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"code": "O60",
"name": "Преждевременные роды",
"icd_name": "Преждевременные роды",
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"lead": "Преждевременными считаются роды, произошедшие на сроке от 22 до 37 нед беременности.",
"description": "Преждевременными считаются роды, произошедшие на сроке от 22 до 37 нед беременности (154–259 дней беременности, считая от первого дня последней менструации).\r\nПреждевременные роды неблагоприятны для ребёнка. При появлении болей внизу живота, напряжении матки, подозрении на излитие вод следует немедленно обратиться к врачу. Рекомендации к госпитализации следует выполнять неукоснительно.",
"etiology": "<p>Гормональные нарушения, инфекция полового тракта и их сочетание — основные этиологические факторы преждевременных родов. Нарушения в системе гемостаза — ещё один механизм прерывания беременности.</p>\r\n<p>Преждевременные роды на сроке 22–27 нед беременности чаще обусловлены инфекционной этиологией и врождённой наследственной патологией плода. На этом сроке лёгкие плода незрелые, добиться ускорения их созревания назначением медикаментозных средств матери за короткий период времени не удаётся. В связи с такими физиологическими особенностями в этот период исход для плода в этой группе наиболее неблагоприятный, чрезвычайно высока смертность и заболеваемость. В 28–33 нед инфекционная этиология преобладает только в 50% случаев, с 34 нед преждевременные роды обусловлены множеством других причин, не связанных с инфекцией.</p>",
"pathogenesis": "<p>Патогенез преждевременных родов связан с:<br />· повышенным выбросом цитокинов при инфекционном поражении;<br />· коагулопатическими процессами, приводящими к микротромбозу плаценты с последующей отслойкой;<br />· повышением количества и активацией окситоциновых рецепторов в миометрии, что способствует открытию кальциевых каналов миоцитов и инициации сократительной деятельности матки.</p>",
"diagnostics": "<p>Диагностика преждевременных родов не представляет трудности и основывается на жалобах беременной, данных общего осмотра и влагалищного исследования.</p>\r\n<p>Лабораторную диагностику проводят с целью определения этиологии угрозы преждевременных родов. При подозрении на инфекционную этиологию производят посев из цервикального канала с обязательным определением чувствительности к антибиотикам, при подозрении на вирусную инфекцию проводят качественную ПЦР.</p>",
"treatment": "<p>При угрозе преждевременных родов показан постельный режим, физический, эмоциональный и половой покой.</p>\r\n<p>Физиотерапевтические методы — электрофорез магния синусоидальным модулированным током, иглорефлексотерапия, электроаналгезия.</p>\r\n<p>Медикаментозное лечение угрозы преждевременных родов комплексное, включает в себя:<br />· токолитическую терапию;<br />· профилактику РДС плода (в случаях необходимости);<br />· седативную и симптоматическую терапию.</p>",
"prevention": "<p>Наблюдение за беременной, своевременная диагностика и лечение возникающих нарушений (инфекции, ИЦН, сопутствующей экстрагенитальной патологии).</p>\r\n<p>К профилактическим мероприятиям относят:</p>\r\n<p>· рациональную предгравидарную подготовку;<br />· выделение групп риска по преждевременным родам;<br />· профилактику плацентарной недостаточности с ранних сроков беременности.</p>\r\n<p> </p>",
"clinical_picture": "<p>· повышение тонуса матки. Беременная предъявляет жалобы на тянущие либо схваткообразные боли внизу живота и в пояснице;<br />· чувство давления и распирания в области влагалища;<br />· учащённое мочеиспускание — симптом низкого расположения предлежащей части.</p>",
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"lead": "расстройство, когда семяизвержение у мужчины происходит до начала введения полового члена или менее чем через минуту после этого",
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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;\">Различают первичную и вторичную (приобретенную) форму. Первичная возникает из-за анатомических дефектов половых органов или патологической наследственности. Дебют ранней эякуляции приходится на период полового созревания, и не зависит от внешних факторов (партнера, ситуации, психологического состояния).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Причины врожденной формы:</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: 8pt; 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;\">гиперчувствительность пениса;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">дисфункция серотониновых рецепторов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">короткая уздечка полового члена;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">кавернозный фиброз.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">Вторичное преждевременное семяизвержение может возникнуть на фоне полного физического здоровья мужчины в любой момент жизни. Основная причина — хронические урогенитальные заболевания. Также привести к возникновению сексуальной дисфункции могут гормональные нарушения, которые свойственны эндокринным патологиям.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </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;\">К факторам, которые значительно увеличивают риск возникновения ПЭ, относят:</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: 8pt; 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;\">ожирение;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">травматический сексуальный опыт;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">хронический стресс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">семейные проблемы (конфликты, эмоциональная холодность между супругами);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">наличие неврологических диагнозов — склероз, болезнь Паркинсона;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">нерегулярный секс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">операции на половых органах или в области малого таза.</span></p>\r\n</li>\r\n</ul>\r\n<p> </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;\">Немаловажным фактором является полноценное питание и ведение здорового образа жизни. Недостаток у мужчины таких микроэлементов, как магний и цинк, негативно влияет на качество эякулята. Чрезмерное увлечение алкоголем уменьшает способность контролировать тело, что влечет за собой возникновение неприятных казусов в постели.</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;\">На основе анамнеза и беседы с пациентов андролог назначает индивидуальное обследование.</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;\">Наиболее распространены следующие исследования:</span></p>\r\n<p> </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: 8pt; 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;\">Лидокаиновый тест – проводится для диагностики чувствительности головки полового члена. Это не больно, не опасно, без вмешательств. На головку полового члена наносится крем Эмла или спрей Лидокаина за 20 минут до полового акта, за 10 минут – состав смывается водой и мылом. Если длительность акта увеличивается, эякуляция восстанавливается, то устанавливается гиперчувствительность кожи.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">УЗИ – назначается для оценки состояния предстательной железы и семенных пузырьков и дает важную информацию о состоянии внутренних структур</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">Клинические исследования крови назначаются для оценки гормонального статуса, определения уровня половых и тиреоидных гормонов</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">Электроэнцефалография – проводится для оценки функционального состояния головного мозга и нервного статуса</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">ПЦР-диагностика – назначается с целью выявления скрытых инфекций</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">Уретроскопия – это эндоскопическое исследование, которое назначается с целью обследования мочеиспускательного канала (уретры)</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; 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;\">Микробиологические исследования – назначаются для исключения хронического простатита и других урологических болезней</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 преждевременной эякуляции всегда комплексное – в первую очередь оно предполагает устранение причины, ее вызывающей.</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;\">Виды лечения преждевременной эякуляции:</span></p>\r\n<p> </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: 7.5pt; 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;\">местное лечение (использование специальных презервативов с местными анестетиками, применение гелей и мазей с анестезирующими веществами);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; 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;\">прием лекарственных препаратов нейролептического направления;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; 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;\">психотерапия (курс лечения у психотерапевта);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; 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;\">лечение сопутствующих заболеваний (воспалительных, инфекционных, эндокринных, травм и т.д.)</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; 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;\">хирургическое лечение преждевременной эякуляции (обрезание, денервация головки полового члена);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; 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;\">физиотерапия (например, массаж простаты).</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p><span id=\"docs-internal-guid-39c22285-7fff-96d7-86a9-3b15310f86ff\"><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;\">С целью профилактики рекомендуется регулярно проходить обследования половой системы, вовремя лечить имеющиеся урологические заболевания, избегать переохлаждения, случайные связи и стрессы.</span></span></p>",
"clinical_picture": "<p> </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: 9.5pt; font-family: Verdana; color: #616262; 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;\">Пока эпизоды быстрого семяизлияния происходят нечасто и не беспокоят человека, его состояние не считается патологическим. Вопрос, как избавиться от преждевременной эякуляции, актуален при наличии следующих признаков:</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 9.5pt; font-family: Verdana; color: #616262; 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;\">извержение семенной жидкости наступает каждый раз (или почти всегда) в течение одной минуты с момента проникновения во влагалище при минимальной стимуляции;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 9.5pt; font-family: Verdana; color: #616262; 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;\">проблема с “фальстартом” напоминает о себе более полугода во всех, включая мастурбацию, сексуальных ситуациях;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 9.5pt; font-family: Verdana; color: #616262; 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;\">по мере снижения сексуальной удовлетворенности возрастают чувства огорчения, разочарования и желание избежать интимной близости. Если ваши симптомы соответствуют этим критериям, стоит прибегнуть к помощи квалифицированных специалистов (уролога, сексолога, психотерапевта). В большинстве случаев достаточно нескольких недель лечения, чтобы добиться 4-8-минутной продолжительности полового акта.</span></p>\r\n</li>\r\n</ul>",
"image": null,
"image_alt": null,
"standard_type": 0,
"danger": 11,
"published": 1,
"parent": 6331,
"block_rubric": 58,
"standards": []
},
{
"id": 13406,
"symptoms": [],
"alternative_names": [],
"complications": [],
"medicine_branches": [],
"who": [
{
"id": 14787,
"gender": 2,
"diseased": 197462,
"deaths": 1416,
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"disease": 6985
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{
"id": 14786,
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"lead": "Преждевременная отслойка нормально расположенной плаценты — отслойка плаценты до рождения плода (во время беременности, в первом и во втором периодах родов).",
"description": "Преждевременная отслойка нормально расположенной плаценты — отслойка плаценты до рождения плода (во время беременности, в первом и во втором периодах родов). В зависимости от площади выделяют частичную и полную отслойку плаценты. При частичной отслойке плаценты от маточной стенки отслаивается часть ее, при полной – вся плацента.\r\nЧастичная отслойка плаценты может быть прогрессирующей и непрогрессирующей.\r\n\r\n",
"etiology": "<p>Отслойка плаценты является проявлением системной, иногда скрыто протекающей патологии у беременных. Среди причин патологии выделяют несколько факторов: сосудистый (васкулопатия, ангиопатия плацентарного ложа, поверхностная инвазия цитотрофобласта в неполноценный эндометрий), гемостатический (тромбофилия), механический.</p>\r\n<p>Таким образом, к предрасполагающим факторам преждевременной отслойки нормально расположенной плаценты можно отнести следующие состояния:</p>\r\n<p>· Во время беременности:<br />- сосудистая экстрагенитальная патология (артериальная <a href=\"/symptom/vysokoe_davlenie/\" title=\"Перейти на страницу симптома Высокое давление\">гипертензия</a>, гломерулонефриты);<br />- эндокринопатии (сахарный диабет);<br />- аутоиммунные состояния (антифосфолипидный синдром, системная красная волчанка);<br />- аллергические реакции на декстраны, гемотрансфузию;<br />- гестоз, особенно на фоне гломерулонефрита;<br />- инфекционноаллергические васкулиты;<br />- генетические дефекты гемостаза, предрасполагающие к тромбозам.</p>\r\n<p>· Во время родов:<br />- излитие околоплодных вод при многоводии;<br />- гиперстимуляция матки окситоцином;<br />- рождение первого плода при многоплодии;<br />- короткая пуповина;<br />- запоздалый разрыв плодного пузыря.</p>\r\n<p>Возможна насильственная отслойка плаценты в результате <a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">падения</a> и травмы, наружных акушерских поворотов,амниоцентеза.</p>",
"pathogenesis": "<p>Образующаяся гематома нарушает целостность всех слоев децидуальной оболочки и отслаивает от мышечного слоя матки плаценту, которая прилегает к этому участку.</p>\r\n<p>При непрогрессирующем варианте отслойки плаценты она может не распространяться дальше, гематомауплотняется, частично рассасывается, в ней откладываются соли. При прогрессирующем варианте участок отслойки может быстро увеличиваться. Матка при этом растягивается. Сосуды в области отслойки не пережимаются.</p>\r\n<p>Вытекающая кровь может продолжать отслаивать плаценту, а затем оболочки и вытекать из половых путей. Есликровь при продолжающейся отслойке плаценты не находит выхода, то она накапливается между стенкой матки иплацентой с образованием гематомы. Кровь при этом проникает как в плаценту, так и в толщу миометрия, что ведет к перерастяжению и пропитыванию стенок матки, раздражению рецепторов миометрия.</p>",
"diagnostics": "<p>Диагностика ПОНРП основана на:<br />· клинической картине заболевания;<br />· данных УЗИ;<br />· изменениях гемостаза.</p>\r\n<p>Клинические симптомы, позволяющие заподозрить отслойку плаценты: кровяные выделения и <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боли в животе</a>; гипертонус,болезненность матки; отсутствие расслабления матки в паузах между схватками во время родов; острая гипоксия плода или антенатальная гибель; симптомы геморрагического шока.</p>\r\n<p>При влагалищном исследовании во время беременности шейка матки обычно сохранена, наружный зев закрыт. Впервом периоде родов при отслойке плаценты плодный пузырь обычно напряжён, иногда наблюдают умеренноеколичество кровяных выделений со сгустками из матки. При вскрытии плодного пузыря изливающиеся околоплодные воды могутсодержать примесь крови.</p>",
"treatment": "<p>Тактика ведения беременности при отслойке плаценты зависит от следующих показателей:</p>\r\n<p>· величина кровопотери;<br />· состояние беременной и плода;<br />· срок гестации;<br />· состояние гемостаза.</p>\r\n<p>Во время беременности и в родах при выраженной клинической картине (средняя и тяжелая степень) отслойки плаценты показано экстренное родоразрешение путем кесарева сечения, независимо от срока гестации и состояния плода. Во время операции необходим осмотр матки для выявления кровоизлияния в мышечную стенку и под серозную оболочку (матка Кувелера). При диагностике матки Кувелера на первом этапе, после родоразрешения производится перевязка внутренних подвздошных артерий. При отсутствии кровотечения объем операции этим ограничивается, и матка сохраняется. При продолжающемся кровотечении следует осуществлять экстирпацию матки.</p>\r\n<p>Если состояние беременной и плода удовлетворительное, нет выраженного наружного или внутреннего кровотечения (небольшая непрогрессирующая ретроплацентарная гематома по данным УЗИ), анемии, при сроке гестации до 34– 36 нед возможна выжидательная тактика. Ведение беременной выполняют под контролем УЗИ, при постоянном наблюдении за состоянием плода (допплерометрия, КТГ). Лечение предполагает постельный режим беременной.</p>",
"prevention": "<p>Специфической профилактики не существует. Предупреждение отслойки плаценты заключается в предгравидарной подготовке, лечении эндометрита и экстрагенитальных заболеваний до наступления беременности, коррекции выявленных дефектов гемостаза.</p>",
"clinical_picture": "<p>Основными симптомами ПОНРП являются:<br />· <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a> и симптомы геморрагического шока;<br />· <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боль в животе</a>;<br />· гипертонус матки;<br />· острая гипоксия плода.</p>\r\n<p>Выраженность и характер симптомов определяются величиной и местом отслойки.</p>\r\n<p><a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">Кровотечение</a> при отслойке плаценты может быть:<br />· наружным;<br />· внутренним;<br />· смешанным (внутренним и наружным).</p>\r\n<p>Лёгкая форма — отслойка небольшого участка плаценты, незначительные выделения из половых путей. Общеесостояние не нарушено. При УЗИ можно определить ретроплацентарную гематому, если же кровь выделяется изнаружных половых органов, то при УЗИ она не выявляется. После родов обнаруживают организовавшийся сгусток на плаценте.</p>\r\n<p>Средняя степень тяжести — отслойка плаценты на 1/3–1/4 поверхности. Из половых путей происходит отделениекрови со сгустками в значительном количестве. При образовании ретроплацентарной гематомы возникает боль вживоте, гипертонус матки. Если отслойка произошла во время родов, матка между схватками не расслабляется. При большой ретроплацентарной гематоме матка может стать асимметричной, резко болезненной при пальпации. Без своевременного родоразрешения плод погибает. Одновременно развиваются симптомы шока (геморрагического и болевого).</p>\r\n<p>Тяжёлая форма — отслойка более 1/2 площади поверхности плаценты. Внезапность возникает <a href=\"/symptom/bol_v_zhivote/\" title=\"Перейти на страницу симптома Боль в животе\">боль в животе</a>,<a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровотечение</a> (первоначально внутреннее, а затем и наружное). Довольно быстро появляются симптомы шока. При осмотре и пальпации матка напряжена, асимметрична, в области ретроплацентарной гематомы можно обнаружить выбухание. Отмечают симптомы острой гипоксии или гибели плода.</p>\r\n<p>Тяжесть состояния, кровопотерю дополнительно усугубляет развитие ДВС-синдрома вследствие проникновения вкровоток матери большого количества активных тромбопластинов, образующихся в месте отслойки плаценты.</p>",
"image": null,
"image_alt": null,
"standard_type": 1,
"danger": 51,
"published": 1,
"parent": null,
"block_rubric": 161,
"standards": [
4893
]
}
]
}