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},
"code": "I70",
"name": "Атеросклероз",
"icd_name": "Атеросклероз",
"gender": 0,
"age_min": 35,
"age_max": 100,
"cause": [
"0",
"3"
],
"periodicity": 3,
"slug": "i70_ateroskleroz",
"lead": "хроническое заболевание, при котором на внутренней стенке артерий откладываются холестерин и другие жиры в форме налетов и бляшек, а сами стенки уплотняются и теряют эластичность",
"description": "<p>Атеросклероз - это х<span style=\"color: #222328; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">роническое очаговое поражение артерий, характеризующееся отложением и накоплением во внутренней оболочке сосуда жиросодержащих белков и доставляемого ими холестерина.</span></p>",
"etiology": "<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Факторы, влияющие на развитие атеросклероза, разделяются на три группы: неустранимые, устранимые и потенциально устранимые. К неустранимым факторам относятся те, которые нельзя исключить с помощью волевого или медицинского воздействия. В их число входят:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Возраст. С возрастом риск развития атеросклероза возрастает. Атеросклеротические изменения сосудов в той или иной мере наблюдаются у всех людей после 40-50 лет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Пол. У мужчин развитие атеросклероза происходит на десять лет раньше и превышает показатель заболеваемости атеросклерозом среди женщин в 4 раза. После 50-55 лет уровень заболеваемости атеросклерозом среди женщин и мужчин выравнивается. Это объясняется снижением продукции эстрогенов и их защитной функции у женщин в период </span><a style=\"text-decoration-line: none;\" href=\"https://www.krasotaimedicina.ru/diseases/zabolevanija_gynaecology/climax\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">менопаузы</span></a><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наследственность. Нередко атеросклероз развивается у пациентов, чьи родственники страдают этой болезнью. </span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Устранимыми факторами атеросклероза считаются те, которые могут быть исключены самим человеком посредством изменения привычного образа жизни. К ним относятся:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Курение. Его влияние на развитие атеросклероза объясняется отрицательным воздействием никотина и смол на сосуды. Многолетнее курение в несколько раз увеличивает риск гиперлипидемии, артериальной гипертензии, ИБС.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Несбалансированное питание. Употребление в пищу большого количества жиров животного происхождения ускоряет развитие атеросклеротических изменений сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиподинамия. Ведение малоподвижного образа жизни способствует нарушению жирового обмена и развитию ожирения, сахарного диабета, атеросклероза сосудов.</span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">К потенциально и частично устранимым факторам риска относят те хронические нарушения и заболевания, которые возможно скорректировать посредством назначенного лечения. Они включают:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Артериальную гипертонию. На фоне повышенного артериального давления создаются условия для повышенного пропитывания сосудистой стенки жирами, что способствует формированию атеросклеротической бляшки. С другой стороны, снижение эластичности артерий при атеросклерозе способствует поддержанию повышенного кровяного давления.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Дислипидимию. Нарушение жирового обмена в организме, проявляющееся повышенным содержанием холестерина, триглицеридов и липопротеидов, играет ведущую роль в развитии атеросклероза.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ожирение и сахарный диабет. Повышают вероятность атеросклероза в 5-7 раз. Это объясняется нарушением жирового обмена, лежащего в основе данных заболеваний и являющегося пусковым механизмом атеросклеротического поражения сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Инфекции и интоксикации. Инфекционные и токсические агенты оказывают повреждающее воздействие на сосудистые стенки, способствуя их атеросклеротическим изменениям.</span></p>\r\n</li>\r\n</ol>",
"pathogenesis": "<p>Атеросклеротическая бляшка — это образование, состоящее из смеси жиров (в первую очередь, холестерина) и кальция.</p>\r\n<p>Со временем бляшка становится непрочной, на ее поверхности возникают дефекты. В месте дефекта на внутренней оболочке сосуда начинает образовываться тромб — скопление клеток, в основном, тромбоцитов (элементы крови, участвующие в процессе свертывания) и белков крови.</p>",
"diagnostics": "<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на атеросклероз врач может назначить:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови на холестерин и сахар;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенологическое исследование;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ангиографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">МРТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ультразвуковую допплерографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ аорты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭКГ.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также при необходимости список обследований могут пополнить:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">кардиологические стресс-тесты для определения критической нагрузки на сердце;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">коронарография;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">липидограмма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ органов брюшной полости.</span></p>\r\n</li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для лечения атеросклероза применяют комплексные меры, которые включают в себя:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">диету, назначаемую с целью снизить уровень холестерина в крови и нормализовать липидный баланс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отказ от вредных привычек: курения и чрезмерного употребления спиртных напитков;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">умеренную физическую нагрузку, подходящую по возрасту и особенностям организма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лекарственную терапию, которая: снижает выработку холестерина, выводит лишний холестерин из организма.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В рамках терапии обычно назначают:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">статины. Именно они существенно понижают уровень холестерина.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">средства, содержащие никотиновую кислоту. Она отвечает за нормализацию липидного уровня.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">фибраты. Благодаря им в организме уменьшается выработка жиров.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">секвестранты. Помогают кишечнику освободиться от желчных кислот.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эстрогены. В качестве ЗГТ для женщин в постменопаузу.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В некоторых случаях прибегают к хирургическому вмешательству посредством:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ангиопластики;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эндарэктомии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">шунтирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">стентирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сосудистого протезирования.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p>С целью предупреждение атеросклероза необходим отказ от курения, исключение стрессового фактора, переход на нежирную и бедную холестерином пищу, систематическая физическая активность соразмерно возможностям и возрасту, нормализация веса.</p>\r\n<p>Целесообразно включение в рацион продуктов, содержащих клетчатку, растительных жиров (льняного и оливкового масел), растворяющих холестериновые отложения.</p>\r\n<p>Прогрессирование атеросклероза можно замедлить приемом холестеринснижающих лекарственных препаратов.</p>",
"clinical_picture": "<p align=\"justify\">При атеросклерозе чаще страдают грудной и брюшной отделы аорты, коронарные, мезентериальные, почечные сосуды, а также артерии нижних конечностей и головного мозга.</p>\r\n<p align=\"justify\">В развитии атеросклероза различают доклинический (бессимптомный) и клинический периоды. В бессимптомном периоде в крови обнаруживается повышенное содержание β-липопротеидов или холестерина при отсутствии симптомов заболевания.</p>\r\n<p align=\"justify\">Клинически атеросклероз начинает себя проявлять, когда происходит <a title=\"Перейти на страницу симптома стеноз\" href=\"/symptom/stenoz/\">сужение</a> артериального просвета на 50% и более. В течении клинического периода выделяют три стадии: ишемическую, тромбонекротическую и фиброзную.</p>\r\n<p align=\"justify\">В стадии ишемии развивается недостаточность кровоснабжения того или иного органа (например, ишемия миокарда вследствие атеросклероза коронарных сосудов проявляется стенокардией). В тромбонекротической стадии присоединяется тромбоз измененных артерий (так, течение атеросклероза коронарных сосудов может осложниться инфарктом миокарда). На стадии фиброзных изменений происходит разрастание соединительной ткани в плохо кровоснабжаемых органах (так, атеросклероз коронарных артерий приводит к развитию атеросклеротического кардиосклероза).</p>\r\n<p align=\"justify\">Клинические симптомы атеросклероза зависят от вида пораженных артерий. Проявлением атеросклероза коронарных сосудов служат стенокардия, инфаркт миокарда и кардиосклероз, последовательно отражающие стадии недостаточности кровообращения сердца.</p>\r\n<p align=\"justify\">Течение атеросклероза аорты длительное и долгое время бессимптомное, даже в тяжелых формах. Клинически атеросклероз грудной аорты проявляется аорталгией – давящими или жгучими болями за грудиной, иррадиирующими в руки, спину, шею, верх живота. В отличие от болей при стенокардии <a title=\"Перейти на страницу симптома Боль в груди \" href=\"/symptom/bol_v_grudi/\">аорталгия</a> может длиться по несколько часов и дней, периодически ослабевая или усиливаясь. Снижение эластичности стенок аорты вызывает усиление работы сердца, приводя к гипертрофии миокарда левого желудочка.</p>\r\n<p align=\"justify\">Атеросклеротическое поражение брюшной аорты проявляется болями в области живота различной локализации, метеоризмом, запорами. При атеросклерозе бифуркации брюшной аорты наблюдается <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и похолодание ног, отек и <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">гиперемия</a> стоп, некрозы и язвы пальцев ног, перемежающаяся <a title=\"Перейти на страницу симптома Нарушения походки\" href=\"/symptom/narusheniya_pohodki/\">хромота</a>.</p>\r\n<p align=\"justify\">Проявлениями атеросклероза мезентериальных артерий служат приступы «брюшной жабы» и нарушение пищеварительной функции вследствие недостаточности кровоснабжения кишечника. У пациентов отмечается появление резких болей спустя несколько часов после еды. Боли локализуются в области пупка или верхних отделах живота. Продолжительность болевого приступа от нескольких минут до 1-3 часов, иногда болевой синдром купируется приемом нитроглицерина. Появляются <a title=\"Перейти на страницу симптома Метеоризм\" href=\"/symptom/meteorizm/\">вздутие</a> живота, <a title=\"Перейти на страницу симптома Отрыжка\" href=\"/symptom/otryzhka/\">отрыжка</a>, <a title=\"Перейти на страницу симптома Запор\" href=\"/symptom/zapor/\">запор</a>, <a title=\"Перейти на страницу симптома Нарушение сердечного ритма\" href=\"/symptom/narushenie_serdechnogo_ritma/\">сердцебиение</a>, повышение артериального давления. Позднее присоединяются зловонные поносы с фрагментами непереваренной пищи и неусвоенным жиром.</p>\r\n<p align=\"justify\">Атеросклероз почечных артерий ведет к развитию вазоренальной симптоматической артериальной гипертензии. В моче определяются эритроциты, белок, цилиндры. При одностороннем атеросклеротическом поражении артерий отмечается медленное прогрессирование гипертонии, сопровождающееся стойкими изменениями в моче и стойко высокими цифрами АД. Двустороннее поражение почечных артерий вызывает злокачественную артериальную гипертонию.</p>\r\n<p align=\"justify\">При атеросклерозе сосудов головного мозга отмечается снижение памяти, умственной и физической работоспособности, внимания, интеллекта, <a title=\"Перейти на страницу симптома Головокружение\" href=\"/symptom/golovokruzhenie/\">головокружение</a>, нарушения сна. В случаях выраженного атеросклероза сосудов мозга изменяется поведение и психика пациента. Атеросклероз артерий мозга может осложняться острым нарушением мозгового кровообращения, тромбозами, кровоизлияниями.</p>\r\n<p align=\"justify\">Проявлениями облитерирующего атеросклероза артерий нижних конечностей служат <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a> и боли в икроножных мышцах голени, <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и зябкость ног. Характерно развитие синдрома «перемежающейся хромоты» (боли в икроножных мышцах возникают при ходьбе и стихают в покое). Отмечаются похолодание, бледность конечностей, трофические нарушения (<a title=\"Перейти на страницу симптома Шелушение кожи\" href=\"/symptom/shelushenie_kozhi/\">шелушение</a> и <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">сухость кожи</a>, развитие трофических язв и сухой гангрены).</p>",
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"code": "I71",
"name": "Аневризма и расслоение аорты",
"icd_name": "Аневризма и расслоение аорты",
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"age_min": 0,
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3
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"slug": "i71_anevrizma_i_rassloenie_aorty",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "Расслаивающаяся аневризма аорты – дефект внутренней оболочки аневризматически расширенной аорты, сопровождающийся образованием гематомы, продольно расслаивающей сосудистую стенку с формированием ложного канала. Расслаивающаяся аневризма аорты проявляется внезапной интенсивной болью, мигрирующей по ходу расслоения, подъемом артериального давления, признаками ишемии сердца, головного и спинного мозга, почек, внутреннего кровотечения.",
"etiology": "<p>К факторам, способствующим развитию аневризмы аорты и ее расслоению, относятся: </p>\r\n<ul>\r\n<li>атеросклероз со значительным изменением vasa vasorum (сосудов сосудов) аорты, ишемию стенки аорты; </li>\r\n<li>гипертоническую болезнь и резкие колебания артериального давления; </li>\r\n<li>сифилис; </li>\r\n<li>очаговые некрозы среднего слоя сосуда бактериально-эмболического происхождения при острых инфекционных заболеваниях; </li>\r\n<li>врожденные дефекты развития аорты (коарктация, двойная дуга, гипоплазия, незаращение боталлова протока, синдром Марфана); </li>\r\n<li>физическое и нервно-эмоциональное перенапряжение; </li>\r\n<li>повреждение аорты смежным процессом (спондилит, рак пищевода, пенетрация пептической язвы пищевода, двенадцатиперстной кишки) или инородным телом; </li>\r\n<li>закрытую травму грудной или брюшной полости. </li>\r\n</ul>",
"pathogenesis": "<p>Аорта имеет три наиболее уязвимых сегмента - корень, перешеек и диафрагму. Гемодинамическое напряжение указанных зон и их хроническая травматизация приводят к дегенеративным изменениям средней оболочки сосуда. Длительное повышение артериального давления всегда ведет к той или иной степени дилатации аорты. Известно также, что внутренняя оболочка по своей структуре менее растяжима, чем средняя и наружная оболочки, обладающие большей эластичностью. Именно поэтому при одном из очередных «критических» повышений артериального давления происходит разрыв внутренней оболочки. Однако гидравлический удар о стенку аорты и разрыв внутренней оболочки сами по себе могут привести лишь к развитию внутристеночной гематомы. Дальнейшее расслоение происходит лишь при наличии патологического процесса в средней оболочке аорты. Если расслоение прорывает стенку аорты полностью (все три слоя), то происходит быстрая массивная кровопотеря и гибель больного. </p>",
"diagnostics": "<p>В случае подозрения на появление расслаивающей аневризмы аорты требуется срочная диагностика, основными методами которой являются: </p>\r\n<ul>\r\n<li>рентгенография грудной клетки; </li>\r\n<li>УЗДГ; </li>\r\n<li>ЭхоКГ; </li>\r\n<li>компьютерная томография; </li>\r\n<li>магнитно-резонансная томография; </li>\r\n<li>аортография. </li>\r\n</ul>\r\n<p>Рентгенография грудной клетки позволяет определить признаки расслаивающей аневризмы: расширение аорты, плевральный выпот, отсутствие пульсации, деформацию контуров аорты. </p>\r\n<p>ЭхоКГ (УЗИ сердца) – более информативный и доступный метод, позволяющий обнаружить отслоившийся лоскут, определить истинный и ложный канал, оценить атеросклеротическое поражение, состояние аортального клапана, состояние грудной аорты. </p>\r\n<p>Аортография дает возможность определить место начального разрыва, протяженность и местонахождения расслоения, состояние аортального клапана, ветвей аорты, коронарных артерий. </p>\r\n<p>МРТ дает возможность точно определить локализацию разрыва и направление расслоения, оценить состояние ветвей аорты и клапана. </p>",
"treatment": "<p>Расслоение аорты требует неотложной медицинской помощи, немедленного лечения. Терапия может заключаться в проведении операции, употреблении лекарственных средств, а также в комбинированном лечении — схема зависит от области аорты, которая подверглась расслоению. </p>\r\n<p>Хирургическое вмешательство - хирурги удаляют как можно большую площадь, подвергшуюся расслоению, а затем реконструируют аорту при помощи синтетической трубки-трансплантата. Если в результате расслоения повреждаются аортальные клапаны, они так же могут быть заменены; </p>\r\n<p>Интенсивная терапия расслаивающейся аневризмы аорты направлена на купирование болевого синдрома (путем введения ненаркотических и наркотических анальгетиков), выведение из шокового состояния, снижение артериального давления. Лекарственные препараты, например, бета-блокаторы и нитропруссид, уменьшают частоту сердечных сокращений и нормализуют низкое кровяное давление, что предотвращает усугубление расслоения. </p>",
"prevention": "<p>Профилактика формирования расслаивающейся аневризмы аорты заключается в контроле за течением сердечно-сосудистых заболеваний. Предупреждение расслоения аорты включает наблюдение кардиолога, мониторинг артериального давления и уровня холестерина крови, периодическое ультразвуковая диагностика сердца и аорты. <br class=\"SCXW45342897\" /> <br class=\"SCXW45342897\" /> </p>",
"clinical_picture": "<p>Для расслаивающейся аневризмы аорты характерно внезапное начало с имитацией симптомов различных сердечно-сосудистых, неврологических, урологических заболеваний. Расслоение аорты проявляется резким нарастанием раздирающей, нестерпимой боли с широкой областью иррадиации (за грудиной, между лопатками и по ходу позвоночника, в эпигастральной области, пояснице), мигрирующей по ходу расслоения. </p>\r\n<p>Отмечается повышение артериального давления с последующим спадом, асимметрия пульса на верхних и нижних конечностях, обильное потоотделение, слабость, синюшность, двигательное беспокойство. Большая часть больных с расслаивающейся аневризмой аорты умирает от развития осложнений. </p>\r\n<p>Неврологическими проявлениями расслаивающейся аневризмы аорты могут служить ишемическое поражение головного или спинного мозга парезы, параличи), периферическая нейропатия, нарушения сознания(обморок, кома). </p>\r\n<p>Расслаивающаяся аневризма восходящей аорты может сопровождаться ишемией миокарда, сдавлением органов средостения (появлением охриплости, дисфагии, одышки, синдрома Горнера, синдрома верхней полой вены), гемоперикарда, тампонады сердца (скопление жидкости между листками околосердечной сумки). </p>\r\n<p>Расслаивающаяся аневризма нисходящей грудной и брюшной части аорты выражается развитием выраженного повышения давления в почечных сосудах и острой почечной недостаточности, острой ишемии органов пищеварения, ишемии кишечника, острой ишемии нижних конечностей. </p>",
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"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;\">Основной причиной развития аневризмы бывает врождённая слабость соединительной ткани, заболевания соединительной ткани. Иногда аневризма может развиваться на фоне атеросклеротических изменениях в артерии, при высоком артериальном давлении или после травмы шеи.</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;\">Пусковым моментом для развития расширения сонной артерии может послужить лучевая терапия опухолей шеи. Расширение внутренней сонной артерии иногда наблюдается после стентирования или удаления атеросклеротической бляшки.</span></p>",
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"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;\">Диагностической алгоритм аневризмы сонной артерии включает в себя: </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анамнестические данные; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">результаты физического осмотра (пальпируемая мешковидная опухоль в области шеи); УЗИ шеи. Это исследование служит для определения размера и расширения аневризмы; ангиографию – золотой стандарт диагностики аневризмы сонной артерии; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">контрастная КТ – обладает такими преимуществами, как легкая и быстрая применимость; является минимально инвазивным методом, который дает возможность увидеть изменения сосудистой стенки, объемом менее 1 мм; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">магнитно-резонансная ангиография – является неинвазивным методом, который может визуализировать сосудистые структуры без необходимости использования контрастной среды или рентгеновского излучения. МРА может показывать тромбированные части аневризмы и остаточные характеристики потока крови.</span></li>\r\n</ul>\r\n<p> </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;\">Неврологи назначают пациентам, у которых диагностирована аневризма сонной артерии, препараты, снижающие концентрацию липидов в крови (ловастатин, симвастин, аторвастин), антиагреганты (клопидогрель, дипиридамол). Больных консультирует сосудистый хирург.</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;\">Радикальный метод лечения аневризмы сонной артерии – хирургическое вмешательство. Сосудистые хирурги проводят следующие операции:</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;\">Эндартерэктомию сонной артерии и ветвей;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Востановление кровеносного сосуда головного мозга с помощью имплантата;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эндоваскулярное стентирование сонной артерии;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Клипирование аневризмы;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эмболизацию аневризмы.</span></li>\r\n</ul>",
"prevention": "<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;\">Чтобы предотвратить осложнения аневризмы сонной артерии, следует отказаться от курения, злоупотребления спиртных напитков, нормализовать массу тела. Лица старше пятидесяти лет должны ежегодно проходить скрининговые исследования.</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;\">Аневризма сонной артерии проявляется следующими неврологическими симптомами:</span></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;\">Цефальгией (головной болью);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Диплопией (двоением в глазах);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Птозом (опущение века);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Анизокорией (сужением одного зрачка);</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Снижением реакции зрачка на свет;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Выпадением полей зрения;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Периферическим парезом лицевого нерва (опущением нижнего века, нарушением выработки слезы, асимметрией лица).</span></li>\r\n</ul>\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;\">В зависимости от локализации аневризмы сонной артерии неврологи определяют следующие симптомы:</span></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;\">Полный или частичный паралич одной половины тела;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Невозможность выполнить произвольные движения;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Речевые расстройства;</span></li>\r\n<li><span style=\"background-color: transparent; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">Эмоциональную лабильность.</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;\">Медленно увеличивающаяся аневризма сонной артерии проявляется симптомами сдавления головного мозга. У пациентов развивается сосудисто-мозговая недостаточность.</span></p>",
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"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;\">Основная причина формирования выпячивания – нарушение структурной целостности стенки сосуда. Патологическое выпячивание может появляться в ответ на влияние повреждающих факторов. К факторам способным провоцировать развитие аневризмы относятся пожилой возраст, нарушение питания, переедание, вредные привычки и нарушение метаболизма, обусловленное сахарным диабетом.</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;\">Главными этиологическими факторами, способными вызвать появление аневризмы почечной артерии являются:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Инфекционные заболевания, запускающие процессы развития микотической аневризмы. Бактериальное поражение стенок аорты вызывает воспалительные и аллергические реакции, вызывающие разрушение эластических волокон стенке сосуда, что повышает вероятность развития аневризмы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Атеросклероз вызывает нарушение баланса передачи и утилизации липопротеидов в системном кровотоке, что провоцирует развитие атерогенеза, связанного с повреждением интимы сосудов. В этом случае наблюдается пропитывание жирными кислотами внутреннего слоя артерии, что сопровождается возникновением пролиферации, разрушением клеток и нарушением передачи межклеточного вещества. Приток лейкоцитов в патологический очаг может вызывать появление воспаления, что сопровождается снижением эластической прочности стенки сосуда.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Врожденные заболевания, связанные с внутриутробным нарушением формирования сосудистой стенки также могут вызывать развитие аневризмы. Иногда аневризма может возникать на фоне наследственных заболеваний, связанных с выявлением дефектов в мышечном слое почечных артерий. Дефицит коллагеновых волокон вызывает ослабление мышечного слоя, особенно в местах бифуркации и изгибов.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Травма почечной артерии также в некоторых случаях могут вызывать формирование аневризматического мешка.</span></li>\r\n</ul>\r\n<p> </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;\">Основой механизма развития аневризмы является утрата эластических свойств медиального слоя стенки артерии почки, приводящая к его неспособности сопротивляться давлению крови. Структурные нарушения могут быть врожденными (при синдроме Марфана) или приобретенными (при атеросклерозе, артериите, инфекционных заболеваниях). Вначале происходит разрыв внутреннего слоя сосуда с сохранением целостности остальных слоев. Кровь попадает в образовавшийся дефект, под ее давлением постепенно образуется продольное расслоение классической мешотчатой формы на месте локального поражения. При диффузном циркулярном повреждении артерии выпячивание имеет веретенообразную форму. При ложных аневризмах участок расширения сосуда формируется из соединительной ткани без участия мышечного слоя.</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;\">Непосредственный распад аневризмы ведет к массивному кровотечению. Микроразрывы могут тромбироваться, после чего образуется забрюшинная гематома с последующей капсуляцией. При попадании инфекции в область гематомы происходит нагноение жировой ткани, без медицинской помощи велик риск развития сепсиса. Сдавление почечной чашечно-лоханочной системы выпячиванием большого размера ухудшает пассаж мочи, провоцирует застойные явления, что увеличивает вероятность присоединения пиелонефрита.</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;\">При подозрении на аневризму почечной аорты больному может быть назначено рентгенологическое, ультразвуковое, аортографическое и топографическое исследования, а также ангиосканирование.</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;\">При обследовании пациентов с аневризмой аорты проводят рентгеноскопию и рентгенографию или ультразвуковое исследование мочеполовой системы. Может потребоваться проведение ультразвуковой допплерографии почечной аорты.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При изолированной, незначительных размеров аневризме почечной аорты может потребоваться проведение выжидательной тактики, основанной на систематическом прохождении рентгенологического исследования для уменьшения вероятности развития различных осложнений.</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;\">Хирургическое лечение заболевания может потребоваться при выявлении у пациента аневризмы с размером от 0,5 до 1 см аневризматического мешка либо увеличением аневризмы в размерах больше чем на 0,5 см за шесть месяцев.</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;\">При разрыве аорты пациент нуждается в проведении экстренного оперативного вмешательства.</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;\">Во всех остальных случаях проводят хирургическое удаление аневризмы, основанное на иссечении аневризматического мешка и замещении патологического участка аллотрансплантатом.</span></p>",
"prevention": "<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;\">Поскольку самой частой причиной потери эластических свойств сосудистой стенки является атеросклероз, профилактика направлена на предупреждение и корректировку метаболических нарушений. Больным следует придерживаться диеты с низким содержанием соли и жиров, большим количеством овощей и фруктов, принимать антиатеросклеротические препараты.</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 незначительных размерах аневризматического мешка заболевание может никак не проявлять себя. В этом случае его выявляют только при профилактическом осмотре либо обследовании при диагностировании какого-либо другого заболевания. Увеличивающаяся в размерах аневризма оказывает давление на близлежащие структуры, что сопровождается появлением ощущения распирания и тянущих болей в пояснице со стороны поражения.</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;\">Если выпячивание располагается в почке, то наблюдается компрессия мочеточника, что затрудняет функционирование органа и может вызвать развитие почечной недостаточности или инфаркт почки.</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;\">У таких пациентов отмечается появление симптомов интоксикации, тошноты, рвоты, слабости, головных болей и головокружений. В случае возникновения мешотчатой формы аневризмы значительно увеличивается риск развития тромбов с дальнейшим разрушением ткани почки. При некрозе почке отмечается появление интенсивных болей в животе, иррадиирующих в низ живота, половые органы либо бедро.</span></p>",
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