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"lead": "воспалительное поражение кровеносных сосудов",
"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;\">Облитерирующий тромбангиит - воспалительный тромбоз мелких артерий, среднего размера артерий и некоторых поверхностных вен, вызывающий артериальную ишемию дистальных отделов конечностей и поверхностный тромбофлебит. Главный фактор риска - курение.</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;\">До настоящего времени причины данного заболевания так до конца и не выяснены. Но на основании многолетних наблюдений за пациентами с облитерирующим тромбангиитом удалось выявить некоторые причинно-следственные связи. К ним можно отнести:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Наследственность, т. е. если данное заболевание наблюдалось хотя бы у одного из кровных родственников (у бабушки, дедушки, мамы, папы или кого-то из братьев и сестёр).</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Аутоиммунный механизм повреждения сосудов циркулирующими иммунными комплексами. В этом случае иммунная система человека вместе защиты организма человека от внешних воздействий, таких как вирусы, бактерии, паразиты и др. возбудители инфекций, начинает повреждать собственные клетки, \"считая\" их врагами. По каким причинам это происходит, к сожалению, медицине до сих пор точно неизвестно.</span></li>\r\n<li style=\"list-style-type: none; font-size: 8pt; font-family: Verdana; color: #181d21; 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;\">Самая главная причина, без которой заболевание не развивается, даже если у человека есть наследственная предрасположенность и аутоиммунная настроенность организма — это табакокурение. В настоящее время выяснено, что 98 % больных облитерирующим тромбангиитом, а по некоторым данным 100 %, являются злостными курильщиками. Именно в связи с этим заболевание еще называют болезнью молодых курильщиков.</span></p>\r\n</li>\r\n</ul>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Первичными в звене патогенеза облитерирующего тромбангиита считаются наследственность и генетическая предрасположенность. В последние годы признаётся важная роль собственных антигенов гистосовместимости (совместимости тканей) в осуществлении ряда основных функций иммунитета человека. Это создаёт предпосылки для понимания механизмов взаимосвязи между антигенами совместимости тканей (они ещё называются HLA-антигены, или human leukocyte antigens) и болезнями. Считается, что эти гены регулируют иммунный ответ и являются посредниками в различных иммунологических реакциях, в том числе патологических (вызывающих заболевание). Однако даже наличие наследственности и генетической предрасположенности не приводит к развитию заболевания без внешних провоцирующих факторов, основным из которых является табакокурение.</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;\">Важно знать, что для развития заболевания не нужен большой стаж курения и не нужно выкуривать по несколько пачек сигарет, достаточно 1-2 сигарет в сутки и через промежуток времени от месяца до года могут возникнуть симптомы заболевания. Но только в том случае, если у пациента имеется генетическая предрасположенность.</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;\">Итак, когда необходимые звенья патогенеза собрались в цепь и были запущены курением, в сосудах мелкого и среднего калибра поэтапно начинают развиваться патологические изменения.</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;\">Никотин, содержащийся в табаке, попадает в кровь и начинает воздействовать на внутреннюю поверхность сосудов — эндотелий. В результате нормальный эндотелий становится изменённым и организм начинает воспринимать его как чужеродный, опасный для себя. При этом запускается механизм выработки циркулирующих иммунных комплексов (это специальные защитники нашего организма для борьбы с чужеродными клетками). Иммунные комплексы в крови взаимодействуют с эндотелием сосудов и начинают атаковать его. В результате в стенке артерии или вены возникает множество повреждённых участков, стенки сосудов воспаляются и утолщаются.</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 таком воспалённом сосуде происходит стаз кровотока (замедление, сгущение) и образуются тромбы. Эти сгустки крови перекрывают просвет сосуда, кровоснабжения тканей ухудшается, что, в свою очередь, является причиной нарушения трофики (клеточного питания) и возникновения клинических симптомов заболевания.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В общем и биохимическом анализах крови выявляются неспецифические изменения: лейкоцитоз, рост СОЭ, увеличение фибрина, серомукоида, гаптоглобина, сиаловых кислот, γ-глобулинов. При иммунологическом исследовании определяются антигены HLA В5, А9, DR4. Коагулограмма при облитерирующем тромбангиите выявляет повышенную свертываемость крови и агрегацию тромбоцитов.</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 проведении кожной термографии и теплометрии определяются зоны пониженной температуры, свидетельствующие о нарушении кровообращения в дистальных отделах конечностей. Степень микроциркуляторных нарушений уточняется в ходе радиоизотопного сканирования (сцинтиграфии), УЗДГ, реовазографии, рентгеноконтрастной ангиографии периферических сосудов. При ЭКГ обнаруживаются ишемические изменения в сердце.</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;\">Медикаментозное лечение включает прием ангиоспазмолитических препаратов (ксантинола никотината, дротаверина, кислоты никотиновой, циннаризина, алпростадила); нестероидных анальгетиков; средств, улучшающих реологические показатели крови (пентоксифиллина, ацетилсалициловой к-ты, дипиридамола) и трофику тканей (витаминов группы В, никотиновой кислоты, аденозинмонофосфата, пирикарбата, даларгина).</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;\">Пациентам с облитерирующим тромбангиитом назначается тренировочная ходьба, фотогемотерапия (УФОК, ВЛОК), плазмаферез, гемосорбция, гипербарическая оксигенация, санаторное лечение.</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 неэффективности консервативной терапии пациенту необходима консультация сосудистого хирурга. Хирургическое лечение облитерирующего тромбангиита может заключаться в проведении поясничная симпатэктомии, операции обходного шунтирования пораженных сосудов, баллонной ангиопластики или ампутации конечности.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика заболевания заключается в соблюдении правил здорового образа жизни:</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;\">категорическом отказе от курения;</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;\">правильном питании;</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;\">активном двигательном режиме (ежедневная ходьба, лёгкий бег, скандинавская ходьба, катание на велосипеде, плавание);</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;\">соблюдении режима сна и бодрствования (необходим полноценный ночной сон длительностью 6-8 часов в сутки).</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 для профилактики заболевания важно регулярно проходить плановые медицинские осмотры.</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;\">Поражение периферических артериальных путей при облитерирующем тромбангиите носит двусторонний характер с заинтересованностью обеих верхних либо нижних конечностей от дистальных до проксимальных отделов. Облитерирующий тромбангиит отличается триадой признаков: перемежающейся хромотой, синдромом Рейно и поверхностным мигрирующим тромбофлебитом дистальных участков конечностей.</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;\">Клинические проявления перемежающейся хромоты включают боли в стопе и икроножных мышцах во время ходьбы; при поражении верхних конечностей в процессе выполнения действий руками боли возникают в кистях и предплечьях. Отмечается бледность и цианотичность пальцев, повышение чувствительности стоп и кистей к холоду, появление кровоизлияний и болезненных узелков на коже подушечек пальцев. Тяжелые ишемические поражения конечностей при облитерирующем тромбангиите проявляются болями в покое, отсутствием пульсации на артериях стопы и рук, изъязвлениями, трофическими нарушениями и гангреной пальцев вплоть до самоампутации некротизированных зон.</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;\">Вовлеченность венечных артерий выражается развитием стенокардии и инфаркта миокарда. При поражении брыжеечных артерий возникают резкие боли в животе, кровотечения из пищеварительного тракта, язвы и некрозы стенки кишки. При заинтересованности сосудов мозга возможно развитие инсульта, ишемического неврита зрительных нервов. Тромбозы почечных артерий ведут к инфарктным изменениям паренхимы почки.</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;\">Обострения облитерирующего тромбангиита провоцируются холодом и частым курением, возможно развитие вторичного инфицирования мягких тканей конечностей.</span></p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": 6562,
"block_rubric": 97,
"standards": []
},
{
"id": 7219,
"symptoms": [
{
"id": 2941,
"synonyms": [
{
"name": "астеническое состояние"
},
{
"name": "астенический синдром"
},
{
"name": "астения"
},
{
"name": "упадок сил"
},
{
"name": "бессилие"
}
],
"body_points": [
{
"x": 464,
"y": 904,
"r": 300
}
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"code": "R55",
"name": "Обморок [синкопе] и коллапс",
"icd_name": "Обморок [синкопе] и коллапс",
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"slug": "r55_obmorok_sinkope_i_kollaps",
"lead": "Нарушение здоровья, относящееся к группе общие симптомы и признаки",
"description": "Обморок - потеря сознания, возникающая в результате недостаточности кровообращения головного мозга. \r\nКоллапс - остро развивающаяся недостаточность сосудов, сопровождающаяся снижением артериального давления, при этом больной не теряет сознание.",
"etiology": "<p>Острая сосудистая недостаточность способна провоцировать обморок и коллапс может развиваться из-за ряда факторов: </p>\r\n<ul>\r\n<li>потеря большого количества крови из-за внутренних разрывов, серьезных внешних повреждений; </li>\r\n<li>быстрая смена положения лежачего пациента; </li>\r\n<li>время полового созревания у девушек; </li>\r\n<li>перенесение всевозможных инфекционных болезней (дизентерии, ОРВИ, вирусного гепатита, пневмонии); </li>\r\n<li>отравление организма от злоупотребления лекарственными препаратами или же пищевая интоксикация; </li>\r\n<li>сбой сердечного ритма: ИМ, тромбоз, миокардит; </li>\r\n<li>поражение электрическим током; </li>\r\n<li>сильно повышенная внешняя температура: тепловой шок. </li>\r\n</ul>",
"pathogenesis": "<p>В основе патогенеза острой сосудистой недостаточности лежит снижение тонуса гладкой мускулатуры сосудистой стенки, приводящее к нарушению адекватного соотношения между объемом циркулирующей крови и емкостью сосудистого русла. В результате развивается гипоксия головного мозга и угнетение жизненно важных функций организма. </p>",
"diagnostics": "<p>В диагностике важно определить наличие и характер продромальных явлений, состояние вне обморока и коллапса, наличие заболевания сердца, нарушения ритма и проводимости. Может быть полезной электрокардиография, исследование крови на сахар. При повторяющихся коллапсах применяются ортостатическая проба, суточное мониторирование АД и ЭКГ. </p>",
"treatment": "<p>Обморок часто не нуждается в медикаментозном лечении. Достаточно уложить больного, лучше приподнять ноги, расстегнуть стесняющую грудь и шею одежду. Можно сбрызнуть лицо водой, похлопать по щекам, поднести ватку, смоченную нашатырным спиртом. Если это не помогает, можно сделать инъекции сосудосуживающих препаратов. </p>\r\n<p>Лечение коллапса направлено на устранения причин его возникновения. Его проводят в условиях стационара. Больного необходимо уложить, приподнять ноги, согреть. Перед транспортировкой делают инъекцию сосудосуживающего препарата. </p>\r\n<p>В условиях стационара назначают лекарственные вещества, действующие как на механизмы возникновения острой сосудистой недостаточности, так и на устранение причины, вызвавшей ее развитие. </p>\r\n<ul>\r\n<li>Препараты, возбуждающие сосудистый и дыхательный центры. Повышают тонус сосудов, увеличивают ударный объем сердца. </li>\r\n<li>Сосудосуживающие вещества. Внутривенное капельное введение адреналина, норадреналина допамина или других гормонов. </li>\r\n<li>Дезинтоксикационная терапия. Включает введение антидотов и детоксикационных растворов. Они обязательны при отравлениях и инфекционных заболеваниях. </li>\r\n<li>Кровь и кровезаменители. Применяют при кровопотере и анемии. При введении необходимо провести пробу на совместимость с кровью больного, а то это может привести к развитию геморрагического шока. </li>\r\n<li>Противовоспалительные средства. Антибиотики назначаются при инфекционных заболеваниях. </li>\r\n<li>Оксигенотерапия. Назначается с целью улучшения обмена веществ и насыщения крови кислородом. </li>\r\n<li>Восстановление объема крови. Вводятся коллоидные растворы, плазма и солесодержащие препараты. </li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p>Лучшей профилактикой недостаточности функции сосудов является предупреждение заболеваний, которые могут ее вызывать. Рекомендуется следить за состоянием сосудов, употреблять меньше холестерина, проходить регулярные обследования системы кровоснабжения и сердца. В отдельных случаях гипотоникам назначают профилактический курс поддерживающих давление препаратов.</p>",
"clinical_picture": "<p>Обмороки проявляются внезапной слабостью, дурнотой, головокружением, онемением рук и ног с последующей кратковременной полной или частичной потерей сознания. Кожа бледная, конечности холодные, дыхание редкое, поверхностное, зрачки узкие, реакция на свет сохранена, пульс малый, артериальное давление низкое, мышцы расслаблены. Продолжается несколько минут, после чего обычно проходит самостоятельно. </p>\r\n<p>Симптомы коллапса: </p>\r\n<p>беспричинный приступ слабости и усталости, головокружение, бледность кожи, озноб, ледяные конечности, холодный липкий пот, пульс сбивчивый, учащенный, цианоз, резкое снижение АД, обморок, судороги. </p>",
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