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Во многих случаях установить точную причину не удается.</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 самым распространенным причинам инфекционного миокардита относятся:</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;\">- вирусные инфекции, среди которых наибольшее значение имеет энтеровирус Коксаки, вирус гриппа А и В, кори, краснухи, инфекционного мононуклеоза и гепатита В;</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;\">- бактериальные инфекции, прежде всего стафилококковая, стрептококковая и дифтеритическая;</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;\">- некоторые паразиты, прежде всего трипаносомы и токсоплазмы;</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;\">- грибы (кандиды, возбудители аспергиллеза и гистоплазмоза).</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;\">Неинфекционные факторы, вызывающие миокардит:</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;\">- лекарственные препараты (антибиотики, сульфаниламиды);</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;\">- наркотические вещества (кокаин);</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;\">- избыток гормонов щитовидной железы;</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;\">- нарушение функции почек;</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;\">- сыворотки и вакцины;</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;\">- заболевания соединительной ткани (неспецифический язвенный колит, склеродермия, ревматоидный артрит, ревматизм, системные васкулиты, гранулематоз Вегенера, системная красная волчанка);</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;\">- травмы и ожоги;</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- факторы неустановленного происхождения (идиопатический миокардит Абрамова – Фидлера).</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>",
"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;\">Вне зависимости от причины заболевания, изменения, возникающие в сердечной мышце, носят схожий характер. В результате воспаления развивается отек миокарда и его кровоснабжение ухудшается. Отдельные клетки могут разрушаться с выбросом в кровь веществ, в том числе и фрагментов белка, которые воспринимаются защитной системой организма как чужеродные из-за их сходства с белками некоторых бактерий и вирусов. Это приводит к активизации иммунной системы и развитию реакции на собственные ткани. Степень выраженности этих реакций во многом определяет тяжесть заболевания.</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;\">По течению различают острые и хронические миокардиты. Течение заболевания во многом зависит от его причины. Инфекционный миокардит чаще всего носит острый или подострый, иногда рецидивирующий характер, в хроническую форму переходит редко. Неинфекционный миокардит обычно переходит в хроническую прогрессирующую форму с развитием таких осложнений, как нарастающая сердечная недостаточность, нарушение сердечного ритма, образование тромбов, инфаркт.</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;\">На приеме у врача рассматриваются жалобы и история болезни пациента. Если есть подозрение на миокардит, то назначается следующая диагностика:</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;\">- Физические осмотры. Измерение кровяного давления, температуры тела и частоты сердечных сокращений. Также рекомендуется прослушивание легких и сердца с помощью стетоскопа.</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;\">- Исследование крови. Проводится для определения возбудителя болезни (бактерии или вирусы).</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;\">- Рентген. С помощью рентгеновских снимков грудной клетки можно обнаружить признаки сердечной недостаточности, вызванной миокардитом. В этом случае сердце увеличено, и можно дополнительно увидеть скопление жидкости в легких.</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;\">- Ультразвуковое исследование сердца (эхокардиография). Определяет наличие слабости насоса и дисфункций сердечной мышцы. Функция сердечного клапана и размер сердца также могут быть оценены при УЗИ.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- ЭКГ-исследование. Электрокардиограмма показывает изменения, которые могут указывать на воспаление при миокардите. Типичными для ЭКГ при воспалении сердечной мышцы являются экстрасистолы (дополнительные сердцебиения). ЭКГ также позволяет определить точное место воспаления сердечной мышцы.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение воспаления сердечной мышцы зависит от присутствующих симптомов и от соответствующего триггера. Крайне важно, чтобы пациент избегал любых физических нагрузок. Это касается не только спортивных мероприятий, но и повседневной работы в домашнем хозяйстве. Пациент остается недееспособным до тех пор, пока есть признаки сердечной слабости.</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 врач назначает пациенту строгий постельный режим, необходимо следить за тем, чтобы не образовались сгустки крови. Чтобы предотвратить это, врач назначает ингибиторы свертывания крови.</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 в рамках различных исследований были обнаружены причинные возбудители миокардита, с этим можно бороться медикаментозно. При бактериально обусловленном миокардите врач назначает больному антибиотики. Если воспаление сердечной мышцы было вызвано вирусами, то антибактериальная терапия является неэффективной.</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;\">Специфической профилактики миокардита не существует. Основные меры, направленные на предупреждение миокардита включают в себя:</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;\">- Плановые профилактические прививки</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;\">- Ограничение контакта с лицами, страдающими острой вирусной инфекцией</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;\">- Своевременное лечение вирусных заболеваний</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;\">- Соблюдение правил личной гигиены</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">- Здоровый образ жизни, исключающий риск заражения ВИЧ, отказ от наркотиков, ограничение алкоголя.</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;\">При остром миокардите в некоторых случаях проявляются симптомы быстро прогрессирующей сердечной слабости. При этом не только ухудшается общее состояние пострадавшего, но и появляется следующая клиническая картина:</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;\">- одышка;</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;\">- ощущение давления или боль за грудиной;</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;\">- сердцебиение;</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;\">- нарушение сердечного ритма;</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;\">- бледность из-за недостатка кислорода в крови;</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">- отек или увеличение селезенки и печени;</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;\">- отечность нижних конечностей.</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;\">Все эти симптомы могут привести к сильной одышке у человека, страдающего миокардитом, уже при легких физических нагрузках.</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 воспаление сердечной мышцы принимает хроническое течение, симптомы являются довольно неспецифическими и выражаются:</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;\">- разбитостью и быстрой утомляемостью;</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;\">- нарушением аппетита и потерей веса;</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;\">- ломотой в теле и общей слабостью;</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;\">- снижением производительности труда.</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;\">Эти симптомы схожи с простудными заболеваниями, что существенно усложняет постановку точного диагноза воспаления сердечной мышцы. 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"description": "Острый назофарингит - это ЛОР-заболевание, в основе которого лежит воспалительный процесс слизистой оболочки носоглотки, чаще всего инфекционного происхождения (вирусы, бактерии). ",
"etiology": "<p>Острый назофарингит имеет вирусную или, реже, бактериальную этиологию. </p>\r\n<p>В роли инфекционных агентов вирусной природы в основном выступают риновирусы, бактериальной природы - стрептококки, стафилококки, диплококки, пневмококки и другая микрофлора, обычно обнаруживаемая в носоглотке в непатогенной форме. </p>\r\n<p>Среди предрасполагающих факторов можно выделить следующие: </p>\r\n<ul>\r\n<li>ослабление иммунитета; </li>\r\n<li>переохлаждение; </li>\r\n<li>травмы слизистой носа; </li>\r\n<li>авитаминоз; </li>\r\n<li>тяжелые физические нагрузки; </li>\r\n<li>вдыхание задымленного, едкого воздуха. </li>\r\n</ul>",
"pathogenesis": "<p>Входными воротами инфекции служит слизистая оболочка носа и, возможно, верхних дыхательных путей. </p>\r\n<p>Их размножение реализуется в эпителиоцитах слизистой оболочки носа, что сопровождается разрушением клеток, развитием местной воспалительной реакции катарального характера с полнокровием и расширением сосудов, умеренной инфильтрацией, резким набуханием, отёчностью слизистой оболочки и обильной секрецией. </p>\r\n<p> </p>",
"diagnostics": "<p>Для постановки диагноза проводят анализ жалоб и сбор анамнеза. Необходимо грамотно провести объективный осмотр больного, особенно полости рта и глотки пациента. </p>\r\n<p>Выполняется общий анализ крови для оценки характера заболевания. </p>\r\n<p>При неясной картине заболевания проводят специальные инструментальные исследования: риноскопию и фарингоскопию. </p>\r\n<p>Риноскопия — информативный метод осмотра полости носа. </p>\r\n<p>Фарингоскопия — методика осмотра глотки при искусственном освещении с помощью шпателя и носоглоточного зеркала. Позволяет увидеть небные миндалины, язычок, заднюю стенку глотки. </p>\r\n<p>Для подбора эффективного лечения проводится микробиологическое исследование. Определяется характер возбудителя и наиболее эффективное антибактериальное средство. </p>\r\n<p> </p>",
"treatment": "<p>При повышенной температуре тела и нарушении общего состояния рекомендуется постельный режим, прием жаропонижающих средств. Больному необходимо обильное питье, особенно полезны для этого свежевыжатые разбавленные фруктовые соки, морсы, компоты, некрепкий чай с лимоном. </p>\r\n<p>Если заболевание вызвано бактериями, врач назначает антибиотики. Чаще всего, лекарственные препараты назначаются местно в виде капель или спрея. </p>\r\n<p>При нарушении носового дыхания применяют сосудосуживающие средства. Их длительное применение более недели приводит к пересыханию слизистой оболочки и еще более выраженному нарушению носового дыхания. </p>\r\n<p>Хорошие результаты дает применение физиотерапевтических процедур: кварц, УФО, УВЧ. </p>\r\n<p>Боли в горле облегчает полоскание отварами трав или растворами антисептиков. </p>",
"prevention": "<p>Комплекс профилактических мероприятий против назофарингита складывается из нескольких правил: </p>\r\n<ul>\r\n<li>Правильного и регулярного питания. Необходимо употреблять много овощей и фруктов, пить больше воды и принимать поливитамины. </li>\r\n<li>Соблюдать санитарные условия в доме, проветривать помещение, не допускать повышения влажности. </li>\r\n<li>Регулярно промывать носовую полость. </li>\r\n<li>Необходимо больше проводить времени на свежем воздухе. </li>\r\n<li>Соблюдать режим труда и отдыха, сна и бодрствования. </li>\r\n<li>Во время процветания болезни требуется избегать большого скопления народа.</li>\r\n</ul>",
"clinical_picture": "<p>Острый назофарингит имеет 3 стадии развития: </p>\r\n<ol>\r\n<li>На начальной стадии возникает ощущение дискомфорта в носоглотке </li>\r\n<li>На втором этапе наблюдается большое количество серозного отделяемого </li>\r\n<li>На третьей стадии выделения приобретают серозно-гнойный характер. </li>\r\n</ol>\r\n<p>У взрослых заболевание протекает легче, чем у детей. Температура может оставаться нормальной или незначительно повышаться. В детском возрасте назофарингит часто сопровождается лихорадкой и нарушением общего состояния. Симптомами заболевания могут быть: </p>\r\n<ul>\r\n<li>Заложенность носа </li>\r\n<li>Покраснение и отек слизистой оболочки носа </li>\r\n<li>Вязкое отделяемое по задней стенке носоглотки </li>\r\n<li>Затруднение носового дыхания </li>\r\n<li>Нарушение обоняния </li>\r\n<li>Повышение температуры </li>\r\n<li>Боль в ушах и снижение слуха </li>\r\n<li>Головные боли. </li>\r\n</ul>\r\n<p> </p>",
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},
"code": "J05",
"name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"icd_name": "Острый обструктивный ларингит [круп] и эпиглоттит",
"gender": 0,
"age_min": 0,
"age_max": 94,
"cause": [
2,
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],
"periodicity": 1,
"slug": "j05_ostryy_obstruktivnyy_laringit_krup_i_epiglottit",
"lead": "Нарушение здоровья, относящееся к группе острые респираторные инфекции верхних дыхательных путей",
"description": "Острый обструктивный ларингит (круп) - воспаление гортани и тканей подскладочного пространства с сужением просвета гортани. Ранее также использовался термин «стенозирующий ларинготрахеит» \r\n\r\nЭпиглоттит – это остро возникшее бактериальное воспаление надгортанника и окружающих тканей, которое может привести к быстрому жизнеугрожающему нарушению проходимости дыхательных путей. ",
"etiology": "<p>Наиболее часто причинно значимыми возбудителями острого обструктивного ларингита являются респираторные вирусы, причем до 80% случаев крупа обусловлено вирусом парагриппа. </p>\r\n<p>В числе прочих возбудителей болезни: вирусы гриппа А и В, аденовирусы, респираторно-синцитиальный вирус, риновирусы, энтеровирусы, бокавирус, коронавирус, метапневмовирус. В крайне редких случаях круп может быть обусловлен бактериальными возбудителями, например, микоплазмой пневмонии. </p>\r\n<p>Этиологическим фактором эпиглоттита в подавляющем большинстве случаев является гемофильная палочка типа b (>90%). В странах, где введена массовая иммунизация против гемофильной инфекции, у вакцинированных детей встречаются эпиглоттиты другой этиологии. В редких случаях эпиглоттит могут вызывать стрептококки, золотистый стафилококк, менингококк. </p>\r\n<p>Неинфекционные причины крупа и эпиглоттита: </p>\r\n<ul>\r\n<li>термические и химические повреждения вследствие приема горячей пищи или проглатывания препаратов бытовой химии; </li>\r\n<li>травмы, вызываемые слепым касанием пальца при попытке удалить инородное тело из глотки; </li>\r\n<li>отек Квинке; </li>\r\n<li>гемофагоцитарный лимфогистиоцитоз; </li>\r\n<li>острая лейкемия; раздражение при курении наркотиков (марихуана, крэк, кокаин); </li>\r\n<li>реакция на проводимую химиотерапию. </li>\r\n<li>лимфопролиферативные заболевания. </li>\r\n</ul>",
"pathogenesis": "<p>В основе механизма развития крупа лежит: </p>\r\n<ul>\r\n<li>Воспалительный отек с клеточной инфильтрацией голосовых связок и слизистой подскладочного пространства и трахеи и прилегающих тканей. </li>\r\n<li>Гиперсекреция слизистых желез, скопление в просвете дыхательных путей густой мокроты. </li>\r\n</ul>\r\n<p>Патогенез эпиглоттита </p>\r\n<p>При внедрении инфекции очень быстро развивается воспаление надгортанника и поддерживающей его черпаловидно-подгортанной складки. Надгортанник становится отечным и гиперемированным; его обычно твердая структура размягчается. Свисая и отклоняясь кзади, надгортанник закрывает вход в гортань, вызывая тяжелую обструкцию дыхательных путей. </p>\r\n<p>Выброс бактерий и их токсинов в кровь приводит к увеличению проницаемости микрососудов легкого, повышению гидростатического давления в малом круге кровообращения и скоплению жидкости в интерстициальном пространстве. Ухудшаются вентиляционно-перфузионные отношения, развиваются гипоксемия (снижение кислорода в крови), гиперкапния (повышение углекислого газа в крови), ацидоз (снижение рН крови). </p>",
"diagnostics": "<p>Диагноз обструктивного ларингита является клиническим и ставится, как правило, на основании анамнеза и симптомов осиплости голоса, лающего кашля, инспираторного стридора. </p>\r\n<p>Эпиглоттит диагностируется на основании характерных клинических признаков. </p>\r\n<p>Лабораторная диагностика включает общий анализ крови, определение уровня С-реактивного белка, при необходимости – уровень прокальцитонина (маркеры воспаления). </p>",
"treatment": "<p> Консервативное лечение крупа </p>\r\n<ul>\r\n<li>Согласно международному консенсусу, а также рекомендациям Всемирной организации здравоохранения, основу лечения острого обструктивного ларингита составляют ингаляционные и системные глюкокортикостероиды. </li>\r\n<li>При тяжелом крупе или отсутствии кортикостероидов возможно ингаляционное применение эпинефрина. </li>\r\n<li>При снижении сатурации крови кислородом ниже 92% показана оксигенотерапия. Стеноз гортани 3-й степени требует неотложной интубации. </li>\r\n</ul>\r\n<p> Консервативное лечение эпиглоттита </p>\r\n<ul>\r\n<li>Не рекомендуется укладывать ребенка, пациент должен находиться в положении сидя, в т.ч., при транспортировке в стационар. </li>\r\n<li>Рекомендована ранняя интубация для профилактики внезапной асфиксии (удушья). </li>\r\n<li>При эпиглоттите категорически не рекомендуется ингалировать, осуществлять седацию, провоцировать беспокойство. </li>\r\n<li>В обязательном порядке рекомендована антибактериальная терапия. Антибактериальная терапия должна быть продолжена до 7 – 10 дней. Начинают лечение обычно с парентерального (внутривенного) введения антибактериального препарата, после купирования лихорадки и нормализации состояния продолжают лечение пероральными антибиотиками. </li>\r\n<li>При асфиксии и невозможности проведения интубации проводится трахеотомия. </li>\r\n</ul>",
"prevention": "<p>Рекомендуется неспецифическая профилактика респираторных вирусных инфекций. </p>\r\n<p>В случае рецидивирования симптомов крупа у детей с гастроэзофагеальным рефлюксом рекомендовано соблюдение противорефлюксного режима с учащенными кормлениями меньшими порциями, а также проведение регулярных курсов противорефлюксной терапии. </p>\r\n<p>К мерам специфической профилактики следует отнести вакцинацию против гриппа, а также вакцинацию против гемофильной и пневмококковой инфекций для предупреждения развития эпиглоттита. </p>",
"clinical_picture": "<p>Обструктивный ларингит (круп) обычно начинается с неспецифических симптомов острой респираторной вирусной инфекции: появляются обильный насморк, першение в горле, кашель. </p>\r\n<p>Чаще протекает на фоне невысокой температуры, редко – на фоне фебрильной лихорадки. </p>\r\n<p>Как правило, симптомам стеноза гортани предшествуют признаки ларингита: осиплость голоса и/или сухой грубый кашель. При прогрессировании воспалительного процесса в гортани осиплость может усиливаться, кашель приобретает лающий характер, появляется шумное дыхание или шумный вдох (стридор). При нарастании степени стеноза гортани развивается инспираторная одышка (затрудненный вдох), которую можно заметить по втяжению яремной ямки на вдохе. </p>\r\n<p>Симптомы обструктивного ларингита обычно развиваются вечером, ночью, нередко в предутренние часы. </p>\r\n<p>I (стадия компенсации) - осиплость, грубый навязчивый кашель, умеренная одышка </p>\r\n<p>II (стадия неполной компенсации) - осиплость, грубый навязчивый кашель, выраженная одышка, возбуждение, дыхание с участием вспомогательной мускулатуры, втяжением податливых мест грудной клетки, раздуванием крыльев носа, цианоз (синюшность) носогубного треугольника, тахикардия </p>\r\n<p>III (стадия декомпенсации) - осиплость, грубый навязчивый кашель, беспокойство, страх, возможна апатия, резкая одышка с выраженным втяжением податливых мест грудной клетки, бледность, акроцианоз </p>\r\n<p>IV (терминальная стадия, асфиксия) - сознание отсутствует, резкая бледность и цианоз, гипотермия, возможны судороги, расширение зрачков, дыхание частое, поверхностное, артериальная гипотензия, нитевидный пульс. Эта стадия предшествует остановке дыхания и сердца. </p>\r\n<p>Эпиглоттит является тяжелой бактериальной инфекцией. </p>\r\n<ul>\r\n<li>заболевание обычно начинается остро с высокой температуры и нарушения общего состояния, </li>\r\n<li>характерны боль в горле, тризм (спазм жевательной мускулатуры), слюнотечение, нарушение глотания, поза «треножника», приоткрытый рот, </li>\r\n<li>быстрое развитие стридора, западение надгортанника в положении на спине. </li>\r\n</ul>\r\n<p>Типичного для крупа лающего кашля не отмечается. </p>",
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"lead": "Нарушение здоровья, относящееся к группе болезни желчного пузыря, желчевыводящих путей и поджелудочной железы",
"description": "Острый панкреатит — стремительно развивающееся воспаление поджелудочной железы, обусловленное поражением органа собственными ферментами, заболевание без лечения может угрожать жизни пациента. Заболевание возникает чаще в возрасте 30—60 лет, причем у женщин в 2 раза чаще, чем у мужчин.",
"etiology": "<p>Факторы, способствующие возникновению острого панкреатита:</p>\r\n<ul>\r\n<li>злоупотребление алкоголем (в 70% случаев), вредные пищевые привычки (жирная, острая пища);</li>\r\n<li>заболевания желчевыводящих путей, в том числе желчнокаменная болезнь (в 25-30% случаев);</li>\r\n<li>вирусные (эпидемический паротит, вирус Коксаки) или бактериальные инфекции;</li>\r\n<li>травмы поджелудочной железы;</li>\r\n<li>хирургические вмешательствапо поводу других патологий поджелудочной железы и желчевыводящих путей;</li>\r\n<li>прием эстрогенов, кортикостероидов, тиазидных диуретиков, азатиоприна, других лекарственных средств с выраженным патологическим действием на поджелудочную железу (медикаментозный панкреатит);</li>\r\n<li>врожденные аномалии развития железы, генетическая предрасположенность, муковисцидоз;</li>\r\n<li>воспалительные заболевании органов пищеварения (холецистит, гепатит, гастродуоденит).</li>\r\n</ul>",
"pathogenesis": "<p>В развитии острого воспаления поджелудочной железы основным фактором выступает повреждение клеток преждевременно активированными ферментами самой железы. В нормальных условиях пищеварительные ферменты вырабатываются поджелудочной железой в неактивной форме и активизируются уже в пищеварительном тракте. Под воздействием внешних и внутренних патологических факторов механизм выработки нарушается, ферменты (фосфолипаза А и липаза) активизируются в поджелудочной железе и начинают переваривание ее собственной ткани. Вследствие этого развивается воспаление, отек ткани, поражаются сосуды паренхимы железы.</p>\r\n<p>Патологический процесс при остром панкреатите может распространяться на близлежащие ткани: забрюшинную клетчатку, сальниковую сумку, брюшину, сальник, брыжейку кишечника и связки печении ДПК. Тяжелая форма острого панкреатита способствует резкому повышению уровня различных биологически активных веществ в крови, что ведет к выраженным общим нарушениям жизнедеятельности.</p>\r\n<p> </p>",
"diagnostics": "<p>Лабораторная диагностика:</p>\r\n<p>При исследовании крови в общем анализе отмечаются признаки воспаления (ускорена СОЭ, повышено содержание лейкоцитов), в биохимическом анализе крови обнаруживают повышение активности панкреатических ферментов (амилаза, липаза), возможна гипергликемия и гипокальциемия. Также проводят определение концентрации ферментов в моче. Может отмечаться билирубинемия и повышения активности печеночных ферментов.</p>\r\n<p>При диагностировании острого панкреатита берут биохимический анализ мочи и определяют активность амилазы мочи.</p>\r\n<p>Инструментальная диагностика:</p>\r\n<p>При ультразвуковом исследовании обнаруживают снижение эхогенности паренхимы железы и появление отсутствующего в норме просвета сальниковой сумки за счёт скопления в ней выпота</p>\r\n<p>Рентгеновское исследование брюшной полости обычно малоинформативно, однако иногда позволяет выявить как косвенные признаки воспалительного процесса в поджелудочной железе</p>\r\n<p>КТ имеет преимущество перед ультразвуковым исследованием, так как обеспечивает лучшую специфическую визуализацию ткани поджелудочной железы.</p>\r\n<p>МРТ позволяет оценить уровень тканевого метаболизма, наличие ишемии, некроз панкреатоцитов. Это важно при оценке течения заболевания до развития тяжёлых состояний и осложнений.</p>\r\n<p>Ангиография позволяет установить нарушения кровообращения в поджелудочной железе и окружающих тканях и органах. Эти данные позволяют определиться с прогнозом и тактикой хирургического вмешательства.</p>\r\n<p>ЭГДС относится к дополнительным методам инструментального исследования острого панкреатита.</p>\r\n<p> </p>",
"treatment": "<p>Тактика лечения больных с острым панкреатитом определяется клинико-морфологической формой заболевания в соответствии с фазой развития воспалительного и некротического процесса и степенью тяжести состояния больного. Оптимальным видом лечения ОП в доинфекционной фазе является интенсивная консервативная терапия, а при появлений инфекционных (септических) осложнении – оперативное лечение.</p>\r\n<p>Немедикаментозное лечение: Голод в течение 2-3 суток, постоянное назогастралъное зондирование и аспирация, местная гипотермия (холод на живот). </p>\r\n<p> Для лечения нетяжёлого панкреатита достаточно проведения базисного лечебного комплекса: - анальгетики; - спазмолитики; - инфузионная</p>\r\n<p>Базисную терапию целесообразно усиливать антисекреторной и антиферментной.</p>\r\n<p>При отсутствии эффекта от проводимой базисной терапии в течение 6 часов и наличии хотя бы одного из признаков тяжёлого панкреатита следует констатировать тяжёлый панкреатит и перевести больного в отделение реанимации и интенсивной терапии и проводить лечение, соответствующее тяжёлому острому панкреатиту.</p>\r\n<p>Протокол интенсивной терапии тяжёлого панкреатита</p>\r\n<p>Основной вид лечения - интенсивная консервативная терапия. Приведенный выше базисный лечебный комплекс при тяжёлом ОП является недостаточно эффективным и должен быть дополнен специализированным лечебным комплексом. Эффективность последнего максимальна при раннем начале лечения (первые 12 часов от начала заболевания). Хирургическое вмешательство в виде лапаротомии показано лишь при развитии осложнений хирургического профиля, которые невозможно устранить эндоскопическими методами (деструктивный холецистит, желудочно-кишечное кровотечение, острая кишечная непроходимость и др.).</p>\r\n<p>Специализированное лечение. 1) Антисекреторная терапия (оптимальный срок - первые трое суток заболевания); 2) Антикоагулянты; 3) Возмещение плазмопотери (коррекция водно-электролитных, белковых потерь и др.; 4) Антиферментная, антиоксидантная и антигипоксантная терапия. 5) Детоксикация – при тяжёлом ОП показаны экстракорпоральные методы детоксикации, из которых наиболее эффективным является серийный лечебный плазмаферез. 6) Антибиотикотерапия широкого спектра действия (цефалоспорины III-IV поколений или фторхинолоны II-III поколений в сочетании с метронидазолом).</p>\r\n<p>Хирургическое лечение показано в случае выявления:</p>\r\n<p>камней в желчных протоках; скоплений жидкости в железе или вокруг нее; участков панкреатического некроза, кист, абсцессов.</p>\r\n<p>К операциям, проводимым при остром панкреатите с образованием кист или абсцессов, относятся: эндоскопическое дренирование, марсупиализация кисты, цистогастростомия и др. При образовании участков некроза, в зависимости от их размера, проводят некрэктомию или резекцию поджелудочной железы. Наличие камней является показанием к операциям на протоке поджелудочной железы.</p>\r\n<p>К хирургическому вмешательству могут прибегать и в случае сомнений в диагностики и вероятности пропустить другое хирургическое заболевание, требующее хирургического лечения.</p>",
"prevention": "<p>Первичной профилактикой панкреатита является рациональное здоровое питание, исключение алкоголя, острой, жирной обильной пищи, отказ от курения. Острый панкреатит может развиться не только у лиц, регулярно злоупотребляющих алкоголем, но и как следствие однократного приема спиртосодержащих напитков под жирную, жареную и острую закуску в больших количествах.</p>",
"clinical_picture": "<p>Характерные симптомы острого панкреатита.</p>\r\n<ul>\r\n<li>Болевой синдром. Боль может локализоваться в эпигастрии, левом подреберье, нередко носит опоясывающий характер, может отдавать под левую лопатку. Боль носит выраженный постоянный характер, в положении лежа на спине усиливается. Усиление боли происходит и после приема пищи, особенно – жирной, острой, жареной, алкоголя.</li>\r\n<li>Тошнота, рвота. Рвота может быть неукротимой, содержит желчь, не приносит облегчения. Как правило, из-за интоксикации и рвоты наступает нарушение водно-электролитного баланса, обезвоживание, которое играет важную роль в патогенезезаболевания.</li>\r\n<li>Повышение температуры тела.</li>\r\n<li>Умеренно выраженная желтушность склер. Редко – легкая желтуха кожных покровов.</li>\r\n</ul>\r\n<p>Кроме того, острый панкреатит может сопровождаться диспепсическими симптомами (вздутие живота, метеоризм, изжога), кожными проявлениями (синюшные пятна на левой боковой стенке живота, иногда с желтоватым оттенком, кровоизлияния в области пупка).</p>",
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}
]
}
