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},
"code": "T17",
"name": "Инородное тело в дыхательных путях",
"icd_name": "Инородное тело в дыхательных путях",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 1,
"slug": "t17_inorodnoe_telo_v_dyhatelnyh_putyah",
"lead": "попадание какого-либо постороннего предмета в дыхательные пути. Механизм попадания – неожиданный глубокий вдох при испуге, смехе, плаче, приводящий к засасыванию постороннего предмета",
"description": "Инородные тела в дыхательных путях — посторонние предметы, нечаянно аспирированные или попавшие в воздухоносные пути через раневые каналы и зафиксированные на различных уровнях.\r\nЧаще наблюдаются у детей до 5 лет, имеющих привычку держать во рту различные предметы (монеты, мелкие игрушки, горошины), которые попадают в дыхательные пути при неожиданном глубоком вдохе (при испуге, плаче, смехе).\r\n",
"etiology": "<p>Инородные тела дыхательных путей делятся на неорганические (пустышка, швейные иглы, английские булавки, монеты, детали от игрушек, гвозди и т. п.) и органические (горох, бобы, фасоль, косточки от персиков, абрикосов, вишен, арбузные семечки и т. д.). Инородными телами могут быть также аскарид и другие гельминты.</p>\r\n<p>Аспирация инородного тела всегда неожиданна и происходит при самых разнообразных условиях. Чаще всего инородные тела обычно попадают в организм естественным путем (через рот), реже — при хирургических вмешательствах (трахеотомия, аденотомия, удаление инородного тела из полости носа, стоматологические вмешательства), а также при проникающих ранениях грудной клетки, шеи, травме гортани. Кроме обычного пути (через рот), инородные тела могут попадать в дыхательные пути из пищевода и желудка в момент рвоты.</p>",
"pathogenesis": "<p>Попадание инородных тел в дыхательные пути происходит во время еды; ему способствуют смех, разговор, плач, внезапный испуг, кашель, падение, а также стремление большинства детей брать все предметы в рот. Находящиеся во рту инородные тела в момент резкого вдоха сильной инспираторной струей воздуха увлекаются внутрь. Инородные тела дыхательных путей чаще отмечаются у детей раннего возраста из-за слабого развития у них защитных рефлексов — спазма входа в гортань и спазма голосовой щели с последующим рефлекторным кашлем.</p>\r\n<p>В зависимости от формы, величины и характера аспирированных инородных тел они локализуются в различных отделах верхних дыхательных путей. В трахее они обычно не задерживаются и до 80% случаев попадают в правый бронх.</p>\r\n<p>В начальном периоде после попадания инородного тела в верхние дыхательные пути возникает генерализованный спазм бронхов, местное покраснение, набухание и изъязвление слизистой бронха. В более поздние сроки вокруг инородного тела формируется капсула, разрастается соединительная ткань.</p>\r\n<p>Инородные тела в бронхах могут занимать различные позиции, ввиду чего наблюдаются разные вторичные изменения легочной ткани. При баллотирующих инородных телах просвет бронха перекрывается не полностью, внешнее дыхание критически не нарушается, воспалительные изменения в легочной ткани умеренные.</p>\r\n<p>При вентильной (по типу клапана) закупорке бронха имеет место неплотное соприкосновение инородного тела со стенками бронха, поэтому на вдохе воздух поступает в легкое, а на выдохе, вследствие бронхоспазма, не может выйти обратно. В результате возникает задержка воздуха в легочной ткани с развитием эмфиземы легкого ниже места обструкции.</p>\r\n<p>При полной закупорке бронха инородным телом в нижележащих невентилируемых отделах легкого происходит спадение альвеол и развивается воспаление (пневмония).</p>\r\n<p> </p>",
"diagnostics": "<p>Инородное тело дыхательных путей распознается на основании тщательно собранного анамнеза, объективных данных. Для диагностики также используются рентгенологические методы исследования (томография, бронхография и т. д.). Для окончательной диагностики используют эндоскопические методы (бронхоскопия, прямая ларингоскопия).</p>\r\n<p>При инородном теле носа проводится бакпосев отделяемого из носа, УЗИ, КТ или рентгенография околоносовых пазух, КТ или рентгенография черепа, фарингоскопия.</p>",
"treatment": "<p>Неотложная помощь при инородном теле дыхательных путей:</p>\r\n<p>При наличии сознания успокоить больного, убедить не сдерживать кашель.</p>\r\n<p>Если самопроизвольного выхода ИТ не произошло в течение 30 секунд или если человек не дышал с самого начала, следует применить маневр Геймлиха.</p>\r\n<p>Техника его выполнения следующая:</p>\r\n<p>Находясь сзади сидящего или стоящего ребенка, обхватить его руками вокруг талии, надавить на живот по средней линии живота между пупком и мечевидным отростком и произвести резкий толчок вверх до 5 раз с интервалом по 3 сек.</p>\r\n<p>При извлечении инородного тела дыхательных путей у детей младше 1 года нужно положить ребенка на левое предплечье лицом вниз, удерживая сложенными в «клешню» пальцами нижнюю челюсть малыша. Головка ребенка должна быть ниже уровня туловища. После этого нанести пять средней силы ударов основанием ладони в межлопаточную область спины. Второй этап – ребенок переворачивается лицом кверху на правое предплечье, после чело спасатель производит пять толчковых движений по грудине в точку, находящуюся на 1 палец ниже межсосковой линии.</p>\r\n<p>Если инородное тело появилось в ротоглотке, оно видимо и может быть удалено без опасности проталкивания его обратно – его удаляют. Если нет – повторяют весь цикл либо до появления ИТ, либо до остановки сердечной деятельности, после которой надо начинать сердечно-легочную реанимацию.</p>\r\n<p>У детей 1-8 лет маневр Геймлиха проводят, уложив ребенка на бедро спасателя. Остальные действия производят по общим правилам.</p>\r\n<p>На госпитальном этапе проводится постоянная оксигенотерапия. Если инородное тело не обнаружено решить вопрос о проведении трахеотомии или интубации трахеи.</p>\r\n<p>В большинстве случаев удается произвести эндоскопическое удаление инородного тела бронха в ходе повторных бронхоскопий. Металлические предметы могут быть извлечены при помощи магнита; мелкие инородные тела бронхов – с использованием электроотсоса. Затем повторно вводят бронхоскоп для осуществления ревизии бронхов на предмет оставления «осколков», ранения стенок бронха и т. д.</p>\r\n<p>Инородные тела, плотно вклинившиеся в стенку бронха, подлежат хирургическому удалению в процессе торакотомии и бронхотомии.</p>\r\n<p>Инородное тело носа, недавно попавшее в него, может быть устранено путем простого выдувания. Пациента просят набрать по-больше воздуха, закрыть рот, прикрыть пальцем здоровую ноздрю и сильно выдуть набранный воздух. Такой способ может применяться только у детей старшего возраста и у взрослых. У взрослых после неудавшейся попытки выдувания инородного тела носа естественным путем и у маленьких детей производят эндоскопическое удаление инородного тела. У взрослых процедуру проводят с применением местного обезболивания, у маленьких детей для этого может потребоваться общий наркоз. В редких случаях, когда эндоскопическое удаление не увенчалось успехом, инородное тело удаляют хирургическим способом.</p>\r\n<p>При необходимости дополнительно применяют промывание полости носа растворами антисептиков, закапывание в нос сосудосуживающих капель, дренирование и промывание околоносовых пазух, проводят лечение осложнений.</p>",
"prevention": "<p>Профилактические меры должны включать контроль со стороны взрослых за качеством игрушек и соответствием их возрасту ребенка; не допускать игр детей с инородными телами во рту. Не держать мелкие предметы (иглы, гвозди, булавки) во рту. Не разговаривать во время еды. Проводить разъяснительную и просветительскую работу среди населения, соблюдение осторожности при проведении медицинских манипуляций.</p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>",
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