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"etiology": "<p>Гидроцефалию могут вызвать: </p>\r\n<p>- доброкачественные или злокачественные опухоли (эпендимома, астроцитома клеток, краниофарингиома, аденома гипофиза, гипоталамуса или глиома зрительного нерва, гамартома и метастатические опухоли); - субарахноидальное кровоизлияние; - черепно-мозговая травма: гидроцефалия обычно вызвана субарахноидальным кровоизлиянием, которое чаще всего происходит из-за травматических повреждений головы; - идиопатическая гидроцефалия: составляет примерно одну треть случаев гидроцефалии; - врожденный акведуктальный стеноз (сужение водопровода мозга): гидроцефалия может протекать бессимптомно до совершеннолетия; - инфекции: например, бактериальный менингит, менингоэнцефалит, церебральный абсцесс; - лекарственные препараты: например, настой Инфликсимаба. </p>\r\n<p>Отдельно выделяют атрофическую (заместительную) форму гидроцефалии, которая возникает вследствие посттравматической гибели или возрастной атрофии тканей головного мозга. При этом цереброспинальная жидкость заполняет пространство, которое образуется внутри черепной коробки в результате уменьшения объема головного мозга. </p>",
"pathogenesis": "<p>По патогенезу различают три основные формы гидроцефалии. </p>\r\n<p>Окклюзионная (закрытая, несообщающаяся) гидроцефалия, при которой происходит нарушение тока цереброспинальной жидкости вследствие закрытия (окклюзии) ликворопроводящих путей опухолью, сгустком крови или поствоспалительным спаечным процессом. </p>\r\n<p>Сообщающаяся (открытая) гидроцефалия, при которой нарушаются процессы резорбции спиномозговой жидкости вследствие поражения структур, участвующих во всасывании ее в венозное русло. </p>\r\n<p>Гиперсекреторная гидроцефалия, которая развивается вследствие избыточной продукции спиномозговой жидкости. </p>",
"diagnostics": "<p>Трансиллюминация (диафаноскопия) черепа позволяет выявить наружную гидроцефалию у детей, исключить гидроанэнцефалию и субдуральную гигрому. Суть его в просвечивании головы пучком света от лампы в затемнённом помещении. В их лучах при гидроцефалии начинает светиться вся голова. </p>\r\n<p>Рентгенография черепа – выявляют истончение костной ткани, расхождение швов черепа, на внутренней поверхности черепной коробки присутствует характерный симптом “пальцевидных вдавлений”. </p>\r\n<p>Магнитно-резонансная и компьютерная томография позволяют с большой точностью визуализировать патологические изменения внутри черепа, выявить место, которое препятствует оттоку ликвора. </p>\r\n<p>Ультрасонография – ультразвуковое исследование головного мозга через открытый большой родничок у детей раннего возраста</p>\r\n<p>С целью снижения продукции ликвора и внутричерепного давления проводится дегидратационная терапия диуретиками, ингибиторами карбоангидразы, салуретиками. </p>\r\n<p>Оптимальный способ оперативного вмешательства определяется этиологией, формой, стадией гидроцефалии у детей. В настоящее время все виды операций при гидроцефалии могут быть поделены на 5 групп: </p>\r\n<p>паллиативные вмешательства, позволяющие временно снизить внутричерепное давление и устранить краниоцеребральную диспропорцию (люмбальные и вентрикулярные пункции, наружное вентрикулярное дренирование) </p>\r\n<p>операции, направленные на подавление ликворопродукции (клипирование, коагуляция сосудистого сплетения) </p>\r\n<p>операции, направленные на восстановление естественных путей циркуляции ликвора или создание новых путей ликворооттока (удаление опухолей, внутричерепных гематом, вентрикулостомия) </p>\r\n<p>операции, активизирующие ликворосорбцию (рассечение арахноидальных спаек и др.) </p>\r\n<p>шунтирующие операции, предусматривающие отведение ликвора в другие системы организма.</p>\r\n<p>. Позволяет определить степень повышения внутричерепного давления. </p>\r\n<p>Офтальмоскопия – осмотр глазного дна. Выявляют застойные диски зрительных нервов, как следствие повышенного внутричерепного давления. </p>\r\n<p>Для оценки давления цереброспинальной жидкости, исследования ее состава и проведения ликвородинамических проб прибегают к вентрикулярной и люмбальной пункциям. </p>",
"treatment": "<p>С целью снижения продукции ликвора и внутричерепного давления проводится дегидратационная терапия диуретиками, ингибиторами карбоангидразы, салуретиками. </p>\r\n<p>Оптимальный способ оперативного вмешательства определяется этиологией, формой, стадией гидроцефалии у детей. В настоящее время все виды операций при гидроцефалии могут быть поделены на 5 групп: </p>\r\n<ul>\r\n<li>паллиативные вмешательства, позволяющие временно снизить внутричерепное давление и устранить краниоцеребральную диспропорцию (люмбальные и вентрикулярные пункции, наружное вентрикулярное дренирование);</li>\r\n<li>операции, направленные на подавление ликворопродукции (клипирование, коагуляция сосудистого сплетения);</li>\r\n<li>операции, направленные на восстановление естественных путей циркуляции ликвора или создание новых путей ликворооттока (удаление опухолей, внутричерепных гематом, вентрикулостомия);</li>\r\n<li>операции, активизирующие ликворосорбцию (рассечение арахноидальных спаек и др.);</li>\r\n<li>Предупреждение инфекций, таких как менингит (воспаление мягких мозговых оболочек), энцефалит (воспаление головного мозга), сифилис (венерическое инфекционное заболевание с поражением кожи, слизистых оболочек, внутренних органов, костей, нервной системы).</li>\r\n<li>Исключение стрессовых ситуаций и переутомления.</li>\r\n<li></li>\r\n<li>шунтирующие операции, предусматривающие отведение ликвора в другие системы организма.</li>\r\n</ul>",
"prevention": "<p>Предупреждение инфекций, таких как менингит (воспаление мягких мозговых оболочек), энцефалит (воспаление головного мозга), сифилис (венерическое инфекционное заболевание с поражением кожи, слизистых оболочек, внутренних органов, костей, нервной системы)</p>\r\n<p>Исключение стрессовых ситуаций и переутомления.</p>\r\n<p> </p>",
"clinical_picture": "<p>У взрослых и детей старшего возраста к симптомам гидроцефалии относятся: не снимающаяся анальгетиками интенсивная головная боль, тошнота, рвота, чувство давления на глазные яблоки. Указанные симптомы могут возникнуть остро или нарастать постепенно, имея в начале заболевания преходящий характер. </p>\r\n<p>В большинстве случаев гидроцефалия сопровождается неврологической симптоматикой. Наиболее часто при гидроцефалии отмечаются вестибулярные и зрительные нарушения. К первым относится вестибулярная атаксия, проявляющаяся головокружением, неустойчивостью походки, шумом в ушах и голове, нистагмом (подергивание глазных яблок). Со стороны зрения может наблюдаться значительное снижение остроты зрения, выпадение определенных участков полей зрения, застойные диски зрительных нервов; при длительном течении гидроцефалии может развиться атрофия зрительных нервов и полная потеря зрения. </p>\r\n<p>Гидроцефалия может протекать с нарушениями двигательной и чувствительной сферы: парезами и параличами, повышением сухожильных рефлексов и мышечного тонуса, понижением или полным выпадением всех видов чувствительности, образованием спастических контрактур конечностей. Окклюзионная гидроцефалия характеризуется симптомами мозжечковой атаксии: нарушением координации и походки, крупноразмашистыми несоразмерными движениями, изменением почерка и пр. </p>\r\n<p>В некоторых случаях гидроцефалия сопровождается психическими расстройствами, которые у взрослых чаще проявляются нарушениями эмоционально-волевой сферы: эмоциональной неустойчивостью, неврастенией, беспричинной эйфорией с быстрым переходом к состоянию безразличия и апатии. При резком увеличении внутричерепного давления, возможно агрессивное поведение.</p>",
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},
"code": "B19",
"name": "Вирусный гепатит неуточненный",
"icd_name": "Вирусный гепатит неуточненный",
"gender": 0,
"age_min": 0,
"age_max": 84,
"cause": [
2,
7,
9,
10
],
"periodicity": 4,
"slug": "b19_virusnyy_gepatit_neutochnennyy",
"lead": "Нарушение здоровья, относящееся к группе вирусный гепатит",
"description": "Вирусные гепатиты – группа инфекционных заболеваний, вызываемых первично-гепатотропными вирусами, характеризующихся преимущественным поражением печени.",
"etiology": "<p>Гепатит может быть вызван многими причинами, но наиболее часто гепатит вызывается вирусами. На данный момент известно большое количество вирусов, способных вызвать вирусный гепатит: вирус гепатита A, вирус гепатита B, вирус гепатита C, вирус гепатита D, вирус гепатита E, вирус гепатита F и вирус гепатита G, вирусы гепатитов TTV и SEN, цитомегаловирус, вирус Эпштейна — Барр, ВИЧ и другие. Некоторые вирусы, вызывающие вирусный гепатит, недостаточно изучены.</p>\r\n<p>Известны также вирусы гепатитов животных:</p>\r\n<ul>\r\n<li>собак (аденовирус),</li>\r\n<li>мышей (коронавирус),</li>\r\n<li>уток (энтеровирус) и, вероятно,</li>\r\n<li>обезьян (пегивирус).</li>\r\n</ul>\r\n<p>Кроме того, гепатит может вызываться такими вирусами, как вирус желтой лихорадки, герпесвирусы, вирус краснухи, вирусы Коксаки, вирус лихорадки Ласса, вирусы лихорадок Марбург-Эбола и другими.</p>",
"pathogenesis": "<p>Вирусы гепатита попадают в организм разными путями: гепатит А и Е — через загрязненные пищевые продукты и воду; гепатит В — через небезопасную кровь и другие жидкости организма; гепатит С — в основном, через зараженную кровь и гепатит D — в качестве дополнительной инфекции при наличии гепатита В.</p>\r\n<p>Вирусы обладают тропностью к ткани печени, при этом они вызывают острое ее воспаление, повреждение и разрушение печеночных клеток (гепатоцитов), воспалительный отек и снижение функциональной деятельности органа. Недостаточность желчеобразующая функции печени является первопричиной повышенного накопления билирубина в крови (билирубинемии) и, как следствие, желтухи. Поскольку в тканях печени нет болевых рецепторных зон, болевой синдром редко выражен и связан с увеличением печени, растяжении ее хорошо иннервированной капсулы и воспалительными процессами в желчном пузыре.</p>\r\n<p>Хроническое воспаление, как правило, развивается вследствие нелеченного или недостаточно леченного острого гепатита. Нередко хронический гепатит постепенно переходит в цирроз печени.</p>",
"diagnostics": "<p><strong></strong></p>\r\n<p>Диагностика гепатитов осуществляется на основании анамнеза, клинических данных, данных физикального осмотра, функциональных и лабораторных исследований.</p>\r\n<p> </p>\r\n<p>Лабораторные исследования включают: </p>\r\n<ul>\r\n<li>Биохимический анализ крови (повышение уровня печеночно-клеточных ферментов – АЛТ, АСТ; повышение общего билирубина, изменение соотношения прямой и непрямой фракций билирубина);</li>\r\n<li>Общий анализ мочи – появление в моче билирубина, накопление уробилина;</li>\r\n<li>Коагулограмма – оценка свертывающей системы крови;</li>\r\n<li>Тимоловая и сулемовая пробы;</li>\r\n<li>ПЦР-диагностика крови – выявление генома (РНК или ДНК) вируса;</li>\r\n<li>ИФА – выявление в сыворотке крови специфических антител (иммуноглобулинов класса М)</li>\r\n</ul>\r\n<p> </p>\r\n<p>Инструментальные методы диагностики включают:</p>\r\n<ul>\r\n<li>УЗИ органов брюшной полости – отмечают увеличение печени и изменение ее звуковой проницаемости и, кроме этого, отмечают увеличение селезенки и, возможно, расширение полой вены;</li>\r\n<li>Реогепатография(исследование печеночного кровотока), </li>\r\n<li>Гепатохолецистосцинтиография(радиоизотопное исследование желчевыводящих путей), </li>\r\n<li>Пункционная биопсия печени.</li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>Лечение острого гепатита обязательно проводится в стационаре.</p>\r\n<p>Назначается:</p>\r\n<p>прописывается диета №5, полупостельный режим (при тяжелом течении – постельный);</p>\r\n<p> </p>\r\n<p>Этиотропная терапия</p>\r\n<ul>\r\n<li>Интерферон-а</li>\r\n<li>Индукторы интерферона</li>\r\n<li>Ламивудин</li>\r\n</ul>\r\n<p>Патогенетическая и посиндромная терапия:</p>\r\n<ul>\r\n<li>Интенсивная дезинтоксикационная инфузионная терапия, при необходимости экстракорпоральная детоксикация;</li>\r\n<li>Желчегонные препараты или тюбажи по Демьянову;</li>\r\n<li>Ферментные препараты;</li>\r\n<li>Гепатопротективные препараты;</li>\r\n<li>Глюкокортикоиды;</li>\r\n<li>Ингибиторы протеолиза;</li>\r\n<li>Поливитамины, витамино-минеральные комплексы, фитотерапия.</li>\r\n</ul>\r\n<p>Хорошие результаты по улучшению общего состояния при выраженной гипоксии дает кислородотерапия, оксигенобаротерапия. Если присутствуют признаки геморрагического диатеза, назначают витамин К внутривенно.</p>",
"prevention": "<p>Первичная профилактика вирусных гепатитов – соблюдение гигиенических предписаний, осуществление санитарно-эпидемических мер, санитарный надзор над предприятиями, могущими стать очагом распространения инфекции, вакцинация. Профилактикой других форм гепатитов является избегание действия гепатотравмирующих факторов – алкоголя, лекарственных средств, токсических веществ.</p>\r\n<p>Вторичная профилактика хронического гепатита заключается в соблюдении диеты, режима, врачебных рекомендаций, регулярном прохождении обследования, контроле клинических показателей крови. Больным рекомендовано регулярное санаторно-курортное лечение, водолечение.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Выделяют две основные формы клинического течения гепатитов: острую и хроническую.</p>\r\n<p>Острая форма течения наиболее характерна для гепатитов вирусной природы. Иногда начало гепатита напоминает грипп: с повышением температуры тела, головной болью, общим недомоганием, ломотой в теле. Как правило, это — так называемая «маска» начинающегося вирусного гепатита, характеризующаяся слабостью.</p>\r\n<p>При острой форме развития гепатита наблюдается заметное ухудшение общего состояния больного, развития признаков общей интоксикации организма и нарушения функции печени (повышение температуры тела, в ряде случаев развитие желтухи и др.), а также повышение уровня печеночных ферментов (трансаминаз) и общего билирубина крови. Моча темнеет, при выраженных нарушениях синтеза желчных кислот кал теряет цвет, становится беловато-глинистым.</p>\r\n<p>Больные могут отмечать такие симптомы, как кожный зуд, возникновение на коже красных точек – петехий, брадикардию, невротические симптомы.</p>\r\n<p>Острый гепатит, как правило, заканчивается полным выздоровлением больного, однако в некоторых случаях наблюдается переход острого течения болезни в хроническое.</p>\r\n<p>Клиническая картина при хроническом гепатите бедная, заболевание долгое время протекает бессимптомно. Хронический гепатит характеризуется постепенным развитием следующих клинических синдромов:</p>\r\n<ul>\r\n<li>астеновегетативный (слабость, повышенная утомляемость, расстройства сна, психическая лабильность, головные боли – обусловлен интоксикацией организма в связи с нарастающей печеночной недостаточностью;</li>\r\n<li>диспепсический (тошнота, иногда - рвота, понижение аппетита, метеоризм, поносы, чередующиеся с запорами, отрыжка горечью, неприятный привкус во рту) связан с нарушениями пищеварения в связи с недостаточностью выработки печенью необходимых для пищеварения ферментов и желчных кислот);</li>\r\n<li>болевой синдром (боль постоянного, ноющего характера локализуется в правом подреберье, усиливается при физических нагрузках и после резких нарушений диеты) – может отсутствовать или выражаться в умеренном ощущении тяжести в эпигастрии;</li>\r\n<li>субфебрилитет (умеренное повышение температуры до 37,3 – 37,5 градусов может держаться по нескольку недель);</li>\r\n<li>телеангиэктазии (сосудистые звездочки на коже) на шее, лице, плечах;</li>\r\n<li>геморрагический (петехии, склонность к образованию синяков и кровоподтеков, носовые, геморроидальные, маточные кровотечения) связан с понижением свертываемости крови вследствие недостаточного синтеза факторов свертываемости в клетках печени;</li>\r\n<li>желтуха – наиболее известный симптом, возникает, когда билирубин, не переработанный в печени, попадает в кровь и придаёт коже характерный желтоватый оттенок. Однако часто бывают и безжелтушные формы гепатита;</li>\r\n<li>увеличение печени, может сочетаться с увеличением селезенки.</li>\r\n</ul>\r\n<p> </p>",
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"code": "A26",
"name": "Эризипелоид",
"icd_name": "Эризипелоид",
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"slug": "a26_erizipeloid",
"lead": "Нарушение здоровья, относящееся к группе некоторые бактериальные зоонозы",
"description": "Эризипелоид – инфекционное заболевание, которое передается человеку от животных и сопровождается воспалительным поражением кожи и суставов. Обычно процесс локализуется в коже и суставах пальцев кисти с тыльной стороны. Редко развивается генерализованная форма.",
"etiology": "<p>Возбудителем эризипелоида является коринебактерия Erysipelothrix rhusiopathiae, которая имеет 2 вида — мышиный и свиной. Первый распространен среди диких животных, второй — среди домашних. Заражение человека происходит контактным путем через почву, сено, воду, шкуру или мясо, инфицированные больным животным, выделяющим патогенные бактерии с мочой и испражнениями. Больной эризипелоидом человек не может стать причиной заражения окружающих.</p>\r\n<p>Проникновение возбудителя эризипелоида в кожу становиться возможным при нарушении ее целостности: царапины, расчесы при укусах насекомых или зудящих дерматозах, опрелости и потертости при травматическом дерматите.</p>",
"pathogenesis": "<p>Возбудитель проникает в организм человека через микротравмы кожи, чаще всего пальцев. В дерме формируется очаг инфекции, развивается местный воспалительный процесс с захватом межфаланговых суставов.</p>\r\n<p>Генерализованные формы наблюдают редко, при этом происходит распространение бактерий по лимфатическим и кровеносным сосудам, ведущее к возникновению распространённых поражений кожи и формированию вторичных очагов инфекции во внутренних органах. В области поражённых участков кожи развивается серозное воспаление с лимфоцитарной инфильтрацией вокруг сосудов, нарушениями микроциркуляции и оттока лимфы.</p>",
"diagnostics": "<p>Лабораторная диагностика. </p>\r\n<p>Возбудитель заболевания может быть выделен из крови при генерализованной инфекции или из везикул, образовавшихся при кожной форме на фоне эритемы. Применяют серологические методы (РА, РНГА), а также биологическую пробу на белых мышах. В большинстве случаев специальные методы исследования при эризипелоиде практически не применяют, а диагноз устанавливают на основе клинико-эпидемиологических данных. </p>",
"treatment": "<p>Этиотропная терапия эризипелоида проводится в течение 7-10 дней и осуществляется с учетом чувствительности возбудителя. Возможно применение антибиотиков пенициллинового, цефалоспоринового, тетрациклинового рядов. По показаниям антибиотикотерапия дополняется дезинтоксикационными мероприятиями, приемом противовоспалительных или антигистаминных препаратов, симптоматическим лечением поражений внутренних органов. Из физиотерапевтических методов при эризипелоиде эффективны УВЧ, УФО, магнитотерапия, электрофорез, магнитолазеротерапия.</p>",
"prevention": "<p>Предупреждение лёгких травм у рабочих мясо- и рыбокомбинатов, немедленная обработка повреждённой кожи дезинфицирующими средствами.</p>\r\n<p>Если кожа на руках повреждена, раны следует обработать так, чтобы возбудитель не проник в организм. Рабочие по уходу за животными должны строго соблюдать правила личной гигиены и постоянно дезинфицировать руки. Наиболее эффективным мероприятием по предотвращению заболевания животных и передаче болезни человеку является систематическая поголовная вакцинация всех свиней.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период эризипелоида длится в среднем 1-3 дня, но может занимать до недели.</p>\r\n<p>Клинические проявления заболевания чаще всего начинают появляться на коже пальца или тыльной стороны кисти.</p>\r\n<p>Выделяет четыре основные формы эризипелоида: кожную, кожно-суставную, ангинозную и генерализованную.</p>\r\n<p>Кожная форма эризипелоида является самой часто встречающейся. Протекает на фоне слабо выраженных признаков интоксикации: субфебрилитет, легкое недомогание, озноб и пр. Типично начало заболевания с ощущения жжения и зуда в месте внедрения возбудителя. Через короткий промежуток времени в этом месте отмечается покраснение (эритема) и отечность кожи. Краснота постепенно приобретает багровый оттенок и распространяется по периферии. Процесс может сопровождаться воспалением регионарных лимфатических узлов и сосудов.</p>\r\n<p>Для эризипелоида типично начало разрешения эритемы с ее центра, который становится вначале синюшного цвета, а затем бледнеет до голубоватого оттенка почти неизмененной кожи. При этом по периферии пораженного участка некоторое время еще сохраняется краснота и отечность, что придает ему своеобразный вид блюдца. В течение нескольких дней краснота краев бледнеет и сглаживается, их отечность спадает. Эритема проходит, оставляя после себя временное легкое шелушение. Весь процесс при кожной форме эризипелоида занимает обычно не более 10 дней.</p>\r\n<p>Кожно-суставная форма – к вышеописанным симптомам эритемы присоединяется артрит — чаще поражаются мелкие межфаланговые суставы. Суставы припухают, подвижность ограничена. Болезнь длится от 3 недель до 6 месяцев.</p>\r\n<p>Ангинозная форма эризипелоида развивается в отдельных случаях, при употреблении зараженных возбудителем продуктов. Характеризуется сочетанием кожных проявлений с клиническими симптомами ангины.</p>\r\n<p>Генерализованная форма эризипелоида отмечается крайне редко. Кожные проявления в виде эритематозных пятен появляются диффузно по всему телу и могут локализоваться на любом участке кожи. Они сопровождаются выраженным общим интоксикационным синдромом, увеличением печени и селезенки. Возможны артриты и поражения внутренних органов с развитием пневмонии, эндокардита, менингита, пиелонефрита. Тяжелым осложнением этой формы эризипелоида является сепсис.</p>",
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"standard_type": 3,
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},
"code": "G90",
"name": "Расстройства вегетативной [автономной] нервной системы",
"icd_name": "Расстройства вегетативной [автономной] нервной системы",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "g90_rasstroystva_vegetativnoy_avtonomnoy_nervnoy_sistemy",
"lead": "Нарушение здоровья, относящееся к группе другие нарушения нервной системы",
"description": "Синдром, характеризующийся нарушениями вегетативной регуляции внутренних органов - сердечно-сосудистой системы, желудочно-кишечного тракта, органов дыхания, желез внутренней секреции.",
"etiology": "<p>Нарушение деятельности внутренних систем человека происходит из-за сбоев в процессе нервной регуляции. Причинами могут быть:</p>\r\n<p> </p>\r\n<ul>\r\n<li>Нарушения в эндокринной систем (ожирение, сахарный диабет);</li>\r\n<li>гормональные сбои или возрастные гормональные изменения в организме (беременность, менструальный цикл, климакс, пубертатный период);</li>\r\n<li>Наследственная предрасположенность;</li>\r\n<li>травмы, ранения, хирургические операции</li>\r\n<li>хронический стресс, мнительность;</li>\r\n<li>Курение, употребления алкоголя и наркотических препаратов;</li>\r\n<li>Несоблюдение правил правильного питания;</li>\r\n<li>Хронические инфекции по типу кариозных образований и тонзиллита;</li>\r\n<li>Аллергическая реакция;</li>\r\n<li>Интоксикация;</li>\r\n<li>Влияние производственных факторов (вибрация, облучение)</li>\r\n<li>Инфекционное поражение периферической вегетативной нервной системы (СПИД, герпес, сифилис, лепра)</li>\r\n</ul>\r\n<p>У детей 1 года жизни заболевания вегетативной нервной системы возникают из-за гипоксии плода (нехватки кислорода при внутриутробном развитии), а также из-за перенесенных стрессов. У детей психика не настолько устойчива, как у взрослых, поэтому для них любая проблема может вызвать психическую травму.</p>",
"pathogenesis": "<p>Основную роль в патогенезе вегетативной дистонии играет нарушение вегетативной регуляции и развитие вегетативного дисбаланса. Отношения между симпатической и парасимпатической вегетативными нервными системами соответствуют принципу «качающегося равновесия»: повышение тонуса одной системы влечет за собой возрастание тонуса другой. Такая форма вегетативного обеспечения позволяет поддерживать постоянство внутренней среды и создавать условия для повышенной лабильности физиологических функций. Клинико-экспериментальные исследования обнаружили эту лабильность практически во всех системах – вариации ритма сердца, артериального давления, температуры тела и других показателей. Выход этих колебаний за пределы нормального диапазона повышает уязвимость системы вегетативной регуляции для повреждающих факторов. В таких условиях экзогенные либо эндогенные стимулы могут приводить к предельному напряжению регуляторных систем, а затем к их «поломке» с клинической манифестацией в виде расстройства вегетативной нервной системы.</p>",
"diagnostics": "<p class=\"txt\">Диагностика вегетативной дистонии преимущественно клиническая. Лабораторные и инструментальные методы требуются для исключения соматических заболеваний, имеющих сходную клиническую картину.</p>\r\n<p class=\"txt\">Дифференциальную диагностику проводят с заболеваниями эндокринных органов (гипо- и гипертиреоз, сахарный диабет, феохромоцитома), сердечно-сосудистой системы (пароксизмы нарушений сердечного ритма и проводимости, сопровождающиеся обмороками), неврологическими заболеваниями (эпилепсия).</p>\r\n<p>Основные (обязательные) диагностические обследования, проводимые на амбулаторном уровне:</p>\r\n<ul>\r\n<li>измерение АД, ЧСС, ЧД в покое, при физической, умственной и эмоциональной нагрузках;</li>\r\n<li>ортостатическая проба – используется для анализа работы сердечно-сосудистой системы при вставании и помогает определить как функционирует симпатический отдел вегетативной нервной системы;</li>\r\n<li>общий анализ крови;</li>\r\n<li>определение натрия, кальция, калия в сыворотке крови;</li>\r\n<li>определение глюкозы в сыворотке крови;</li>\r\n<li>общий анализ мочи;</li>\r\n<li>электрокардиографическое исследование (в 12 отведениях);</li>\r\n</ul>\r\n<p>Основные (обязательные) диагностические обследования, проводимые на стационарном уровне:</p>\r\n<ul>\r\n<li>холтеровское (суточное) мониторирование электрокардиограммы;</li>\r\n<li>суточное мониторирование АД;</li>\r\n<li>тест на толерантность к глюкозе;</li>\r\n<li>ЭЭГ-видеомониторинг.</li>\r\n</ul>\r\n<p>Дополнительные диагностические обследования, проводимые на стационарном уровне:</p>\r\n<ul>\r\n<li>Коагулология;</li>\r\n<li>определение гормонов щитовидной железы ИФА-методом;</li>\r\n<li>МРТ головного мозга;</li>\r\n<li>УЗДГ сосудов головы;</li>\r\n<li>Ультразвуковая диагностика комплексная;</li>\r\n<li>Рентгенография обзорная органов грудной клетки;</li>\r\n<li>Люмбальная пункция;</li>\r\n<li>Исследование спиномозговой жидкости.</li>\r\n</ul>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>",
"treatment": "<p><strong>Немедикаментозное лечение </strong></p>\r\n<p>Включает соблюдение режима труда и отдыха, освобождение от дополнительных нагрузок.</p>\r\n<p>При вторичных нарушениях вегетативной нервной системы необходима диетотерапия, согласно протокола основного заболевания (сахарный диабет, онкологические заболевания, заболевания ЖКТ и т.д.)</p>\r\n<p>Для детей старше пяти лет можно применять иглорефлексотерапию</p>\r\n<p>Показана ранняя реабилитация (массаж, водные процедуры, игротерапия, музыкотерапия, индивидуальная или групповая психотерапия, ЛФК).</p>\r\n<p><strong> Медикаментозное лечение </strong></p>\r\n<p>Назначается только в случае неэффективности немедикаментозных мероприятий или в сочетании с ними.</p>\r\n<p>В случае преобладания активности симпатического отдела нервной системы назначают седативные средства. По показаниям - бензодиазепиновые производные альфа- и бета-адреноблокаторы.</p>\r\n<p>При преобладании тонуса парасимпатической системы используют средства, повышающие АД, холинолитики центрального и периферического воздействие.</p>\r\n<p>В связи с частым сочетанием вегетативных и эмоциональных нарушений применяют антидепрессанты, противотревожные (анксиолитики) и снотворные препараты. Лечение следует проводить с участием психотерапевта или психиатра.</p>",
"prevention": "<p>Профилактику следует начинать с немедикаментозных мероприятий – нормализации режима дня, питания, прогулки на свежем воздухе, водные процедуры. Профилактика нарушений вегетативной нервной системы возможна лишь при ранней их диагностике, определяемых задолго до появления жалоб. В основе профилактики лежит здоровый образ жизни. Оптимизация физической активности и сбалансированное рациональное питание с низкой калорийностью и антисклеротической направленностью – главные составляющие профилактики заболеваний нервной и сердечно-сосудистой систем.</p>",
"clinical_picture": "<p>В клинике расстройств вегетативной нервной системы выделяют гипотензивный и гипертензивный варианты, ведущим проявлением которых являются изменения артериального давления (АД), а также кардиологический вариант с преобладанием болей в области сердца.</p>\r\n<p>Гипотензивный тип устанавливают в случаях, когда величина систолического АД колеблется в пределах 110-80 мм рт. ст., а диастолического 45-60 мм рт. ст. и имеются клинические признаки хронической сосудистой недостаточности.</p>\r\n<p>Жалобы больных, наиболее значимых для диагноза, - зябкость кистей, стоп и склонность к ортостатическим расстройствам (головокружение при перемене положения тела, резком повороте головы, туловища), непереносимость транспорта. Наблюдаются проявления астеновегетативного синдрома: быстрая истощаемость умственной и физической активности, снижение памяти, концентрации внимания, слабость, повышенная утомляемость. Свойственны лабильность настроения, высокая тревожность, склонность к ипохондрии.</p>\r\n<p>При осмотре определяют астеническое телосложение, бледность кожных покровов, мраморность, пастозность тканей, снижение температуры кожи конечностей, влажность ладоней и стоп, учащенное сердцебиение. Нередко выявляется снижение аппетита, тошнота, не связанная с приемом пищи, периодические боли в животе, запоры, головные боли.</p>\r\n<p>Гипертензивный тип характеризуется транзиторным повышением АД и связанные с ним головные боли, боли в области сердца, головокружения, сердцебиения, мелькание мушек перед глазами, чувство жара, приливов к голове и шее. Головная боль возникает преимущественно при психоэмоциональных и физических перегрузках, носит ноющий, иногда пульсирующий характер с преимущественной локализацией в затылке. Отмечается эмоциональная лабильность, повышенная утомляемость, раздражительность, нарушения сна, ипохондрию, метеозависимость.</p>\r\n<p>Кардиалгический тип устанавливают, если нет изменений АД, но есть жалобы на сердцебиение или перебои в сердце, боли в области сердца, одышку. Объективно выявляется тахикардия, выраженная синусовая аритмия или экстрасистолия.</p>\r\n<p>В крайней степени выраженности заболевание может проявляться вегетативными кризами, нейрорефлекторными синкопальными состояниями, перманентными вегетативными нарушениями. Вегетативные кризы могут быть симпатическими, парасимпатическими и смешанными. </p>\r\n<p>При преобладании тонуса симпатической нервной системы (симпатикотония) возникают типичные вегетативные кризы (панические атаки). При осмотре выявляются тахикардия, побледнение кожных покровов, повышение АД, ослабление перистальтики кишечника, расширение зрачков, озноб, ощущение нехватки воздуха, одышка. Важно присутствие тревоги, беспокойства, ощущение страха, который может носить витальную окраску (больной опасается за свою жизнь, хотя видимой угрозы не существует). Возможен страх сойти с ума, совершить неконтролируемое действие, нанести увечья себе или близким.</p>\r\n<p>Гипервентиляционный криз также включает в себя сочетание вегетативных и аффективных нарушений. У больного наблюдаются усиленное, учащенное дыхание, ощущение нехватки воздуха с преимущественным затруднением вдоха. Возможно появление чувства кома в горле, «мурашек» на коже, похолодания рук и ног, неустойчивости походки. Появляется страх потерять сознание, умереть. Вследствие преходящей гипокалиемии возможно развитие гипервентиляционной тетании с напряжением мышц предплечий и кисти («рука акушера»), голеней и стоп (карпопедальные спазмы). Кисти и стопы становятся влажными, холодными на ощупь. Приступ может закончиться обмороком.</p>\r\n<p>Ваготонические кризы сопровождаются брадикардией, затруднением дыхания, покраснением кожи лица, потливостью, саливацией, понижением АД, желудочно-кишечными дискинезиями. Возможно снижение уровня глюкозы в крови. Приступ также может заканчиваться кратковременной утратой сознания. У отдельных больных возможны аллергические явления в виде крапивницы или отека Квинке. Такие кризы могут провоцироваться пребыванием в душном помещении, несвоевременным приемом пищи («голодный обморок»), интенсивными нагрузками, волнением.</p>\r\n<p>Смешанные кризы проявляются сочетанием симптомов, типичных для преобладания тонуса симпатической или парасимпатической нервной системы, либо поочередным их появлением.</p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
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},
"code": "G81",
"name": "Гемиплегия",
"icd_name": "Гемиплегия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "g81_gemiplegiya",
"lead": "Нарушение здоровья, относящееся к группе церебральный паралич и другие паралитические синдромы",
"description": "Гемиплегия – неврологический синдром, проявляющийся полным отсутствием произвольных движений в верхней и нижней конечности на одной стороне. ",
"etiology": "<p>К органическим причинам гемиплегии относятся: </p>\r\n<ul>\r\n<li>Нарушение кровообращения головного мозга (кровоизлияние в мозг, спазм сосудов мозга, тромбоз мозговых сосудов);</li>\r\n<li>Воспалительные заболевания головного мозга (абсцесс мозга, арахноидит);</li>\r\n<li>Опухоли головного мозга; </li>\r\n<li>Нарушение обусловлено повреждением двигательной пирамидной системы мозга. </li>\r\n</ul>\r\n<p>Функциональная гемиплегия вызвана истерией и является симптомом диссоциативного расстройства. </p>\r\n<p>К факторам риска гемиплегии относятся: </p>\r\n<ul>\r\n<li>Заболевания сердца и сосудов в пожилом возрасте;</li>\r\n<li>Травмы мозга в анамнезе;</li>\r\n<li>Роды с осложнениями (риск для детей);</li>\r\n<li>Заболевания крови;</li>\r\n<li>Переедание;</li>\r\n<li>Алкогольная и наркотическая зависимость, курение.</li>\r\n</ul>",
"pathogenesis": "<p>Анатомический субстрат развития гемиплегии – поражение на различных уровнях пирамидного пути, по которому передача нервного импульса осуществляется в верхне-нижнем направлении: от клеток коры головного мозга через его структуры к мотонейронам (двигательным нервным клеткам), располагающимся в передних рогах спинного мозга. </p>\r\n<p>В нижнем отделе (хвостовом, или каудальном) продолговатого мозга волокна пирамидного тракта совершают частичный перекрест, поэтому, как правило, поражение левой половины тела говорит о повреждении структур правого полушария (и наоборот, если повреждение располагается ниже перекреста – гемиплегия определяется на стороне повреждения). </p>",
"diagnostics": "<p>Поскольку патология обладает специфической симптоматикой, с установлением правильного диагноза зачастую не возникает проблем. Однако для дифференциации различных форм необходим комплексный подход. </p>\r\n<p>В первую очередь необходимо: </p>\r\n<ul>\r\n<li>ознакомиться с историей болезни – для установления основного патологического этиологического фактора; </li>\r\n<li>собрать и проанализировать жизненный анамнез – для выявления возможных причин формирования врожденной разновидности болезни; </li>\r\n<li>провести тщательный физикальный осмотр; </li>\r\n<li>осуществить комплекс неврологических тестов – таким образом специалистом осуществляется определение состояния рефлексов и мышц больной руки и ноги; </li>\r\n</ul>\r\n<p>Лабораторные исследования в данном случае включают в себя: </p>\r\n<ul>\r\n<li>общий и биохимический анализ крови; </li>\r\n<li>микроскопическое изучение спинномозговой жидкости; </li>\r\n<li>общеклинический анализ мочи. </li>\r\n</ul>\r\n<p>Инструментальных методы включают проведение: </p>\r\n<ul>\r\n<li>электромиографии; </li>\r\n<li>КТ и МРТ головного мозга – помогает отличить между собой центральную форму с альтернирующей разновидностью; </li>\r\n<li>доплерографии сосудов головного мозга; </li>\r\n<li>электроэнцефалографии; </li>\r\n<li>люмбальной пункции – для получения ликвора. </li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>При комплексной терапии гемиплегии применяются: </p>\r\n<ul>\r\n<li>Препараты, улучшающие обменные и трофические процессы в нервной ткани; </li>\r\n<li>Нейропротекторы - это средства, которые предупреждают повреждение нейронов мозга, обусловленное действием патогенного фактора; </li>\r\n<li>Миорелаксанты - препараты, расслабляющие мускулатуру; </li>\r\n<li>Антиоксиданты - препараты, нейтрализующие окислительное действие свободных радикалов; </li>\r\n<li>ингибиторы холинэстеразы, витамигы группы В - препараты, способствующие передаче нервного импульса; </li>\r\n<li>физиотерапевтическое воздействие (массаж, электрофорез, кинезотерапия, ЛФК). </li>\r\n</ul>",
"prevention": "<p> К общим профилактическим рекомендациям относятся: </p>\r\n<ul>\r\n<li>контроль над адекватным протеканием беременности; </li>\r\n<li>полный отказ от вредных привычек; </li>\r\n<li>правильное и сбалансированное питание; </li>\r\n<li>умеренная физическая активность (ЛФК); </li>\r\n<li>избегание травм головы и спинного мозга; </li>\r\n<li>своевременное обнаружение и лечение патологических этиологических факторов (в частности, наиболее частой причины – ишемического инсульта), которые могут привести к развитию такой проблемы; </li>\r\n<li>регулярное прохождение полноценного профилактического осмотра в медицинском учреждении с посещением всех клиницистов. </li>\r\n</ul>",
"clinical_picture": "<p>Симптомы центральной гемиплегии: </p>\r\n<ul>\r\n<li>полное отсутствие активных движений в пораженных конечностях, мимических мышцах на стороне, противоположной поражению; </li>\r\n<li>спастический гипертонус мышц; </li>\r\n<li>симптом складного ножа (мышечное сопротивление при попытке пассивно согнуть конечность пациента в коленном или локтевом суставах, после преодоления начального сопротивления сгибание происходит без затруднений); </li>\r\n<li>повышение сухожильных и надкостничных рефлексов в парализованных конечностях;</li>\r\n<li>снижение брюшных рефлексов на стороне гемиплегии; </li>\r\n<li>снижение глубокой и поверхностной чувствительности (тактильной, температурной, болевой, давления); </li>\r\n<li>снижение суставных рефлексов (Лери, Майера); </li>\r\n<li>патологические рефлексы конечностей (Бабинского, Гордона, Оппенгейма, Шеффера, разгибательные Редлиха и Россолимо, Бехтерева – Менделя, Жуковского и др.); </li>\r\n<li>выявление рефлексов спинального автоматизма; </li>\r\n<li>содружественные синкинезии (непроизвольные мышечные сокращения и движения, сопутствующие активному двигательному акту). </li>\r\n</ul>\r\n<p>При периферической гемиплегии мышечный тонус понижен (возможно сочетание спастических изменений мышечного тонуса с гипотонией), рефлексы также снижены на стороне поражения. Мимические мышцы в данном случае в патологический процесс не вовлекаются. </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 73,
"standards": []
}
]
}
