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"description": "<p>Стенокардия - это не самостоятельное заболевание, а совокупность симптомов, относящихся к болевому синдрому. Стенокардитический синдром или просто стенокардия является проявлением ишемической болезни сердца</p>",
"etiology": "<p align=\"justify\">Ведущей причиной стенокардии, как и ишемической болезни сердца, является вызванное атеросклерозом сужение коронарных сосудов. Приступы стенокардии развиваются при сужении просвета коронарных артерий на 50-70%. Чем выраженнее атеросклеротический стеноз, тем тяжелее протекает стенокардия. Степень тяжести стенокардии также зависит от протяженности и локализации стеноза, от количества пораженных артерий. Патогенез стенокардии часто носит смешанный характер, и наряду с атеросклеротической обструкцией могут иметь место процессы тромбообразования и спазма коронарных артерий.</p>\r\n<p align=\"justify\">Иногда стенокардия развивается только в результате ангиоспазма без атеросклерозирования артерий. При ряде патологий желудочно-кишечного тракта (диафрагмальной грыже, желчнокаменной болезни и др.), а также инфекционно-аллергических заболеваниях, сифилитических и ревматоидных поражениях сосудов (аортит, периартериит, васкулит, эндартериит) может развиваться рефлекторный кардиоспазм, вызванный нарушением высшей нервной регуляции венечных артерий сердца - так называемая, рефлекторная стенокардия.</p>\r\n<p align=\"justify\">На развитие, прогрессирование и проявление стенокардии влияют модифицируемые (устранимые) и немодифицируемые (неустранимые) факторы риска.</p>\r\n<p align=\"justify\">К немодифицируемым факторам риска стенокардии относятся пол, возраст и наследственность. Уже отмечалось, что мужчины наиболее подвержены риску возникновения стенокардии. Эта тенденция преобладает до 50-55 лет, т. е. до наступления менопаузальных изменений в женском организме, когда снижается выработка эстрогенов – женских половых гормонов, «защищающих» сердце и коронарные сосуды. После 55 лет стенокардия встречается у лиц обоего пола приблизительно с равной частотой. Часто стенокардия наблюдается у прямых родственников пациентов, страдающих ИБС или перенесших инфаркт миокарда.</p>\r\n<p align=\"justify\">На модифицируемые факторы риска стенокардии человек имеет возможность повлиять или исключить их из своей жизни. Нередко эти факторы тесно взаимосвязаны, и уменьшение негативного влияния одного устраняет другой. Так, уменьшение жиров в потребляемой пище ведет к снижению холестерина, массы тела и артериального давления. В число устранимых факторов риска стенокардии входят:</p>\r\n<ul>\r\n<li>Гиперлипидемия</li>\r\n</ul>\r\n<p align=\"justify\">У 96% пациентов со стенокардией обнаруживается повышение холестерина и др. липидных фракций, обладающих атерогенным действием (триглицеридов, липопротеинов низкой плотности), что ведет к отложению холестерина в артериях, питающих миокард. Повышение липидного спектра, в свою очередь, усиливает процессы тромбообразования в сосудах.</p>\r\n<ul>\r\n<li>Ожирение</li>\r\n</ul>\r\n<p align=\"justify\">Обычно возникает у лиц, употребляющих высококалорийную пищу с чрезмерным содержанием животных жиров, холестерина и углеводов. Пациентам со стенокардией необходимо ограничение холестерина в питании до 300 мг, поваренной соли – до 5 г, увеличение употребления пищевой клетчатки – более 30 г.</p>\r\n<ul>\r\n<li>Гиподинамия</li>\r\n</ul>\r\n<p align=\"justify\">Недостаточная физическая активность предрасполагает к развитию ожирения и нарушению липидного обмена. Воздействие сразу нескольких факторов одновременно (гиперхолестеринемия, ожирение, гиподинамия) играет решающую роль в возникновении стенокардии и ее прогрессировании.</p>\r\n<ul>\r\n<li>Курение</li>\r\n</ul>\r\n<p align=\"justify\">Курение сигарет повышает в крови концентрацию карбоксигемоглобина – соединения угарного газа и гемоглобина, вызывающего кислородное голодание клеток, в первую очередь кардиомиоцитов, спазм артерий, повышение АД. При наличии атеросклероза курение способствует раннему проявлению стенокардии и повышает риск развития острого инфаркта миокарда.</p>\r\n<ul>\r\n<li>Артериальная гипертония</li>\r\n</ul>\r\n<p align=\"justify\">Часто сопровождает течение ИБС и способствует прогрессированию стенокардии. При артериальной гипертензии из-за повышения систолического АД возрастает напряжение миокарда и увеличивается его потребность в получении кислорода.</p>\r\n<ul>\r\n<li>Анемия и интоксикации</li>\r\n</ul>\r\n<p align=\"justify\">Эти состояния сопровождаются снижением доставки кислорода к сердечной мышце и провоцируют приступы стенокардии, как на фоне коронарного атеросклероза, так и при его отсутствии.</p>\r\n<ul>\r\n<li>Сахарный диабет</li>\r\n</ul>\r\n<p align=\"justify\">При наличии сахарного диабета риск ИБС и стенокардии повышается в 2 раза. Диабетики с 10-летним стажем заболевания страдают выраженным атеросклерозом и имеют худший прогноз в случае развития стенокардии и инфаркта миокарда.</p>\r\n<ul>\r\n<li>Увеличение относительной вязкости крови</li>\r\n</ul>\r\n<p align=\"justify\">Способствует процессам тромбообразования в месте развития атеросклеротической бляшки, повышает риск тромбоза коронарных артерий и развития опасных осложнений ИБС и стенокардии.</p>\r\n<ul>\r\n<li>Психоэмоциональный стресс</li>\r\n</ul>\r\n<p align=\"justify\">Сердце при стрессе работает в условиях повышенной нагрузки: развивается ангиоспазм, возрастает АД, ухудшается снабжение миокарда кислородом и питательными веществами. Поэтому стресс является мощным фактором, провоцирующим стенокардию, инфаркт миокарда, внезапную коронарную смерть.</p>\r\n<p align=\"justify\">В число факторов риска стенокардии также включают иммунные реакции, дисфункцию эндотелия, повышенную частоту сердечных сокращений, преждевременную менопаузу и прием гормональных контрацептивов у женщин и др.</p>\r\n<p align=\"justify\">Сочетание 2-х и более факторов, даже выраженных умеренно, увеличивает суммарный риск развития стенокардии. Наличие факторов риска должно учитываться при определении лечебной тактики и вторичной профилактики стенокардии.</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;\">В основе патогенеза стенокардии лежит нарушение коронарного кровотока вследствие сужения артерии (чем больше степень стеноза, тем, как правило, тяжелее течение стенокардии). Самая частая причина этого — наличие атеросклеротических бляшек (в 95%).</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;\">Чем больше степень стеноза коронарной артерии, тем тяжелее проявления Стенокардии. Последние также зависят от локализации, протяженности, количества стенозов и числа пораженных артерий.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С точки зрения влияния на тяжесть нарушений коронарного кровотока выделяют три степени сужения артерий:</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;\">• несущественная - просвет артерии уменьшается менее 50% (поле сечения диаметра менее 75%) В стабильном состоянии нет патологии, имеется соответствие доставка—потребность;</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;\">• существенная — просвет артерии снижен на 50-80% (поле сечения — на 75-90%). В покое коронарный кровоток не нарушен вследствие ауторегуляции в системе микроциркуляции, которой не достаточно в период ФН, когда рост потребления кислорода (П02) миокардом не компенсируется. Это приводит к ишемии миокарда, что клинически проявляется стенокардией;</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;\">• критическая — диаметр артерии снижен более 80% (поле сечения более 90%). В этих случаях коронарный кровоток неадекватен потребностям даже в покое. Каждое усилие вызывает приступ стенокардии.</span></p>",
"diagnostics": "<p align=\"justify\">При распознавании стенокардии учитывают жалобы пациента, характер, локализацию, иррадиацию, продолжительность болей, условия их возникновения и факторы купирования приступа.</p>\r\n<p align=\"justify\">Лабораторная диагностика включает исследование в крови общего холестерина, АСТ и АЛТ, липопротеидов высокой и низкой плотности, триглицеридов, лактатдегидрогеназы, креатинкиназы, глюкозы, коагулограммы и электролитов крови. Особую диагностическую значимость имеет определение кардиальных тропонинов I и Т - маркеров, свидетельствующих о повреждении миокарда. Выявление этих миокардиальных белков говорит о произошедшем микроинфаркте или инфаркте миокарда и позволяет предупредить развитие постинфарктной стенокардии.</p>\r\n<p align=\"justify\">ЭКГ, снятая на высоте приступа стенокардии, выявляет снижение ST-интервала, наличие отрицательного зубца Т в грудных отведениях, нарушения проводимости и ритма. Суточное ЭКГ-мониторирование позволяет зафиксировать ишемические изменения или их отсутствие при каждом приступе стенокардии, ЧСС, аритмии. Возрастающая перед приступом частота сердечных сокращений позволяет думать о стенокардии напряжения, нормальная ЧСС – о спонтанной стенокардии. ЭхоКГ при стенокардии выявляет локальные ишемические изменения и нарушения сократимости миокарда.</p>\r\n<p align=\"justify\">Велгоэргометрия (ВЭМ) является пробой, показывающей, какую максимальную нагрузку может перенести пациент без угрозы развития ишемии. Нагрузка задается с помощью велотренажера до достижения субмаксимальной ЧСС с одновременной записью ЭКГ. При отрицательной пробе субмаксимальная ЧСС достигается за 10-12 мин. в отсутствие клинических и ЭКГ-проявлений ишемии. Положительной считается проба, сопровождающаяся в момент нагрузки приступом стенокардии или смещением ST-сегмента на 1 и более миллиметр. Выявление стенокардии также возможно путем индуцирования контролируемой преходящей ишемии миокарда с помощью функциональных (чрезпищеводная стимуляция предсердий) или фармакологических (изопротереноловой, пробы с дипиридамолом) нагрузочных тестов.</p>\r\n<p align=\"justify\">Сцинтиграфия миокарда проводится с целью визуализации перфузии сердечной мышцы и выявления в ней очаговых изменений. Радиоактивный препарат таллий активно поглощается жизнеспособными кардиомиоцитами, а при стенокардии, сопровождающейся коронаросклерозом, выявляются очаговые зоны нарушения перфузии миокарда. Диагностическая коронарография проводится для оценки локализации, степени и распространенности поражения артерий сердца, что позволяет определиться в выборе способа лечения (консервативного или хирургического).</p>",
"treatment": "<p align=\"justify\">При развитии приступа стенокардии необходимо удобно сесть, опустив ноги вниз. На фоне продолжающегося приступа категорически запрещено вставать, ходить и выполнять какую-либо физическую работу. Необходимо освободить горло и грудь человека, у которого развился приступ стенокардии , расстегнув рубашку и сняв галстук или шарф. Также следует по возможности открыть форточку или окно, обеспечив доступ свежего воздуха.</p>\r\n<p align=\"justify\">В сидячем, максимально расслабленном положении человек с приступом стенокардии должен разжевать половину или одну стандартную таблетку Аспирина, после чего для облегчения боли положить под язык Нитроглицерин или Нитролингвал. Также для купирования болей можно применять Изокет, прыснув одну дозу под язык. Затем следует спокойно сидеть и ждать окончания приступа стенокардии , который не должен продолжаться дольше 15 минут. Если в течение 3 минут после приема Нитроглицерина или Нитролингвала боль не ослабевает, то можно принять еще одну таблетку. Изокет можно прыскать с интервалом в одну минуту при отсутствии клинического эффекта. Нельзя использовать для купирования одного приступа стенокардии более трех таблеток Нитроглицерина и Нитролингвал или трех доз Изокета.</p>\r\n<p align=\"justify\">Скорую помощь следует обязательно вызвать в следующих случаях:</p>\r\n<ol>\r\n<li>Если приступ стенокардии случился впервые в жизни;</li>\r\n<li>Боль в области сердца продолжается более пяти минут, не утихает или усиливается;</li>\r\n<li>Боль в области сердца усиливается, продолжается более пяти минут и сочетается с трудностями с дыханием, слабостью и рвотой;</li>\r\n<li>Боль в области сердца не прекратилась или усилилась после приема таблетки Нитроглицерина в течение пяти минут.</li>\r\n</ol>\r\n<p align=\"justify\">В вышеуказанных случаях абсолютно необходимо вызвать \"скорую помощь\", поскольку у человека может быть не приступ стенокардии , а начальная стадия инфаркта.</p>\r\n<p align=\"justify\">Плановая медикаментозная терапия стенокардии включает прием антиангинальных (антиишемических) препаратов, уменьшающих потребность сердечной мышцы в кислороде: нитратов пролонгированного действия (эринита, сустака, нитросорбида, нитронга и др.), b-адреноблокаторов (анаприлина, тразикора и др.), молсидомина (корватона), блокаторов кальциевых каналов (верапамила, нифедипина), предуктала и др.;</p>\r\n<p align=\"justify\">В лечении стенокардии целесообразно применение антисклеротических препаратов (группы статинов - ловастатина, зокора), антиоксидантов (токоферола, аевита), антиагрегантов (аспирина).</p>\r\n<p align=\"justify\">По показаниям проводится профилактика и лечение нарушений проводимости и ритма; при стенокардии высокого функционального класса выполняется хирургическая реваскуляризация миокарда: баллонная ангиопластика, аортокоронарное шунтирование.</p>\r\n<p align=\"justify\"> </p>\r\n<p align=\"justify\"> </p>",
"prevention": "<p align=\"justify\">Для эффективной профилактики стенокардии необходимо исключение факторов риска: снижение избыточного веса, контроль за АД, оптимизация диеты и образа жизни и т. д.</p>\r\n<p align=\"justify\">В качестве вторичной профилактики при уже установленном диагнозе стенокардии необходимо избегать волнений и физических усилий, профилактически принимать нитроглицерин перед нагрузками, осуществлять профилактику атеросклероза, проводить терапию сопутствующих патологий (сахарного диабета, заболеваний ЖКТ). Точное следование рекомендациям по лечению стенокардии, прием пролонгированных нитратов и диспансерный контроль кардиолога позволяют достичь состояния длительной ремиссии.</p>",
"clinical_picture": "<p align=\"justify\">Типичным признаком стенокардии являются боли за грудиной, реже левее грудины (в проекции сердца). Болевые ощущения могут быть сжимающими, давящими, жгущими, иногда – режущими, тянущими, сверлящими. Болевая интенсивность может быть от терпимой до весьма выраженной, заставляющей пациентов стонать и кричать, испытывать страх близкой смерти.</p>\r\n<p align=\"justify\">Боли иррадиируют преимущественно в левую руку и плечо, нижнюю челюсть, под левую лопатку, в эпигастральную область; в атипичных случаях – в правую половину туловища, ноги. Иррадиация боли при стенокардии обусловлена ее распространением от сердца к VII шейному и I—V грудными сегментам спинного мозга и далее по центробежным нервам к иннервируемым зонам.</p>\r\n<p align=\"justify\">Боль при стенокардии чаще возникает в момент ходьбы, подъема по лестнице, усилия, стресса, может возникать в ночные часы. Приступ боли продолжается от 1 до 15-20 минут. Факторами, облегчающими приступ стенокардии, являются прием нитроглицерина, положение стоя или сидя.</p>\r\n<p align=\"justify\">Во время приступа пациент испытывает нехватку воздуха, старается остановиться и замереть, прижимает руку к груди, бледнеет; лицо принимает страдальческое выражение, верхние конечности холодеют и немеют. Вначале пульс учащается, затем урежается, возможно развитие аритмии, чаще экстрасистолии, повышение давления.</p>",
"image": null,
"image_alt": null,
"standard_type": 2,
"danger": 66,
"published": 1,
"parent": null,
"block_rubric": 93,
"standards": [
5142
]
},
{
"id": 11002,
"symptoms": [],
"alternative_names": [],
"complications": [],
"medicine_branches": [],
"who": [
{
"id": 14459,
"gender": 2,
"diseased": 12783363,
"deaths": 90254,
"danger": 0.02,
"mortality": 2.1,
"outpatient_days": 3,
"hospital_days": 122,
"diseased_1": 350,
"diseased_1_4": 175,
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},
"code": "A33",
"name": "Столбняк новорожденного",
"icd_name": "Столбняк новорожденного",
"gender": 0,
"age_min": 0,
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"cause": [
5
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"slug": "a33_stolbnyak_novorozhdennogo",
"lead": "Столбняк — острая инфекционная болезнь из группы сапрозоонозов с контактным механизмом передачи возбудителя. ",
"description": "Возбудитель столбняка особо опасен для новорожденных, он может инфицировать малыша через пупочную ранку, что при отсутствии у него антитоксического иммунитета может привести к летальному исходу. ",
"etiology": "<p>Возбудителем столбняка у новорожденного является особый микроб (столбнячная палочка), которой для размножения и роста необходимо отсутствие кислорода. Микробы крайне устойчивы во внешней среде, в виде особых спор они сохраняются в почвах, воде или на поверхности грязных предметов годами. Опасна не сама бактерия, а вырабатываемый ею в условиях размножения в организме токсин. Он относится к сильнейшим нейротропным ядам, что дает сильнейшие проявления со стороны нервной системы.</p>\r\n<p>Учитывая то, что иммунная защита к столбнячному токсину развивается только после вакцинирования, а это делают с 3-ех месяцев, новорожденные не защищены от него. Им опасно попадание возбудителя в область пупочной ранки, так как в области ранки нет кислорода, бацилла активно размножается, токсин проникает в кровь и поражает все отделы нервной системы. Это приводит к гипертонусу всех групп мышц и формированию судорог. Особенно опасно для новорожденных поражение мозга, что может привести к летальному исходу. </p>\r\n<p>Период инкубации у новорожденного крохи короткий, от 2 до 14 дней, область входных ворот инфекции - это пуповина, особенно опасен столбняк для детей, рожденных вне условий стационара с неполноценной обработкой остатка пупочного канатика и несоблюдением правил обработки ран.</p>",
"pathogenesis": "<p>Попадая в организм через повреждения наружного покрова, споры возбудителя остаются в месте входных ворот. При наличии анаэробных условий (некротические ткани, сгустки крови, ишемия, инородные тела, флора, потребляющая кислород) и отсутствии достаточного уровня иммунной защиты споры прорастают в вегетативные формы. После этого начинается интенсивная выработка столбнячного экзотоксина. Токсин гематогенным, лимфогенным и периневральным путями распространяется по организму и прочно фиксируется в нервной ткани. Он избирательно блокирует тормозящее действие вставочных нейронов на мотонейроны прежде всего в двигательных клетках передних рогов спинного мозга. Импульсы, спонтанно возникающие в мотонейронах, беспрепятственно проводятся к поперечнополосатым мышцам, обусловливая их тоническое напряжение.</p>\r\n<p>Постоянное мышечное напряжение сочетается с нарушением микроциркуляции. Возникает порочный круг: метаболический ацидоз и нарушения микроциркуляции ведут к развитию судорог, а судорожный синдром в свою очередь усугубляет метаболический ацидоз и нарушения микроциркуляции. Если больной не умирает на «пике» судорожного приступа от остановки дыхания или сердечной деятельности, то при дальнейшем течении болезни причинами смерти могут быть прямое действие токсина на дыхательный и сосудодвигательный центры в сочетании с глубокими метаболическими нарушениями, а также гнойно-септические осложнения.</p>",
"diagnostics": "<p>Диагноз столбняка в ранние сроки устанавливают, если выявляют <a href=\"/symptom/trizm/\" title=\"Перейти на страницу симптома Тризм\">тризм</a>, сардоническую улыбку и дисфагию. Позднее появляется ригидность мышц затылка; гипертонус распространяется на другие мышцы туловища, присоединяются тетанические судороги, характерная особенность которых — сохранение гипертонуса мышц после приступа. Отличительная черта болезни — ясное сознание, <a href=\"/symptom/vysokaya_temperatura_38-42/\" title=\"Перейти на страницу симптома Высокая температура 38-42° \">лихорадка</a>, <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a> и гиперсаливация.</p>\r\n<p>Лабораторная диагностика столбняка имеет второстепенное значение. При появлении клинических симптомов болезни токсин в крови невозможно обнаружить даже самыми чувствительными методами. Выявление антитоксических антител не имеет диагностического значения, поскольку оно свидетельствует лишь о прививках в анамнезе. При столбняке нарастания титров антител не происходит, так как даже летальные дозы экзотоксина не вызывают иммунного ответа.</p>\r\n<p>В отдельных случаях применяют бактериологические методы (микроскопия мазков-отпечатков, гистологическое исследование тканей, иссекаемых при хирургической обработке ран, посевы раневого отделяемого на питательные среды в анаэробных условиях), позволяющие обнаружить возбудитель в месте расположения входных ворот инфекции. Выделить культуру возбудителя из раны удаётся не более чем у 30% больных.</p>",
"treatment": "<p>Важен лечебно-охранительный режим, помогающий уменьшить частоту судорожных приступов. Пациентов размещают в отдельных палатах, максимально изолируя от внешних раздражителей, способных провоцировать судороги.</p>\r\n<p>Возможности этиотропного лечения весьма ограничены. Проводят хирургическую обработку ран, чтобы удалить нежизнеспособные ткани, инородные тела, вскрыть карманы, создать отток раневого отделяемого, что предотвращает дальнейшую выработку токсина возбудителем.</p>\r\n<p>Для нейтрализации циркулирующего экзотоксина вводят внутримышечно однократно 50–100 тыс. МЕ противостолбнячной очищенной концентрированной сыворотки или, что предпочтительнее, 900 МЕ противостолбнячного иммуноглобулина. На фиксированный в тканях токсин не удаётся воздействовать никакими средствами.</p>\r\n<p>При среднетяжёлом и тяжёлом течении столбняка необходимо назначать миорелаксанты, поэтому больных сразу переводят на искусственную вентиляцию легких.</p>\r\n<p>При тяжёлом течении болезни для борьбы с гиповолемией показана инфузионная терапия (кристаллоиды) под контролем гематокрита, параметров гемодинамики, таких, как центральное венозное давление, давление заклинивания лёгочных капилляров, сердечный выброс, общее периферическое сопротивление сосудов. Показано назначение средств, улучшающих микроциркуляцию (пентоксифиллин, никотиновая кислота) и уменьшающих метаболический ацидоз (раствор натрия гидрокарбоната в расчётных дозах). Эффективно использование гипербарической оксигенации, иммуноглобулинов — иммуноглобулина человека нормального (пентаглобин) и метаболических средств (большие дозы водорастворимых витаминов, триметазидин, мельдоний, анаболические стероиды). При длительной ИВЛ на первый план выходят вопросы ухода за больным.</p>",
"prevention": "<p>Основа профилактики столбняка у новорожденных – роды в условиях стационара и полноценная надлежащая обработка пупочной ранки. Важно также своевременное вакцинирование женщины, планирующей беременность. При ней женщина передает младенцу антитоксический иммунитет, защищающий его от столбняка после рождения.</p>\r\n<p> </p>",
"clinical_picture": "<p>Зачастую столбняк у малышей может начинаться нетипично, и первые его проявления могут быть не сильно выраженными, типичными для многих других проблем в здоровье. Многие родители в начальном этапе отмечают <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">беспокойство</a> детей, плохое сосание груди или отказ от него, формирование запоров, напряжение передней стенки живота. Ребенок может начинать пронзительно кричать, что наталкивает родителей на мысль о том, что у малыша что-либо болит. При этом нет видимых причин боли и о патологии никто не догадывается.</p>\r\n<p>Первый признак заболевания у новорожденных – изменение мышечного тонуса в области мышц лица, особенно жевательной группы. Это приводит к нарушению сосания, его существенному затруднению, а затем присоединяется подрагивание всем телом и конечностями. Также формируется <a href=\"/symptom/sudoroga/\" title=\"Перейти на страницу симптома Судорога\">спазм</a> мышц лица – уголки растягиваются вниз, формируя полулунную форму рта, лоб морщинится, губы вытягиваются в хоботок. Это придает лицу специфическое выражение. Постепенно происходит присоединение судорог на всем теле, сгибаются предплечья в области локтевых суставов, кисти в запястьях, пальчики формируют неразжимаемые кулачки. Ноги при этом неестественно для крохи вытягиваются. Изначально судороги длятся не более нескольких секунд, постепенно частота и длительность их нарастает, при тяжелых приступах они беспрерывны, возникают на фоне незначительных раздражителей (прикосновения, шум, свет). Тонус даже вне судорог резко повышен. Нарушается дыхание ребенка, оно поверхностное учащенное до 100 вздохов в минуту, присоединяются судороги диафрагмы. При приступе ребенок кричит и его дыхание останавливается на 20-40 секунд. Личико бледнеет, затем краснеет и синеет, вены на шее вздуваются. Может урежаться частота сердца и наступает <a href=\"/symptom/obmorok/\" title=\"Перейти на страницу симптома Обморок\">потеря сознания</a>. После приступа цвет лица медленно нормализуется, в легких могут прослушиваться <a href=\"/symptom/hripy/\" title=\"Перейти на страницу симптома Хрипы\">хрипы</a>, что говорит об отеке.</p>\r\n<p>В период судорог родничок выбухает, сильно напряжен, после окончания приступа резко западает. Голос может снижаться, при судорогах полностью исчезает. Присоединяется невозможность глотания, что приводит к нарушению поступления пищи и истощению. Спазмы мышц брюшной полости дают запоры, повышается температура.</p>",
"image": "http://api.symptomd.ru/storage/70408f153b269fa8f55af3bf90ef1422_Znjqc1u.png",
"image_alt": "Столбняк",
"standard_type": 1,
"danger": 71,
"published": 1,
"parent": null,
"block_rubric": 4,
"standards": []
}
]
}
