Disease List

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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;\">В основе первичных миопатий лежат генетически детерминированные нарушения в функционировании митохондрий и ионных каналов миофибрилл, в синтезе мышечных белков или ферментов, регулирующих обмен веществ мышечной ткани. Наследование дефектного гена может происходить рецессивно, доминантно и сцеплено с Х-хромосомой. При этом внешние факторы зачастую выступают в роли триггеров, запускающих развитие болезни. Подобными &laquo;пусковыми&raquo; факторами могут являться разнообразные инфекции (хронический тонзиллит, частые ОРВИ, бактериальная пневмония, сальмонеллез, пиелонефрит и пр.), алиментарная дистрофия, тяжелые травмы (перелом костей таза, политравма, ЧМТ и др.), физическое перенапряжение, интоксикации.</span></p>\r\n<p>&nbsp;</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;\">Приобретенные миопатии могут развиваться на фоне эндокринных расстройств (гиперпаратиреоза, болезни Иценко-Кушинга, гиперальдостеронизма), хронических интоксикаций (токсикомании, наркомании, алкоголизма, профессиональных вредностей), мальабсорбции и авитаминозов, тяжелых хронических заболеваний (ХПН, хронической печеночной недостаточности, сердечной недостаточности, ХОБЛ), опухолевых процессов.</span></p>",
            "pathogenesis": "<p>&nbsp;</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;\">Наличие генетически детерминированных или приобретенных дефектов метаболитов, участвующих в обмене веществ и построении мышечных волокон, приводит к возникновению и прогрессированию дегенеративных изменений последних. Развивается атрофия миофибрилл, происходит их замещение жировой и соединительной тканью. Мышцы утрачивают способность к сокращению, что обуславливает мышечную слабость и ограничение возможности выполнять активные движения.</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;\">Установить диагноз миопатии неврологу помогают электрофизиологические методы обследования: электронейрография (ЭНГ) и электромиография (ЭМГ). Они позволяют исключить поражение периферического двигательного нейрона и, таким образом, дифференцировать миопатию от инфекционной миелопатии, нарушений спинномозгового кровообращения, миелита и опухолей спинного мозга. Данные ЭМГ говорят о характерных для миопатий изменениях мышечных потенциалов - уменьшении их амплитуды и сокращении длительности. О прогрессирующем процессе свидетельствует наличие большого количества коротких пиков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Биохимический анализ крови при миопатии показывает повышение содержания альдолазы, КФК, АЛТ, АСТ, ЛДГ и др. ферментов. В биохимическом анализе мочи показательным является увеличение концентрации креатинина. В установлении формы миопатии первостепенное значение имеет биопсия мышц. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Морфологическое исследование образцов мышечной ткани выявляет наличие беспорядочно разбросанных атрофированных миофибрилл среди практически сохранных и гипертрофированных мышечных волокон, а также замещение участков мышечной ткани на соединительную или жировую. Постановка окончательного диагноза возможна только после сопоставления результатов гистохимических, иммунобиохимических и молекулярно-генетических исследований.</span></p>\r\n<p>&nbsp;</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;\">С целью диагностики поражений сердечной мышцы пациенту с миопатией могут быть назначены консультация кардиолога, ЭКГ, УЗИ сердца; при подозрении на возникновение пневмонии &mdash; консультация пульмонолога и рентгенография легких.</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;\">Генетически передаваемые типы миопатий не поддаются излечению, а терапия в данном случае исключительно симптоматическая. Комплекс мер по нейтрализации симптомов подбирается, исходя из основных жалоб больного.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">В большинстве случаев врач назначает ортопедическую коррекцию при помощи специальных устройств, дающих пациенту возможность двигаться. В зависимости от степени поражения это могут быть поддерживающие конструкции или инвалидные кресла-коляски.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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 всех формах миопатий показана дыхательная гимнастика для улучшения вентиляции легких и ЛФК, призванная восполнять дефицит мышечной нагрузки. Медикаментозная терапия включает в себя прием антагонистов тиреоидных гормонов, которые устраняют избыток гормонов, вырабатываемых щитовидной железой.</span></p>\r\n<p>&nbsp;</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;\">Миопатии, причинами которых стали системные заболевания, вызывающие нарушение синтеза коллагена, лечатся посредством применения стероидных гормонов и препаратов, угнетающих иммунную реакцию организма.</span></p>",
            "prevention": "<p>Специфические меры профилактики не разработаны.</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;\">Основным симптомом, свидетельствующим о наличии одной из разновидностей миопатий, является постоянная слабость мышц. После отдыха это ощущение либо не проходит вовсе, либо становится чуть менее выраженным, но все равно весьма заметным.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Второй характерный признак &mdash; атрофия. Ткани становятся тонкими и крайне малоактивными. Атрофия может затрагивать только некоторые группы мышц, к примеру, отдел плечевого пояса или бедер или поражать все мышечные ткани в равной степени, полностью лишая человека возможности нормально двигаться.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Характерен для миопатии и крайне сниженный мышечный тонус. Каждая мышца в области поражения становится дряблой и вялой на ощупь. Соответственно, это сказывается на двигательной активности, которая не может оставаться на прежнем уровне.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Из-за того, что мышечный каркас перестает выполнять функцию поддержки туловища в правильном положении, позвоночник начинает испытывать чрезмерные нагрузки, в результате чего происходит его искривление. Позвоночник может изгибаться по-разному. Наиболее распространенные варианты &mdash; это искривление спереди назад, в результате чего развивается лордоз или кифоз, и вбок, как при обычном сколиозе. Искривление позвоночника при миопатии может принять такую серьезную степень, что уже само по себе будет являться значимой и сложно разрешимой проблемой.</span></p>\r\n<p>&nbsp;</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;\">Последний симптом миопатий &mdash; это появление псевдогипертрофии мышечных тканей. Из-за сильного истончения некоторых зон конечностей, мышцы других отделов внешне выглядят слишком крупными. Например, так происходит при атрофии мышц бедер, когда икры выглядят чрезмерно массивными на их фоне. На самом деле в данном случае как раз икроножные мышцы имеют нормальный размер, но визуально они выглядят неестественно увеличенными.</span></p>",
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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;\">Причины, способные вызывать миозит, разнообразны и не связаны между собой.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">1. Воздействие патогенных биологических агентов:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">неспецифических (стрептококки, стафилококки и т.д.);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">специфических (туберкулез, сифилис);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">паразитарные инвазии (трихинеллез, эхинококкоз, цистистеркоз).</span></p>\r\n</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;\">2. Аутоиммунная патология (ревматизм, системная красная волчанка).</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;\">3. Травмы, в том числе микротравматизация при занятиях спортом, у лиц определенных профессий.</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;\">4. Интоксикации, в том числе алкогольные и инфекционные (грипп).</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;\">5. Злокачественные новообразования (паранеопластический миозит).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">6. Наследственная патология (прогрессирующий оссифицирующий миозит).</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;\">Патологические изменения включают повреждение клеток и их атрофию на фоне воспаления различной степени выраженности. Мышцы кистей, стоп и лица повреждаются в меньшей степени, чем другая скелетная мускулатура. Поражение мускулатуры глотки и верхних отделов пищевода, реже &ndash; сердечной мышцы может приводить к нарушению функций указанных органов. Также возможны воспалительные изменения суставов и легких, особенно при наличии антисинтетазных антител.</span></p>\r\n<p>&nbsp;</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;\">Дерматомиозит характеризуется отложением иммунных комплексов в стенках сосудов и рассматривается как опосредованная комплементом васкулопатия. В то же время основным патофизиологическим феноменом при полимиозите является прямое повреждение мышцы, опосредованное Т-клетками.</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;\">Врач может заподозрить миозит на основе таких симптомов как слабость в мышцах, болей и других симптомов, характерных для миозита. В диагностике миозита используются:</span></p>\r\n<p>&nbsp;</p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">Анализы крови. Повышенные уровни ферментов тканей мышцы (например, креатинкиназа), могут быть свидетельством повреждения мышечной ткани. Анализы на наличие аутоантител могут идентифицировать аутоиммунное заболевание.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">МРТ. Сканирование с использованием мощного магнита и компьютера позволяет получить изображение мышц. Анализ МРТ помогает идентифицировать зоны повреждения мышц в текущий момент и в динамике.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">Электромиография (ЭМГ). С помощью введения игольчатых электродов в мышцы, врач может проверить реакцию мышц на электрические стимуляторы и нервные импульсы. ЭМГ позволяет идентифицировать слабые или поврежденные миозитом мышцы.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; 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;\" dir=\"ltr\">\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;\">Биопсия мышцы. Это самый точный анализ при диагностике миозита. Доктор определяет слабую мышцу, делает маленький разрез, и удаляет небольшой кусочек ткани мышцы для того, чтобы исследовать ткань под микроскопом. Биопсия мышцы дает достоверный диагноз миозита.</span></p>\r\n</li>\r\n</ul>",
            "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 миозита прежде всего заключается в необходимости устранения причины возникновения патологии. При острых воспалениях, вызванных инфекциями, назначают антибактериальные средства, паразитарных миозитах &ndash; противопаразитарные и так далее.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Если проявления миозита вызваны локальным переохлаждением (сквозняк), эффективно сухое тепло на пораженную мышцу, в том числе согревающие мази.</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;\">Для того чтобы уменьшить воспаление, обычно назначают нестероидные противовоспалительные средства (ибупрофен, нимесулид, реже &ndash; ацетилсалициловая кислота). В тяжелых случаях назначают препараты на основе глюкокортикоидов, которые обладают способностью снимать воспаление, независимо от его причины.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Эффективность лечения зависит от причин миозита: при остром процессе чаще всего происходит полное выздоровление, при наследственных патологиях прогноз обычно неблагоприятный.</span></p>",
            "prevention": "<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Следить за осанкой, чтобы мышцы спины работали правильно.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Закаляться и заниматься спортом, если он вам не противопоказан. Хорошо помогает в профилактике плавание, гимнастика и велосипедный спорт.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Проводить профилактические курсы мануальной терапии и массажа.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При физической нагрузке не перенапрягать мышцы.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Своевременно лечить заболевания, у которых миозит &ndash; одна из форм осложнения.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">При сидячей работе не забывать выполнять разгрузочные комплексы упражнений для мышц плечевого пояса, спины и рук.</span></li>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Избегать переохлаждения и сквозняков.</span></li>\r\n</ul>\r\n<p><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">&nbsp;</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;\">Первый признак &mdash; ноющие боли в мышцах, усиливающиеся при движении. Часто при прощупывании пораженных мест обнаруживаются тяжи, узлы. Если в открытую травму попадет инфекция &mdash; возможен гнойный миозит, с ознобом и повышением температуры, припуханием и уплотнением мышц.</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;\">Миозит в острой форме провоцирует резкое напряжение мышц, травмы и инфекции, а хронический &mdash; обычно является следствием острого (или инфекции, перенесенной &laquo;на ногах&raquo;).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Возможен отек мягких тканей, покраснение кожи, головная боль, повышение чувствительности кожи. Если миозит в легкой форме &mdash; боль обычно проходит через несколько дней, но при физических перегрузках и охлаждении возможны частые рецидивы. Также известен паразитарный миозит, при котором боль в мышцах сопровождается лихорадкой.</span></p>\r\n<p>&nbsp;</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;\">В воспалительный процесс со временем вовлекаются новые мышцы, боли и мышечная слабость нарастают; заболевшему человеку становится трудно вставать, подниматься по лестнице, одеваться, жевать, держать голову. Возникает кашель, затрудняется глотание, появляется одышка &mdash; при поражении соответствующих мышц и других тканей. Также вероятны отложения солей кальция &mdash; т.н. оссифицирующий миозит, с прогрессирующей атрофией мышц.</span></p>",
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                            "name": "боль в мышцах"
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                        {
                            "name": "мышцы болят"
                        },
                        {
                            "name": "Миалгия"
                        },
                        {
                            "name": "ломота"
                        },
                        {
                            "name": "боль в мышцах рук"
                        },
                        {
                            "name": "боль в мышцах ног"
                        },
                        {
                            "name": "боль в мышцах после тренировки"
                        },
                        {
                            "name": "боль в мышцах спины"
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                        {
                            "name": "боль икроножная"
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                    "name": "Боль в мышцах     ",
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                    "lead": "Мышечная боль, которая периодически возникает у людей при нагрузке или в покое, называется миалгией. Она может вызываться различными причинами и сопровождаться другими симптомами",
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                    "id": 2989,
                    "synonyms": [
                        {
                            "name": "Потемнение мочи"
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            },
            "code": "R82.1",
            "name": "Миоглобинурия",
            "icd_name": "Миоглобинурия",
            "gender": 0,
            "age_min": 1,
            "age_max": 100,
            "cause": [
                "0"
            ],
            "periodicity": 1,
            "slug": "r82.1_mioglobinuriya",
            "lead": "патологическое состояние, при котором в моче обнаруживается миоглобин",
            "description": "<p>&nbsp;</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;\">Миоглобинурия &mdash; синдром, выражающийся в наличии в моче пигмента миоглобина, являющегося хромопротеидом; наблюдается при патологическом распаде мышечного белка. При этом моча приобретает красно-бурую окраску.&nbsp;</span></p>",
            "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;\">Причины миоглобинурии</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;\">Наследственно-семейные патологии:</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;\">с выясненным механизмом аномалии (синдром Мак-Ардла, синдром Таруи, недостаточность карнитинпальмитилтрансферазы);</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;\">с неизвестной первичной аномалией (злокачественная форма гипертермии, расстройство синтеза молочной кислоты, неправильное окисление жирных кислот);</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;\">врожденный вариант миопатии на фоне дополнительного фактора &ndash; наркоза (дистрофия мышечная врожденная Ши и Меджи, миопатия Дюшенна, хондродистрофическая миотония).</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;\">Приобретенные патологии:</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;\">изменения, связанные с механическим нарушением (травма, инфаркт, ишемия);</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;\">гипернагрузка на мускулатуру (перегруз нетренированной мускулатуры, подъем тяжелых предметов, эпистатус, психоз, электрошок);</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;\">лихорадочные состояния (интоксикации, инфекции и пр.);</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;\">инфекции без лихорадки (грипп, столбняк, заболевания, которые сопровождаются ацидозом и нарушением электролитного баланса);</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;\">воспалительные процессы, отравления, интоксикации.</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;\">Провоцирующими факторами при миоглобинурии могут выступать:</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;\">физические гиперусилия;</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;\">чрезмерное напряжение мышц;</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;\">ограниченное поступление углеводов в организм;</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;\">воспалительные заболевания мышечной ткани;</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;\">механические повреждения мышечной ткани (травмы, краш-синдром, синдром позиционного сдавления);</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;\">перетренировки;</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;\">токовое воздействие;</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;\">интоксикации (лекарственные, алкогольные и пр.).</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;\">Миоглобинурия может развиваться у людей, страдающих алкогольной зависимостью, а также у тех, кто выкуривает более пачки сигарет ежедневно. В подобной ситуации патология возникает в результате токсического влияния этилового спирта, угарного газа и никотиновых смол.</span></p>\r\n<p>&nbsp;</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;\">Заболевание нередко поражает любителей кокаина, героина, амфетамина, а также наблюдается после укусов змей, скорпионов, ядовитых пауков, после отравления грибами.</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;\">&nbsp;</span></p>",
            "pathogenesis": "",
            "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;\">Для оценки состояния больного, уточнения вида патологии, сопровождающейся миоглобинурией, назначаются следующие диагностические процедуры:</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;\">Биохимическое исследование крови. Типична увеличенная концентрация миоглобина и КФК. Уровень соединений постепенно повышается на протяжении первых 12 часов. Максимальная активность миоглобина наблюдается в течение первых суток, креатинфосфокиназы &ndash; на 3-5 день. В анализах повышено количество мочевой кислоты и креатинина, наблюдаются гипокальциемия, гиперкалиемия, гиперфосфатемия, гиперурикемия.</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;\">Оценка диуреза. Имеет большую клиническую значимость из-за риска ОПН. О наличии осложнения свидетельствует уменьшение количества отделяемой мочи на 8-10%. В дальнейшем диурез сокращается на четверть, в тяжелых случаях развивается анурия. При восстановлении почечных функций объем суточного диуреза увеличивается, затем постепенно нормализуется.</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;\">Измерение субфасциального давления. Дает возможность подтвердить миофасциальный компартмент-синдром, исключить иные патологии. Выполняется специальным прибором. Полученные результаты сравнивают с диастолическим давлением. Разница менее 40 мм рт. ст. говорит в пользу сдавления мышц.</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;\">Электрофизиологические методы. Электромиография и электронейрография применяются для диагностики миопатии, дифференцировки патологии от миелита, нарушений спинномозгового кровообращения, новообразований спинного мозга. По результатам ЭМГ определяется сокращение длительности, уменьшение амплитуды мышечных потенциалов. Множество коротких пиков указывает на прогрессирующий характер процесса.</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;\">Другие методики. При сдавлении тканей в отдельных случаях выполняются УЗИ или МРТ, визуализирующие отек, разрушение скелетных мышц. Для исключения переломов и вывихов требуется рентгенологическое исследование. Тяжесть поражения миокарда при инфаркте, миопатиях, гаффской болезни оценивают с помощью ЭКГ, УЗИ сердца.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p>&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Консервативная терапия</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;\">Устранение миоглобинурии осуществляется путем лечения основной патологии. При высоком уровне миоглобина в анализе мочи необходима срочная госпитализация в реанимационное отделение, контроль диуреза, диета с низким содержанием белка и калия. Схема медикаментозной терапии включает следующие направления:</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;\">Профилактика ОПН. Подразумевает назначение диуретиков, внутривенное капельное введение раствора гидрокарбоната натрия.</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;\">Восстановление объема жидкости. Инфузионную терапию с использованием солевых растворов начинают при поступлении, оптимально &ndash; в первые 6 часов с момента повреждения мышц. Лечение производится под контролем КОС крови и диуреза.</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;\">Устранение интоксикации и обменных нарушений. Предусматривает введение инсулина с глюкозой, агонистов бета-адренорецепторов, гидрокарбоната натрия, глюконата кальция. Для удаления токсинов из ЖКТ применяют энтеросорбенты.</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;\">Экстракорпоральная гемокоррекция. Чаще выполняется гемосорбция, иногда &ndash; плазмаферез. Больным с почечной недостаточностью показано проведение гемодиализа.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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 открытых травмах, газовой гангрене, формировании некротических очагов необходима антибиотикотерапия. Пациентам с гаффской болезнью назначают анальгетики, противосудорожные и антигистаминные средства, медикаменты для улучшения микроциркуляции, поливитаминные комплексы. Иногда требуются гипербарическая оксигенация, переливание свежезамороженной плазмы, тромбоцитарной и эритроцитарной массы.</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;\">Патогенетическое лечение миопатий не разработано. Симптоматическая терапия направлена на активизацию метаболических процессов в мышечной ткани. Рекомендованы аминокислоты, неостигмин, АТФ, анаболические стероиды, антихолинэстеразные препараты, кальций, калий, тиаминпирофосфат. Медикаментозные методы дополняют ЛФК, массажем, физиотерапией.</span></p>\r\n<p><strong id=\"docs-internal-guid-82a2a015-7fff-8e08-88c8-84fe27577349\" style=\"font-weight: normal;\">&nbsp;</strong></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;\">Хирургическое лечение</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;\">В раннем периоде оперативные вмешательства требуются пациентам с миоглобинурией на фоне обширного рабдомиолиза, тяжелого сдавления мышц, образования участков некроза. В отдаленные сроки некоторые больные нуждаются в устранении вторичных дефектов костно-мышечной системы. С учетом стадии заболевания и имеющейся симптоматики проводятся:</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;\">Декомпрессионная фасциотомия. Показана при высоком давлении в фасциальном футляре вследствие компартмент-синдрома. Позволяет восстановить питание и сохранить жизнеспособность мышечной ткани, снизить риск возникновения ОПН.</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;\">Некрэктомия. Необходима при электротравме, термических ожогах, СДР, газовой гангрене. При обширных поражениях, подтверждении нежизнеспособности конечности, угрозе ОПН из-за поступления токсинов в организм осуществляется ампутация или экзартикуляция.</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;\">Реконструктивно-пластические вмешательства. Проводятся для улучшения функциональности конечностей. Включают пластику рубцов, миопластику, замещение дефектов мягких тканей с использованием филатовского стебля.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</p>\r\n<p>&nbsp;</p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">&nbsp;</span></p>",
            "prevention": "",
            "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;\">Симптоматика при миоглобинурии далеко не во всех случаях одинакова: это зависит от концентрации миоглобина и наличия сопутствующих патологических расстройств. Большинство больных жалуются на внезапную сильную слабость, болезненность в мышцах, тяжесть в поясничной области, приступы тошноты. Объем выделяемой мочевой жидкости резко и сильно снижается &ndash; не исключается также развитие анурии. Обращает на себя внимание изменение цвета мочи. Так, первые признаки миоглобинурии заключаются в том, что мочевая жидкость становится от насыщенно красной до насыщенно бурой, вплоть до почернения.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\">&nbsp;</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;\">Бензидиновая проба оказывается положительной. Удельный вес мочи постепенно снижается, обнаруживается протеинурия. Мочевой осадок содержит цилиндры, гематин, эритроциты.</span></p>\r\n<p>&nbsp;</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;\">Если в дальнейшем развивается острая недостаточность почечной деятельности, то нарастают признаки общей интоксикации, наблюдаются азотемия, гиперкалиемия, явления ацидоза.</span></p>",
            "image": null,
            "image_alt": null,
            "standard_type": 0,
            "danger": 24,
            "published": 1,
            "parent": 7243,
            "block_rubric": 196,
            "standards": []
        }
    ]
}