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"description": " \r\nВрожденная пневмония — это остро протекающее инфекционно-воспалительное заболевание легких, которое проявляется в первые 72 часа жизни. ",
"etiology": "<p>Воспаление легких у новорожденных вызывают различного рода болезнетворные микроорганизмы, грибы, вирусы, простейшие. К ним относятся возбудители: стафилококк, стрептококк, пневмококк, вирус простого герпеса, цитомегаловирус, микоплазмы, хламидии, грибы рода Кандида и множество других. Пути попадания инфекции различны. </p>\r\n<p>Классифицируют бронхогенный (заражение происходит через легкие во время прохождения по родовым путям) и гематогенный (инфицирование ребенка матерью через кровь во время вынашивания плода) способ ее проникновения в детский организм. </p>\r\n<p>К группе риска относятся младенцы, период дородового развития которых происходил с такими осложнениями, как: </p>\r\n<ul>\r\n<li>внутриутробная гипоксия (недостаток получения кислорода плодом); </li>\r\n<li>застойные явления в легких при гипотрофии, то есть недоразвитие дыхательных путей; </li>\r\n<li>пороки сердца, легких; </li>\r\n<li>нарушение иммунитета, передающееся по наследству; </li>\r\n<li>недостаток или избыток витаминов в организме плода; </li>\r\n<li>хронические болезни матери и перенесенные инфекции в период созревания ребенка; </li>\r\n<li>патологические кровотечения во время беременности; </li>\r\n<li>слишком раннее отхождение околоплодных вод; </li>\r\n<li>повреждения головного мозга и верхних дыхательных путей при родах. </li>\r\n</ul>",
"pathogenesis": "<p>Возбудитель, проникнув в легкие через кровь или дыхательные пути, вызывает здесь воспалительный процесс (как правило, двусторонний). Это сопровождается отеком тканей, патологической продукцией секрета, очаговым спаданием альвеол. В результате — легкие не в состоянии качественно исполнять свою функцию, а организм новорожденных страдает от недостаточности кислорода, избытка углекислого газа, нарушения обменных процессов. При отсутствии адекватного лечения возможны опасные последствия: тяжелые дыхательные расстройства, отек легких, нарушение сердечной деятельности, полиорганная недостаточность. </p>",
"diagnostics": "<p>В общем анализе крови выявляют повышение (или снижение) числа лейкоцитов, сдвиг формулы влево, появление незрелых форм. </p>\r\n<p>Исследование мочи поможет определить кетоацидоз, поражение почек. </p>\r\n<p>На рентгенографии грудной клетки выявляют характерные воспалительные инфильтраты, усиление легочного рисунка, расширение прикорневой зоны. </p>\r\n<p>Бактериологические и серологические исследования крови (ликвора) дают возможность определить возбудителя и его чувствительность к лекарственным средствам. </p>",
"treatment": "<p>Уход. Необходимо поддерживать оптимальную температуру окружающей среды, недопустимо переохлаждение и перегревание ребенка. Правильный уход предусматривает свободное пеленание, частые перемены положения ребенка, регулярную обработку кожи и слизистых оболочек. </p>\r\n<p>Оксигенотерапия применяется для борьбы с дыхательной недостаточностью и в зависимости от ее степени тяжести осуществляется путем ингаляций, помещения ребенка в кислородную палатку, </p>\r\n<p>Вскармливание. Способ кормления (грудь, соска, зонд) и количество пищи определяется возрастом ребенка и его состоянием. </p>\r\n<p>В качестве этиотропной (направленной на возбудителя) терапии назначаются антибактериальные препараты с учетом чувствительности к ним возбудителя. </p>\r\n<p>Инфузионная терапия с целью детоксикации. </p>\r\n<p>Кислородотерапия. </p>\r\n<p>Пассивная иммунотерапия. При тяжелом течении пневмонии показаны специфические иммуноглобулины. </p>\r\n<p>Местная терапия: - СВЧ на грудную клетку 5-7 сеансов, далее электрофорез с эуфиллином, новокаином, препаратами кальция 7-10 сеансов; - отвлекающая терапия - горчичное обертывание грудной клетки; - регулярные санации трахеобронхиального дерева или бронхоскопии с промыванием бронхов антисептическими растворами. </p>",
"prevention": "<p>Профилактика врожденной пневмонии заключается в устранении предрасполагающих факторов к развитию пневмонии, соблюдении санэпидрежима в родильном доме, в отделениях больниц для новорожденных. </p>",
"clinical_picture": "<p>Клиническая картина заболевания выглядит следующим образом: </p>\r\n<ul>\r\n<li>гипотония (понижение кровяного давления); </li>\r\n<li>асфиксия (затрудненное дыхание, удушье); </li>\r\n<li>бледный с серым оттенком цвет кожи; </li>\r\n<li>рвота, частое срыгивание; </li>\r\n<li>отечность конечностей; </li>\r\n<li>наличие хрипов при прослушивании легких; </li>\r\n<li>вялость, слабость, сонливость, отказ от кормления, заторможенность; </li>\r\n<li>появление кашля и одышки; </li>\r\n<li>нередко сердечно-сосудистая недостаточность, вздутие живота; </li>\r\n<li>повышение у доношенных детей температуры тела до 40°С; </li>\r\n<li>понижение у недоношенных детей температуры тела до 35°С; </li>\r\n<li>при взятии анализа крови определяется повышенный лейкоцитоз; </li>\r\n<li>резкое снижение веса в первые дни жизни.</li>\r\n</ul>",
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"code": "J15",
"name": "Бактериальная пневмония, не классифицированная в других рубриках",
"icd_name": "Бактериальная пневмония, не классифицированная в других рубриках",
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"age_min": 0,
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"cause": [
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"periodicity": 1,
"slug": "j15_bakterialnaya_pnevmoniya_ne_klassificirovannaya_v_drugih_rubrikah",
"lead": "Нарушение здоровья, относящееся к группе грипп и пневмония",
"description": "Пневмония, воспаление лёгких — воспаление лёгочной ткани, как правило, инфекционного происхождения с преимущественным поражением альвеол (развитием в них воспалительной экссудации) и интерстициальной ткани лёгкого. ",
"etiology": "<p>Бактериальная пневмония развивается при поражении легких грамположительными и грамотрицательными бактериями, многие из которых могут присутствовать в нормальной микрофлоре верхних дыхательных путей. </p>\r\n<p>Внутрибольничная бактериальная пневмония обычно вызывается штаммами золотистого стафилококка, синегнойной палочки, клебсиеллы пневмонии, энтеробактерий, гемофильной палочки, анаэробов. </p>\r\n<p>При других бактериальных заболеваниях (сибирской язве, гонорее, сальмонеллезе, туляремии, брюшном тифе, коклюше) возбудителями пневмонии могут служить представители специфической микрофлоры. </p>\r\n<p>Патогенные микроорганизмы могут проникать в легочную ткань воздушно-капельным путем. Источником, распространяющим инфекцию, обычно является человек с манифестным или стертым течением болезни, бактерионоситель. </p>\r\n<p>Гематогенная диссеминация возбудителя бактериальной пневмонии происходит с током крови из внелегочного очага. Инфекция может проникать в легкие при ранениях грудной клетки, интубации трахеи. </p>",
"pathogenesis": "<p>Различают четыре стадии развития патологического процесса пневмонии: </p>\r\n<p>Первая стадия длится на протяжении первых трех суток и характеризуется значительным наполнением кровью сосудов и достаточно сильной экссудацией (пропотевание жидкости из сосудов в ткани). В экссудативной жидкости при микробиологическом исследовании определяется большое число пневмококков. </p>\r\n<p>Вторая стадия именуется «красным опеченением» и проявляется следующими признаками: альвеолы полностью заполнены экссудатом, фибрином и эритроцитами. Пораженный участок паренхимы легкого становится полностью безвоздушным и по внешнему виду становится похож на печень (красного цвета). </p>\r\n<p>Третья стадия называется «серозным опеченением» и характеризуется тем, что в альвеолах становится уже больше лейкоцитов, чем эритроцитов, и вследствие этого паренхима меняет свой цвет. Такое патологическое состояние возникает уже по окончанию первой недели болезни. </p>\r\n<p>На четвертой стадии возникают процессы разрешения воспаления, исчезает жидкость, а паренхима принимает свой нормальный цвет. </p>",
"diagnostics": "<p>Заподозрить болезнь можно исходя из жалоб больного и данных объективного обследования пациента (тупой перкуторный звук над легкими, влажные крепитирующие (хрустящие) хрипы при выслушивании). </p>\r\n<p>Обязательными диагностическими методами являются: </p>\r\n<ul>\r\n<li>Рентгенографическое исследование органов грудной клетки. </li>\r\n<li>Микроскопия мокроты (изучение мазков мокроты под микроскопом для установления возбудителя болезни). </li>\r\n<li>Посев биоматериала на питательные среды и определение чувствительности к антибиотикам выделенного микроорганизма. </li>\r\n<li>Общий и биохимический анализ крови и мочи </li>\r\n<li>Исследование оксигенации крови (определение уровня насыщенности крови кислородом). </li>\r\n<li>Серологическая диагностика (определение антител к возбудителю). </li>\r\n</ul>",
"treatment": "<p>На период лихорадки назначается постельный режим, рекомендуется полноценная, сбалансированная диета, употребление достаточного количества жидкости. </p>\r\n<p>Этиотропная (направленная на возбудителя) терапия заключается в применении антибактериальных препаратов, обладающих наибольшей активностью в отношении выделенного возбудителя. </p>\r\n<p>Патогенетический подход к лечению пневмонии основан на проведении дезинтоксикационной терапии, использовании бронхолитиков (препаратов, расширяющих бронхи), противовоспалительных и мочегонных средств. </p>\r\n<p>Симптоматическая терапия подразумевает прием жаропонижающих, противокашлевых, отхаркивающих препаратов, проведение отвлекающей и местной терапии (ингаляции, орошение зева антисептическими растворами). </p>\r\n<p>В фазе разрешения к медикаментозному лечению добавляются реабилитационные мероприятия: дыхательная гимнастика, физиотерапия, массаж грудной клетки, витаминотерапия. </p>",
"prevention": "<p>Профилактика бактериальной пневмонии: </p>\r\n<ul>\r\n<li>Избегать переохлаждений, контакта с инфекционными больными </li>\r\n<li>Придерживаться правил личной гигиены </li>\r\n<li>Правильно и сбалансированно питаться </li>\r\n<li>Отказаться от вредных привычек </li>\r\n<li>Своевременно лечить сопутствующие болезни. </li>\r\n</ul>",
"clinical_picture": "<p>Типичная форма бактериальной пневмонии: </p>\r\n<ul>\r\n<li>Повышенная, длительно не спадающая температура тела. </li>\r\n<li>Сухой кашель, с плохо отходящими выделениями желтовато-зеленоватого оттенка, иногда с кровяными частичками. </li>\r\n<li>Односторонние болевые ощущения в груди во время кашля, при глубоком вдохе-выдохе. </li>\r\n<li>Ощущения слабости, вялости, утомляемости, ночная потливость, отсутствие аппетита. </li>\r\n<li>Мышечная, головная боль – реакция организма на интоксикацию инфекционными агентами. </li>\r\n<li>Присутствие одышки, можно заметить отсутствие синхронности движения во время дыхания сторон грудины. </li>\r\n<li>Кожные покровы бледные. </li>\r\n<li>Резкие перепады жара и озноба. </li>\r\n</ul>\r\n<p>Атипичная форма бактериальной пневмонии: </p>\r\n<ul>\r\n<li>Отсутствие кашля. </li>\r\n<li>Субфебрильная температура тела, колеблющаяся на уровне 37,5° C или вовсе без повышения. </li>\r\n<li>Ощущение слабости может выступать, как единственный симптом болезни. </li>\r\n<li>Преобладают внелегочные поражения (обострение сопутствующих заболеваний, дисфункция ЦНС, диарея, нарушения работы печени). </li>\r\n</ul>",
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