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},
"code": "O21",
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0
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"lead": "Рвота беременных- патологическое состояние в первой половине беременности, относимое к раннему токсикозу. Возникает более чем у половины беременных, но только 8—10 % из них нуждаются в лечении.",
"description": "Рвота беременных- патологическое состояние в первой половине беременности, относимое к раннему токсикозу. Возникает более чем у половины беременных, но только 8—10 % из них нуждаются в лечении. Чем более раннее начало, тем тяжелее она протекает. Чрезмерная длительная рвота может осложниться обезвоживанием и потерей веса.",
"etiology": "<p>Этиология не определена. Важную роль в развитии заболевания играют нарушения взаимоотношения деятельности центральной нервной системы и внутренних органов. В начале беременности вегетативные расстройства одновременно могут быть обусловлены гормональными нарушениями, в частности, увеличением уровня хорионического гонадотропина человека (гормон берееменности) в организме. К факторам, предрасполагающим к развитию токсикозов, относят хронические заболевания желудочно-кишечного тракта, печени, а также астенический синдром.</p>\r\n<p>***Важное значение имеет преобладание возбуждения в подкорковых структурах ЦНС (ретикулярной формации, центрах регуляции продолговатого мозга). В указанных областях располагаются рвотный центр и хеморецепторная триггерная зона, регулирующие рвотный акт, дыхательный, вазомоторный и слюноотделительный центры, а также ядра обонятельной системы мозга. Тесное расположение указанных центров обусловливает предшествующие рвотному акту ощущения тошноты и ряд сопутствующих вегетативных расстройств (усиление саливации, углубление дыхания, <a href=\"/symptom/tahikardiya/\" title=\"Перейти на страницу симптома Тахикардия\">тахикардия</a>, бледность кожных покровов вследствие спазма периферических сосудов).</p>\r\n<p>В подкорковых структурах преобладание возбуждения мозга с возникновением ответной вегетативной реакции связывают с патологическими процессами в половых органах (перенесённые воспалительные заболевания, интоксикации), нарушающими работу рецепторного аппарата матки (возможно также его повреждение плодным яйцом), что, скорее всего, возможно при нарушении физиологических взаимосвязей материнского организма и трофобласта в ранние сроки гестации.</p>\r\n<p> </p>",
"pathogenesis": "<p>В патогенезе рвоты беременных определяющими звеньями считают нарушение нейроэндокринной регуляции всех видов обмена, частичное (или полное) <a href=\"/symptom/otkaz_ot_pischi/\" title=\"Перейти на страницу симптома Отказ от пищи\">голодание</a> и обезвоживание. В организме матери при прогрессировании рвоты постепенно нарушаются водно-солевой (гипокалиемия), углеводный, жировой и белковый обмен на фоне нарастающего обезвоживания, истощения и уменьшения массы тела.</p>\r\n<p>***При голодании первоначально расходуются запасы гликогена в печени и других тканях. Затем активизируются катаболические реакции (увеличивается жировой и белковый обмен). На фоне угнетения активности ферментных систем тканевого дыхания энергетические потребности организма матери удовлетворяются благодаря анаэробному распаду глюкозы и аминокислот. В этих условиях β- окисление жирных кислот невозможно, в результате чего в организме накапливаются недоокисленные метаболиты жирового обмена — кетоновые тела (ацетон, ацетоуксусная и β-оксимасляная кислоты), которые выделяются с мочой.</p>\r\n<p>Изменения в органах беременной первоначально имеют функциональный характер, а затем, по мере нарастания обезвоживания, усиления катаболических реакций, интоксикации недоокисленными продуктами, переходят в дистрофические процессы в печени, почках и других органах. Первоначально нарушаются белковосинтетическая, антитоксическая, пигментная и другие функции печени, выделительная функция почек; в последующем дистрофические изменения отмечают в ЦНС, лёгких, сердце.</p>",
"diagnostics": "<p>Для определения степени тяжести рвоты необходимо клиническое обследование больной: исследование общего анализа крови и мочи; определение в динамике Ht, содержания в крови билирубина, остаточного азота и мочевины, электролитов (калий, натрий, хлориды), общего белка и белковых фракций, трансаминаз, показателей кислотно-основного состояния, глюкозы. В моче определяют уровень ацетона, уробилина, желчных пигментов, белка. При значительной дегидратации в сгущении крови могут быть ложнонормальные показатели содержания Hb, эритроцитов, белка. Степень обезвоживания определяют по уровню Ht. Значение его выше 40% свидетельствует о выраженном обезвоживании.</p>",
"treatment": "<p>Лечение рвоты включает немедикаментозное и медикаментозное.</p>\r\n<p>При немедикаментозном лечении большое значение необходимо придавать диете. В связи со снижением аппетита рекомендуют разнообразную пищу в соответствии с желанием женщины. Пища должна быть легкоусвояемой, содержать большое количество витаминов. Её следует принимать в охлаждённом виде, небольшими порциями каждые 2–3 ч, лёжа в кровати. Показана минеральная щелочная вода без газа в небольших объёмах (5–6 раз в день). Назначают также охлаждённый отвар имбиря или мелиссы небольшими порциями не менее 1 л в сутки.</p>\r\n<p>При рвоте средней степени тяжести назначают смеси для энтерального питания.</p>\r\n<p>Учитывая небольшой срок беременности, для исключения отрицательного влияния лекарственных средств на плодное яйцо целесообразно проведение немедикаментозного лечения. Для нормализации функционального состояния коры головного мозга и устранения вегетативной дисфункции показаны центральная электроаналгезия, иглоукалывание, психотерапия и гипнотерапия. Эффективно применение гомеопатических препаратов. Указанных методов лечения может быть достаточно при лечении больных с лёгкой формой рвоты беременных, а при средней и тяжёлой степени они позволяют ограничить объём лекарственной терапии.</p>\r\n<p>При рвоте беременных медикаментозное лечение должно быть комплексным:</p>\r\n<p>• препараты, регулирующие функцию центральной нервной системы и блокирующие рвотный рефлекс;<br />• инфузионные средства для регидратации, дезинтоксикации и парентерального питания;<br />• препараты, предназначенные для нормализации метаболизма.</p>\r\n<p>Основное правило медикаментозной терапии при тяжёлой и средней степени тяжести рвоты — парентеральныйметод введения препаратов до достижения стойкого эффекта.</p>\r\n<p>Важное значение для нормализации функции центральной нервоной системы играют правильно организованный лечебно-охранительный режим, устранение отрицательных эмоций. При госпитализации больную целесообразно поместить в отдельную палату, чтобы исключить рефлекторную рвоту.</p>\r\n<p>Назначают препараты, непосредственно блокирующие рвотный рефлекс: препараты, воздействующие на различные нейромедиаторные системы продолговатого мозга: М-холиноблокаторы (атропин), блокаторы дофаминовых рецепторов (нейролептики — галоперидол, дроперидол, производные фенотиазина — тиэтилперазин), а также прямые антагонисты дофамина (метоклопрамид) и препараты центрального действия, блокирующие серотониновые рецепторы (ондансетрон).</p>\r\n<p>Важным звеном лечения считают инфузионную терапию, которая включает в себя применение кристаллоидов и средств для парентерального питания. Кристаллоиды предназначены для регидратации. Из кристаллоидов используют комплексные растворы, такие, как раствор Рингера–Локка, трисоль, хлосоль. Для парентерального питания применяют растворы глюкозы, аминокислот и жировые эмульсии общей энергетической ценностью до 1500 ккал в сутки. С целью лучшего усвоения глюкозы вводят инсулин. При снижении общего объёма белка крови до 5 г/л показаны коллоидные растворы (например, 5–10% раствор альбумина до 200–400 мл).</p>\r\n<p>Объём инфузионной терапии составляет 1–3 л в зависимости от тяжести токсикоза и массы тела больной.</p>\r\n<p>Критериями достаточности инфузионной терапии считают уменьшение обезвоживания и увеличение тургора кожи, нормализацию величины Ht и диуреза.</p>\r\n<p>Одновременно с инфузионной терапией назначают препараты, нормализующие метаболизм.</p>\r\n<p>Терапию продолжают до стойкого прекращения рвоты, нормализации общего состояния, постепенного увеличения массы тела. Лечение рвоты беременных лёгкой и средней степени тяжести почти всегда бывает эффективным.</p>\r\n<p>Чрезмерная <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> беременных в отсутствие эффекта от комплексной терапии в течение 3 суток служит показанием к прерыванию беременности.</p>",
"prevention": "<p>Специфической профилактики не существует.</p>",
"clinical_picture": "<p>В 50–60% случаев рвоту беременных расценивают как физиологический признак беременности, а в 8–10% — как осложнение беременности (токсикоз). При нормальной беременности <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a> и <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> могут быть не более 2–3 раз в сутки по утрам, чаще натощак, однако это не нарушает общего состояния женщины и, соответственно, лечения не требует. Как правило, по окончании процесса плацентации к 12–13 недели <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a> и <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> прекращаются.</p>\r\n<p>Рвоту, которая возникает несколько раз в день независимо от приёма пищи, сопровождается снижением аппетита, изменением вкусовых и обонятельных ощущений, чувством слабости, иногда уменьшением массы тела, относят к токсикозам. Различают рвоту беременных лёгкой, средней степени тяжести и чрезмерную.</p>\r\n<p>Классификация и степень тяжести:</p>\r\n<ul>\r\n<li>I степень — лёгкая форма. Частота рвоты не превышает 5 раз в сутки. Общее состояние не страдает. Потеря массы не превышает 2—3 кг, частота пульса не более 80 уд/мин, анализы мочи и крови в норме.</li>\r\n<li>II степень — <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> средней тяжести. Беспокоит <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a>, <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, иногда субфебрилитет. <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">Рвота</a> от 6 до 10 раз в сутки, потеря массы тела более 3 кг за 7—10 дней, пульс учащен до 90—100 уд/мин, АД несколько снижено. В анализах мочи — положительня реакция на ацетон.</li>\r\n<li>III степень — чрезмерная (тяжелая) <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">рвота</a> беременных. <a href=\"/symptom/rvota/\" title=\"Перейти на страницу симптома Рвота\">Рвота</a> повторяется до 20—25 раз в сутки, общее состояние резко ухудшается, нарушен сон, потеря массы тела до 8 — 10 кг и более. Беременная не может принимать пищу и воду, из-за чего развивается обезвоживание и метаболические нарушения. Температура повышается до 37,2 — 37,5°С, пульс до 120 уд/мин, АД снижается, диурез снижен. В анализах мочи положительная реакция на ацетон (+++ или ++++), белок и цилиндры. В крови повышается билирубин, креатинин. В настоящее время эта степень встречается очень редко.</li>\r\n</ul>",
"image": "http://api.symptomd.ru/storage/9f6775300296a62cb49a365304814e6f_kO3WeQ5.png",
"image_alt": "Рвота беременных",
"standard_type": 1,
"danger": 51,
"published": 1,
"parent": null,
"block_rubric": 160,
"standards": [
4886
]
}
]
}
