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},
"code": "F10",
"name": "Алкоголизм",
"icd_name": "Психические и поведенческие расстройства, вызванные употреблением алкоголя",
"gender": 0,
"age_min": 16,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "f10_alkogolizm",
"lead": "Неумеренное употребление спиртных напитков (пьянство), приводящее к психическим и поведенческим нарушениям",
"description": "В медицинском смысле это болезнь, относящаяся к группе токсикоманий и характеризующаяся совокупностью определенных болезненных изменений в организме под влиянием чрезмерного употребления спиртных напитков.",
"etiology": "<p>Причины употребления алкоголя – его определенное влияние на психическое и физическое состояние человека. На психическую сферу алкоголь оказывает релаксирующее (расслабляющее, снимающее напряжение), эйфоризирующее и отчасти седативное действие. Потребность в таком эффекте больше у лиц плохо адаптированных, в частности с невротическими и психопатическими особенностями, облегчающими как начало алкоголизации, так и ее углубление. Имеют значение и микросреда, воспитание, традиции, психическое и физическое перенапряжение, психотравмирующие ситуации. Определенное значение имеет отягощенная наследственность. Особое социальное значение имеет хронический алкоголизм (алкогольная болезнь) – непреодолимое (болезненное) влечение к алкоголю, связанное с психической и физической зависимостью от него и, как следствие, с постоянным его употреблением, приводящим к психическим и физическим расстройствам (алкогольной энцефалопатии, полинейродистрофии, дистрофии и циррозу печени). Алкоголизм формируется медленно и проходит несколько стадий.</p>",
"pathogenesis": "<p>Первая стадия алкоголизма определяется рядом признаков, таких как:</p>\r\n<p> </p>\r\n<p>1) симптом исчезновения рвоты в выраженном опьянении;</p>\r\n<p>2) снижение и даже утрата способности контролировать количество употребляемого алкоголя;</p>\r\n<p>3) алкогольная амнезия – запамятование отдельных событий, происходивших накануне и во время выпивки;</p>\r\n<p>4) потребность во все возрастающих дозах алкоголя для достижения выраженного опьянения – симптом повышения толерантности.</p>\r\n<p> </p>\r\n<p>Первая стадия алкоголизма чаще всего продолжается от 3 до 6 лет. Вторая стадия алкоголизма – дальнейшее развитие алкогольной токсикомании. Самый важный и наиболее постоянный признак, свидетельствующий о наступлении второй стадии, – появление абстинентного похмельного синдрома. Все чаще больной выпивает в одиночку, тайком, становится раздражительным, придирчивым, нередко агрессивным, толерантность к алкоголю становится наивысшей. Абстинентный синдром (<a title=\"Перейти на страницу симптома Похмельный синдром\" href=\"../../../symptom/pohmelnyy_sindrom/\">похмелье</a>) характеризуется тем, что на следующий день после сильного опьянения принятое небольшое количество алкоголя уменьшает или снимает соматические и психические нарушения, но на очень кратковременный период, затем необходимо употребление следующей дозы алкоголя, вплоть до повторного сильного опьянения.</p>\r\n<p> </p>\r\n<p>Характерным признаком третьей стадии болезни является снижение толерантности к алкоголю. Пьянство не прекращается, т. е. больной постоянно находится в состоянии тяжелого опьянения или оно носит характер длительных запоев. Синдром абстиненции не успевает развиваться. Происходит стойкое ухудшение соматического состояния – отмечаются резкая <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома потливость\" href=\"../../../symptom/potlivost/\">потливость</a>, сосудистая <a title=\"Перейти на страницу симптома Дистония\" href=\"../../../symptom/distoniya/\">дистония</a>, <a title=\"Перейти на страницу симптома Нарушение сердечного ритма\" href=\"../../../symptom/narushenie_serdechnogo_ritma/\">нарушение сердечного ритма</a> и дыхания (вследствие алкогольной кардиомиопатии), <a title=\"Перейти на страницу симптома Анорексия\" href=\"../../../symptom/anoreksiya/\">анорексия</a>, похудание (вследствие поражения печени – жировой дистрофии, алкогольного цирроза). В третьей стадии алкоголизма резко выражены изменения личности, на первый план выступает откровенное стремление к выпивке, все чаще больные употребляют суррогаты. Они злобны, грубы, агрессивны, находятся в состоянии тупой эйфории, сильно страдает память, сон. Нередки алкогольные психозы. В третьей стадии алкоголизма происходят стойкие прогрессирующие изменения во всем организме, во всех органах и тканях.</p>",
"diagnostics": "<p>В диагностике используют данные о злоупотреблении алкоголем, наличии патологического влечения к опьянению, измененной устойчивости к алкоголю, наличии абстинентного синдрома, изменений личности.</p>\r\n<p>Имеют значение характерные нарушения нервной системы, типичные повреждения внутренних органов.</p>\r\n<p>Полисистемный характер поражения позволяет диагностировать алкоголизм врачам любой специализации. На поздних стадиях диагноз затруднений не вызывает. В начальных стадиях можно использовать лабораторные методы — биологические маркеры хронического употребления алкоголя: повышение активности алкогольдегидрогеназы (АДГ) и микросомальной этанолокисляющей системы; снижение активности альдегидрогеназы; обнаружение гиперлипидемии, общей гиперхолестеринемии, гипертриглицеридемии; повышение уровня холестерина в составе липопротеидов высокой плотности (ХЛВП).</p>\r\n<p>Факт хронической алкогольной интоксикации подтверждают высокая и колеблющаяся при 2—3-кратном исследовании (в течение 1—10 дней) активность комплекса ферментов глутамил-трансферазы (ГГТ), аланинаминотрансферазы (АЛТ) и аспартатаминотрансферазы (ACT), щелочной фосфатазы (наиболее часто и значительно повышается активность ГГТ в сочетании с ACT).</p>\r\n<p>Колебания активности свидетельствуют в пользу интоксикационной природы отклонений и позволяют отличить их от ферментопатий патологии внутренних органов. При воздержании в раннем периоде заболевания активность ферментов возвращается к норме. Сформированная патология удерживает высокую активность ГГТ, АЛТ и ACT до полугода.</p>\r\n<p>Алкогольная миокардиодистрофия характеризуется следующими изменениями на ЭКГ: синусовой тахикардией , суправентрикулярной экстрасистолией, мерцательной аритмией , изменениями зубца Т и интервала S-T. В первой—начале второй стадиях алкоголизма характерно укорочение интервала P-Q, косовосходящее смещение сегмента S-T, высокий заостренный зубец Т в отведениях V2—V5. Со второй стадии (при алкогольном анамнезе более 10 лет) помимо описанных изменений регистрируются увеличение левого желудочка, нарушения внутрижелудочковой проводимости в виде расщепления и уширения комплекса QRS, возможно появление отрицательного зубца Т.</p>\r\n<p>Эхокардиография выявляет распространенные изменения миокарда, увеличение полостей сердца.</p>\r\n<p>Исследование кровообращения на первой стадии выявляет изменения по гиперкинетическому типу с увеличением минутного объема и понижением периферического сопротивления; при прогрессировании заболевания отмечается гипокинетический тип кровообращения со стойким снижением сердечного выброса.</p>\r\n<p>При развитии острого алкогольного панкреатита помимо типичных клинических проявлений, характерны изменения со стороны клеток крови: лейкоцитоз со сдвигом лейкоцитарной формулы влево и ускорение СОЭ. В моче повышен уровень альфаамилазы. Биохимическое исследование крови также выявляет повышение уровня альфаамилазы, липазы, трипсина, гаммаглобулинов, сиаловых кислот и серомукоида. При хроническом панкреатите описанные изменения характерны для развития обострений. Кроме того, отмечается снижение устойчивости к глюкозе при проведении стандартного теста.</p>\r\n<p>Острый алкогольный гепатит приводит к воспалительной реакции белой крови: лейкоцитозу со сдвигом формулы влево, повышению СОЭ. Содержание билирубина в сыворотке крови, ACT и АЛТ многократно превышают нормальные показатели. Хронический алкогольный гепатит характеризуется преходящей гипербилирубинемией, диспротеинемией — гипоальбуминемией и гипергаммаглобулинемией.</p>\r\n<p>Алкогольные психозы диагностируют при наличии хронического алкоголизма и клиники психоза, в том числе динамики симптомов. Следует помнить, что алкоголизм может наслаиваться или провоцировать развитие многих психических заболеваний, поэтому в каждом отдельном случае необходимо тщательное психиатрическое обследование.</p>\r\n<p>Диагноз алкогольных энцефалопатии устанавливают преимущественно на основании клинической картины и данных анамнеза. Дифференцировать их необходимо с делирием, опухолями головного мозга, шизофренией, острыми симптоматическими психозами.</p>",
"treatment": "<p>Алкоголизм. Лечение. Лечение больных должно быть поэтапным и комплексным. Схема лечения включает три этапа, каждый из которых преследует собственные цели.</p>\r\n<p>В задачи I этапа входят устранение последствий массивной интоксикации алкоголем и прекращение абстинентного синдрома.</p>\r\n<p>На II этапе необходимо добиться подавления патологического влечения к алкоголю и коррекции психологических и внутренних нарушений. III этап — профилактическая терапия.</p>\r\n<p>Для прекращения абстинентного синдрома в сочетании с дезинтоксикационной терапией (гипертонические, изотонические, плазмозамещающие растворы, тиоловые производные) широко применяются витамины группы B, а также C, PP и др., сердечнососудистые средства; препараты, нормализующие сон м снижающие вторичное влечение к алкоголю — транквилизаторы бензодиазепинового ряда (лоразепам, флюрозепам, феназепам, грандаксин, диазепам), натрия оксибутират, хлорпротиксен.</p>\r\n<p>В первые дни лишения алкоголя возможно развитие психоза. Поэтому широко применяют парентеральное введение нейролептиков— фенотиазинов и бутирофеноноэ. Широко используются антиконвульсанты — карбамазепин (тегретол, финлепсин), вальпроат натрия. Среди ноотропных средств наибольшее применение имеет ороцетам. Его следует использовать, если в клинике абстинентного синдрома преобладают соматовегетативные расстройства.</p>\r\n<p>Для прекращения абстинентного синдрома можно использовать специальные схемы иглорефлексотерапии, краниоцеребральную гипртермию, гемосорбцию.</p>\r\n<p>На втором и третьем этапах терапии продолжают применяться сенсибилизирующие средства — преимущественно дисульфирам (антабус, тетурам, аверсан, эспераль). Эффект препарата связан с подавлением активности альдегидрогеназы (АльДГ), что ведет к накоплению ацетальдегида.</p>\r\n<p>Этот процесс начинается не ранее чем через 12 ч после приема дисульфирама и продолжается несколько дней. В результате развивается выраженное расстройство функций внутренних органов и нервной системы, так называемая антабусалкогольная реакция (ААР). Она приводит к невозможности совместного приема дисульфирама и спиртного. Однако в последнее время отмечается относительно низкая эффективность сенсибилизирующей терапии как препаратами дисульфирама, обладающего большим количеством побочных эффектов, так и другими средствами (трихополом, циамидом, фуразолидоном, никотиновой кислотой).</p>\r\n<p>Наиболее широко для лечения больных алкоголизмом на втором этапе применяются препараты тимонейролептического действия (терален, труксал, тиоридазин, неулептил). Для лечения расстройств депрессивного спектра широко используются антидепрессанты (триптизол, пиразидол, азафен), сочетающие антидепрессивный и успокаивающий эффекты. На втором этапе терапии продолжается применение транквилизаторов бензодиазепинового ряда. Однако следует помнить, что у больных алкоголизмом легко формируется перекрестная зависимость, в том числе и к этой группе препаратов.</p>\r\n<p>На втором этапе после прекращения абстиненции основной задачей лечения является формирование стабильного улучшения состояния больного. Это достигается только при совместном применении фармако- и психотерапии. Вначале применяется индивидуальная, а затем и групповая психотерапия, которые обладают наибольшим лечебным потенциалом. Она позволяет больным сформировать критическое отношение к заболеванию, а также получить поддержку не только от врача, но и от других членов группы.</p>\r\n<p>На этапе сформировавшейся ремиссии в межприступном периоде может потребоваться курсовая терапия психотропными средствами в случаях спонтанного ухудшения состояния или под влиянием неблагоприятных внешних факторов, приводящих к возобновлению на то или иное время патологического влечения к алкоголю. Желателен продолжительный контакт с психотерапевтом (наркологом) или ленами группы самопомощи, предотвращающий развитие рецидивов.</p>",
"prevention": "",
"clinical_picture": "<p>Проявляется навязчивым влечением к опьянению, психическим дискомфортом в трезвом состоянии и улучшением, психических функций в состоянии опьянения. При развитии физической зависимости возникают физическая (неудержимая) потребность в опьянении, потеря контроля за количеством выпитого, явления абстиненции, улучшение физических функций в состоянии опьянения.</p>\r\n<p>Последствия хронической интоксикации проявляются как на неврологическом, внутреннем и личностном уровнях, так и в социальной деятельности.</p>\r\n<p>К неврологическим последствиям относят острые мозговые, так называемые дисциркуляторнотоксические синдромы (эпилептиформный, Гайе—Вернике, мозжечковый, стриопаллидарной недостаточности, периферические невриты, атрофия зрительного и слухового нервов, особенно при употреблении суррогатов).</p>\r\n<p>Последствиями алкоголизма для организма являются поражение сердечнососудистой системы, органов дыхания, желудка, печени и поджелудочной железы, почек, полигландулярная недостаточность эндокринной системы, снижение иммунологической реактивности.</p>\r\n<p>Среди психических последствий выделяют астению, психопатизацию личности, аффективные расстройства (колебания настроения, депрессии и дисфории с агрессивностью и тенденциями к самоубийству, в далеко зашедших случаях — деменцию (<a title=\"Перейти на страницу симптома Деменция\" href=\"../../../symptom/demenciya/\">слабоумие</a>). Характерным проявлением является так называемый алкогольный юмор — плоский, грубый, бестактный. Могут возникать психотические состояния — острые (делириозный, галлюцинаторно-параноидный синдромы) и хронические (галлюциноз, <a title=\"Перейти на страницу симптома Бред\" href=\"../../../symptom/bred/\">бред</a> ревности, корсаковский <a title=\"Перейти на страницу симптома Психоз\" href=\"../../../symptom/psihoz/\">психоз</a>) состояния.</p>\r\n<p>Продолжительность жизни больных алкоголизмом укорачивается на 15—20 лет в связи с повышенной заболеваемостью внутренних органов (особенно сердечнососудистой патологией), а также травматизмом. Трудоспособность прогрессивно падает. Сроки появления последствий хронической алкогольной интоксикации зависят не только от продолжительности заболевания, но и от компенсаторных возможностей функциональных систем организма.</p>\r\n<p> </p>\r\n<full></full>\r\n<p>Осложнения вызванные алкоголизмом</p>\r\n<ol>\r\n<li>Алкогольная миопатия – прогрессирующая мышечная дистрофия, характеризующаяся изменением структуры мышечных волокон. Под влиянием алкоголя нарушается белковый и углеводный обмен в мышечной ткани, постепенно мышцы истончаются, большая часть волокон замещается соединительной тканью и жиром. Вследствие этого появляются мышечная <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, атрофия, угасают сухожильные рефлексы, развиваются парезы.</li>\r\n</ol>\r\n<ol start=\"2\">\r\n<li>Алкогольная полинейропатия – заболевание, характеризующееся множественным поражением корешков и периферических нервов под воздействием алкоголя (токсическое воздействие). Клинические симптомы полиневропатии тесно связаны с течением основного заболевания, к ним относятся парестезии, тянущие боли по ходу нервных стволов и в мышцах, нарушение чувствительности, парезы, параличи. Первоначально выключается функция дистальных отделов конечностей. Заболевание постепенно прогрессирует до полного паралича, бульбарных нарушений, паралича дыхательной мускулатуры и сердечной мышцы.</li>\r\n</ol>\r\n<ol start=\"3\">\r\n<li>Нарушение функции печени. При употреблении суррогатов алкоголя нередко возникает <a title=\"Перейти на страницу симптома Острая интоксикация\" href=\"../../../symptom/ostraya_intoksikaciya/\">отравление</a> и развивается острая печеночная недостаточность, при этом отмечаются полная <a title=\"Перейти на страницу симптома Обморок\" href=\"../../../symptom/obmorok/\">потеря сознания</a>, резкая <a title=\"Перейти на страницу симптома Одышка\" href=\"../../../symptom/odyshka/\">одышка</a>, <a title=\"Перейти на страницу симптома Холодный пот\" href=\"../../../symptom/holodnyy_pot/\">холодный пот</a>. Выдыхаемый больным воздух напоминает запах сырой печени, больного крайне редко выводят из этого состояния, прогноз крайне неблагоприятный.</li>\r\n</ol>\r\n<p>В результате нарушения всех видов обмена веществ в организме под влиянием алкоголя развивается дистрофия печени (печеночные клетки заменяются жиром) или цирроз (диффузное разрастание соединительной ткани).</p>\r\n<p> </p>\r\n<ol start=\"4\">\r\n<li>Цирроз печени (от греч. kirros – «рыжий») характеризуется нарушением архитектоники печени и поражением всех ее структурных элементов – паренхимы (происходит разрушение и замещение гепатоцитов соединительной тканью), промежуточной ткани, ретикуло-эндотелиальной системы, желчных ходов, сосудов, капсулы. Клинические проявления цирроза разнообразны и зависят от стадии болезни: отмечаются <a title=\"Перейти на страницу симптома Слабость\" href=\"../../../symptom/slabost/\">слабость</a>, похудание, боли в правом подреберье, <a title=\"Перейти на страницу симптома Диспепсия\" href=\"../../../symptom/dispepsiya/\">диспепсия</a>, <a title=\"Перейти на страницу симптома Метеоризм\" href=\"../../../symptom/meteorizm/\">метеоризм</a>, <a title=\"Перейти на страницу симптома Желтуха\" href=\"../../../symptom/zheltuha/\">желтуха</a>, <a title=\"Перейти на страницу симптома Асцит\" href=\"../../../symptom/ascit/\">асцит</a>, <a title=\"Перейти на страницу симптома Кровотечение\" href=\"../../../symptom/krovotechenie/\">кровоточивость</a>. Печень уменьшается в размерах, приобретает рыжий оттенок. На коже больного появляются сосудистые звездочки, возникает <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"../../../symptom/pokrasnenie_kozhi/\">эритема</a> ладоней, пальцы приобретают вид барабанных палочек. Печень перестает выполнять свои функции в организме.</li>\r\n</ol>\r\n<ol start=\"5\">\r\n<li>«Врожденный алкоголизм». Еще в большей степени от алкоголизма страдает женский организм, заболевание развивается значительно быстрее и протекает тяжелее. При употреблении алкоголя в период беременности (систематическом пьянстве) развивается алкогольный синдром у плода, проявляющийся преждевременными родами, различными нарушениями физического и умственного развития, а также беспричинным беспокойством, отказом от груди, нарушением сна. Однако после кормления грудью в состоянии алкогольного опьянения или при добавлении к молоку нескольких капель алкоголя ребенок успокаивается и засыпает. Постепенно у новорожденного ребенка развивается синдром абстиненции. Употребляется, как термин «врожденный алкоголизм».</li>\r\n</ol>",
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