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"code": "P36",
"name": "Бактериальный сепсис новорожденного",
"icd_name": "Бактериальный сепсис новорожденного",
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"age_min": 0,
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"periodicity": 2,
"slug": "p36_bakterialnyy_sepsis_novorozhdennogo",
"lead": "Нарушение здоровья, относящееся к группе инфекционные болезни, специфичные для перинатального периода",
"description": "Сепсис новорожденных – это тяжелое инфекционное заболевание, возникающее у детей первого месяца жизни. При нем образуются: гнойное воспаление одного или нескольких органов, полиорганная недостаточность (нарушение функций всех органов), циркуляция бактерий в крови (бактериемия). Сепсис — одна из основных причин смерти новорожденных.",
"etiology": "<p>Неонатальный сепсис вызывается условнопатогенной бактериальной микрофлорой. Наиболее частой причиной инфицирования в период внутриутробного развития плода и чаще в интранатальный период является S. Agalacticae — представитель стрептококков группы А. Реже сепсис вызывает E. Coli и другая кишечная грамотрицательная флора. </p>\r\n<p>Большую роль играют острые и хронические инфекционные заболевания у матери, различные акушерские вмешательства, длительный безводный период,эндометрит, наличие других гнойно-воспалительных очагов у матери (гнойный мастит и др. ).</p>\r\n<p>Предрасполагающими факторами являются внутриутробная гипоксия, внутричерепная родовая травма, незрелость новорожденного, повреждение кожи новорожденного во время акушерских операций и такие манипуляции, как интубация, катетеризация подключичных и пупочных вен и др. </p>",
"pathogenesis": "<p>Входными воротами чаще бывают раневая поверхность на коже, слизистых оболочках, пупочная рана и пупочные сосуды, а также неповрежденная кожа и слизистые оболочки верхних дыхательных путей, желудочно-кишечного тракта. При внутриутробном сепсисе очаг инфекции обычно локализуется в плацента или каком-либо органе беременной. Нередко входные ворота и первичный септический очаг определить не удается. </p>\r\n<p>Возбудитель проникает в кровеносную систему, вызывая бактериемию, токсинемию и антигенную стимуляцию продуктами жизнедеятельности и распада. В ответ на инфекцию организм отвечает системной воспалительной реакцией, проявляющейся выбросом провоспалительных цитокинов и активацией нейтрофилов, системы комплемента, свертывания крови и агрегацией тромбоцитов. Чрезмерный системный ответ, наряду с токсическим и антигенным воздействием возбудителя, приводит к повреждающему действию на органы и системы организма. Нарушается микроциркуляция, проницаемость и функции эндотелия капилляров, развивается синдром внутрисосудистого свертывания. В дальнейшем возникает полиорганная недостаточность. </p>",
"diagnostics": "<p>Клинический анализ крови: повышение количества лейкоцитов (клетки крови, отвечающие за иммунитет) либо их резкое снижение. </p>\r\n<p>Повышение уровня С-реактивного белка и прокальцитонина в крови (показатели острого воспалительного процесса в организме). </p>\r\n<p>Посев крови для выделения возбудителя и определения чувствительности к антибиотикам (какие антибиотики действуют на данного возбудителя в данном случае). </p>\r\n<p>Посев спинномозговой жидкости либо мочи, либо гнойного отделяемого с кожи (в зависимости от входных ворот инфекции (например, гноя с пуповинного остатка, если первично возникло его поражение). Взятый материал сеют на питательную среду и через определенное время анализируют, какие возбудители размножились. </p>",
"treatment": "<p>Лечение включает: </p>\r\n<ul>\r\n<li>Нахождение ребенка в кувезе (специальном аппарате для выхаживания новорожденных, в котором поддерживается оптимальная температура и влажность воздуха). </li>\r\n<li>Вскармливание предпочтительно грудное. В тяжелых случаях — парентеральтное (введение питательных растворов внутривенно). </li>\r\n<li>Антибактериальная терапия (действует непосредственно на причину болезни, то есть на бактерии) является кардинальным направлением в лечении сепсиса. Антибиотики сначала назначаются исходя из предположения о наиболее вероятных возбудителях инфекции у данного больного. После получения результатов посева крови с определением чувствительности данных возбудителей к антибиотикам возможна коррекция терапии. </li>\r\n<li>Инфузионная терапия (внутривенное введение растворов). </li>\r\n<li>Иммунокорригирующая терапия — внутривенное введение иммуноглобулинов, интерферонов. </li>\r\n<li>Переливание крови и плазмы крови (проводят для восполнения клеточного состава крови, факторов свертывания крови, плазма – для плазмофереза, то есть очищения жидкого компонента крови). </li>\r\n<li>С целью местного лечения гнойных очагов производится вскрытие фурункулов и абсцессов, перевязки с антибактериальными и ферментными препаратами; назначается УВЧ, СВЧ, электрофорез. </li>\r\n</ul>",
"prevention": "<p>Профилактика сепсиса новорожденных включает выявление и санацию инфекций мочеполовой сферы у беременной, соблюдение противоэпидемических мероприятий медперсоналом родильных домов и отделений новорожденных, тщательный гигиенических уход за новорожденным, естественное вскармливание. Вопрос о сроках вакцинации новорожденных с сепсисом против туберкулеза и против гепатита В , проводимой в первые дни жизни, решается в индивидуальном порядке.</p>",
"clinical_picture": "<p>Предвестниками сепсиса новорожденных могут выступать вялость или беспокойство, снижение аппетита, обильные частые срыгивания, плохая прибавка в весе. </p>\r\n<p>В период разгара развивается температурная реакция (повышение или снижение температуры тела), отечный синдром или обезвоживание, снижение массы тела. Характерным признаком сепсиса новорожденных является грязновато-серый (землистый) оттенок кожных покровов, желтушность, мраморность кожи, сыпь. </p>\r\n<p>Вследствие токсического поражения различных органов возникают увеличение печени и селезенки, поражение легких (учащение дыхания, синюшность, дыхательная недостаточность), поражение сердца (тахикардия или брадикардия, артериальная гипотензия), диспепсия, мочевой синдром (снижение диуреза, острая почечная недостаточность), кровотечения, надпочечниковая недостаточность. Чаще всего септицемия осложняется присоединением пневмонии (воспаления легких), которая выступает как самостоятельное интеркуррентное заболевание. </p>\r\n<p>Септикопиемия или сепсис новорожденных с гнойными очагами характеризуется возникновением на фоне интоксикации вторичных очагов отсева в мозговых оболочках, легких, костях, печени, других органах. Чаще всего септикопиемия протекает с развитием гнойного менингита, абсцедирующей пневмонии, остеомиелита; реже – с формированием абсцесса печени, гнойного артрита, поражения глаз, желудка или кишечника. </p>\r\n<p>В восстановительном периоде происходит опорожнение гнойных очагов, стихание интоксикации, постепенное восстановление нарушенных функций. </p>\r\n<p>Молниеносная форма сепсиса новорожденных протекает с развитием септического шока: стремительным ухудшением состояния ребенка, снижением температуры тела, брадикардией, кровоточивостью, отеком легких, острой почечной недостаточностью. Летальный исход при молниеносном течении сепсиса новорожденных наступает в течение 3-5 суток. </p>",
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"lead": "Хронический запор (хроническая констипация) – симптомокомплекс, включающий в себя уменьшение частоты актов дефекации и выраженные затруднения в процессе испражнения, выявляющиеся на протяжении полугода или более. Является полиэтиологическим патологическим состоянием, рассматривается в современной проктологии, как важнейшая социальная и медицинская проблема. Специалисты считают, что хроническими запорами различной степени выраженности страдают 30-50% взрослых и 5-20% детей США и стран Европы. Точные статистические данные о частоте запоров в России отсутствуют, поскольку пациенты стесняются или не считают нужным обращаться к врачам и нередко занимаются самолечением. С возрастом вероятность развития хронического запора увеличивается.\r\n\r\nНеспециалисты нередко полагают, что запором является состояние, при котором акт дефекации осуществляется реже, чем 1 раз в сутки. Такой подход приводит к самостоятельной гипердиагностике и необоснованному приему слабительных препаратов. Между тем, физиологической нормой условно считается частота испражнений от 3 раз в день до 3 раз в неделю. Для хронического запора характерно не только увеличение временного интервала между испражнениями, но и уменьшение количества фекальных масс, повышенная плотность, сухость и твердость кала, а также ощущение неполного опорожнения кишечника после акта дефекации. При хроническом запоре могут наблюдаться как все перечисленные признаки, так и один или два из них, при этом выраженность того или иного признака может сильно различаться.",
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"code": "E68",
"name": "Последствия избыточности питания",
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"description": " \r\n\r\nТермин ожирение алиментарно-конституционального генеза или первичное ожирение подразумевает расстройство в функционировании организма, спровоцированное нехваткой двигательной активности и неправильно составленным рационом питания – так называемым перееданием. \r\n",
"etiology": "<p>Эндогенные (внутренние) причины развития болезни: </p>\r\n<ul>\r\n<li>Генетическая предрасположенность – если в семье есть люди, страдающие от этого заболевания, то риск его развития у следующих поколений повышен; </li>\r\n<li>Строение жировой ткани, скорость обмена жиров; </li>\r\n<li>Активность функционирования центров голода и сытости в гипоталамусе; </li>\r\n<li>Изменения гормонального фона, которые могут быть вызваны периодом беременности, родов и лактации, климактерическим синдромом. </li>\r\n</ul>\r\n<p>К экзогенным (внешним) факторам развития заболевания относятся: </p>\r\n<ul>\r\n<li>Ожирение алиментарно-конституционального генеза может быть вызвано избыточным потреблением пищи в любом возрасте, включая детский; </li>\r\n<li>Рефлексы, привязанные ко времени и количеству еды, – некоторые люди в стрессовых ситуациях успокаиваются только во время принятия пищи, другие отдыхают после рабочего дня на диване перед телевизором с тарелкой, полной любимых, но не всегда полезных продуктов; </li>\r\n<li>Национальные традиции, исходя из которых люди усваивают определенный тип, а также рацион питания; </li>\r\n<li>Распространенный во всем мире малоактивный образ жизни, приводящий к гиподинамии.</li>\r\n</ul>",
"pathogenesis": "<p> Алиментарное ожирение базируется на стимуляции секреции инсулина в результате обильной еды, повышении активности центра голода и торможения центра сытости, находящихся в гипоталамусе. </p>\r\n<p>В патогенезе ожирения нельзя не придавать значения эндокринным органам и прежде всего гипофизу, надпочечникам, островковому аппарату поджелудочной железы, щитовидной и половым железам. </p>\r\n<p>Повышение функциональной активности системы гипофиз - кора надпочечников и инсулярного аппарата поджелудочной железы способствует накоплению жира в жировых депо. Снижение соматотропной активности аденогипофиза, сопровождающееся ослаблением процессов мобилизации жира из депо и последующего его окисления в печени, также выступает в качестве патогенетического фактора. </p>\r\n<p>Пониженное образование адреналина - активного липолитического фактора - имеет существенное значение в понижении мобилизации жира и является одним из патогенетических факторов ожирения. </p>",
"diagnostics": "<p>Для диагностики ожирения в практической медицине наиболее часто используют индекс массы тела (ИМТ). Применяется также индекс Борнгардта, в отличие от ИМТ учитывающий телосложение человека. </p>\r\n<p>Показателем для определения избыточного веса является Индекс массы тела (ИМТ). </p>\r\n<p>ИМТ = масса тела/рост2 (кг/м2).. </p>\r\n<p>Нормальной массе тела соответствует ИМТ 18,5-24,5. ИМТ 25,0-29,9 говорит об избытке массы тела, а ИМТ более 30 указывает на наличие у пациента ожирения. </p>\r\n<p>Диагноз I степени ставится при ИМТ 30,0 – 34,9, </p>\r\n<p>II степени – при ИМТ 35,0 – 39,9, </p>\r\n<p>III степени при ИМТ более 40. </p>\r\n<p>Нужно помнить, что показатель ИМТ не является достоверным для детей, беременных, а также спортсменов и лиц с очень развитой мускулатурой. Для этих категорий пациентов наличие ожирения и его степень определяется по-другому. </p>\r\n<p>Наиболее точным методом определения количества жировой ткани в организме считается МРТ. </p>\r\n<p>В быту количество жировой ткани в организме человека обычно определяется бытовыми весами с анализатором состава тела методом биоимпедансометрии (метод диагностики состава тела человека посредством измерения импеданса – электрического сопротивления участков тела – в разных частях организма). </p>",
"treatment": "<p>Основные способы лечения при избыточном весе и ожирении</p>\r\n<p>К ним относят соблюдение диеты с повышенным содержанием клетчатки, витаминов и других биологически активных компонентов (злаки и цельнозерновые продукты, овощи, фрукты, орехи, зелень и др.) и ограничением употребления легкоусваиваемых организмом углеводов (сахар, сладости, выпечка, хлебобулочные и макаронные изделия из муки высших сортов), а также физические упражнения. </p>\r\n<p>Общий подход при лекарственном лечении ожирения состоит в испытании всех известных препаратов для лечения ожирения.</p>\r\n<p>По механизму действия препараты для лечения ожирения делятся на три группы: </p>\r\n<ol>\r\n<li>снижающие потребление пищи (подавляющие аппетит); </li>\r\n<li>увеличивающие расход энергии; </li>\r\n<li>уменьшающие всасывание питательных веществ. </li>\r\n</ol>\r\n<p>Если результат медикаментозного лечения оказывается незначительным или его нет, то необходимо прекратить такое лечение. Возможно рассмотрение вопроса целесообразности проведения хирургического лечения. Используют бариатрические операции (направленные на уменьшение объема желудка) и косметические операции (удаление излишков жировой ткани). </p>\r\n<p>Применяется также психотерапевтическое лечение (поведенческая терапия). </p>",
"prevention": "<p>Людям со склонностью к избыточному весу следует уравновесить количество потребляемой пищи и уровень физических нагрузок. Диета должна быть сбалансированной. Увеличение физических нагрузок, занятия спортом должны идти вслед за изменением диеты.</p>",
"clinical_picture": "<p>К симптомам первичного ожирения относятся: </p>\r\n<ul>\r\n<li>гипертензия; </li>\r\n<li>завышенные показатели индекса массы тела (ИМТ) по сравнению с нормой; </li>\r\n<li>инсулинорезистентность (снижение чувствительности тканей к действию инсулина); </li>\r\n<li>нарушения в работе внутренних органов, в первую очередь сердечно-сосудистой системы; </li>\r\n<li>одышка; </li>\r\n<li>повышенное потоотделение; </li>\r\n<li>постепенное увеличение объёмов пищи, переедание; </li>\r\n<li>развитие внутренних комплексов из-за внешнего вида; </li>\r\n<li>сахарный диабет II типа; </li>\r\n<li>значительная прибавка в весе; </li>\r\n<li>увеличение объёмов талии (у женщин — превышает 80 см, у мужчин — 94)</li>\r\n</ul>",
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