая инфаркты и инсульты, – <a href=\"/symptom/vysokoe_davlenie/\" title=\"Перейти на страницу симптома Высокое давление\">гипертония</a>. При гипотонии кровеносные сосуды дольше остаются чистыми и им не страшен атеросклероз. По статистике, люди с хронической гипотонией живут значительно дольше гипертоников.</p>",
"treatment": "<p>В большинстве случаев медикаментозное лечение гипотонии не требуется. Самые распространенные причины низкого давления – неправильный образ жизни и стрессы. Физиологическую гипотонию лечить <a href=\"/symptom/erektilnaya_disfunkciya/\" title=\"Перейти на страницу симптома Эректильная дисфункция\">не стоит</a>, но о ней нужно обязательно помнить, чтобы не допускать скачков давления. Если беспокоит какой-то один симптом гипотензии, к примеру, <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>, то, прежде всего, стоит наладить режим дня. Одного этого бывает достаточно, чтобы справиться с неприятным состоянием. Можно призвать на борьбу с гипотонией народную медицину.</p>",
"prevention": "<p><a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">Гипотония</a>, если она не вызвана органическими нарушениями, прекрасно может быть скорректирована правильным образом жизни. Чтобы для лечения гипотензии не понадобились лекарства, следует:</p>\r\n<ol>\r\n<li>Соблюдать режим дня;</li>\r\n<li>Высыпаться (как правило, гипотоникам нужно большее количество сна, чем людям с нормальным давлением);</li>\r\n<li>Правильно питаться, обеспечивая себя всеми витаминами и минералами, а если это невозможно при обычном питании, стоит принимать витаминные комплексы;</li>\r\n<li>Пить достаточно воды;</li>\r\n<li>Чаще бывать на воздухе, желательно каждый день совершать прогулку не менее получаса;</li>\r\n<li>Заниматься спортом – даже минимальная физическая нагрузка творит чудеса, это не должен быть профессиональный спорт, конечно, достаточно утренней гимнастики, активных игр с детьми;</li>\r\n<li>Принимать водные процедуры – обливаться прохладной водой, плавать, закаливаться;</li>\r\n<li>Посещать баню или сауну, которые благотворно действуют на тонус сосудов;</li>\r\n<li>Сохранять хорошее настроение и не беспокоиться по пустякам.</li>\r\n</ol>\r\n<p>Это базовые рекомендации, которые необходимо соблюдать всем людям с разным уровнем давления, однако для гипотоников такая профилактика может полностью заменить лечение.</p>",
"clinical_picture": "<p>Кровяное давление – величина измеряемая, его можно определить при помощи тонометра. Если прибор показывает значения 90 мм ртутного столба систолического (так называемого верхнего) и 60 мм ртутного столба диастолического (нижнего) давления или ниже, то такое состояние можно назвать артериальной гипотензией или пониженным давлением.</p>\r\n<p>Помимо показаний тонометра существуют следующие симптомы гипотонии:</p>\r\n<ul>\r\n<li><a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>;</li>\r\n<li><a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>;</li>\r\n<li>чувствительность к погодным изменениям;</li>\r\n<li>эмоциональная неустойчивость, <a href=\"/symptom/apatiya/\" title=\"Перейти на страницу симптома Апатия\">апатия</a>;</li>\r\n<li>рассеянность, ухудшение памяти;</li>\r\n<li><a href=\"/symptom/vyalost/\" title=\"Перейти на страницу симптома Вялость\">вялость</a> по утрам;</li>\r\n<li>повышенная <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a>;</li>\r\n<li>нарушение терморегуляции (холодные кисти и стопы);</li>\r\n<li>чувствительность к смене климатических условий;</li>\r\n<li><a href=\"/symptom/odyshka/\" title=\"Перейти на страницу симптома Одышка\">одышка</a> и сильное <a href=\"/symptom/narushenie_serdechnogo_ritma/\" title=\"Перейти на страницу симптома Нарушение сердечного ритма\">сердцебиение</a> при физических нагрузках;</li>\r\n<li>бледность;</li>\r\n<li><a href=\"/symptom/golovnaya_bol/\" title=\"Перейти на страницу симптома Головная боль\">головная боль</a>, обычно тупая, стягивающая, распирающая или пульсирующая чаще в лобно-височной или лобно-теменной области;</li>\r\n<li>головокружения;</li>\r\n<li>склонность к укачиванию, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>.</li>\r\n</ul>\r\n<p>Артериальная <a href=\"/symptom/nizkoe_davlenie/\" title=\"Перейти на страницу симптома Низкое давление\">гипотония</a> очень часто проявляется обмороками, особенно в душных помещениях. В целом, можно сказать, что люди с пониженным давлением негативно реагируют на малейшие изменения внешней среды – на изменение температуры воздуха, влажности, на духоту, а также на различные эмоциональные раздражители.</p>\r\n<p>Сами по себе перечисленные признаки не являются симптомами, точно подтверждающими наличие гипотензии. Единичные случаи слабости или головокружения не говорят о низком давлении. А вот если симптомов несколько и они постоянны, то стоит обратиться к доктору.</p>",
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"parent": null,
"block_rubric": 99,
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},
{
"id": 11320,
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{
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"periodicity": 1,
"slug": "t68_gipotermiya",
"lead": "критическое переохлаждение организма, когда температура тела падает до 35 °С и ниже",
"description": "<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;\"> </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>",
"etiology": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Постоянство температуры тела поддерживается балансом теплопродукции, то есть соотношением выработки тепла и теплоотдачи. Если теплоотдача начинает преобладать над теплопродукцией, развивается состояние гипотермии.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Основные причины гипотермии:</span></p>\r\n<ul>\r\n<li><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;\">длительная регионарная или общая анестезия;</span></li>\r\n<li><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;\">длительное пребывание на холоде, погружение в холодную воду;</span></li>\r\n<li><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;\">объемная инфузия холодных растворов, цельной крови или ее препаратов.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гипотермия может развиваться вследствие длительного пребывания на холоде или погружения в холодную воду</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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В группу риска по развитию гипотермии входят:</span></p>\r\n<ul>\r\n<li><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;\">дети;</span></li>\r\n<li><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;\">пожилые люди;</span></li>\r\n<li><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;\">лица в состоянии алкогольного опьянения;</span></li>\r\n<li><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;\">пациенты в бессознательном состоянии или обездвиженные (вследствие острого нарушения мозгового кровообращения, гипогликемии, обширных травм, отравления и т. п.).</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Помимо патологической гипотермии, возникающей в результате переохлаждения, существует терапевтическая гипотермия. Она используется с целью снижения риска необратимого ишемического повреждения тканей из-за недостаточного кровообращения. Показаниями к терапевтической гипотермии являются:</span></p>\r\n<ul>\r\n<li><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;\">тяжелая гипоксия новорожденных;</span></li>\r\n<li><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;\">ишемический инсульт;</span></li>\r\n<li><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;\">тяжелые травматические повреждения центральной нервной системы;</span></li>\r\n<li><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;\">нейрогенная лихорадка, возникающая вследствие травмы головного мозга;</span></li>\r\n<li><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;\">остановка сердца.</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;\">Основной метод диагностики гипотермии – определение центральной температуры тела. В данном случае нельзя ориентироваться на показания температуры в подмышечной (аксиллярной) области, так как даже в обычном состоянии разница между центральной и аксиллярной температурой составляет 1–2 градуса. При гипотермии она еще больше.</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;\">Измерение центральной температуры выполняется в наружном слуховом проходе, пищеводе, назофарингеальной области, мочевом пузыре или прямой кишке при помощи специальных электронных термометров.</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;\">Для оценки общего состояния, имеющихся нарушений метаболизма и функций жизненно важных органов проводится лабораторное обследование:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий анализ крови;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">биохимический анализ крови с определением мочевины, креатинина, глюкозы, лактата;</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;\">коагулограмма;</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 крови на кислотно-щелочное равновесие и уровень электролитов (хлоридов, магния, калия, натрия);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">общий анализ мочи.</span></li>\r\n</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;\">Необходим мониторинг состояния пациента (ЭКГ-контроль, пульсоксиметрия, измерение артериального давления, температуры тела, почасовое измерение диуреза).</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>",
"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;\">При умеренной гипотермии пациента (если он находится в сознании) помещают в сухое теплое помещение и согревают, накрывая теплым одеялом с головой, давая горячее питье. Этого может оказаться достаточно.</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 легкой гипотермии достаточно обеспечения пациенту тепла и горячего питья.</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 тяжелой гипотермии также нужно провести активное согревание пациента с учетом ряда моментов. Пострадавшего не следует пытаться согреть целиком, помещая его, например, в ванну с горячей водой, что приведет к расширению периферических кровеносных сосудов и массивному поступлению холодной крови в магистральные сосуды и к внутренним органам.</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 результате произойдут резкое падение артериального давления и снижение частоты сердечных сокращений, что может иметь критические последствия.</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;\">Помимо патологической гипотермии, возникающей в результате переохлаждения, существует терапевтическая гипотермия. Она используется с целью снижения риска необратимого ишемического повреждения тканей из-за недостаточного кровообращения.</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;\">Наиболее эффективно и безопасно внутреннее согревание пациента одним из следующих методов:</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;\">ингаляция увлажненного и подогретого до 45 °С кислорода через интубационную трубку или маску;</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;\">внутривенная инфузия теплого (40–42 °С) кристаллоидного раствора;</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;\">лаваж (промывание) желудка, кишечника или мочевого пузыря теплыми растворами;</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;\">лаваж грудной клетки с помощью двух торакостомических трубок (наиболее эффективный метод согревания даже в самых тяжелых случаях гипотермии);</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;\">лаваж брюшной полости теплым диализатом (показан пациентам с тяжелой гипотермией, сопровождающейся выраженными нарушениями электролитного баланса, интоксикацией или острым некрозом скелетной мускулатуры).</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;\">Активное внутреннее согревание должно быть прекращено, как только центральная температура достигнет 34 °С. Это предотвратит развитие последующего гипертермического состояния. При проведении активного согревания необходим ЭКГ-контроль, поскольку высок риск нарушения ритма сердечных сокращений (желудочковой тахикардии, мерцательной аритмии).</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;\">Защитные меры делятся на два этапа:</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;\">1. Пассивная защита от холода:</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;\">Пассивная защита – это правильно подобранная одежда, в которой есть три отдельных слоя:</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;\">Базовый - убирает влагу от кожи. Лучший вариант – термобелье.</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;\">Термоизоляционный – удерживает тепло.</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;\">Защитный – не дает сырости проникнуть внутрь. В современных куртках – это водонепроницаемая мембрана.</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;\">Одежда должна быть чистой, грязь мешает испаряться влаге.</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;\">2. Активное восполнение тепла:</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;\">Пополнить запасы тепла в организме поможет еда, лучше выбирать высококалорийные порции, плотно обедать перед выходом. Термос с теплым питьем не даст замерзнуть. На холоде не чувствуется жажды, поэтому обезвоживание заработать легче, чем на жаре, а недостаток воды в организме усиливает симптомы гипотермии.</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;\">Внешний источник тепла – самый простой способ согреться. При прогулках по городу нужно делать паузы и заходить в помещения. Подходящий вариант – термохимические и электрические грелки.</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;\">Основная причина гипотермии – потеря тепла на холоде через кожу и дыхание. Включается защитная программа – механизм терморегуляции. Организм спасает важные органы, жертвуя кожными покровами, пальцами рук и ног, носом – без этого человек может выжить.</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;\">Гипотермию разделяют на три стадии:</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;\">1. Лёгкая:</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;\">Температура падает до первой критической отметки 35-34 °С. Появляется дрожь – выделение тепла через мышечную активность. Сосуды сужаются – кожа бледнеет. На этом этапе легко получить обморожение. Замедляется обмен веществ, поэтому человек чувствует заторможенность, апатию, страдает критическое мышление. К симптомам легкой гипотермии относятся проблемы с памятью, человек не помнит куда или откуда направляется. Если гипотермия начинается на природе в этот момент легко потерять ориентиры. Голод и усталость усиливают симптомы.</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;\">2. Средней тяжести:</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;\">Температура тела понижается до 30 °С. Пульс слабый – сердце замедляет работу, чтобы сохранить тепло и защитить мозг. Кожа становится холодной, бескровной – характерного мраморного оттенка. Конечности с трудом сгибаются. Нарушается обмен веществ, и химические реакции в нервной системе. Прогрессируют нарушения сознания – сильная сонливость, нарушения речи, иногда начинаются галлюцинации.</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;\">3. 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},
"code": "H44.4",
"name": "Гипотония глаза",
"icd_name": "Гипотония глаза",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h44.4_gipotoniya_glaza",
"lead": "синдром, патогномоничным признаком которого является снижение внутриглазного давления",
"description": "",
"etiology": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Формирование внутриглазного давления формируется за счет давления стекловидного тела и внутриглазной жидкости на оболочку изнутри. Патологическое снижение внутриглазного давления происходит в следующих случаях:</span></p>\r\n<ul>\r\n<li><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;\">негерметичность швов после операций на глазах</span></li>\r\n<li><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;\">инъекции препаратов в позадибульбарную клетчатку (при лечении прочих заболеваний глаз)</span></li>\r\n<li><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;\">прорыв склеры во время наложения швов на верхнюю прямую мышцу глаза</span></li>\r\n<li><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;\">отслойка сетчатки</span></li>\r\n<li><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;\">побочное действие некоторых лекарственных препаратов</span></li>\r\n<li><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;\">общая гипотония организма и состояние комы</span></li>\r\n<li><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;\">воспалительные процессы радужной оболочки</span></li>\r\n<li><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;\">сбои в процессе формирования внутриглазной жидкости</span></li>\r\n<li><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;\">патология сосудов глаз</span></li>\r\n<li><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;\">пониженное внутричерепное давление</span></li>\r\n<li><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;\">заболевания эндокринной системы</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">При гипотонии глазного яблока уменьшается интенсивность продукции ВГЖ. Это вызвано дефицитом кровоснабжения, который ведет к трофическим нарушениям и ишемии окружающих тканей. Впоследствии развиваются деструктивные изменения цилиарного тела с его дальнейшей дисфункцией. В патогенезе посттравматической гипотонии важная роль отводится гидродинамическим сдвигам. При прободном ранении стойкая офтальмогипертензия после повреждения оболочек глаза сменяется выраженной гипотонией. В ряде случаев тонус глазного блока низкий из-за повышенного оттока камерной влаги. Подобные патологические изменения наблюдаются при отрыве или плоской отслойке цилиарного тела.</span></p>",
"diagnostics": "<p> </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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для диагностирования заболевания глаза проводятся такие методы исследований как:</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<ul>\r\n<li><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;\">общий анализ крови и мочи</span></li>\r\n<li><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;\">коагулограмма, анализ крови на сифилис, сахар, анализ на определение антигена гепатита В</span></li>\r\n<li><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;\">визометрия – исследование для определения остроты зрения</span></li>\r\n<li><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;\">периметрия – обследование, при котором определяют границы поля зрения и области выпадения части поля зрения</span></li>\r\n<li><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;\">офтальмоскопия и измерение глазного давления (тонометрия)</span></li>\r\n<li><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;\">гониоскопия – метод диагностики, используемый для изучения структур передней камеры глазного яблока</span></li>\r\n<li><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;\">биомикроскопия – детальное исследование структур глаза с помощью специального оптического прибора</span></li>\r\n</ul>",
"treatment": "<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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Этиотропная терапия при сниженном офтальмотонусе направлена не только на повышение ВГД, но и на улучшение кровоснабжения оболочек глаз, что увеличивает активность метаболических процессов в его структурах. Для этого внутривенно вводятся плазмозаменители и ангиопротекторы. При гипотонии, вызванной нарушением продукции ВГЖ, целесообразно назначение циклоплегических мидриатиков и сосудорасширяющих средств. Рекомендовано попеременное применение антиоксидантов (метилэтилпиридинол) и синтетических глюкокортикостероидов (дексаметазона фосфат). Однако данные методы позволяют повысить внутриглазное давление лишь на короткий промежуток времени.</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: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Эффективным способом воздействия на синтез ВГЖ принято считать лазерную стимуляцию цилиарного тела. Для восстановления офтальмотонуса у лиц с ранее проведенной антиглаукоматозной операцией показана пластика фильтрующей зоны. Для этого в полость фильтрационной подушки вводится раствор объемно-структурированного геля коллагена. Выполняется ревизия зоны хирургического вмешательства. Пластика тканей осуществляется путем наложения дополнительных швов на трепанационное отверстие и склеральный лоскут.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p 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-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для снижения оттока водянистой влаги используются такие методы физического воздействия, как диатермия, лазерная терапия и криоапликации. При проникающем ранении глаза необходимо свести края раны с целью достижения полной герметизации. В случае выраженного уменьшения размера стекловидного тела рекомендовано интравитреальное введение силикона, изотонического раствора хлорида натрия или гиалона.</span></p>\r\n<p> </p>",
"prevention": "<p><span style=\"font-family: Verdana; font-size: 9.33333px; white-space: pre-wrap;\">Специфические превентивные меры не разработаны. Неспецифическая профилактика направлена на предупреждение травмирования глаз. Для этого рекомендовано использовать средства индивидуальной защиты (очки, маски) при высоком риске травматизации.</span></p>",
"clinical_picture": "<p> </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 незначительном уменьшение внутриглазного давления отмечается развитие плавающих помутнений и мушек перед глазами. При продолжительном течении заболевания у пациента могут возникать головные боли, которые локализируются в области затылка. Больные могут жаловаться на повышенную утомляемость при зрительных нагрузках. При тяжелой степени гипотонии может выявляться снижение остроты зрения. Также больные могут отмечать появление дискомфорта при движении глазных яблок и снижение периферического зрения. Интенсивные боли в глазном яблоке могут указывать на травматическую природу заболевания. При возникновении заболевания на фоне инфекции отмечается покраснение сосудов конъюнктивы и развитие усиленного слезотечения.</span></p>",
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"danger": 30,
"published": 1,
"parent": 6465,
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},
{
"id": 6233,
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{
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"name": "акушерство и гинекология",
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"lead": "Область медицины, включающая в себя лечение 739 заболеваний. В 1042 клиниках России оказывается помощь по этому направлению медицины.",
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{
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"name": "лабораторная генетика",
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