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"lead": "Нарушение здоровья, относящееся к группе другие болезни плевры",
"description": "Пневмотораксом называют проникновение воздуха в полость плевры, из-за чего возникает частичный (неполный) или абсолютный коллапс легкого, герметичность которого нарушилась. Патология бывает одно- или двухсторонней, травматичной этиологии или спонтанно возникающая. ",
"etiology": "<p>К причинам развития пневмоторакса относят: </p>\r\n<ul>\r\n<li>закрытая травма грудной клетки: повреждение лёгкого отломками рёбер; </li>\r\n<li>открытая травма грудной клетки: проникающие ранения; </li>\r\n<li>ятрогенные повреждения (осложнение после лечебного или диагностического вмешательства) </li>\r\n<li>неспецифический пневмоторакс: разрыв булл (очаговая буллезная эмфизема), кист, прорыв абсцесса лёгкого в плевральную полость (пиопневмоторакс), спонтанный разрыв пищевода; </li>\r\n<li>туберкулёзный пневмоторакс: разрыв каверны, прорывы казеозных очагов; </li>\r\n<li>искусственный пневмоторакс накладывают с лечебной целью при туберкулёзе лёгких, с диагностической для торакоскопии, для дифференциальной диагностики образований грудной стенки. </li>\r\n</ul>\r\n<p>Причинами первичного спонтанного пневмоторакса могут быть: </p>\r\n<ul>\r\n<li>генетически обусловленная слабость плевры, при которой для её разрыва достаточно смеха, приступа кашля, физического напряжения; </li>\r\n<li>врожденная нехватка фермента альфа-1-антитрипсина, вызывающая патологические процессы в легких; </li>\r\n<li>путешествие на самолете (перепады давления), дайвинг, ныряние. </li>\r\n</ul>\r\n<p>Вторичный спонтанный пневмоторакс развивается в связи с легочной патологией: </p>\r\n<ul>\r\n<li>болезни легких, травмирующие соединительную ткань (саркоидоз, лимфангиолейомиоматоз, идиопатический пневмосклероз, туберозный склероз); </li>\r\n<li>злокачественные новообразования (рак легкого, саркома); </li>\r\n<li>болезни дыхательных путей (муковисцидоз, бронхиальная астма в тяжелой форме, ХОБЛ); </li>\r\n<li>инфекционные болезни легких (абсцесс легкого, туберкулез, пневмония на фоне ВИЧ); </li>\r\n<li>системные болезни соединительной ткани, включающие поражение легких (дерматомиозит, ревматоидный артрит, системная склеродермия, полимиозит, синдром Марфана). </li>\r\n</ul>",
"pathogenesis": "<p>Воздух или газ может попадать в плевральную полость снаружи (при открытом повреждении грудной клетки и сообщении с внешней средой) или из внутренних органов (например, при травматическом разрыве лёгкого при закрытой травме, либо при разрыве эмфизематозных пузырей, «булл», при минимальной травме или кашле, спонтанный пневмоторакс). В норме лёгкое расправлено за счёт того, что в плевральной полости, как правило, давление меньше, чем в самом легком. Поэтому при попадании туда воздуха лёгкое спадается. </p>\r\n<p>Различают открытый, закрытый и клапанный пневмоторакс. При открытом полость плевры сообщается с просветом бронхов, при закрытом дефект в плевре закрывается в результате коллапса легкого, воспаления и выпадения фибрина. При клапанном пневмотораксе воздух входит во время вдоха в плевральную полость, но на выдохе дефект закрывается. В результате нарастает внутриплевральное давление с развитием напряженного пневмоторакса, смещением органов средостения в противоположную сторону, нарастанием дыхательной и сердечной недостаточности. </p>",
"diagnostics": "<p>При анализе газов артериальной крови гипоксемия (снижение парциального давления кислорода крови) наблюдается у 75 % больных с пневмотораксом. </p>\r\n<p>Для подтверждения диагноза необходимо проведение рентгенографии грудной клетки (оптимальная проекция — переднезадняя, при вертикальном положении больного. Для диагностики небольших по размеру пневмотораксов КТ является более надежным методом по сравнению с рентгенографией. </p>",
"treatment": "<p>Первая помощь при открыом пневмотораксе - перевести его в закрытый путем наложения стерильной повязки на открытую рану грудной клетки. При наличии клапанного пневмоторакса необходимо срочное проведение плевральной пункции с целью удаления свободного газа, расправления легкого и устранения смещения органов средостения. </p>\r\n<p>Лечение пневмоторакса заключается в его ликвидации путём отсасывания воздуха из плевральной полости и восстановления в ней отрицательного давления. </p>\r\n<p>При закрытом пневмотораксе без действующего сообщения с лёгким достаточно пункционной аспирации газа из плевральной полости при помощи набора для ликвидации пневмоторакса в асептических условиях операционной. Если аспирация иглой оказывается неэффективной, это свидетельствует о поступлении воздуха из ткани лёгкого. В таких случаях выполняют герметичное дренирование плевральной полости («дренаж по Бюлау»), либо создают систему активной аспирации, в том числе с применением электровакуумных приборов. </p>\r\n<p>Открытый пневмоторакс требует первоначальной торакотомии или торакоскопии, ревизии органов плевральной полости, устранения повреждений легочной паренхимы, а затем дренирования плевральной полости и ушивания последней. </p>\r\n<p>При наличии неразорвавшихся булл принимается решение об удалении сегмента или доли легкого и плевродеза (формирование сращений между листками плевры) для недопущения возникновения пневмоторакса. </p>",
"prevention": "<p>Рекомендованная для пневмоторакса профилактика включает в себя: </p>\r\n<ul>\r\n<li>Своевременное лечение заболевания лёгких; </li>\r\n<li>Предотвращение травм грудной клетки; </li>\r\n<li>Профилактика повторных пневмотораксов.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>При возникновении пневмоторакса наблюдается: </p>\r\n<ul>\r\n<li>Резкая, колющего характера, сильно ощутимая болезненность в районе грудной клетки с иррадиацией в брюшину (в область кишечника), шею, плечевой пояс; </li>\r\n<li>Нехватка воздуха;</li>\r\n<li>Неполноценное дыхание, кашель;</li>\r\n<li>Учащение, поверхностность дыхательных движений;</li>\r\n<li>Цианоз кожного покрова;</li>\r\n<li>Бледность лица и верхней части туловища;</li>\r\n<li>Выпирание межреберного пространства над пораженным легким;</li>\r\n<li>Отставание в респираторном акте половины грудной полости со стороны предполагаемой патологии;</li>\r\n<li>Беспокойство, боязнь смерти;</li>\r\n<li>Вынужденное положение тела (на больном боку лежа). </li>\r\n</ul>\r\n<p>Пациент с открытым пневмотораксом принимает вынужденное положение, лежа на поврежденной стороне и плотно зажимая рану. Воздух засасывается в рану с шумом, из раны выделяется пенистая кровь с примесью воздуха, экскурсия грудной клетки асимметрична (пораженная сторона отстает при дыхании). </p>\r\n<p>Спустя несколько часов интенсивность боли и одышки ослабевают: боль беспокоит в момент глубокого вдоха, одышка проявляется при физическом усилии. Возможно развитие подкожной или медиастинальной эмфиземы – выход воздуха в подкожную клетчатку лица, шеи, грудной клетки или средостения, сопровождающийся вздутием и характерным хрустом при пальпации. Аускультативно на стороне пневмоторакса дыхание ослаблено или не выслушивается. </p>",
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}