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"code": "A35",
"name": "Другие формы столбняка",
"icd_name": "Другие формы столбняка",
"gender": 0,
"age_min": 10,
"age_max": 94,
"cause": [
1,
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],
"periodicity": 2,
"slug": "a35_drugie_formy_stolbnyaka",
"lead": "Нарушение здоровья, относящееся к группе другие бактериальные болезни",
"description": "Столбняк – острое бактериальное заболевание, при котором возникает тяжелейшее поражение нервной системы с развитием тонического напряжения скелетных мышц и генерализованных судорог. ",
"etiology": "<p>Возбудитель столбняка — грамположительная палочка, живущая в бескислородной среде и способная образовывать споры. Бактерия подвижна, имеет около 20 жгутиков.</p>\r\n<p>Возбудитель столбняка относится к категории вездесущих, наибольшая обсеменённость столбнячной палочкой наблюдается в сельскохозяйственных районах с достаточной влажностью, где палочка обнаруживается в почвах садов, огородов, пастбищ и других местах, где присутствует загрязнённость фекалиями человека и животных.</p>\r\n<p>В присутствии кислорода и температуре не ниже 4 °C образует споры. Споры устойчивы к внешнему воздействию: выдерживают нагревание до 90 °C в течение 2 часов, при кипячении погибают только через 1—3 часа, в сухом состоянии переносят нагревание до 150 °C, в солёной морской воде живут до 6 месяцев. В испражнениях, почве, на различных предметах сохраняются на протяжении многих лет.</p>\r\n<p>При отсутствии кислорода, температуре 37 °C и достаточной влажности споры прорастают в малоустойчивую вегетативную форму.</p>\r\n<p>Возбудитель образует столбнячный экзотоксин — один из сильнейших бактериальных ядов, уступающий по силе лишь ботулиническому токсину. Токсин разрушается при нагревании, воздействии солнечного света, щелочной среды. Не всасывается через слизистую оболочку кишечника, в связи с чем безопасен при проглатывании.</p>\r\n<p> </p>",
"pathogenesis": "<p>Входными воротами (местом внедрения бактерии в организм человека) могут служить травмы различной локализации: ранения, ожоги, операции, роды, инъекции, но чаще столбняк возникает после мелких бытовых травм.</p>\r\n<p>Попадая в бескислородную среду, споры превращаются в вегетативные формы, продуцирующие экзотоксин, состоящий из трех фракций. Основой, определяющей патологические изменения, является нейротоксин – тетаноспазмин, который действует на нервную систему, вызывая тонические сокращения поперечно-полосатой мускулатуры, и тетаногемолизин, вызывающий распад эритроцитов крови.</p>\r\n<p>Токсин из раны по двигательным волокнам периферических нервов, через кровь и лимфу поступает в спинной и продолговатый мозг, фиксируясь в синапсах, передающих возбуждение мышцам. Нейротоксин избирательно блокирует тормозящее действие вставочных нейронов на мотонейроны. В результате этого происходит беспрерывное поступление возбуждающих импульсов в мышцы, которые приходят в состояние тонического напряжения. При столбняке могут поражаться и жизненно важные центры (дыхательный и др.).</p>\r\n<p>Причины смерти при столбняке – асфиксия, паралич сердечной деятельности, дыхания, пневмония, сепсис.</p>",
"diagnostics": "<p>Клиническая картина столбняка достаточно специфична для постановки диагноза. Исследованию на предмет выявления возбудителя могут подвергаться материалы вскрытия трупа, перевязочный и шовный материал, смывы с хирургического инструментария, пыль, почва, воздух.</p>\r\n<p>Выделение возбудителя обычно возможно из места попадания инфекции (соскоб или отделяемое в месте повреждения кожи). Иногда возникает необходимость мазков из носа и слизистой глотки, влагалища и матки (при послеродовом или послеабортном столбняке). Исследуя полученный биологический материал, производят выделение столбнячного экзотоксина и биологическую пробу на мышах.</p>",
"treatment": "<p>Больной подлежит немедленной госпитализации в специализированный стационар.</p>\r\n<p>Лечение включает в себя:</p>\r\n<ol>\r\n<li>Борьбу с возбудителем в первичном очаге инфекции (вскрытие, санацияи аэрация раны).</li>\r\n<li>Нейтрализацию столбнячного токсина путём введения противостолбнячной сыворотки.</li>\r\n<li>Противосудорожное лечение (тотальная миорелаксация).</li>\r\n<li>Шумоизоляционный асептический бокс</li>\r\n<li>Поддержание жизненно важных функцийорганизма (искусственная вентиляция лёгких, контроль сердечной деятельности).</li>\r\n<li>Профилактику и лечение осложнений (борьба с сопутствующими инфекциями, тромбозом),профилактика механических повреждений при судорогах.</li>\r\n<li>Полноценное питание и уход.</li>\r\n</ol>\r\n<p>Больной помещается в отдельную затемнённую палату, где исключается возможность воздействия внешних раздражителей (шум, свет и т. д.). Устанавливается круглосуточное медицинское наблюдение (пост). Больному нельзя покидать постель.</p>\r\n<p>Питание больных в период разгара болезни очень затруднено, так как сильное напряжение мышц препятствует введению пищи через зонд и внутривенно. Рекомендуется питание жидкими продуктами (молоко, бульон и т. д.) Больные охотно и с удовольствием пьют воду.</p>\r\n<p>Период лечения в стационаре составляет от 1 до 3 месяцев.</p>\r\n<p> </p>",
"prevention": "<p>Специфическая профилактика заключается в плановой поэтапной вакцинации детей вакциной АКДС и последующим ревакцинациям каждые 10 лет препаратами АДС, АС и АДС-М.</p>\r\n<p>Экстренная профилактика применяется как привитым, так и непривитым людям при:</p>\r\n<ol>\r\n<li>ранениях и травмах при нарушении целостности кожных покровов и слизистых оболочек.</li>\r\n<li>ранениях и операциях желудочно-кишечного тракта.</li>\r\n<li>ожогах и обморожениях II—IV степени.</li>\r\n<li>родах и абортахвне медицинских учреждений.</li>\r\n<li>гангренеили некрозе тканей, длительно текущих абсцессах, карбункулах, язвах, пролежнях.</li>\r\n<li>укусах животных.</li>\r\n</ol>\r\n<p>Меры неспецифической профилактики столбняка подразумевают соблюдение санитарно-гигиенических норм в быту (в особенности в лечебно-профилактических учреждениях), снижении травматизма. Индивидуальная профилактика включает тщательную дезинфекционную обработку травм и своевременное обращение к врачу для осуществления специфической профилактики при загрязнении ран, ссадин и пр.</p>\r\n<p> </p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Инкубационный период длится в среднем 1-2 недели. Чем короче этот период, тем тяжелее течение.</p>\r\n<p>Симптомы при столбняке следующие:</p>\r\n<ul>\r\n<li>Тупые тянущие боли, подергивания и напряжение в области травматизации;</li>\r\n<li>Головная боль, раздражительность, потливость, озноб, зевота, бессонница;</li>\r\n<li>Напряжение и судорожные подергивания жевательных мышц (тризм);</li>\r\n<li>Судорожные сокращения мимических мышц, из-за чего у человека появляется сардоническая улыбка (брови подняты, губы застывают в улыбке, но уголки рта опущены вниз);</li>\r\n<li>Опистотонус (спазмирование мышц спины и конечностей);</li>\r\n<li>Вследствие спазма мышцглотки нарушается глотание;</li>\r\n<li>Болезненная ригидность затылочных мышц;</li>\r\n<li>Ригидность постепенно опускается вниз вплоть до нижних конечностей, болезненные судороги возникают даже при незначительном раздражении (светом, звуком, прикосновением).</li>\r\n</ul>\r\n<p>Всё вышеперечисленное может приводить к нарушению функции глотания, дыхания, мочеиспускания и дефекации, нарушению сердечной деятельности, что нередко является причиной летального исхода.</p>",
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