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},
"code": "R04",
"name": "Кровотечение из дыхательных путей",
"icd_name": "Кровотечение из дыхательных путей",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
0,
1
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"periodicity": 1,
"slug": "r04_krovotechenie_iz_dyhatelnyh_putey",
"lead": "Нарушение здоровья, относящееся к группе симптомы и признаки, относящиеся к системам кровообращения и дыхания",
"description": "Кровотечение из верхних дыхательных путей— это опасное осложнение различных заболеваний органов дыхания. Сопровождается истечением крови из бронхиальных или легочных сосудов, сосудов полости носа и выделением ее из дыхательных путей.",
"etiology": "<p>Наиболее распространённые причины носового кровотечения:</p>\r\n<ul>\r\n<li>Травманоса;</li>\r\n<li>Инородные тела;</li>\r\n<li>Воспалительные процессы.</li>\r\n</ul>\r\n<p>Другие возможные причины:</p>\r\n<ul>\r\n<li>Анатомические деформации;</li>\r\n<li>Вдыхание наркотиков(особенно кокаина);</li>\r\n<li>Опухоли полости носа (назофарингеальная карциномаи др.);</li>\r\n<li>Низкая относительная влажность вдыхаемого воздуха;</li>\r\n<li>Применение носового кислородного катетера;</li>\r\n<li>Применение назального спрея;</li>\r\n<li>Баротравма;</li>\r\n<li>Оперативное вмешательство (пластика носовой перегородки и др.).</li>\r\n</ul>\r\n<p>Кровотечения из дыхательных путей могут вызывать также:</p>\r\n<ul>\r\n<li>болезни трахеи и бронхов: бронхоэктазия, бронхит, острый ларинготрахеит, опухоли; болезни легких: пневмонии, инфаркт легкого, туберкулез легкого, рак легкого, легочное нагноение, паразитарные болезни (эхинококкоз легкого, аскаридоз);</li>\r\n<li>профессиональные болезни легких; синдром Гудпасчера; идиопатический гемосидероз легких, эмфизема легких;</li>\r\n<li>травмы, груди, острое повышение внутригрудного давления; психоэмоциональное перенапряжение; перегревание под солнцем; проявление истерии;</li>\r\n<li>системные заболевания (красная волчанка, васкулиты, саркоидоз, лейкозы); уремия; холемия; передозировка антикоагулянтов, антиагрегантов;</li>\r\n<li>инфекционные заболевания: грипп, корь, коклюш, геморрагическая лихорадка, легкая форма чумы;</li>\r\n</ul>\r\n<p>Нарушение свертываемости крови при длительном и неадекватном приеме антикоагулянтов (препараты, разжижающие кровь).</p>\r\n<p> </p>",
"pathogenesis": "<p>Причинами кровотечений из дыхательных путей могут быть:</p>\r\n<ul>\r\n<li>повреждение кровеносного сосуда (в т.ч. при травме)</li>\r\n<li>разъедание стенки (аррозия) сосуда: бронхоэктазы, опухоли, каверны;</li>\r\n<li>разрыв сосуда (при артериовенозных аневризмах, телеангиэктазии);</li>\r\n<li>воспаление сосудов – артерииты;</li>\r\n<li>излияние крови в альвеолы из бронхиальной артерии (при инфаркте легкого);</li>\r\n<li>диапедезные кровотечения (тромбоцитопенический синдром, застойное полнокровие легочных сосудов).</li>\r\n</ul>",
"diagnostics": "<p>Для определения локализации источника носового кровотечения (переднее или заднее кровотечение) проводится осмотр пациента, фарингоскопия и передняя риноскопия.</p>\r\n<p>Локализацию источника кровотечения можно установить при рентгенологическом исследовании (по характеру поражения легких), более точно — при трахеобронхоскопии.</p>\r\n<p>Лабораторная диагностика включает: коагулограмму (исследование крови на ее способность к свертыванию); анализ мокроты (выявление микобактерий туберкулеза).</p>\r\n<p>Диагностика включает также:</p>\r\n<ul>\r\n<li>рентгенографию органов грудной клетки;</li>\r\n<li>компьютерную томографию (КТ) органов грудной клетки;</li>\r\n<li>ангиопульмонографию – исследование сосудов легких с помощью вводимого в сосуды контрастного вещества (выделяется на снимках при проведении рентгенографии и позволяет определить наличие патологических изменений в сосудах легких);</li>\r\n<li>биопсия – взятие кусочка легочной ткани для исследования на клеточный состав.</li>\r\n</ul>",
"treatment": "<p>При носовом кровотечении придать сидячее положение, успокоить больного. Прижать крылья носа к носовой перегородке на 10-15 мин, холод на переносицу. Ввести в носовые ходы турунды, смоченные 3% раствором перекиси водорода, можно использовать гемостатическую губку. При отсутствии эффекта проводится передняя тампонада носа.</p>\r\n<p>При легочном кровотечении проводится:</p>\r\n<ul>\r\n<li>Обеспечение больному полусидячего положения с опущенными вниз ногами.</li>\r\n<li>Удаление крови из дыхательных путей (отсасывание с помощью специальных аппаратов).</li>\r\n<li>Введение кровоостанавливающих препаратов.</li>\r\n<li>Лечебная бронхоскопия – метод, позволяющий осмотреть дыхательные пути изнутри, определить источник кровотечения и произвести манипуляции по остановке кровотечения: закупорка кровоточащего сосуда с помощью специальных средств. </li>\r\n<li>Оперативное лечение – открытая операция на легких с ушиванием кровоточащего сосуда или удалением части легкого.</li>\r\n<li>При большом объеме потерянной крови – переливание крови и ее компонентов, введение препаратов, восстанавливающих объем циркулирующей крови.</li>\r\n<li>Антибиотики – для профилактики присоединения инфекции.</li>\r\n<li>Лечение основного заболевания, приведшего к легочному кровотечению.</li>\r\n</ul>",
"prevention": "<p>Профилактические мероприятия включают:</p>\r\n<ul>\r\n<li>своевременное выявление и проведение адекватного лечения болезней дыхательной и сердечно-сосудистой систем, а также системных заболеваний;</li>\r\n<li>периодический контроль состояния свертывающей системы крови в случае применения антикоагулянтов (лекарственных препаратов, разжижающих кровь);</li>\r\n<li>избегание травм грудной клетки и носа.</li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p>Непосредственным признаком носового кровотечения является истечение крови из полости носа наружу или внутрь носоглотки. В последнем случае кровь стекает в ротоглотку, где и обнаруживается при фарингскопии.</p>\r\n<p>Могут возникнуть головокружение, шум в ушах, жажда, общая слабость, сердцебиение. В некоторых случаях может отмечаться незначительная бледность кожи.</p>\r\n<p>Кровопотеря средней степени тяжести сопровождается выраженным головокружением, падением артериального давления, акроцианозом, тахикардией и одышкой. При тяжелой кровопотере развивается геморрагический шок. Пациент заторможен, возможна потеря сознания. Во время осмотра выявляют нитевидный пульс, выраженную тахикардию, резкое падение АД.</p>\r\n<p>Симптомы легочного кровотечения:</p>\r\n<ul>\r\n<li>выделение при кашле алой крови или ее сгустков из дыхательных путей, часть выделенной крови пенистая;</li>\r\n<li>кожа покрывается холодным липким потом, бледная;</li>\r\n<li>одышка;</li>\r\n<li>учащенное сердцебиение;</li>\r\n<li>снижение артериального давления;</li>\r\n<li>чувство страха;</li>\r\n<li>шум в ушах;</li>\r\n<li>головокружение;</li>\r\n<li>при массивном кровотечении – обморок.</li>\r\n</ul>\r\n<p>При кровохарканьи наблюдается выделение (откашливание) из бронхов и легких крови в виде прожилок и примеси крови в мокроте, окрашенных кровью плевков. Объем выделяемой крови не превышает 50 мл в сутки.</p>",
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"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациентам с ксантелазмой рекомендована консультация дерматолога и эндокринолога. Характерный внешний вид и локализация ксантелазмы позволяют поставить диагноз сразу же после осмотра пациента. При осмотре ксантелазмы или ксантомы используют надавливание предметным стеклом (диаскопия). Таким образом добиваются обескровливания образований, что позволяет четко увидеть их желтый цвет.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обязательно проводят исследование липидного обмена. Для этого назначают определение холестерина в сыворотке крови и липопротеидов. В некоторых случаях необходим дифференциальный диагноз с сирингомой, эластической псевдоксантомой и опухолевыми заболеваниями кожи.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ксантелазма не имеет специфического лечения. При возникновении ксантелазмы или ксантоматоза на фоне заболевания, которое может быть причиной нарушения жирового обмена, необходимо лечение этого заболевания. По показаниям может быть назначен инсулин, тиреоидин.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациентам с выявленным нарушением липидного состава крови или повышением холестерина следует придерживаться диеты с пониженным содержанием животных жиров. Для этого животные жиры заменяют растительными, например, подсолнечным и оливковым маслом. Таким пациентам с ксантелазмой назначают липотропные препараты и средства, снижающие содержание холестерина в крови. К ним относятся: цетамифен, пирикарбат, эфиры ненасыщенных жирных кислот, липоевая кислота, кислота тиоктовая, диоспонин, клофибрат.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Из препаратов растительного происхождения липотропным действием обладают: березовые почки, корень одуванчика, плоды шиповника, кукурузные рыльца, сок подорожника, цветки бессмертника. Следует помнить, что эти препараты обладают желчегонным эффектом и их применение противопоказано при нарушениях отведения желчи по желчевыводящим путям. В лечении ксантелазмы применяют никотиновую и аскорбиновую кислоты, цианокобаламин, пиридоксин, кальция пангамат, холина хлорид.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение ксантелазм показано по косметическим соображениям. Оно проводится путем иссечения ксантелазмы, ее удаления лазером, электрокоагуляции, криовоздействия или деструкции радиоволновым способом. Удаление в большинстве случаев производится под местным обезболиванием в амбулаторных условиях.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Мелкие ксантелазмы обычно удаляют при помощи диатермокоагуляции. Более крупные бляшки отсепаровывают ножницами и пинцетом. Края раны сводят и смазывают полуторахлористым железом, которое образует прочный струп и позволяет ране зажить первичным натяжением в течение 1-1,5 недель. После отсепаровывания ксантелазм с широким основанием края раны прижигают путем диотермокоагуляции. При сочетании ксантелазм с нависанием кожной складки на веке производят их хирургическое иссечение совместно с избытком кожи верхнего века.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Не существует точных рекомендаций в плане профилактики при ксантелазме. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специалисты могут дать лишь общие рекомендации, которые помогут пациентам выйти из группы риска и избежать появления таких образований с возрастом: </span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">следить за своим весом и ввести в рацион больше полезных продуктов; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">в рацион добавить продукты, содержащие клетчатку, а также ежедневно съедать до трехсот граммов овощей и фруктов; животные жиры заменить растительными, но употреблять их в разумных количествах; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выпивать в день не менее 1,5 литров воды; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">регулярно заниматься физическими упражнениями; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">постараться отказаться от курения и алкоголя; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">контролировать обмен веществ, при необходимости – посещать диетолога и эндокринолога.</span></li>\r\n</ul>\r\n<p> </p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ксантелазма представляет собой немного выступающую бляшку желтого цвета, расположенную на верхнем веке. Она безболезненна при ощупывании и имеет мягкую консистенцию. Как правило, ксантелазмы появляются на обоих веках. Они могут быть единичными и множественными. В последнем случае ксантелазмы могут сливаться, образуя бугристые элементы. Иногда ксантелазмы сливаются в сплошную желтую полоску с неравномерным контуром, проходящую через все верхнее веко.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для ксантелазмы характерно внезапное, без предшествующих изменений кожи века, появление. Развитие ее происходит постепенно и достаточно медленно, не доставляя пациенту никаких субъективных ощущений. Ксантелазма может достигать размеров от маленькой горошины до крупной фасолины. Она никогда не подвергается трансформации в злокачественное новообразование и не представляет угрозы для организма человека. Однако крупные и множественные ксантелазмы, не смотря на свою безобидность с медицинской точки зрения, представляют заметную косметическую проблему.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если ксантелазмы являются проявлением ксантоматоза, то они часто сопровождаются поражением нижнего века, на котором образуются ксантомы. При этом ксантомы локализуются и на других участках кожного покрова: лицо, шея, коленные и локтевые суставы, разгибательная поверхность конечностей, ягодицы и др. Возможно их появление на слизистой мягкого и твердого неба, губ. Ксантомы могут быть мелкоузелковыми (эруптивными), плоскими в виде бляшек или бугорчатыми в виде крупных узлов с неровной поверхностью. Диаметр этих образований варьирует от 2 мм до 5 см. В отдельных случаях ксантомы сливаются между собой и происходит образование крупной бляшки с дольчатым строением.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возникшие ксантомы и ксантелазмы сохраняются всю жизнь. Постепенно они растут в размерах, их количество увеличивается. Появление ксантелазм и ксантом у маленьких детей может быть признаком наследственного гиперхолестеринемического ксантоматоза, который затем проявляется нарушениями со стороны сердечно-сосудистой системы и печени, может сопровождаться образованием костных кист.</span></p>",
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