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"code": "R95",
"name": "Внезапная смерть грудного ребенка",
"icd_name": "Внезапная смерть грудного ребенка",
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"slug": "r95_vnezapnaya_smert_grudnogo_rebenka",
"lead": "Нарушение здоровья, относящееся к группе неточно обозначенные и неизвестные причины смерти r95-r99",
"description": " Синдром внезапной детской смерти – понятие, применяемое в отношении неожиданной смерти ребенка первого года, наступившей во сне без установленных причин.",
"etiology": "<p>Точные причины СВДС пока не установлены. </p>\r\n<p>К факторам риска развития СВДС относят: </p>\r\n<ul>\r\n<li>сон ребенка на животе; </li>\r\n<li>использование для ребенка мягких постельных принадлежностей: матраса, подушки, одеяла; </li>\r\n<li>перегревание ребенка (использование ватных одеял или чрезмерное отопление в комнате); </li>\r\n<li>недоношенность; </li>\r\n<li>Малый вес ребенка при рождении; </li>\r\n<li>многоплодная беременность; </li>\r\n<li>большое число беременностей у матери и короткие промежутки между ними; </li>\r\n<li>случаи СВДС или мертворождение ранее родившихся детей у этих родителей; </li>\r\n<li>позднее начало или отсутствие врачебного наблюдения в период беременности; </li>\r\n<li>анемия и гипоксия плода; </li>\r\n<li>недавно перенесенное ребенком заболевание; </li>\r\n<li>возраст матери моложе 17 лет; </li>\r\n<li>курение, употребление наркотических веществ или алкоголя матерью; </li>\r\n<li>плохие экономические или социальные условия в семье (скученность в квартире, отсутствие регулярного проветривания, курение членов семьи, безработные родители, отсутствие знаний по уходу за младенцем); </li>\r\n<li>рождение ребенка у матери-одиночки; </li>\r\n<li>депрессия у матери в послеродовом периоде. </li>\r\n</ul>",
"pathogenesis": "<p>Существует несколько теорий, объясняющих механизм возникновения СВДС</p>\r\n<p>Нарушение функции дыхания </p>\r\n<p>Во время сна в норме периодически возникает нарушение функции дыхания, и дыхание на короткое время прекращается. В результате такой остановки дыхательной деятельности в крови образуется недостаточное количество кислорода (гипоксемия), что в норме вызывает пробуждение и восстановление дыхания. Если же восстановление дыхания не происходит, ребенок умирает. </p>\r\n<p>Нарушение сердечной деятельности </p>\r\n<p>Некоторые ученые считают ведущим фактором при СВДС нарушение ритма сердечной деятельности, остановку сердца (асистолию). Факторами риска эти ученые называют нарушения ритма сердца по типу экстрасистол и блокад на электрокардиограмме, снижение числа сердечных сокращений менее 70 в 1 минуту (брадикардия), часто меняющуюся частоту сердечных сокращений. </p>\r\n<p>Стресс. </p>\r\n<p>Это такие изменения, как: мелкие кровоизлияния в вилочковой железе, легких, иногда в наружной оболочке сердца, следы изъязвления слизистой пищеварительного тракта, сморщенные лимфоидные образования, снижение вязкости крови. Все эти явления – симптомы неспецифического синдрома стресса. </p>\r\n<p>Иммунная теория и инфекционный механизм возникновения СВДС </p>\r\n<p>У большей части детей, умерших внезапно, в течение недели или в последний день жизни имели место проявления какой-либо инфекции. </p>\r\n<p>Сторонники этой теории считают, что микроорганизмы выделяют токсины или цитокинины, которые вызывают нарушение механизмов защиты в организме. В итоге наличие факторов риска при возникновении инфекции усугубляется. Токсины микроорганизмов (чаще всего посмертно выделяли золотистый стафилококк) провоцируют и усиливают воспалительную реакцию. А организм младенца еще не в состоянии регулировать собственные защитные реакции. </p>",
"diagnostics": "<p>Детям, перенесшим абортивный синдром внезапной детской смерти, необходимо проведение комплексного обследования. </p>\r\n<p>Из инструментальных исследований наибольшее диагностическое значение могут представлять электроэнцефалографию, исследование сна, УЗИ головы, ЭКГ, УЗИ сердца ребенку, холтеровский мониторинг ЭКГ, рентгенография грудной клетки. </p>\r\n<p>Лабораторные методы могут включать инфекционную диагностику (ИФА, ПЦР, микробиологическое исследование), определение кислотно-основного состояния крови, биохимический анализ крови и др. </p>",
"treatment": "<p>При возникновении очевидного жизнеугрожающего эпизода необходимо взять ребенка на руки, потормошить, энергично помассировать кисти рук, ступни, мочки ушей, спину вдоль позвоночника. Обычно этих действий бывает достаточно, чтобы ребенок снова задышал. Если дыхание не восстановилось, необходимо срочно вызывать «скорую помощь» и начинать проведение искусственного дыхания и закрытого массажа сердца. </p>\r\n<p> </p>",
"prevention": "<p>Считается достаточно эффективным для профилактики СВСМ выполнение родителями следующих общих рекомендаций: </p>\r\n<ul>\r\n<li>Головка ребенка должна быть открыта во время сна </li>\r\n<li>Ребенка нельзя туго пеленать, оставлять в постели с соской </li>\r\n<li>Ограничить или не использовать в кроватке пуховые одеяла, подушки, думки, мягкие игрушки и мягкие бортики </li>\r\n<li>Рекомендуется укладывать спать ребенка на спине или на боку с валиком, мешающим ему перевернуться и оказаться лежащим вниз лицом </li>\r\n<li>Использовать жесткий, пригнанный матрас </li>\r\n<li>Необходимо оградить младенца от пассивного курения </li>\r\n<li>Обязательно регулярно проветривать комнаты </li>\r\n<li>Исключить шум, громкую музыку и т.п. </li>\r\n<li>Проводить тактильную стимуляцию.</li>\r\n</ul>",
"clinical_picture": "<p>Клиническими проявлениями этого синдрома являются такие признаки, как насморк, выделения из глаз; увеличение миндалин, печени и селезенки; сыпь; потеря веса. Эти симптомы отмечаются за 2-3 недели до СВДС у 90 % детей. </p>\r\n<p>В отношении младенцев, переживших в грудном возрасте очевидный жизнеугрожающий эпизод и выжившим, используется понятие абортивный синдром внезапной детской смерти или near-miss СВДС. </p>\r\n<p>Предвестником синдрома внезапной смерти у детей можно быть апноэ. При задержке дыхания у младенца может быть резкая слабость, посинение кожных покровов, состояние «замирания», снижение тонуса мышц. </p>\r\n<p>В 50-70% случаях у таких детей удается выявить корреляцию очевидного жизнеугрожающего эпизода с каким-либо патологическим состоянием: судорожным синдромом, миопатией, инфекциями дыхательных путей, гастроэзофагеальной рефлюксной болезнью, врожденными аномалиями развития, заболеваниями обмена веществ и пр. </p>",
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}
]
}
