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"description": "Нарушения голоса - это отсутствие или расстройство фонации вследствие патологических изменений голосового аппарата. \r\n\r\nАфония - полное отсутствие голоса и дисфония - частичные нарушения высоты, силы и тембра. ",
"etiology": "<p>К нарушениям голоса часто приводят следующие факторы: </p>\r\n<ul>\r\n<li>параличи и парезы голосообразующих органов; </li>\r\n<li>патологические процессы в коре или структуре головного мозга, в проводящих нервных путях; </li>\r\n<li>ДЦП; </li>\r\n<li>наличие воспалительных процессов в голосовых связках; </li>\r\n<li>неправильное строение голосового аппарата; </li>\r\n<li>воспаление гортани хронического характера; </li>\r\n<li>травмы или ожоги верхней части дыхательного горла; </li>\r\n<li>наличие новообразований в горле; </li>\r\n<li>наличие рубцов в гортани после операции; </li>\r\n<li>операция по удалению верхней части дыхательного горла; </li>\r\n<li>психическая травма; </li>\r\n<li>заболевания эндокринной сферы; </li>\r\n<li>вредные привычки; </li>\r\n<li>операции, в ходе которых удаляются гортань и голосовые связки; </li>\r\n<li>принадлежность к женскому полу. </li>\r\n</ul>",
"pathogenesis": "<p>В патогенезе функциональных нарушений голоса выделяют 3 основных момента: </p>\r\n<ol>\r\n<li>наличие невротического фона </li>\r\n<li>наличие пускового момента (различные невротические реакции - страх, горе, предшествующие воспалительные заболевания, перенапряжение голоса) </li>\r\n<li>фиксации нервной системой механизмов неправильного голосообразования по типу патологических условных рефлексов </li>\r\n</ol>\r\n<p>Для возникновения центральных функциональных нарушений голоса необходимо сочетание всех трех компонентов. </p>\r\n<p>Периферические функциональные нарушения голоса: чаще всего это результат перенапряжения голосовой функции. Невротический фон отсутствует. </p>\r\n<p>Для функциональных нарушений голоса характерно: </p>\r\n<ul>\r\n<li>часто резко возрастает двигательная функция гортани, может наблюдаться дискоординация между речевым дыханием, голосообразованием и артикуляцией </li>\r\n<li>могут быть нарушения сенсорной функции (чувствительности в голосовом аппарате), возникать неприятные ощущения в гортани (першение и т. п.) </li>\r\n<li>возможны нарушения секреторных функций, которые иногда сопровождаются ощущением инородного тела в области гортани. </li>\r\n<li>(нарушения моторных, сенсорных, секреторных функций) </li>\r\n<li>неврологическая симптоматика (высокие сухожильные рефлексы, неустойчивый фон настроения, депрессии, нарушения сна). </li>\r\n</ul>\r\n<p> </p>",
"diagnostics": "<p>Для выявления анатомических или воспалительных изменений голосового аппарата выполняется ларингоскопия; с целью оценки функции голосовых складок — стробоскопия. В диагностике опухолевых поражений незаменимы рентгенография и МСКТ гортани. Для получения сведений о функции мышц гортани проводится электромиография. С помощью электроглоттографии оцениваются изменения голосового аппарата в динамике. </p>\r\n<p>Логопедическое обследование включает оценку анамнеза, жалоб, особенностей голоса, характера голосообразования и голосовой атаки, физиологического и фонационного дыхания, темпо-ритмических и интонационных характеристик речи; определение времени максимальной фонации. </p>",
"treatment": "<p>При функциональных нарушениях голоса решающее значение придается общеукрепляющему лечению, массажу передней поверхности шеи, ЛФК, физиотерапии, соблюдению голосового режима. При органических нарушениях голоса проводится общая и местная медикаментозная терапия (эндоларингеальное введение лекарственных препаратов, ингаляции), по показаниям – хирургическое лечение ЛОР-патологии (удалении избыточной ткани голосовых складок, резекция гортани, ларингэктомия и др.). </p>\r\n<p>Логопедическую работу по восстановлению нарушений голоса следует начинать как можно раньше, чтобы предупредить фиксацию патологической голосоподачи, добиться лучших результатов, предотвратить развитие невротических реакций на дефект. Основные направления коррекционной работы включают психотерапию, коррекцию дыхания, развитие координации фонации и артикуляции, автоматизацию достигнутых навыков и введение голоса в свободное речевое общение. </p>",
"prevention": "<p>С целью предупреждения нарушений голоса необходимо воспитание правильных голосовых привычек (не форсировать голос), профилактика простудных заболеваний, отказ от курения и алкоголя, приема чрезмерно охлажденной и горячей пищи. Лица голосоречевых профессий должны владеть навыками диафрагмального дыхания и правильной голосоподачи. Любую, даже самую малую, простуду недопустимо переносить на ногах; в период болезни следует соблюдать щадящий голосовой режим.</p>",
"clinical_picture": "<p><strong>Симптомы органических нарушений голоса </strong></p>\r\n<p>Нарушения голоса при хронических ларингитах выражается утратой нормального звучания, сильной утомляемостью, иногда - невозможностью выполнения голосовой нагрузки. Характерны неприятные субъективные ощущения в горле – царапанье, першение, саднение, ощущение «комка», боль, давление. </p>\r\n<p>В случае периферических параличей и парезов гортани голос может отсутствовать совсем или иметь хриплое звучание. Нарушение голоса сопровождается сильным речевым утомлением, рефлекторным кашлем, поперхиванием, расстройством дыхания. </p>\r\n<p>Нарушения голоса, связанные с доброкачественными и злокачественными опухолями гортани развиваются постепенно, по мере роста образований. После любого, даже щадящего оперативного вмешательства на гортани возникают преходящие голосовые нарушения. При удалении гортани человек полностью лишается голоса; при этом резко нарушается функция дыхания, поскольку происходит разобщение трахеи и глотки. </p>\r\n<p>При центральных парезах и параличах гортани голос становится слабым, тихим, прерывистым, глухим, монотонным, нередко – с назальным оттенком. </p>\r\n<p>Органические нарушения голоса, возникшие у ребенка раннего возраста, сопровождаются отставанием в речевом развитии, задержкой накопления словаря и развития грамматических структур, нарушением звукопроизношения, трудностями коммуникации и ограничением социальных контактов. Нарушения голоса, развившиеся во взрослом возрасте, могут обусловливать профессиональную непригодность. </p>\r\n<p><strong>Симптомы функциональных нарушений голоса </strong></p>\r\n<p>Будучи периферическим функциональным нарушением голоса, нарушение голоса является профессиональным «заболеванием» лиц голосоречевых профессий. К проявлениям болезни относятся невозможность произвольно регулировать звучание голоса, (усиливать или ослаблять), прерывание (осечки) и быстрая утомляемость голоса, охриплость. В остром периоде голос может пропадать совсем. В большинстве случаев голос восстанавливается самостоятельно после периода отдыха. </p>\r\n<p>При гипотонусной дисфонии вследствие пареза внутренних мышц гортани развивается несмыкание голосовых складок, что проявляется осиплостью голоса, голосовым утомлением, болями в мышцах шеи и затылка; в тяжелых случаях возможна только шепотная речь. При гипертонусной дисфонии, обусловленной тоническим спазмом гортанных мышц, голос искажается, становится глухим, грубым; при афонии – не голос отсутствует совсем. </p>",
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"code": "R61",
"name": "Гипергидроз",
"icd_name": "Гипергидроз",
"gender": 0,
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"age_max": 94,
"cause": [
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"slug": "r61_gipergidroz",
"lead": "Нарушение здоровья, относящееся к группе общие симптомы и признаки",
"description": " Гипергидроз — обильное потоотделение, происходящее независимо от физических факторов: повышенной двигательной активности, перегревания, высокой температуры окружающей среды или других.",
"etiology": "<p>Различают общий и локализованный гипергидроз: </p>\r\n<ul>\r\n<li>Общий гипергидроз наблюдается при воздействии высокой температуры окружающей среды, физических и эмоциональных напряжениях (физиологический гипергидроз), а также при ряде болезней (туберкулёз, поражения нервной системы, резком падении уровня глюкозы в сыворотке крови). </li>\r\n<li>Наиболее частые формы локализованного гипергидроза — ладонно-подошвенный гипергидроз и гипергидроз крупных складок. Нередко эти формы являются проявлением вегетососудистой дистонии, а также результатом несоблюдения личной гигиены, плоскостопия, использования тесной, резиновой обуви, одежды из синтетических тканей и т.д.</li>\r\n</ul>",
"pathogenesis": "<p>Терморегуляционныйгипергидроз. Потоотделение – один из важнейших путей терморегуляции наряду c излучением тепла, теплопроводностью и конвекцией. Утрата тепла путём испарения находится под контролем главного механизма регуляции потоотделения в организме – гипоталамуса, и осуществляется в автономном режиме. Данный процесс является основным способом охлаждения при повышении температуры тела человека. На интенсивность терморегуляционного потоотделения влияют многочисленные факторы – температура окружающего воздуха и тела, влажность и интенсивность движения воздуха, физическое напряжение, теплоизоляционные свойства одежды, площадь поверхности тела, количество функционирующих потовых желез, прямое и отражённое излучение и т.д. </p>\r\n<p><br />Психогенный гипергидроз.Психогенный (эмоциональный) гипергидроз возникает в результате эмоционального и психического напряжения (тревога, гнев, страх, боль). Повышение потоотделения может иметь при этом различную интенсивность, усиливаться как на ограниченных участках (преимущественно на ладонях и подошвах), так и на всей поверхности тела.</p>\r\n<p><br />Пищевой гипергидроз.Пищевой гипергидроз может наблюдаться после еды, богатой экстрактивными веществами (острых блюд, алкоголя), и связан с наличием нейронных связей в стволе мозга между слюноотделительными ядрами и симпатическими путями. Бывает локализованным (преимущественно в области лица) и генерализованным (по всему телу).</p>\r\n<p><br />Спонтанный гипергидроз.Спонтанный гипергидроз возникает внезапно и обусловлен психогенными факторами.<br />Фармакологический гипергидроз.Вызывается приёмом лекарственных препаратов, воздействующих преимущественно на парасимпатический отдел вегетативной нервной системы.</p>",
"diagnostics": "<p>Диагноз устанавливается на основании жалоб больного и показании йодно-крахмальная проба Минора. Суть ее состоит в следующем: на обследуемые участки тела пациента наносят раствор йода, после высыхания которого притрушивают пятно крахмалом и следят за реакцией. При выделении пота йод растворяется и вступает в реакцию с крахмалом, от чего места, на которых выделился пот, чернеют. По размерам почерневшего пятна врачи определяют зону повышенного потоотделения и соответственно объемы предстоящего лечения. </p>",
"treatment": "<p>Современная медицина располагает различными методами лечения гипергидроза: </p>\r\n<ul>\r\n<li>безоперационными – применение медицинских антиперспирантов, ионофорез; </li>\r\n<li>малоинвазивными – инъекции ботулотоксина; </li>\r\n<li>инвазивными – симпатэктомия, кюретаж, лечение лазером. </li>\r\n</ul>\r\n<p>Начинают лечение обычно с наименее инвазивных способов – антиперспирантов и ионофореза. И только если они не дают желаемого результата, проводят инъекции ботоксом или оперативное вмешательство. </p>\r\n<p>МЕДИЦИНСКИЕ АНТИПЕРСПИРАНТЫ </p>\r\n<p>Эти средства могут использоваться для области подмышек, рук, стоп и даже лица. По своему действию они похожи на косметические антиперспиранты, однако концентрация активных веществ (обычно солей алюминия) в них намного выше. </p>\r\n<p>ИОНОФОРЕЗ </p>\r\n<p>Ионофорез – это достаточно эффективный и безопасный метод лечения гипергидроза. Суть данного метода заключается в том, что токи и ионизирующие вещества, проходя через кожу, «выключают» потовые железы. </p>\r\n<p>ЛЕЧЕНИЕ БОТУЛОТОКСИНОМ </p>\r\n<p>Инъекции ботокса, широко используемые для омоложения, применяются и для лечения гипергидроза. При внутрикожном введении ботулотоксин блокирует передачу нервных импульсов от нервов к потовым железам и тем самым уменьшает выделение пота. Особенно эффективен этот метод при аксиллярном (подмышечном) гипергидрозе. Эффект от применения данного метода лечения сохраняется 6-8 месяцев. </p>\r\n<p>ИНВАЗИВНЫЕ МЕТОДЫ ЛЕЧЕНИЯ ГИПЕРГИДРОЗА </p>\r\n<p>Кюретаж – хирургический метод лечения аксиллярного гипергидроза. Суть заключается в механическом разрушении потовых желез с помощью специального приспособления – кюретки. Проводится данная процедура под местной анестезией, для введения кюретки на коже делается небольшой разрез. Эффект после кюретажа сохраняется 4-6 месяцев, потом появляются новые потовые железы, однако такой повышенной потливости, как до операции, как правило уже не наблюдается. Побочным действием применения кюретажа является временное нарушение чувствительности под мышками из-за повреждения нервных волокон. </p>\r\n<p>Самый современный метод лечения гипергидроза – это применение лазера. Во время операции под кожу аксиллярной области через небольшой разрез вводится световод, после чего лазерный луч разрушает потовые железы. Восстановление после такой операции проходит намного быстрее, чем после обычного кюретажа. </p>\r\n<p>Симпатэктомия – еще один метод лечения гипергидроза, заключающийся в пересечении или клипировании симпатических нервных волокон. При повышенной потливости ладоней проводится эндоскопическая торакальная симпатэктомия, а при гипергидрозе стоп – поясничная симпатэктомия. Осуществляются эти операции под общим наркозом. </p>",
"prevention": "<p>Главными методами профилактики в борьбе с гипергидрозом должно стать тщательное соблюдение правил личной гигиены: следует ежедневно принимать душ, делать теплые ванночки для ладоней и стоп (лучше с настоем ромашки или дубовой коры), делать обтирания. Для уничтожения запаха пота рекомендуется пользоваться дезодорантами. Не рекомендуется носить одежду, особенно нижнее белье и носки, из синтетических тканей, поскольку они воздухонепроницаемы. Менять белье, носки, колготки следует как можно чаще. Обувь должна быть удобной, легкой со специальными стельками-вкладышами, а летом – открытой. Необходимо ограничить, а по возможности и исключить из рациона совсем, слишком горячую, острую пищу, алкоголь, никотин, кофе. Усиливают неприятный запах пота такие продукты, как лук и чеснок, специи.</p>",
"clinical_picture": "<p>Гипергидроз подмышек </p>\r\n<p>Повышенная потливость подмышек — наиболее распространенная форма гипергидроза. У человека заметны: </p>\r\n<ul>\r\n<li>Огромные мокрые следы в подмышечных впадинах; </li>\r\n<li>При высыхании пот оставляет следы на одежде желтоватого, красного и фиолетового цвета; </li>\r\n<li>Резкий запах, заметный для окружающих даже при использовании дезодоранта. </li>\r\n</ul>\r\n<p>Гипергидроз стопы </p>\r\n<p>Неприятный запах от ног, быстро возникающий после мытья, обусловлен изменением кислотности кожи. При этом на «вечно мокрых от пота» ногах быстро развивается грибок, что еще более усугубляет внешние проявления гипергидроза. </p>\r\n<p>Гипергидроз ладоней </p>\r\n<p>Мокрые, всегда холодные ладони — в большинстве случаев признак неустойчивой нервной системы и высокой эмоциональности. Даже минимальное переживание может спровоцировать моментальное потение ладоней. Человек стесняется при рукопожатии и общении с другими людьми. </p>\r\n<p>Гипергидроз ног </p>\r\n<p>В этом случае потеют не только стопы, мокрой испариной покрывается вся кожа ног. Капли пота стекают от паховой области, вызывая потертости на внутренней поверхности бедер и раздражая наиболее нежную кожу подколенных ямок. </p>\r\n<p>Другие признаки гипергидроза </p>\r\n<p>Гипергидроз может локализоваться и на других участках кожи. Несколько реже встречается общий гипергидроз тела. При этом появляется: </p>\r\n<ul>\r\n<li>Покраснение и блеск лица, капли пота на лбу (человек постоянно вытирает лицо салфеткой); </li>\r\n<li>Потертости под грудью у женщин; </li>\r\n<li>Мацерация кожи в паху; </li>\r\n<li>Стекающие ручейки пота по позвоночнику; </li>\r\n<li>Мокрое нижнее белье — в таких случаях человек говорит: «мокрый, хоть выжимай». </li>\r\n</ul>",
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"parent": null,
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},
"code": "R64",
"name": "Кахексия",
"icd_name": "Кахексия",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "r64_kaheksiya",
"lead": "Крайняя степень истощения организма, для которой характерно резкое исхудание, общая слабость, снижение активности физиологических процессов, расстройства психики",
"description": "Выделяют 2 формы кахексии:\r\nПервичную (экзогенная) — при низком поступлении пищи в организм или в том случае, если ее энергетическая и питательная ценность низки;\r\nВторичную (эндогенная) — является осложнением различных заболеваний.\r\n",
"etiology": "<p><a href=\"/symptom/otkaz_ot_pischi/\" title=\"Перейти на страницу симптома Отказ от пищи\">Голодание</a> или длительное <a href=\"/symptom/snizhenie_appetita/\" title=\"Перейти на страницу симптома Снижение аппетита\">недоедание</a>, поражения пищевода, болезни органов желудочно-кишечного тракта, психогенная <a href=\"/symptom/anoreksiya/\" title=\"Перейти на страницу симптома Анорексия\">анорексия</a>, длительная интоксикация при хронических инфекционных болезнях, амилоидоз, истощающие диффузные заболевания соединительной ткани, тяжелая сердечная недостаточность, злокачественные опухоли, эндокринные заболевания с нарушением обмена энергии, болезни щитовидной железы.</p>",
"pathogenesis": "<p><a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">Кахексия</a> приводит не только к упадку сил, она меняет реакцию на лечение и ухудшает переносимость, что фатально сказывается на продолжительности жизни. При потере за полгода не более 5% массы тела, сопровождающейся патологическим отвращением к пище и признаками воспаления, предполагается прекахексия. О системной воспалительной реакции можно говорить при температуре выше 38 °C или ниже 36 °C, тахикардии от 90 ударов, учащённом дыхании, лейкоцитах выше 12 тысяч или ниже 4 тысяч. Только на стадии прекахексии лечением можно остановить потерю мышечной массы, что изменит ближайшую судьбу больного. При потере более 5% массы со всеми указанными признаками говорят о собственно кахексии. Это же состояние возникает у больного с изначально низким весом при утрате только 2% массы тела. Дальнейшее не просто снижение, а форменное <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">истощение</a> с невозможностью встать с постели или из-за слабости проводить в ней более половины дня, безответное применение противоопухолевой терапии — уже рефрактерная <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">кахексия</a>.</p>",
"diagnostics": "<p>Чаще всего диагноз «<a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">кахексия</a>» можно установить только по внешнему виду пациента, настолько очевидны проявления кахексии при простом визуальном осмотре. Сбор анамнеза помогает уточнить сроки и стадию заболевания, тяжесть поражения организма. Для более точной оценки степени изменений производят стандартные лабораторные обследования: общий и биохимический анализы крови, общий анализ мочи (при необходимости – бакпосев мочи для исключения сепсиса), лабораторные и инструментальные методы обследования для выявления основного заболевания и его тяжести (рентген, УЗИ, МРТ, КТ, гастроскопия). При необходимости к обследованию могут привлечены и другие специалисты – гастроэнтеролог, кардиолог, гинеколог, невропатолог, психиатр, эндокринолог, онколог.</p>",
"treatment": "<p>Направлено на основное заболевание и должно включать мероприятия по восстановлению питания больного и обеспечению тщательного ухода.</p>\r\n<p> </p>\r\n<p>В рацион вводится пища, богатая белками, жирами, витаминами, предпочтительно употреблять легкоусваиваемые продукты. При нарушениях переваривания и всасывания пищи назначают полиферментные препараты. В тяжелых случаях парентерально вводят растворы глюкозы, электролитов, витамины, белковые гидролизаты, аминокислотные смеси. По показаниям применяют анаболические гормоны.</p>",
"prevention": "<p>Профилактика кахексии сводится к своевременному и адекватному лечению заболеваний, на фоне которых может развиться <a href=\"/symptom/kaheksiya/\" title=\"Перейти на страницу симптома Кахексия\">кахексия</a>. При чрезмерном употреблении алкоголя и приеме наркотиков необходимо лечение от этих зависимостей. </p>",
"clinical_picture": "<p>Резко выраженная <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, утрата трудоспособности, <a href=\"/symptom/anormalnaya_poterya_vesa/\" title=\"Перейти на страницу симптома Анормальная потеря веса\">резкое похудание</a>, признаки обезвоживания, могут наблюдаться безбелковые отеки подкожной клетчатки.</p>\r\n<p> </p>\r\n<p>В тяжелых случаях потеря массы достигает 50 % и более. Кожа бледная или землисто-серая, дряблая, морщинистая. Отмечаются трофические изменения волос и ногтей. Развивается стоматит, нередко выпадают зубы, отмечаются упорные запоры. Понижается половая функция, у женщин наступает аменорея. Уменьшается объем циркулирующей крови, АД обычно снижено.</p>",
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]
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