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"pathogenesis": "<p>Классифицируются выделения из уретры по нескольким признакам. По количеству они подразделяются на скудные, умеренные и обильные. Затем по цвету они могут быть желтыми, белыми, зелеными, желто-зелеными, красноватыми. По прозрачности: прозрачные и мутные. По консистенции выделения из уретры бывают жидкие и густые.</p>\r\n<p> </p>\r\n<p>Классификация по времени появления такова. Они могут быть постоянными и периодическими, а также возникающими при определенных обстоятельствах, например после полового акта или мочеиспускания.</p>",
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"name": "Гипергидроз"
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{
"name": "Руки потеют"
},
{
"name": "Пот"
},
{
"name": "Повышенное потоотделение"
},
{
"name": "Потливость ладоней"
},
{
"name": "Ночная потливость"
},
{
"name": "Сильно потею"
},
{
"name": "Потею во сне"
}
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},
"code": "R42",
"name": "Приступ головокружения и нарушение устойчивости",
"icd_name": "Головокружение и нарушение устойчивости",
"gender": 0,
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3,
0
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"slug": "r42_pristup_golovokruzheniya_i_narushenie_ustoychivosti",
"lead": "патологическое состояние, проявляющееся в ощущении вращения либо окружающих предметов вокруг человека, либо самого человека вокруг собственной оси",
"description": "",
"etiology": "<p>Причинами головокружения могут быть повреждение ядер вестибулярного нерва в продолговатом мозге, повреждение периферических волокон вестибулярного нерва, наличие патологического процесса в вестибулярных рецепторах. <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">Головокружение</a> также является симптомом болезни Меньера, опухолей задней черепной ямки, невротических состояний.</p>",
"pathogenesis": "<p>А. Вестибулярное <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> (истинное <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, вертиго) обычно обусловлено поражением периферического или центрального отдела вестибулярной системы. Оно проявляется иллюзией движения собственного тела или окружающих предметов. При этом возникают ощущения вращения, <a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">падения</a>, наклона или раскачивания. Острое <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> часто сопровождается вегетативными симптомами (тошнотой, рвотой, повышенным потоотделением), чувством страха, нарушением равновесия и нистагмом (последний иногда приводит к нечеткости зрения).</p>\r\n<p>Б. <a href=\"/symptom/obmorok/\" title=\"Перейти на страницу симптома Обморок\">Обморок</a> и предобморочное состояние. Этими терминами обозначают временную потерю сознания или ощущение приближающейся потери сознания. В предобморочном состоянии часто наблюдаются <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома Потливость\">повышенное потоотделение</a>, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, чувство страха и потемнение в глазах. Непосредственная причина обморока - <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">падение</a> мозгового кровотока ниже уровня, необходимого для обеспечения мозга глюкозой и кислородом. <a href=\"/symptom/obmorok/\" title=\"Перейти на страницу симптома Обморок\">Обморок</a> и предобморочное состояние обычно развиваются на фоне артериальной гипотонии, заболеваний сердца или вследствие вегетативных реакций, и тактика при этих состояниях совершенно иная, чем при вестибулярном головокружении.</p>\r\n<p>В. Нарушение равновесия характеризуется неустойчивостью, шаткой («пьяной») походкой, но не истинным головокружением. Причина этого состояния - поражения различных отделов нервной системы, обеспечивающих пространственную координацию. Однако больные с мозжечковыми, зрительными, экстрапирамидными и проприоцептивными расстройствами часто определяют ощущение неустойчивости как «<a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>».</p>\r\n<p>Г. Неопределенные ощущения, часто описываемые как <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, возникают при эмоциональных расстройствах, таких, как гипервентиляционный синдром, ипохондрический или истерический <a href=\"/symptom/nervoznost/\" title=\"Перейти на страницу симптома Нервозность\">невроз</a>, <a href=\"/symptom/depressiya/\" title=\"Перейти на страницу симптома Депрессия\">депрессия</a>. Больные обычно жалуются на «туман в голове», чувство легкого опьянения, дурноту или <a href=\"/symptom/strah/\" title=\"Перейти на страницу симптома Страх\">страх</a> <a href=\"/symptom/narushenie_koordinacii/\" title=\"Перейти на страницу симптома Нарушение координации\">падения</a>. Эти ощущения достаточно четко отличаются от ощущений при вестибулярном головокружении, обморочных состояниях и нарушениях равновесия. Поскольку любое <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, независимо от его причины, может вызвать <a href=\"/symptom/trevozhnost/\" title=\"Перейти на страницу симптома Тревожность \">тревожность</a>, она не может служить доказательством психогенной природы заболевания.</p>\r\n<p>Д. Некоторые больные с жалобами на <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> затрудняются описать свои ощущения. В этом случае целесообразно провести провокационные пробы.</p>\r\n<p>1. Стандартный набор провокационных проб на <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> включает:</p>\r\n<p>а. Ортостатическую пробу.<br />б. Форсированную гипервентиляцию в течение 3 мин.<br />в. Резкие повороты во время ходьбы или круговое вращение в положении стоя.<br />г. Пробу Нилена-Барани на позиционное <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>.<br />д. Пробу Вальсальвы, которая усиливает <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, обусловленное краниовертебральными аномалиями (например, синдромом Арнольда-Киари) или перилимфатической фистулой, а также вызывает предобморочное состояние у больных сердечно-сосудистыми заболеваниями.</p>\r\n<p>2. После каждой пробы необходимо спросить, напоминает ли возникшее <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> то ощущение, которое беспокоит больного. При ортостатической гипотонии, гипервентиляционном синдроме, позиционном головокружении и многих вестибулярных нарушениях результаты проб хорошо воспроизводятся, что позволяет получить важную диагностическую информацию.</p>",
"diagnostics": "<p>Проводится на основании жалоб, данных анамнеза, объективного осмотра.</p>",
"treatment": "<p>Патогенетическую терапию при головокружении проводят с учетом механизмов возникновения вестибулярного синдрома. При дисциркуляторных расстройствах назначают вазоактивные препараты, соответствующие типу ангиодистонии, антиагреганты и препараты, улучшающие микроциркуляцию. Специфическое лечение при системном головокружении известно лишь для ограниченного круга заболеваний. <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">Головокружение</a> в рамках вертебробазилярной недостаточности требует назначения антиагрегантов (ацетилсалициловая кислота 75–330 мг/сут., тиклопедин 500 мг/сут.), а при нарастании симптоматики — антикоагулянтов. Эффективность противовирусных препаратов и глюкокортикоидов не доказана.</p>\r\n<p>Лечение приступов болезни Меньера симптоматическое. Наиболее эффективен бетагистин, который является ингибитором диаминоксидазы — фермента, инактивирующего гистамин. Стабилизируя образующийся в организме гистамин, бетагистин оказывает гистаминоподобное действие. Препарат эффективен при пероральном применении. Основными показаниями для применения являются болезнь Меньера, водянка лабиринта внутреннего уха, синдромы, характеризующиеся приступами головокружения, шумом в ушах, понижением слуха, тошнотой, рвотой. Препарат оказывает расслабляющее действие на прекапиллярные запирательные мышцы в системе микроциркуляции внутреннего уха, увеличивая таким образом приток крови к сосудистой полоске лабиринта. Снижает частоту и интенсивность головокружений, уменьшает <a href=\"/symptom/shum_v_ushah/\" title=\"Перейти на страницу симптома Шум в ушах\">шум в ушах</a>, улучшает слух в случае его снижения. Средняя суточная доза по 1 таблетке 3 раза в день. С осторожностью следует назначать препарат больным, имеющим в анамнезе язвенную болезнь желудка или двенадцатиперстной кишки. Бетагистин не показан при беременности, бронхиальной астме, наличии феохромоцитомы.</p>\r\n<p>Для профилактики назначают диету с пониженным содержанием соли и диуретики. Для симптоматического лечения системного головокружения применяют вестибулолитические средства, действующие на вестибулярные рецепторы либо на центральные вестибулярные структуры, главным образом вестибулярные ядра. К первым относятся антигистаминные препараты: меклозин назначают 12,5–25 мг внутрь 4 раза в сутки, прометазин — 25–50 мг внутрь 4–6 раз в сутки. Центральным вестибулолитическим эффектом обладают бензодиазепины: оксазепам — 10–15 мг внутрь 4 раза в сутки, диазепам — 5–10 мг внутрь, в/м или в/в 4–6 раз в сутки. Также применяют стимулятор гистаминовых рецепторов бетагистин — 8–16 мг внутрь 2–3 раза в сутки, антагонисты кальция (циннаризин 25–50 мг внутрь или в/м 4 раза в сутки, флунаризин 10 мг в сутки во второй половине дня).</p>\r\n<p>Эффективным средством для лечения головокружений является комбинированный препарат, содержащий 400 мг пирацетама и 25 мг циннаризина. Его назначают по 2 капсулы 3 раза в день в течение 3–6 недель.</p>\r\n<p>Для купирования тошноты и рвоты назначают прохлорперазин 5–10 мг внутрь или в/м 4 раза в сутки или метоклопрамид 5–50 мг внутрь, в/м или в/в 4–6 раз в сутки. Центральным вестибулолитическим и противорвотным действием обладает тиэтилперазин. Назначают 6,5 мг внутрь, ректально, п/к, в/м или в/в 1–3 раза в сутки. Эффективно сочетание антигистаминных препаратов и бензодиазепинов. Для уменьшения седативного эффекта вестибулолитических средств рекомендуется назначение метилфенидата гидрохлорида 5 мг внутрь 2 раза в сутки (в первой половине дня). Вестибулолитические средства следует назначать лишь при остром системном головокружении. Их прием должен быть максимально кратким, так как длительное применение замедляет процесс центральной компенсации дефекта.</p>\r\n<p>При всех формах вестибулярного синдрома назначают лекарственные средства, снижающие возбудимость центральных и периферических отделов вестибулярного анализатора и подавляющие сопутствующие вегетативные реакции. Антигистаминные препараты применяют как для лечения, так и для профилактики головокружения. Назначают дифенгидрамин 2–3 раза в день внутрь (0,02–0,05 г), в свечах (0,01–0,02) или по 1 мл 1% раствора в мышцу; прометазин 2–3 раза в день внутрь (0,025 г) или по 2 мл 5% раствора в мышцу; дименгидринат по 50–100 мг внутрь 2–3 раза в день. Нейролептики подавляют возбудимость центральных вегетативных образований. При головокружении предпочтительнее назначать тиэтилперазин по 1 таблетке (0,0065 г) 1–2 раза в день внутрь, в свечах (0,0065 г) или по 1 мл в вену или мышцу; алимемазин внутрь по 0,005 г 2–4 раза в день; метоклопрамид по 0,01 г 2–3 раза в день внутрь или по 1–2 мл в мышцу или вену. При выраженных сопутствующих вегетативных реакциях назначают хлорпромазин, галоперидол, левомепромазин. При хроническим вестибулярном синдроме проводят этиотропную терапию, эффективны повторные курсы биостимуляторов (алоэ, ФИБС, стекловидное тело, апилак, кокарбоксилаза, витамины группы В) и ноотропные препараты.</p>\r\n<p>При лечении тяжелых пароксизмов больному внутримышечно вводят 2 мл тиэтилперазина или метоклопрамида, 1–2 мл диазепама, 1–2 мл дифенгидримина или прометазина, под кожу 0,5–1 мл платифиллина, дают внутрь 1 таблетку беллатаминала. При приступе болезни Меньера рекомендуется приложить грелку к ногам, на шейно-затылочную область — горчичник, внутримышечно вводят 1–2 мл тиэтилперазина и 2 мл метоклопрамида, 1 мл прометазина, в вену — 5 мл 0,5% раствора новокаина на 20 мл 40% раствора глюкозы, 40 мг фуросемида. При неэффективности этих мер вводят внутримышечно 1 мл аминазина, под кожу — 1 мл 0,1% раствора атропина сульфата и 1 мл 10% раствора кофеина-бензоата натрия.</p>\r\n<p>Вестибулярная <a href=\"/symptom/migren/\" title=\"Перейти на страницу симптома Мигрень\">мигрень</a> купируется при сочетании холинолитиков и альфа-адреноблокаторов, дифенина и транквилизаторов. Для межприступного лечения мигрени назначают курсы бета-блокаторов, антисеротониновые средства, антагонисты кальция. При головокружении, возникшем на фоне повышения ВЧД или отека лабиринта, применяют диуретики, ограничивают прием жидкости, назначают бессолевую диету. Больным, страдающим головокружением инфекционно-токсического генеза, проводят противовоспалительную, дегидратирующую и дезинтоксикационную терапию. При головокружении вследствие медикаментозной интоксикации отменяют или уменьшают дозу препарата, вызвавшего <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a>, назначают дезинтоксикационную терапию, витамины и вазоактивные средства. При головокружении, вызванном эндогенной интоксикацией в случаях нарушения метаболизма, необходимы коррекция электролитов плазмы и КОС, дезинтоксикационная терапия, препараты витаминов. Психогенное <a href=\"/symptom/golovokruzhenie/\" title=\"Перейти на страницу симптома Головокружение\">головокружение</a> купируется психотропными средствами.</p>",
"prevention": "",
"clinical_picture": "<p>Приступ головокружения сопровождается чувством вращения окружающих предметов вокруг человека либо вращения самого человека вокруг собственной оси. Больные предъявляют жалобы на повышенную <a href=\"/symptom/potlivost/\" title=\"Перейти на страницу симптома потливость\">потливость</a>, тошноту, рвоту. В период приступа у больных отмечаются <a href=\"/symptom/tahikardiya/\" title=\"Перейти на страницу симптома Тахикардия\">тахикардия</a>, повышение артериального давления, а также <a href=\"/symptom/nistagm/\" title=\"Перейти на страницу симптома Нистагм\">нистагм</a> глаз. Различают ротаторный или диагональный <a href=\"/symptom/nistagm/\" title=\"Перейти на страницу симптома Нистагм\">нистагм</a>, а также вертикальный и горизонтальный <a href=\"/symptom/nistagm/\" title=\"Перейти на страницу симптома Нистагм\">нистагм</a>.</p>",
"image": null,
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"standard_type": 3,
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"published": 1,
"parent": null,
"block_rubric": 192,
"standards": []
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}
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