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"code": "I71",
"name": "Аневризма и расслоение аорты",
"icd_name": "Аневризма и расслоение аорты",
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"age_min": 0,
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3
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"slug": "i71_anevrizma_i_rassloenie_aorty",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "Расслаивающаяся аневризма аорты – дефект внутренней оболочки аневризматически расширенной аорты, сопровождающийся образованием гематомы, продольно расслаивающей сосудистую стенку с формированием ложного канала. Расслаивающаяся аневризма аорты проявляется внезапной интенсивной болью, мигрирующей по ходу расслоения, подъемом артериального давления, признаками ишемии сердца, головного и спинного мозга, почек, внутреннего кровотечения.",
"etiology": "<p>К факторам, способствующим развитию аневризмы аорты и ее расслоению, относятся: </p>\r\n<ul>\r\n<li>атеросклероз со значительным изменением vasa vasorum (сосудов сосудов) аорты, ишемию стенки аорты; </li>\r\n<li>гипертоническую болезнь и резкие колебания артериального давления; </li>\r\n<li>сифилис; </li>\r\n<li>очаговые некрозы среднего слоя сосуда бактериально-эмболического происхождения при острых инфекционных заболеваниях; </li>\r\n<li>врожденные дефекты развития аорты (коарктация, двойная дуга, гипоплазия, незаращение боталлова протока, синдром Марфана); </li>\r\n<li>физическое и нервно-эмоциональное перенапряжение; </li>\r\n<li>повреждение аорты смежным процессом (спондилит, рак пищевода, пенетрация пептической язвы пищевода, двенадцатиперстной кишки) или инородным телом; </li>\r\n<li>закрытую травму грудной или брюшной полости. </li>\r\n</ul>",
"pathogenesis": "<p>Аорта имеет три наиболее уязвимых сегмента - корень, перешеек и диафрагму. Гемодинамическое напряжение указанных зон и их хроническая травматизация приводят к дегенеративным изменениям средней оболочки сосуда. Длительное повышение артериального давления всегда ведет к той или иной степени дилатации аорты. Известно также, что внутренняя оболочка по своей структуре менее растяжима, чем средняя и наружная оболочки, обладающие большей эластичностью. Именно поэтому при одном из очередных «критических» повышений артериального давления происходит разрыв внутренней оболочки. Однако гидравлический удар о стенку аорты и разрыв внутренней оболочки сами по себе могут привести лишь к развитию внутристеночной гематомы. Дальнейшее расслоение происходит лишь при наличии патологического процесса в средней оболочке аорты. Если расслоение прорывает стенку аорты полностью (все три слоя), то происходит быстрая массивная кровопотеря и гибель больного. </p>",
"diagnostics": "<p>В случае подозрения на появление расслаивающей аневризмы аорты требуется срочная диагностика, основными методами которой являются: </p>\r\n<ul>\r\n<li>рентгенография грудной клетки; </li>\r\n<li>УЗДГ; </li>\r\n<li>ЭхоКГ; </li>\r\n<li>компьютерная томография; </li>\r\n<li>магнитно-резонансная томография; </li>\r\n<li>аортография. </li>\r\n</ul>\r\n<p>Рентгенография грудной клетки позволяет определить признаки расслаивающей аневризмы: расширение аорты, плевральный выпот, отсутствие пульсации, деформацию контуров аорты. </p>\r\n<p>ЭхоКГ (УЗИ сердца) – более информативный и доступный метод, позволяющий обнаружить отслоившийся лоскут, определить истинный и ложный канал, оценить атеросклеротическое поражение, состояние аортального клапана, состояние грудной аорты. </p>\r\n<p>Аортография дает возможность определить место начального разрыва, протяженность и местонахождения расслоения, состояние аортального клапана, ветвей аорты, коронарных артерий. </p>\r\n<p>МРТ дает возможность точно определить локализацию разрыва и направление расслоения, оценить состояние ветвей аорты и клапана. </p>",
"treatment": "<p>Расслоение аорты требует неотложной медицинской помощи, немедленного лечения. Терапия может заключаться в проведении операции, употреблении лекарственных средств, а также в комбинированном лечении — схема зависит от области аорты, которая подверглась расслоению. </p>\r\n<p>Хирургическое вмешательство - хирурги удаляют как можно большую площадь, подвергшуюся расслоению, а затем реконструируют аорту при помощи синтетической трубки-трансплантата. Если в результате расслоения повреждаются аортальные клапаны, они так же могут быть заменены; </p>\r\n<p>Интенсивная терапия расслаивающейся аневризмы аорты направлена на купирование болевого синдрома (путем введения ненаркотических и наркотических анальгетиков), выведение из шокового состояния, снижение артериального давления. Лекарственные препараты, например, бета-блокаторы и нитропруссид, уменьшают частоту сердечных сокращений и нормализуют низкое кровяное давление, что предотвращает усугубление расслоения. </p>",
"prevention": "<p>Профилактика формирования расслаивающейся аневризмы аорты заключается в контроле за течением сердечно-сосудистых заболеваний. Предупреждение расслоения аорты включает наблюдение кардиолога, мониторинг артериального давления и уровня холестерина крови, периодическое ультразвуковая диагностика сердца и аорты. <br class=\"SCXW45342897\" /> <br class=\"SCXW45342897\" /> </p>",
"clinical_picture": "<p>Для расслаивающейся аневризмы аорты характерно внезапное начало с имитацией симптомов различных сердечно-сосудистых, неврологических, урологических заболеваний. Расслоение аорты проявляется резким нарастанием раздирающей, нестерпимой боли с широкой областью иррадиации (за грудиной, между лопатками и по ходу позвоночника, в эпигастральной области, пояснице), мигрирующей по ходу расслоения. </p>\r\n<p>Отмечается повышение артериального давления с последующим спадом, асимметрия пульса на верхних и нижних конечностях, обильное потоотделение, слабость, синюшность, двигательное беспокойство. Большая часть больных с расслаивающейся аневризмой аорты умирает от развития осложнений. </p>\r\n<p>Неврологическими проявлениями расслаивающейся аневризмы аорты могут служить ишемическое поражение головного или спинного мозга парезы, параличи), периферическая нейропатия, нарушения сознания(обморок, кома). </p>\r\n<p>Расслаивающаяся аневризма восходящей аорты может сопровождаться ишемией миокарда, сдавлением органов средостения (появлением охриплости, дисфагии, одышки, синдрома Горнера, синдрома верхней полой вены), гемоперикарда, тампонады сердца (скопление жидкости между листками околосердечной сумки). </p>\r\n<p>Расслаивающаяся аневризма нисходящей грудной и брюшной части аорты выражается развитием выраженного повышения давления в почечных сосудах и острой почечной недостаточности, острой ишемии органов пищеварения, ишемии кишечника, острой ишемии нижних конечностей. </p>",
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"code": "I71",
"name": "Аневризма и расслоение аорты",
"icd_name": "Аневризма и расслоение аорты",
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"age_min": 0,
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"slug": "i71_anevrizma_i_rassloenie_aorty",
"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "Расслаивающаяся аневризма аорты – дефект внутренней оболочки аневризматически расширенной аорты, сопровождающийся образованием гематомы, продольно расслаивающей сосудистую стенку с формированием ложного канала. Расслаивающаяся аневризма аорты проявляется внезапной интенсивной болью, мигрирующей по ходу расслоения, подъемом артериального давления, признаками ишемии сердца, головного и спинного мозга, почек, внутреннего кровотечения.",
"etiology": "<p>К факторам, способствующим развитию аневризмы аорты и ее расслоению, относятся: </p>\r\n<ul>\r\n<li>атеросклероз со значительным изменением vasa vasorum (сосудов сосудов) аорты, ишемию стенки аорты; </li>\r\n<li>гипертоническую болезнь и резкие колебания артериального давления; </li>\r\n<li>сифилис; </li>\r\n<li>очаговые некрозы среднего слоя сосуда бактериально-эмболического происхождения при острых инфекционных заболеваниях; </li>\r\n<li>врожденные дефекты развития аорты (коарктация, двойная дуга, гипоплазия, незаращение боталлова протока, синдром Марфана); </li>\r\n<li>физическое и нервно-эмоциональное перенапряжение; </li>\r\n<li>повреждение аорты смежным процессом (спондилит, рак пищевода, пенетрация пептической язвы пищевода, двенадцатиперстной кишки) или инородным телом; </li>\r\n<li>закрытую травму грудной или брюшной полости. </li>\r\n</ul>",
"pathogenesis": "<p>Аорта имеет три наиболее уязвимых сегмента - корень, перешеек и диафрагму. Гемодинамическое напряжение указанных зон и их хроническая травматизация приводят к дегенеративным изменениям средней оболочки сосуда. Длительное повышение артериального давления всегда ведет к той или иной степени дилатации аорты. Известно также, что внутренняя оболочка по своей структуре менее растяжима, чем средняя и наружная оболочки, обладающие большей эластичностью. Именно поэтому при одном из очередных «критических» повышений артериального давления происходит разрыв внутренней оболочки. Однако гидравлический удар о стенку аорты и разрыв внутренней оболочки сами по себе могут привести лишь к развитию внутристеночной гематомы. Дальнейшее расслоение происходит лишь при наличии патологического процесса в средней оболочке аорты. Если расслоение прорывает стенку аорты полностью (все три слоя), то происходит быстрая массивная кровопотеря и гибель больного. </p>",
"diagnostics": "<p>В случае подозрения на появление расслаивающей аневризмы аорты требуется срочная диагностика, основными методами которой являются: </p>\r\n<ul>\r\n<li>рентгенография грудной клетки; </li>\r\n<li>УЗДГ; </li>\r\n<li>ЭхоКГ; </li>\r\n<li>компьютерная томография; </li>\r\n<li>магнитно-резонансная томография; </li>\r\n<li>аортография. </li>\r\n</ul>\r\n<p>Рентгенография грудной клетки позволяет определить признаки расслаивающей аневризмы: расширение аорты, плевральный выпот, отсутствие пульсации, деформацию контуров аорты. </p>\r\n<p>ЭхоКГ (УЗИ сердца) – более информативный и доступный метод, позволяющий обнаружить отслоившийся лоскут, определить истинный и ложный канал, оценить атеросклеротическое поражение, состояние аортального клапана, состояние грудной аорты. </p>\r\n<p>Аортография дает возможность определить место начального разрыва, протяженность и местонахождения расслоения, состояние аортального клапана, ветвей аорты, коронарных артерий. </p>\r\n<p>МРТ дает возможность точно определить локализацию разрыва и направление расслоения, оценить состояние ветвей аорты и клапана. </p>",
"treatment": "<p>Расслоение аорты требует неотложной медицинской помощи, немедленного лечения. Терапия может заключаться в проведении операции, употреблении лекарственных средств, а также в комбинированном лечении — схема зависит от области аорты, которая подверглась расслоению. </p>\r\n<p>Хирургическое вмешательство - хирурги удаляют как можно большую площадь, подвергшуюся расслоению, а затем реконструируют аорту при помощи синтетической трубки-трансплантата. Если в результате расслоения повреждаются аортальные клапаны, они так же могут быть заменены; </p>\r\n<p>Интенсивная терапия расслаивающейся аневризмы аорты направлена на купирование болевого синдрома (путем введения ненаркотических и наркотических анальгетиков), выведение из шокового состояния, снижение артериального давления. Лекарственные препараты, например, бета-блокаторы и нитропруссид, уменьшают частоту сердечных сокращений и нормализуют низкое кровяное давление, что предотвращает усугубление расслоения. </p>",
"prevention": "<p>Профилактика формирования расслаивающейся аневризмы аорты заключается в контроле за течением сердечно-сосудистых заболеваний. Предупреждение расслоения аорты включает наблюдение кардиолога, мониторинг артериального давления и уровня холестерина крови, периодическое ультразвуковая диагностика сердца и аорты. <br class=\"SCXW45342897\" /> <br class=\"SCXW45342897\" /> </p>",
"clinical_picture": "<p>Для расслаивающейся аневризмы аорты характерно внезапное начало с имитацией симптомов различных сердечно-сосудистых, неврологических, урологических заболеваний. Расслоение аорты проявляется резким нарастанием раздирающей, нестерпимой боли с широкой областью иррадиации (за грудиной, между лопатками и по ходу позвоночника, в эпигастральной области, пояснице), мигрирующей по ходу расслоения. </p>\r\n<p>Отмечается повышение артериального давления с последующим спадом, асимметрия пульса на верхних и нижних конечностях, обильное потоотделение, слабость, синюшность, двигательное беспокойство. Большая часть больных с расслаивающейся аневризмой аорты умирает от развития осложнений. </p>\r\n<p>Неврологическими проявлениями расслаивающейся аневризмы аорты могут служить ишемическое поражение головного или спинного мозга парезы, параличи), периферическая нейропатия, нарушения сознания(обморок, кома). </p>\r\n<p>Расслаивающаяся аневризма восходящей аорты может сопровождаться ишемией миокарда, сдавлением органов средостения (появлением охриплости, дисфагии, одышки, синдрома Горнера, синдрома верхней полой вены), гемоперикарда, тампонады сердца (скопление жидкости между листками околосердечной сумки). </p>\r\n<p>Расслаивающаяся аневризма нисходящей грудной и брюшной части аорты выражается развитием выраженного повышения давления в почечных сосудах и острой почечной недостаточности, острой ишемии органов пищеварения, ишемии кишечника, острой ишемии нижних конечностей. </p>",
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