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"description": "Флебит – это заболевание вен, при котором происходит воспаление их сосудистых стенок. Преимущественно актуально это заболевание для области нижних конечностей. \r\nТромбофлебит же собой представляет воспаление вены в таком варианте, течение которого сопровождается появлением тромбов. ",
"etiology": "<p>Чаще всего в качестве причин, провоцирующей развитие флебита и тромбофлебита, выделяют: </p>\r\n<ul>\r\n<li>варикозное расширение вен; </li>\r\n<li> избыточный вес; </li>\r\n<li>гиподинамия (состояние, провоцируемое нехваткой двигательной активности); </li>\r\n<li>длительность пребывания в стоячем положении; </li>\r\n<li>запоры в хронической форме течения этого заболевания. </li>\r\n</ul>\r\n<p>Развитие тромбофлебита также возможно и в результате воздействия аллергической реакции, что определяет такую его разновидность, как аллергический флебит, помимо этого возможно развитие заболевания и в качестве осложнения, возникающего после родов – в этом случае речь идет уже о болевом флебите. Не исключаются и такие случаи, при которых тромбофлебит возникает при инфекционном поражении вены или при ее травмировании, что подразумевает под собой нарушение целостности в ее сосудистой стенке. </p>",
"pathogenesis": "<p>Для возникновения тромбофлебита нужно присутствие одного или нескольких факторов из трех (т.н. триада Вирхова): </p>\r\n<ol>\r\n<li>Повреждение стенки вены (может быть как механическим, вследствие травмы, так и химическим – ожог при введении концентрированных препаратов, наркотических веществ) </li>\r\n<li>Нарушение реологических свойств крови (повышение свертываемости, вязкости и т.п.). Это бывает при обезвоживании, некоторых заболеваниях, гормональных, генетических нарушениях. </li>\r\n<li>Замедление кровотока в вене (при сдавлении вены, ограничении движений (например, при ношении гипсовой повязки)). </li>\r\n</ol>\r\n<p>Под действием одного или нескольких факторов происходит образование тромба в просвете сосуда и воспаление его стенки. Пример: при серьезной травме ноги присутствуют все три фактора – механическое повреждение (надрывы стенки вены вследствие удара), повышение свертываемости (вследствие кровопотери), замедление кровотока (отек тканей, наложение гипса). </p>\r\n<p>Обычно при тромбофлебите поверхностных вен поражается одна вена, воспаление также может распространяться и на ее притоки. Известен мигрирующий тромбофлебит – при нем происходит последовательное воспаление нескольких вен на разных участках конечностей. Такой тромбофлебит требует дополнительной диагностики для исключения онкологических процессов или генетических нарушений свертываемости. </p>",
"diagnostics": "<p>Физикальное обследование: </p>\r\n<ul>\r\n<li>Болезненный плотный инфильтрат в виде шнура по ходу подкожной вены. </li>\r\n<li>Над инфильтратом возможна гиперемия кожи с уплотнением подкожной клетчатки. </li>\r\n<li>При ходьбе - умеренная болезненность. </li>\r\n<li> Температура тела субфебрильная. </li>\r\n</ul>\r\n<p>Лабораторные исследования: признаки воспаления (лейкоцитоз, ускоренное СОЭ). </p>\r\n<p>Инструментальные исследования Дуплексное сканирование вен - позволяет определить истинную границу тромба, так как она может не совпадать с границей, определяемой пальпаторно. Тромбированный участок вены становится ригидным, просвет его неоднороден, кровоток не регистрируется. </p>",
"treatment": "<p>Необходимо применять эластические компрессионные бинты, чулки, колготки как дополнение к медикаментозному лечению больных. Все пациенты с ТГВ должны носить эластические компрессионные чулки для снижения риска развития посттромботического синдрома. </p>\r\n<p>Системная консервативная терапия осуществляется с применением нестероидных противовоспалительных фармпрепаратов в комбинации со средствами, уменьшающими проницаемость венозной стенки. </p>\r\n<p>Антикоагулянтную терапию рекомендуется проводить при симультантном тромбозе глубоких вен или при развитии восходящего тромбофлебита у пациентов с ограничением показаний для оперативного лечения, при возникновении посттромбофлебитического синдрома. </p>\r\n<p>В первоначальные несколько дней заболевания рекомендуется локальное применение холода, эластичная компрессия больной конечности (эластичное бинтование), нанесение мазей, в составе которых содержатся нестероидное противовоспалительное средство и гепарин (категорически недопустимо применение мазевых компрессов, которые ограничивают теплоотдачу и могут способствовать прогрессированию заболевания). </p>\r\n<p> </p>",
"prevention": "<p>Чтобы избежать появления тромбофлебита нужно вести здоровый образ жизни. Необходимо своевременное лечение варикозной болезни. Следует избегать травм, обезвоживания. Несколько повышает риск развития тромбофлебита прием гормональных контрацептивов. При появлении первых симптомов нужно срочно обратиться к врачу – это позволит эффективно лечить заболевание и избежать осложнений. <br class=\"SCXW95579271\" /> <br class=\"SCXW95579271\" /> <br class=\"SCXW95579271\" /> <br class=\"SCXW95579271\" /> </p>",
"clinical_picture": "<p>Тромбофлебит поверхностных вен нижних конечностей </p>\r\n<ul>\r\n<li>Начинается с варикоза, отчего симптоматику патологии невозможно спутать с каким-либо другим заболеванием. </li>\r\n<li>Помимо болевых ощущений, которые зачастую возникают именно в том месте, где произошло уплотнение стенок с образованием кровяных сгустков, у больного отмечается повышенная температура тела. К числу сопутствующей симптоматики относят увеличение лимфоузлов. </li>\r\n<li>Пораженные вены можно обнаружить при пальпации. Как правило, кожные покровы в этих местах приобретают красный оттенок, а при ощупывании места можно обнаружить характерное уплотнение, причем при визуальном рассмотрении нередко отмечается припухлость. При пальпации больного мучают сильные боли. </li>\r\n</ul>\r\n<p>Флебит и тромбофлебит глубоких сосудов нижних конечностей </p>\r\n<ul>\r\n<li>Характеризуются болевыми ощущениями, в особенности при опускании ноги. В этот же момент больной часто ощущает распирание, что может сопровождаться повышением температуры кожных покровов в месте поражения. </li>\r\n<li>Вследствие развития патологии человек замечает у себя набухание и изменение оттенка кожных покровов на синий. Уже на вторые сутки от начала заболевания ноги больного «покрываются» соответствующей венозной и сосудистой сеткой, которая не только портит внешний вид, но и доставляет дискомфорт. </li>\r\n<li>Так, при ходьбе и в статичном положении человек страдает от болевого синдрома, в то время, когда при сжимании с передней и задней стороны наступает нестерпимая боль. При этом также отмечается, что сжимания со сторон не доставляет неудобств. </li>\r\n</ul>\r\n<p>Бедренной вены </p>\r\n<ul>\r\n<li>Проявляется набуханием и покраснением поверхности с внутренней стороны бедра; </li>\r\n<li>здесь же отмечается боль и разбухание подкожных вен; </li>\r\n<li>поражения общей бедренной вены сопровождается распуханием венозной системы, набуханием, покраснением, повышением температуры тела, лихорадкой, а также острой болью. </li>\r\n</ul>\r\n<p>Тромбофлебит подвздошно-бедренного участка магистральной вены </p>\r\n<ul>\r\n<li>характеризуется болевыми ощущениями в области поясницы и крестца, нередко присутствует боль с одной стороны живота; </li>\r\n<li>причем болевой синдром может быть ярко выраженным при полном перекрытии сосуда, и слабо выражен в случае частичного перекрытия. </li>\r\n</ul>\r\n<p>Глубоких вен </p>\r\n<ul>\r\n<li>Также проявляется в зависимости от локализации и расположения тромба. Более того, представленные поражения проявляются лишь незначительными болевыми ощущениями и малой отечностью, что затрудняет диагностирование заболевания. </li>\r\n<li>При отсутствии своевременного лечения глубокие тромбозы открываются, что провоцирует развитие тромбоэмболии легочных артерий. </li>\r\n<li>Опасность тромбоэмболии заключена в ее стремительном течении и размером тромба. Если отрывается тромб больших размеров, смертельный исход наступает в течение получаса. </li>\r\n</ul>",
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},
"code": "I71",
"name": "Аневризма и расслоение аорты",
"icd_name": "Аневризма и расслоение аорты",
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"age_min": 0,
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"cause": [
3
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"periodicity": 1,
"slug": "i71_anevrizma_i_rassloenie_aorty",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "Расслаивающаяся аневризма аорты – дефект внутренней оболочки аневризматически расширенной аорты, сопровождающийся образованием гематомы, продольно расслаивающей сосудистую стенку с формированием ложного канала. Расслаивающаяся аневризма аорты проявляется внезапной интенсивной болью, мигрирующей по ходу расслоения, подъемом артериального давления, признаками ишемии сердца, головного и спинного мозга, почек, внутреннего кровотечения.",
"etiology": "<p>К факторам, способствующим развитию аневризмы аорты и ее расслоению, относятся: </p>\r\n<ul>\r\n<li>атеросклероз со значительным изменением vasa vasorum (сосудов сосудов) аорты, ишемию стенки аорты; </li>\r\n<li>гипертоническую болезнь и резкие колебания артериального давления; </li>\r\n<li>сифилис; </li>\r\n<li>очаговые некрозы среднего слоя сосуда бактериально-эмболического происхождения при острых инфекционных заболеваниях; </li>\r\n<li>врожденные дефекты развития аорты (коарктация, двойная дуга, гипоплазия, незаращение боталлова протока, синдром Марфана); </li>\r\n<li>физическое и нервно-эмоциональное перенапряжение; </li>\r\n<li>повреждение аорты смежным процессом (спондилит, рак пищевода, пенетрация пептической язвы пищевода, двенадцатиперстной кишки) или инородным телом; </li>\r\n<li>закрытую травму грудной или брюшной полости. </li>\r\n</ul>",
"pathogenesis": "<p>Аорта имеет три наиболее уязвимых сегмента - корень, перешеек и диафрагму. Гемодинамическое напряжение указанных зон и их хроническая травматизация приводят к дегенеративным изменениям средней оболочки сосуда. Длительное повышение артериального давления всегда ведет к той или иной степени дилатации аорты. Известно также, что внутренняя оболочка по своей структуре менее растяжима, чем средняя и наружная оболочки, обладающие большей эластичностью. Именно поэтому при одном из очередных «критических» повышений артериального давления происходит разрыв внутренней оболочки. Однако гидравлический удар о стенку аорты и разрыв внутренней оболочки сами по себе могут привести лишь к развитию внутристеночной гематомы. Дальнейшее расслоение происходит лишь при наличии патологического процесса в средней оболочке аорты. Если расслоение прорывает стенку аорты полностью (все три слоя), то происходит быстрая массивная кровопотеря и гибель больного. </p>",
"diagnostics": "<p>В случае подозрения на появление расслаивающей аневризмы аорты требуется срочная диагностика, основными методами которой являются: </p>\r\n<ul>\r\n<li>рентгенография грудной клетки; </li>\r\n<li>УЗДГ; </li>\r\n<li>ЭхоКГ; </li>\r\n<li>компьютерная томография; </li>\r\n<li>магнитно-резонансная томография; </li>\r\n<li>аортография. </li>\r\n</ul>\r\n<p>Рентгенография грудной клетки позволяет определить признаки расслаивающей аневризмы: расширение аорты, плевральный выпот, отсутствие пульсации, деформацию контуров аорты. </p>\r\n<p>ЭхоКГ (УЗИ сердца) – более информативный и доступный метод, позволяющий обнаружить отслоившийся лоскут, определить истинный и ложный канал, оценить атеросклеротическое поражение, состояние аортального клапана, состояние грудной аорты. </p>\r\n<p>Аортография дает возможность определить место начального разрыва, протяженность и местонахождения расслоения, состояние аортального клапана, ветвей аорты, коронарных артерий. </p>\r\n<p>МРТ дает возможность точно определить локализацию разрыва и направление расслоения, оценить состояние ветвей аорты и клапана. </p>",
"treatment": "<p>Расслоение аорты требует неотложной медицинской помощи, немедленного лечения. Терапия может заключаться в проведении операции, употреблении лекарственных средств, а также в комбинированном лечении — схема зависит от области аорты, которая подверглась расслоению. </p>\r\n<p>Хирургическое вмешательство - хирурги удаляют как можно большую площадь, подвергшуюся расслоению, а затем реконструируют аорту при помощи синтетической трубки-трансплантата. Если в результате расслоения повреждаются аортальные клапаны, они так же могут быть заменены; </p>\r\n<p>Интенсивная терапия расслаивающейся аневризмы аорты направлена на купирование болевого синдрома (путем введения ненаркотических и наркотических анальгетиков), выведение из шокового состояния, снижение артериального давления. Лекарственные препараты, например, бета-блокаторы и нитропруссид, уменьшают частоту сердечных сокращений и нормализуют низкое кровяное давление, что предотвращает усугубление расслоения. </p>",
"prevention": "<p>Профилактика формирования расслаивающейся аневризмы аорты заключается в контроле за течением сердечно-сосудистых заболеваний. Предупреждение расслоения аорты включает наблюдение кардиолога, мониторинг артериального давления и уровня холестерина крови, периодическое ультразвуковая диагностика сердца и аорты. <br class=\"SCXW45342897\" /> <br class=\"SCXW45342897\" /> </p>",
"clinical_picture": "<p>Для расслаивающейся аневризмы аорты характерно внезапное начало с имитацией симптомов различных сердечно-сосудистых, неврологических, урологических заболеваний. Расслоение аорты проявляется резким нарастанием раздирающей, нестерпимой боли с широкой областью иррадиации (за грудиной, между лопатками и по ходу позвоночника, в эпигастральной области, пояснице), мигрирующей по ходу расслоения. </p>\r\n<p>Отмечается повышение артериального давления с последующим спадом, асимметрия пульса на верхних и нижних конечностях, обильное потоотделение, слабость, синюшность, двигательное беспокойство. Большая часть больных с расслаивающейся аневризмой аорты умирает от развития осложнений. </p>\r\n<p>Неврологическими проявлениями расслаивающейся аневризмы аорты могут служить ишемическое поражение головного или спинного мозга парезы, параличи), периферическая нейропатия, нарушения сознания(обморок, кома). </p>\r\n<p>Расслаивающаяся аневризма восходящей аорты может сопровождаться ишемией миокарда, сдавлением органов средостения (появлением охриплости, дисфагии, одышки, синдрома Горнера, синдрома верхней полой вены), гемоперикарда, тампонады сердца (скопление жидкости между листками околосердечной сумки). </p>\r\n<p>Расслаивающаяся аневризма нисходящей грудной и брюшной части аорты выражается развитием выраженного повышения давления в почечных сосудах и острой почечной недостаточности, острой ишемии органов пищеварения, ишемии кишечника, острой ишемии нижних конечностей. </p>",
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