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"code": "I74",
"name": "Эмболия и тромбоз артерий",
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"lead": "Нарушение здоровья, относящееся к группе болезни артерий, артериол и капилляров",
"description": "\r\nТромбозы и эмболии артерий – это патология, возникающая при острой закупорке просвета артерий тромбом или эмболом, приводящее к нарушению кровотока в тканях. При этом дальнейшее поступление крови по сосуду прекращается, ткани испытывают гипоксию (кислородное голодание).\r\n",
"etiology": "<p>К причинам возникновения артериальных тромбозов относятся:</p>\r\n<ul>\r\n<li>Сердечно-сосудистые заболевания, облитерирующий атеросклероз, тромбангиит;</li>\r\n<li>Сахарный диабет;</li>\r\n<li>Повреждения стенок артерий при ушибах мягких тканей, вывихах и переломах костей конечностей, компрессия сосудистого пучка опухолью или гематомой;</li>\r\n<li>Предшествующие ангиографические исследования, эндоваскулярные вмешательства, реконструктивные операции на сосудах и другие интервенционные процедуры;</li>\r\n<li>Гематологические заболевания (эритроцитоз);</li>\r\n<li>Инфекционные заболевания (сыпной тиф, сепсис, грипп и т.д.).</li>\r\n</ul>\r\n<p>К причинам возникновения артериальных эмболий относятся:</p>\r\n<ul>\r\n<li>В 92-95% случаев – сердечно-сосудистые заболевания, в первую очередь инфаркт миокарда (особенно в первые 2-3 нед заболевания), осложненный тяжелыми нарушениями ритма сердца, острой или хронической аневризмой левого желудочка;</li>\r\n<li>Внутрипредсердный тромбоз;</li>\r\n<li>Тромбы, образующиеся в аневризмах брюшной аорты и крупных магистральных артерий;</li>\r\n<li>Атероматозные язвы аорты.</li>\r\n</ul>",
"pathogenesis": "<p>Непременными условиями возникновения артериальных тромбозов являются нарушение целостности сосудистой стенки, изменение системы гемостаза и замедление кровотока. Во всех указанных случаях ответной реакцией на повреждения внутренней стенки сосуда является прилипание тромбоцитов, склеивание их между собой и дальнейший рост, что связано с воздействием биологически активных веществ, вырабатываемых в организме. В то же время под действием биологически активных веществ происходит активация свертывающей системы крови и снижение способности растворять тромбы. В результате на поверхности агрегата адсорбируются нити фибрина, образующие сетчатую структуру, которая, задерживая форменные элементы крови, способствует образованию кровяного свертка - тромба.</p>\r\n<p>Эмболия - закупорка просвета кровеносного сосуда эмболом, который обычно представлен частью тромба или бляшки, \"оторвавшейся\" от сосудистой стенки, мигрирующих с током крови по кровеносному руслу. Эти тромбы отрываются от мест прикрепления и, переносясь током крови, застревают в местах анатомических сужений артерий или их разделения на ветви. После закупорки сосуда происходит его рефлекторный спазм ниже эмбола. Сам эмбол стимулирует образование и рост тромба, который иногда достигает очень больших размеров.</p>\r\n<p>Тромбоз и эмболия приводят к полному обескровливанию конечности ниже закупорки. Артериальная ишемия в подавляющем большинстве случаев приводит к гангрене.</p>",
"diagnostics": "<p>Диагностика включает в себя сбор жалоб, анамнеза заболевания и жизни; физикальное обследование.</p>\r\n<p>Лабораторные методы исследования: коагулограмма (обнаруживается повышение свертываемости крови).</p>\r\n<p>Инструментальные методы:</p>\r\n<ol>\r\n<li>Ультразвуковое ангиосканирование аорты и артерий:</li>\r\n</ol>\r\n<ul>\r\n<li>увеличение скорости кровотока в местах препятствия току крови – стеноз (выше уровня тромбоза);</li>\r\n<li>отсутствие кровотока в аорте или артерии на уровне тромбоза (эмболии);</li>\r\n<li>кровоток отсутствует или коллатеральный ниже уровня тромбоза (эмболии);</li>\r\n<li>утолщение стенки артерии, выявление атеросклеротических бляшек.</li>\r\n</ul>\r\n<ol start=\"2\">\r\n<li>Ангиография проводится на операционном столе для уточнения воспринимающего сосудистого русла и позволяет определить характер хирургического вмешательства.</li>\r\n</ol>\r\n<ol start=\"3\">\r\n<li>Мультиспиральная компьютерная томография проводится при наличии времени для детальной диагностики и позволяет очень точно выявить характер поражений и определить лечебную тактику.</li>\r\n</ol>",
"treatment": "<p>Тактика лечения зависит от давности начала заболевания, уровня поражения сосуда, степени нарушения артериального кровообращения, от наличия сопутствующих заболеваний. </p>\r\n<p>Консервативную терапию следует проводить в течение 2 – 4 часов при субкомпенсации кровообращения конечности. Если наступает улучшение кровообращения конечности, то следует продолжить консервативную терапию до ликвидации ишемических проявлений конечности. Если за это время улучшения не наступает, следует ставить вопрос о немедленном оперативном лечении.</p>\r\n<p> Немедикаментозное лечение:</p>\r\n<ul>\r\n<li>Режим I, II, III.</li>\r\n<li>Диета №10.</li>\r\n</ul>\r\n<p> Медикаментозное лечение:</p>\r\n<ul>\r\n<li>Назначается тромболитическая терапия, направленная на восстановление кровотока в в сосуде за счет лизиса тромба внутри сосудистого русла.</li>\r\n<li>С целю профилактики восходящего и нисходящего вторичного тромбоза применяется антикоагулянтные препараты прямого действия.</li>\r\n<li>Для улучшения реологических свойств кров применяются антиагрегантные препараты.</li>\r\n<li>Спазмолитическая терапия показана для снижения периферического артериоспазма и улучшения кровотока по пораженной конечности за счет расширения коллатерального кровотока. Для лизиса эмбола или тромба применяют препараты, повышающие фибринолитическую активность крови.</li>\r\n</ul>\r\n<p>Хирургическое лечение острых артериальных эмболии заключается в удалении эмбола и тромботических масс из просвета артерии с помощью катетера.</p>\r\n<p>При тяжелой ишемии, сопровождающейся отеком мышц или мышечной контрактурой с целью декомпрессии и улучшения тканевого кровотока показана фасциотомия (рассечение мышечной фасции (оболочки)).</p>\r\n<p>При остром тромбозе, развившемся на фоне органического поражения артериальной стенки, простое удаление тромба обычно неэффективно, так как быстро наступает повторный тромбоз сосуда. Поэтому должна проводиться реконструктивная операцией.</p>\r\n<p>При развитии гангрены конечности показана ампутация.</p>",
"prevention": "<p>Профилактика тромбозов и эмболий артерий включает здоровое питание, подвижный образ жизни, отказ от курения, нормализация индекса массы тела, своевременное и полноценное лечение сердечно-сосудистых и инфекционных заболеваний.</p>\r\n<p> </p>",
"clinical_picture": "<p>Тромбозы и эмболии развиваются внезапно, на фоне относительного благополучия. При закупорке артерий конечности возникает острая сильная боль, затем появляются и нарастают чувство онемения, похолодания и потеря чувствительности. Вместе с этим возникает полная обездвиженность. Сначала движения становятся невозможными из-за сильных болей, а затем — из-за наступившей ишемии конечности и окоченения мышц.</p>\r\n<p>При обследовании больного часто отмечается аритмичный пульс. Конечность более бледная и холодная на ощупь, чем контралатеральная, мраморность окраски кожи. Пульсация периферических артерий ниже места эмболии не определяется. Болевая и тактильная чувствительность снижена или отсутствует. Больной продолжает страдать от сильных болей в конечности.</p>\r\n<p>Закупорка брыжеечной артерии вызывает геморрагический (кровяной) инфакркт и даже гангрену соответствующего участка кишки с жалобами и объективными признаками острого живота – резкими болями в животе, напряжением брюшной стенки, вздутием живота, тошнотой, рвотой, явлениями шока, легким повышением температуры, иногда диареей.</p>\r\n<p>Закупорка брюшной аорты вызывает резкую боль в средней части живота или в спине, а также в обеих ногах, побледнение, потерю чувствительности, а затем движений в ногах, явления шока. Исчезает пульс на сосудах нижних конечностей, развивается гангрена.</p>",
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