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},
"code": "R33",
"name": "Задержка мочи",
"icd_name": "Задержка мочи",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "r33_zaderzhka_mochi",
"lead": "обусловлена различными заболеваниями органов мочеполовой системы, при которых полностью или частично закрывается просвет мочеиспускательного канала в результате поражения центральной нервной системы, воспалительных заболеваний, при травмах ",
"description": "Задержка мочи – состояние, при котором отмечается нарушение адекватного опорожнения мочевого пузыря. Данная ситуация развивается в результате затруднения оттока мочи или при снижении сократительной способности мочевого пузыря.",
"etiology": "<p>Причины, вызывающие задержку мочеиспускания, можно разделить на две группы:</p>\r\n<ol>\r\n<li>Патологические изменения в мочевых органах или их сдавление:</li>\r\n</ol>\r\n<ul>\r\n<li>Травматические повреждения (травма, размозжение, отрыв мочеиспускательного канала).</li>\r\n<li>Закупорка просвета мочеиспускательного канала (камень, полип, дивертикул, рак мочевого пузыря, поствоспалительные стриктуры уретры и т.д.);</li>\r\n<li>Сдавление мочеиспускательного канала патологически измененными органами мочеполовой системы (при аденоме, раке, кисте, абсцессе, склерозе предстательной железы, простатите, фимозе, парафимозе, баланопостите).</li>\r\n<li>Сдавление мочеиспускательного канала патологически измененными органами полости малого таза (рак прямой кишки, парапроктит, опухоли матки, паховые грыжи, аневризма подчревной артерии, гематома промежности и др.).</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Заболевания нервной системы (неврогенная дисфункция мочевого пузыря).</li>\r\n</ol>\r\n<p>К причинам нарушения процессов сокращения и расслабления мышцы мочевого пузыря и пузырно-уретрального сегмента относят опухоли, воспалительные заболевания, травмы спинного и головного мозга, грыжи спинного мозга, нарушение периферической иннервации мочевого пузыря после операций на органах малого таза. В эту же группу причин следует отнести и рефлекторную задержку мочеиспускания после оперативных вмешательств, родов, спинномозговой анестезии.</p>",
"pathogenesis": "<p>При переполнении мочевого пузыря больной не может самопроизвольно опорожнить мочевой пузырь за счет препятствия в области шейки мочевого пузыря или уретры и несостоятельности главной мышцы – детрузора. Поступающая из почек новая порция мочи, повышает внутрипузырное давление и развивается так называемая парадоксальная ишурия, когда моча самопроизвольно начинает вытекать, преодолевая препятствие. При этом мочевой пузырь не опорожняется полностью.</p>",
"diagnostics": "<p>Полная ишурия (как острая, так и хроническая) диагностируется без затруднений. В случае выраженной задержке мочи при физическом осмотре в надлобковом участке выявляют выбухание, которое связано с переполнением пузыря. Может осуществляться перкуссия (простукивание), которая позволяет определить границы переполненного мочевого пузыря.</p>\r\n<p>При менее выраженных случаях ишурии осуществляется УЗИ-диагностика мочевого пузыря и почек. Также неполное задерживание мочи может быть диагностировано в случае наличия большого количества мочи (более трехсот миллилитров), которое определяется посредством катетеризации, осуществленной непосредственно после акта мочеиспускания. Определение остатков может производиться и путем ввода радиоизотопных средств, которые быстро выводятся почками и оседают в мочевом пузыре вместе с оставшейся мочой после мочеиспускания. Кроме этого, применяются следующие диагностические методы:</p>\r\n<ul>\r\n<li>общий анализ крови (с целью определения симптомов воспалительного процесса);</li>\r\n<li>общий анализ мочи (для обнаружения воспаления в мочевых путях и почках);</li>\r\n<li>биохимический анализ крови (осуществляется для выявления разных отклонений в функционировании почек);</li>\r\n<li>ультразвуковая диагностикапростаты.</li>\r\n</ul>",
"treatment": "<p>Неотложное мероприятие – срочное опорожнение мочевого пузыря. На догоспитальном этапе это возможно сделать при помощи катетеризации мочевого пузыря эластичным катетером или надлобковой пункцией. Если ОЗМ продолжается более двух суток, оправдано оставление катетера в мочевых путях с назначением профилактической антибактериальной терапии.</p>\r\n<p>В некоторых случаях прибегают к цистостомии (установка трубочки в мочевой пузырь через переднюю брюшную стенку). После дренирования выявляют и по возможности устраняют причину нарушения оттока мочи.</p>\r\n<p>В случае хронической задержки мочи лечение проводится в зависимости от причины заболевания.</p>\r\n<p>При рефлекторной ишурии осуществляются попытки наладить опорожнение рефлекторно (звук текущей воды из крана, орошение гениталий теплой водой). Если данные методики оказываются неэффективными, применяются медикаментозные средства. Осуществляется подкожное введение прозерина (ингибитора холинэстеразы).</p>",
"prevention": "<p>С целью профилактики задержки мочеиспускания необходимо:</p>\r\n<ul>\r\n<li>осуществлять контроль ПСА (специфический белок, уровень которого в крови увеличивается при болезнях предстательной железы) у мужчин;</li>\r\n<li>избегать переохлаждений, травм мочеполовых органов;</li>\r\n<li>отказаться от злоупотреблений алкоголем;</li>\r\n<li>посещать урологараз в год (касается лиц возрастом после сорока пяти лет);</li>\r\n<li>незамедлительно обращаться к специалисту для коррекции лечения в случае возникновения затруднений мочеиспускания во время приема некоторых лекарственных препаратов.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Острая задержка мочи характеризуется:</p>\r\n<ul>\r\n<li>мучительными позывами на мочеиспускание;</li>\r\n<li>беспокойством больного;</li>\r\n<li>сильными болями в надлобковой области (могут быть незначительными при медленно развивающейся задержке мочи);</li>\r\n<li>ощущением распирания внизу живота.</li>\r\n</ul>\r\n<p>При ишурии на фоне болезней нервной системы мочеиспускательные позывы или совсем не проявляются, или очень слабо выражены, пациент спокоен, не смотря на выраженное переполнение его мочевого пузыря. Во время диагностирования обнаруживается определенный неврологический синдром (парезы, расстройства чувствительности и пр.)</p>\r\n<p>Хроническая задержка мочи не вызывает выраженного дискомфорта или болезненности в области лона, однако это ощущение носит постоянный и изнуряющий характер. Присутствуют трудности с началом мочеиспускания, оно часто возникает после напряжения мышц брюшного пресса или при помощи надавливания руками на низ живота. После начала мочеиспускания струя мочи слабая и может прерываться. После мочеиспускания часто сохраняется ощущение неполного опорожнения мочевого пузыря, что вызывает необходимость повторной попытки мочеиспускания через малый промежуток времени. Помимо функциональных нарушений развивается ряд психологических проблем и комплексов, связанных с необходимостью часто и подолгу мочиться.</p>\r\n<p>При парадоксальной ишурии моча, независимо от воли больного, постоянно каплями выделяется из мочеиспускательного канала, то есть на фоне полной задержки мочеиспускания наблюдается недержание мочи.</p>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 191,
"standards": [
5009,
5113
]
},
{
"id": 6973,
"symptoms": [
{
"id": 3210,
"synonyms": [
{
"name": "Тяжесть в животе при беременности"
},
{
"name": "Дискомфорт в животе при беременности"
},
{
"name": "Вздутие живота при беременности"
}
],
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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;\">Вероятность многоплодной беременности существенно выше у некоторых категорий пациенток:</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;\">наследственность;</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;\">женщин, планирующих зачатие после отказа от гормональных контрацептивов;</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;\">женщин старше 35 лет;</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;\">тех, у кого имеются врожденные нестандартные особенности строения матки;</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;\">будущих мам, воспользовавшихся возможностями современных репродуктивных технологий (процедура ЭКО и др.). </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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Число плодов может быть любым, как правило, речь идет о двойне или тройне. Выделяют однояйцевые (оплодотворение одной яйцеклетки, рождение идентичных младенцев — близнецов) и двуяйцевые беременности. Во втором случае оплодотворяются две (или более) яйцеклеток, в результате рождаются разные дети. Именно такой случай чаще обуславливается возрастом женщины, вмешательством в репродуктивные процессы (ЭКО, стимуляция овуляции, отмена КОК). Эти факторы приводят к более активной работе яичников, в результате чего в один менструальный цикл созревает сразу несколько яйцеклеток.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Механизм развития многоплодной беременности зависит от ее варианта. При вынашивании разнояйцевых близнецов каждая из зигот развивается самостоятельно и отдельно имплантируется в стенку матки, формируя собственную плаценту и плодные оболочки. Если многоплодная гестация является однояйцевой, в ее развитии важную роль играет время деления оплодотворенной яйцеклетки. При раздвоении зиготы в течение 0-72 часов после зачатия плацентация является такой же, как у двуяйцевых близнецов, — бихориально-биамниальной. Такой вариант многоплодной монозиготной беременности наблюдается в четверти случаев.</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 70% беременных деление эмбриона происходит на 4-8-е сутки гестации после нидации и формирования хориона, в результате каждый из плодов имеет собственные оболочки, но развивается на общей хориальной площадке. В 5% монозиготных беременностей эмбрион делится после формирования хориона и амниона (на 9-13-е сутки). В результате плоды растут в общей оболочке и получают питание от единой плаценты. Расщепление зародыша после 13-го дня развития обычно бывает неполным (сросшиеся или сиамские близнецы). В редких случаях в матке развиваются одновременно моно- и дизиготные двойни.</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;\">УЗИ точно подтвердит наличие в матке нескольких эмбрионов уже с 5‒6 недели — на ранних сроках их уже видно, и они выглядят как две (а может быть три или четыре) горошины. Уже на 9‒10 неделе можно определить, есть ли у каждого плода отдельные пузырь и плацента, также доктор прослушивает сердцебиение каждого малыша.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Что еще предстоит:</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;\">УЗИ проводят ежемесячно, чтобы следить за нормальным функционированием плаценты и исключить патологическое состояние одного или всех плодов.</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;\">После 20 недели проводится допплерография, после 30 недели — кардиотокография . С двойней чаще всего назначают такие обследования каждую неделю.</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;\">При многоплодной чаще, чем при обычной беременности, нужно сдавать кровь, чтобы вовремя определить анемию.</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;\">При ведении монохориальной двойни дополнительно обследуют сосуды плаценты, чтобы исключить гипоксию и фетоплацентарную недостаточность. При задержке развития одного или нескольких плодов проводят оценку биофизического профиля.</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;\">С учетом высокой вероятности осложненного течения пациенткам с многоплодием рекомендованы соблюдение щадящего режима (ограничение физических и психоэмоциональных нагрузок, достаточный сон и дневной отдых), специальный рацион для удовлетворения повышенной потребности в белках, углеводах, жирах, витаминах и микроэлементах, динамическое наблюдение для оценки состояния женщины и детей. Особое внимание уделяется профилактике анемии, ранней диагностике сердечно-сосудистой и почечной патологии, нарушений гемостаза. При выявлении гестозов и других осложнений предпочтительна госпитализация в акушерский стационар. Беременную с неосложненной многоплодной гестацией направляют в роддом за 2-3 недели до предполагаемых родов, при вынашивании трех плодов и больше — за 4 недели, при монохориальной плацентации — на 26-27 неделях. При выборе способа родоразрешения учитывают наличие осложнений, число близнецов, их размеры и положение в матке. Для завершения беременности могут быть рекомендованы:</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;\">Естественные роды. Хотя многоплодие не служит прямым показанием к проведению кесарева сечения, родоразрешение через родовые пути при близнецовой беременности применяется реже, чем одноплодной. Естественные роды возможны при наличии двойни, когда близнецы находятся в продольном положении и головном предлежании. При нормальных показателях фетального развития родовую деятельность рекомендуется индуцировать на 37 неделе.</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;\">Оперативное родоразрешение. Кесарево сечение проводится в плановом порядке при вынашивании крупных или сиамских близнецов, более двух плодов, неготовности родовых путей после 37 недели гестации, тазовом варианте предлежания первого близнеца, поперечной позиции первого или обоих плодов, гипоксии. Экстренное хирургическое вмешательство выполняется при внезапном возникновении угрозы матери или плодам (отслойке плаценты и др.).</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> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По показаниям в период беременности пациенткам могут проводиться операции для устранения или коррекции синдрома фето-фетальной трансфузии (амниоредукция, эндоскопическая коагуляция лазером анастомозированных плацентарных сосудов, септостомия, в исключительных случаях — избирательная эвтаназия плода-донора). При естественном родоразрешении после появления первого близнеца иногда допускается выполнение под ультразвуковым контролем наружного поворота на головку оставшегося ребенка. В многоплодных родах необходимы мероприятия по предупреждению послеродовых кровопотерь.</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;\">Эффективных мероприятий по профилактике множественного зачатия на сегодняшний день не предложено. Для предупреждения возможных осложнений рекомендованы ранняя постановка на учет и регулярное наблюдение у акушера-гинеколога, сбалансированное питание, витаминизация, более частый отдых в положении на боку.</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 многоплодной беременности к организму женщины предъявляются повышенные требования: сердечно-сосудистая система, легкие, печень, ночки и другие органы функционируют с большим напряжением. В связи с этим многоплодная беременность протекает тяжелее одноплодной. </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;\">Беременные часто жалуются на утомляемость и одышку, которая усиливается к концу беременности. Причиной одышки является затруднение деятельности сердца в связи со значительным смещением диафрагмы дном матки, размер которой при многоплодной беременности больше, чем при одноплодной. </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;\">Нередко возникает расширение вен нижних конечностей. К концу беременности часто отмечается учащение позывов на мочеиспускание вследствие давления большого плодовместилища на мочевой пузырь. </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;\">Беременные нередко жалуются на изжогу и запоры. </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;\">При многоплодной беременности чаще, чем при одноплодной, возникают токсикозы: рвота, слюнотечение, отеки, нефропатия, эклампсия. </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;\">При двойнях нередко встречается многоводие одного из плодов, что ведет к резкому увеличению и перерастяжению матки, одышке, тахикардии и другим расстройствам. Многоводие чаще наблюдается у одного из однояйцовых близнецов. В некоторых случаях многоводию одного близнеца сопутствует маловодие другого плода. </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;\">Часто возникает преждевременное прерывание многоплодной беременности. </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;\">При двойнях преждевременные роды наблюдаются не менее чем у 25% женщин. </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;\">При тройнях преждевременное прерывание беременности происходит чаще, чем при двойнях. Чем больше число вынашиваемых плодов, тем чаще наблюдаются преждевременные роды. </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;\">Развитие близнецов, родившихся в срок, в большинстве случаев бывает нормальным. Однако масса их тела обычно меньше, чем у одиночных плодов. Нередко существует разница в массе тела близнецов на 200—300 г, а иногда и больше. </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;\">Неравномерное развитие близнецов связано с неодинаковым поступлением питательных веществ из единого плацентарного круга кровообращения. </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\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 30,
"published": 1,
"parent": null,
"block_rubric": 161,
"standards": [
5341
]
},
{
"id": 15353,
"symptoms": [],
"alternative_names": [],
"complications": [],
"medicine_branches": [],
"who": [
{
"id": 15123,
"gender": 2,
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},
{
"id": 15122,
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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;\">Данное психическое расстройство обычно развивается под воздействием общественных факторов, к которым относят:</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;\">навязывание искусственных стандартов красоты в интернете, на телевидении, в рекламе;</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;\">межличностные контакты;</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;\">избыточная самокритичность, возникающая в результате негативного влияния кого-то из близких людей;</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;\">низкая самооценка, неуверенность в себе;</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;\">стремление к идеальным формам, излишняя педантичность.</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;\">Существует еще ряд факторов, которые могут спровоцировать развитие заболевания.</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;\">К ним относятся:</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;\">наследственная предрасположенность;</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;\">нехватка в организме серотонина;</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;\">депрессия;</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;\">хронический стресс;</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;\">повышенная тревожность</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p> </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;\">Периодическое неконтролируемое переедание формируется на базе эмоционального напряжения по типу аддиктивного поведения. Булимическим приступам предшествует нарастание аффективного дискомфорта: тревоги, печали, злости. Чем интенсивнее негативная эмоция, тем сильнее голод. В процессе приема пищи развивается кратковременный период эйфории, напряжение исчезает. Больные не в состоянии контролировать поглощение пищи, не ощущают момента насыщения, прекращают есть при появлении тошноты, чувства распирания, тяжести и боли в животе. Эйфория сменяется переживанием вины, злости и презрения к собственным привычкам. Попытки вернуть прежнее состояние реализуются с помощью провокации рвоты, приема слабительных средств и диуретиков. После опустошения желудочно-кишечного тракта аффективные переживания ослабевают. Через некоторое время приступ повторяется. Таким образом, переедание становится регулятором эмоциональной жизни пациентов.</span></p>",
"diagnostics": "<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;\">Диагноз устанавливается на основе клинико-анамнестических данных, полученных в ходе беседы психиатра или психотерапевта с больным и его родственниками. Среди симптомов клиницист выделяет невротические (депрессия, самообвинения, тревога), соматические (изменения веса, расстройства пищеварения) и поведенческие (переедание, провокация диареи, рвоты). Дополнительно могут использоваться специфические психодиагностические опросники, например, Тест отношения к приему пищи EAT-26.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение заболевания включает в себя следующие этапы:</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;\">Психотерапия. Лечить булимию нужно комплексно. Ведь данная патология приводит не только к органическим и функциональным нарушениям, но и к психопатологическим последствиям для здоровья. Поэтому тем, кто ищет способы, как избавиться самостоятельно от булимии, лучше не тратить время и сразу обратиться за помощью к специалистам. Основным методом лечения булимии на сегодняшний день является когнитивно-поведенческая терапия. Кроме этого, хорошие результаты показывает межличностная терапия и когнитивно-эмоциональная терапия. Детей и подростков лечат при помощи системной семейной психотерапии.</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;\">Медикаментозное лечение. Для коррекции данного патологического состояния пациенту назначают антидепрессанты. Это помогает быстро нормализовать эмоциональный фон, снизить силу и частоту приступов, что в комбинации с психотерапией дает хорошие результаты. При правильно подобранном лечении и соблюдении пациентом всех рекомендаций лечащего врача прогноз благоприятный.</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;\">Питание. Пациентам необходимо питаться разнообразно, полноценно, не переедать, не голодать, не сидеть на диетах, отказаться от приема лекарств для снижения веса.</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для предотвращения новых приступов необходимо соблюдать следующие профилактические меры:</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;\">улучшать самооценку пациента;</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;\">создать в семье здоровую психологическую обстановку;</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;\">настроить человека на позитивное мышление;</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;\">создать стабильную и безопасную обстановку в окружении \u2028.</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;\">Необходимо, чтобы пациент четко осознавал свои проблемы и понимал, что борьба с ними должна продолжаться до полного выздоровления. Важнейшей мерой профилактики является соблюдение принципов рационального и здорового питания.</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;\">Основными признаками заболевания 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;\">постоянный контроль веса, восприятие себя как толстого человека, хотя на самом деле это не так, страх поправиться;</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;\">неконтролируемое, навязчивое желание поесть;</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;\">постоянное переедание — бывает объективным, когда пациент действительно съедает за раз слишком много пищи и субъективным, когда пищи съедено немного, но человек считает, что он переедает, периодичность подобных эпизодов при булимии составляет не менее двух раз в неделю в течение трех месяцев и более, после приема пищи пациент чувствует вину, отчаяние, злость;</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;\">избавление от съеденной пищи искусственными методами, чтобы избежать набора веса (прием препаратов для снижения аппетита, слабительных средств, вызов рвоты, постановка очистительных клизм).</span></li>\r\n</ul>\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;\">Помимо вышеперечисленных признаков человек с булимией ощущает одиночество, беспомощность перед своей проблемой, у него развивается депрессия. В результате в поиске поддержки многие люди вместо обращения к специалисту находят тематические сообщества про булимию и анорексию в интернете и пытаются решить свои проблемы самостоятельно, что редко дает результат. Если булимию запустить, то со временем это приводит к нарушению метаболизма и развитию заболеваний внутренних органов</span></p>",
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"name": "удушение"
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{
"name": "Асфиксия"
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},
"code": "J46",
"name": "Астматическое статус [status asthmaticus]",
"icd_name": "Астматическое статус [status asthmaticus]",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "j46_astmaticheskoe_status_status_asthmaticus",
"lead": "Нарушение здоровья, относящееся к группе хронические болезни нижних дыхательных путей",
"description": "Астматический статус - тяжелый, затянувшийся более 6 часов приступ бронхиальной астмы, характерихующийся прогрессирующей дыхательной недостаточностью и резистентностью к бронхолитикам, вследствие функциональной блокады В2-адренорецепторов. ",
"etiology": "<p>Причины развития астматического статуса: </p>\r\n<ul>\r\n<li>Массивное воздействие аллергенов4 </li>\r\n<li>Инфекционные болезни; </li>\r\n<li>Ошибки в лечении бронхиальной астмы; </li>\r\n<li>Стрессы; </li>\r\n<li>Прием лекарственных препаратов, способных вызвать приступ бронхиальной астмы, который при отсутствии лечения или при массивном приеме указанных препаратов способен перейти в астматический статус. </li>\r\n<li>Метеовоздействия. </li>\r\n</ul>",
"pathogenesis": "<p>Бронхиальная обструкция при астматическом статусе обусловлена: </p>\r\n<ul>\r\n<li>острым генерализованным бронхоспазмом; </li>\r\n<li>подострым отеком слизистой бронхов; </li>\r\n<li>обтурацией бронхов слизистыми пробками. </li>\r\n</ul>",
"diagnostics": "<p>Диагностика включает: </p>\r\n<ul>\r\n<li>Общий осмотр: наблюдается вынужденная поза пациента, цианоз (посинение) кожных покровов, втяжение межреберных промежутков, над- и подключичных ямок; большое количество сухих свистящих хрипов, удлинение выдоха на первой стадии, в последующем – появление «немых» участков легкого, не участвующих в акте дыхания. </li>\r\n<li>Отсутствие эффекта от бронхолитиков (препараты, расширяющие бронх, которые применяются для снятия приступа бронхиальной астмы). </li>\r\n<li>Изменения газового состава крови – гиперкапния (увеличение содержания углекислого газа), гипоксемия (снижение содержания кислорода). </li>\r\n<li>Пикфлоуметрия – резкое снижение объема выдыхаемого воздуха в специальный аппарат. </li>\r\n</ul>",
"treatment": "<p>Глюкокортикостероиды - оказывают неспецифическое противовоспалительное действие, повышают чувствительность β-адренорецепторовоказывают. </p>\r\n<p>Борьба с гипоксемией – кислородотерапия: непрерывная подача кислородно-воздушной смеси с низкой скоростью через носовые канюли или маску. </p>\r\n<p>Инфузионная терапия восполняет дефицит жидкости и устраняет сгущение крови, способствует разжижению бронхиального содержимого, облегчает откашливание мокроты и уменьшает обструкцию бронхов. </p>\r\n<p>Эуфиллин вызывает расслабление бронхиальной мускулатуры, снижает давление в малом круге кровообращения, уменьшает парциальное давление углекислого газа в крови и склеивание тромбоцитов. </p>\r\n<p>Для предупреждения тромбоэмболических осложнений, а также с целью улучшения реологических свойств крови назначают гепарин. </p>\r\n<p>Применяют ингаляции аэрозолей теплой стерильной воды, изотонического раствора натрия хлорида, 0,5-1% раствора гидрокарбоната натрия для разжижения мокроты. Активно пользуются методами физической терапии, включающими перкуссионный и вибрационный массажи грудной клетки. </p>\r\n<p>Если проводимая терапия в течение 1,5-2 часов не ликвидирует картину «немого легкого», необходимо переводить больного на искусственную вентиляцию легких (ИВЛ), которая обеспечивает необходимый объем вентиляции, облегчает удаление мокроты. При ИВЛ устраняется также непроизводительная работа дыхательных мышц, что облегчает проведение лаважа дыхательных путей. </p>\r\n<p>В ІІІ стадии астматического статуса пациента переводят на ИВЛ, проводятся бронхоскопическая санация, посегментарный лаваж бронхиального дерева. </p>",
"prevention": "<p>Профилактика астматического статуса заключается в постоянных и регулярных осмотрах пациентов с бронхиальной астмой. Таким пациентам стоит избегать нервных и физических перенапряжений, стремиться к снижению минимальной эффективной дозы бронходилататора. Здоровый образ жизни, десенсибилизация к аллергенам так же помогает избежать осложнений.</p>",
"clinical_picture": "<p>Течение астматического статуса характеризуется стадийностью. </p>\r\n<p>1 стадия (стадия отсутствия чувствительности к бета-2 агонистам (бронхорасширяющим препаратам), стадия отсутствия вентиляционных расстройств): </p>\r\n<ul>\r\n<li>пациент тревожен, испуган, но в сознании; </li>\r\n<li>нарастающее удушье; </li>\r\n<li>значительное затруднение выдоха; </li>\r\n<li>пациенты занимают позу, облегчающую дыхание, – сидя или стоя с опорой руками на стул или кровать, с наклоном корпуса вперед; </li>\r\n<li>мучительный, непродуктивный кашель (мокрота не выделяется); </li>\r\n<li>хрипы в груди, иногда слышимые на расстоянии (свистящее дыхание); </li>\r\n<li>посинение носогубного треугольника; </li>\r\n<li>активное участие в акте дыхания дополнительной дыхательной мускулатуры (втяжение межреберных промежутков); </li>\r\n<li>за счет компенсаторных возможностей организма газовый состав крови поддерживается в пределах нормальных значений. </li>\r\n</ul>\r\n<p>2 стадия (стадия « немого легкого», стадия нарастания вентиляционных расстройств): </p>\r\n<ul>\r\n<li>резкое усугубление симптомов первой стадии; </li>\r\n<li>пациент в сознании, но заторможен; </li>\r\n<li>грудная клетка раздута, находится в положении максимального вдоха, движения ее редки и практически не заметны; </li>\r\n<li>западение над- и подключичных ямок; </li>\r\n<li>посинение кожных покровов (особенно губ, пальцев); </li>\r\n<li>снижение артериального давления; </li>\r\n<li>пульс частый, слабый, аритмичный; </li>\r\n<li>за счет закупорки вязкой мокротой просвета бронхов из акта дыхания выключаются некоторые участки легкого (« немое легкое»), что ведет к дефициту кислорода и нарастанию содержания углекислого газа в организме. </li>\r\n</ul>\r\n<p>3 стадия (стадия резко выраженных вентиляционных нарушений, стадия гиперкапнической комы): </p>\r\n<ul>\r\n<li>утрата контакта с медперсоналом, судороги, кома; </li>\r\n<li>дыхание редкое, поверхностное или отсутствует; </li>\r\n<li>пульс слабый; </li>\r\n<li>падение артериального давления; </li>\r\n<li>резкое снижение содержания кислорода, выраженное увеличение содержание углекислого газа в организме. </li>\r\n</ul>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 2,
"parent": null,
"block_rubric": 104,
"standards": [
5116
]
},
{
"id": 8005,
"symptoms": [
{
"id": 3094,
"synonyms": [
{
"name": "Анус болит"
},
{
"name": "Боль в области заднего прохода"
},
{
"name": "болит вокруг ануса"
},
{
"name": "Задний проход болит"
}
],
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{
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