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"code": "G81",
"name": "Гемиплегия",
"icd_name": "Гемиплегия",
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"cause": [
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"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>",
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},
"code": "D86",
"name": "Саркоидоз",
"icd_name": "Саркоидоз",
"gender": 0,
"age_min": 5,
"age_max": 94,
"cause": [
3
],
"periodicity": 1,
"slug": "d86_sarkoidoz",
"lead": "Нарушение здоровья, относящееся к группе отдельные нарушения, вовлекающие иммунный механизм",
"description": "Саркоидоз – это заболевание, при котором могут поражаться различные органы и системы (чаще всего легкие), характеризующееся образованием в пораженных тканях гранулем (ограниченные очаги воспаления, состоящие из скопления нормальных и видоизмененных клеток).",
"etiology": "<p>Этиология саркоидоза до конца не выяснена. В настоящее время существуют лишь теории возможного вклада в развитие заболевания следующих факторов:</p>\r\n<ul>\r\n<li>наследственная предрасположенность (отмечаются семейные случаи заболевания);</li>\r\n<li>инфекции, которая рассматривается не как причина развития саркоидоза, а как пусковой фактор. В качестве таких пусковых агентов обсуждаются микобактерии туберкулеза, Chlamydophila pneumoniae, Borrelia burgdorferi, отдельные виды вирусов: вирус гепатита С, вирус герпеса;</li>\r\n<li>факторов окружающей среды: вдыхание металлической пыли (пыль алюминия, бария, бериллия, кобальта, меди, золота, титана и циркония);</li>\r\n<li>курения, которое не рассматривается как непосредственная причина саркоидоза, однако у курильщиков заболевание протекает тяжелее (в большей степени снижаются функциональные возможности легких).</li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>В основе патогенеза саркоидоза лежит накопление Т-лимфоцитов вследствие иммунного ответа Th-1 типа. По неизвестной пока причине активированные макрофаги и лимфоциты скапливаются в том или ином органе и продуцируют повышенное количество интерлейкинов, фактора некроза опухолей (TNF-альфа). TNF-альфа считают ключевым цитокином, участвующим в формировании гранулемы при саркоидозе.</p>\r\n<p>Развитие гранулематозной реакции связывают также с нарушениями механизмов апоптоза (запрограммированной гибели клеток) иммунокомпентентных клеток.</p>\r\n<p>Как правило, саркоидоз характеризуется полиорганным течением. Легочный саркоидоз начинается с поражения альвеолярной ткани и сопровождается развитием атипичного воспаления в легких с последующим образованием саркоидных гранулем в легких. В дальнейшем гранулема либо рассасывается, либо прорастает соединительной тканью, превращаясь в бесклеточную гиалиновую (стекловидную) массу.</p>\r\n<p>При прогрессировании саркоидоза легких развиваются выраженные нарушения вентиляционной функции, как правило, по рестриктивному типу (снижается способность легких расправляться). При сдавлении лимфатическими узлами стенок бронхов возможны обструктивные нарушения, а иногда и развитие зон гиповентиляции и спадение альвеол (ателектаз).</p>\r\n<p>Одновременно с легкими поражаются различные группы внутригрудных лимфатических узлов, которые увеличиваются за счет скопления в них множественных гранулем Саркоидные гранулемы нередко обнаруживаются в печени и селезенке, в почках. Поражение почек может приводить к почечной недостаточности.</p>\r\n<p>Кожа вовлекается в процесс гораздо реже легких и ВГЛУ, однако именно поражение кожи часто служит основной причиной обращения больных к врачу. Поражения кожи отмечаются приблизительно в 10 - 15% случаев. Выявляются мелкоузелковая, крупноузелковая, а также атипичные формы саркоидоза кожи.</p>",
"diagnostics": "<p>Диагностика саркоидоза включает:</p>\r\n<ul>\r\n<li>Сбор анамнеза (истории развития) и жалоб заболевания (расспрос о беспокоящих симптомах).</li>\r\n<li>Общий осмотр (осмотр кожных покровов, лимфатических узлов, выслушивание легких с помощью фонендоскопа).</li>\r\n<li>Общий анализ крови.</li>\r\n<li>Биохимический анализ крови.</li>\r\n<li>Туберкулиновая проба (реакция Манту) – внутрикожный тест на определение специфической чувствительности организма к микобактериям туберкулеза.</li>\r\n<li>Рентгенография органов грудной клетки, которая позволяет обнаружить увеличение внутригрудных лимфатических узлов и изменения в легких.</li>\r\n<li>Компьютерная томография органов грудной клетки.</li>\r\n<li>Спирометрия (спирография). Позволяет оценить воздушную проходимость дыхательных путей и способность легких к расправлению.</li>\r\n<li>Проба с бронходилятатором – выполнение спирометрии до и после ингаляции препарата, расширяющего бронх. Применяется для оценки обратимости сужения бронха.</li>\r\n<li>Исследование газового состава крови (определение напряжения в крови кислорода, углекислого газа, оценка насыщения крови кислородом).</li>\r\n<li>Бодиплетизмография – метод оценки функции внешнего дыхания, который позволяет определять все объемы и емкости легких, в том числе те, которые не определяются спирографией.</li>\r\n<li>Фибробронхоскопия – исследование, позволяющее осмотреть слизистую оболочку бронхов изнутри и исследовать ее клеточный состав с помощью специального аппарата.</li>\r\n<li>Биопсия легких, внутригрудных лимфатических узлов и кожных проявлений саркоидоза. Исключение составляет узловатая эритема: ее биопсия не является информативной.</li>\r\n<li>Электрокардиография (ЭКГ), холтеровское мониторирование ЭКГ, эхокардиография (ЭХО-КГ, УЗИ сердца) – для оценки функционального состояния сердца.</li>\r\n<li>Магнитно-резонансная томография (МРТ) сердца, позитронно-эмиссионная томография (ПЭТ), сцинтиграфия миокарда – редко использующиеся дорогостоящие методы, позволяющие оценить локализацию и объем поражения сердца.</li>\r\n<li>УЗИ органов брюшной полости – при их вовлечении в процесс.</li>\r\n</ul>",
"treatment": "<p>Этиотропной терапии саркоидоза не существует. Во всех случаях основной тактикой врача является сопоставление необходимости назначения лечения с тяжестью последствий от применения современной кортикостероидной, цитостатической и биологической («таргетной») терапии.</p>\r\n<p>В лечении больных саркоидозом используются средства, направленные на подавление воспалительной реакции и предотвращение фиброзной трансформации гранулем. В настоящее время наиболее эффективным средством являются кортикостероиды. Кортикостероидная терапия проводится длительно: в течение 6-8 мес.</p>\r\n<p>Используют также нестероидные противовоспалительные средства (делагил, плаквенил), антиоксиданты (тиосульфат натрия, альфа-токоферол, аскорутин), иммуномодулирующую терапию.</p>\r\n<p>Немедикаментозные методы лечения: разгрузочно-диетическая терапия, физиотерапия, плазмаферез.</p>",
"prevention": "<p>В качестве возможной меры профилактики можно рекомендовать избегать инфекционных заболеваний и контакта с металлической пылью (пыль алюминия, бария, бериллия, кобальта, меди, золота, титана и циркония).</p>\r\n<p>Для профилактики обострений саркоидоза следует стараться соблюдать здоровый образ жизни. Самое главное при поражении лёгких — не курить, так как это может привести к затруднению дыхания и осложнениям болезни. Также следует избегать лекарств и контактов с химикатами, вредными для печени, с токсичными летучими веществами, пылью, парами, газами, которые могут повреждать лёгкие. При саркоидозе наблюдается увеличение кальция в крови, что может привести к образованию камней в почках и мочевом пузыре. Поэтому следует избегать употребления продуктов, богатых кальцием. По этой же причине не следует загорать.</p>\r\n<p> </p>",
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