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},
"code": "I70",
"name": "Атеросклероз",
"icd_name": "Атеросклероз",
"gender": 0,
"age_min": 35,
"age_max": 100,
"cause": [
"0",
"3"
],
"periodicity": 3,
"slug": "i70_ateroskleroz",
"lead": "хроническое заболевание, при котором на внутренней стенке артерий откладываются холестерин и другие жиры в форме налетов и бляшек, а сами стенки уплотняются и теряют эластичность",
"description": "<p>Атеросклероз - это х<span style=\"color: #222328; font-family: Verdana; font-size: 7pt; white-space: pre-wrap;\">роническое очаговое поражение артерий, характеризующееся отложением и накоплением во внутренней оболочке сосуда жиросодержащих белков и доставляемого ими холестерина.</span></p>",
"etiology": "<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Факторы, влияющие на развитие атеросклероза, разделяются на три группы: неустранимые, устранимые и потенциально устранимые. К неустранимым факторам относятся те, которые нельзя исключить с помощью волевого или медицинского воздействия. В их число входят:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Возраст. С возрастом риск развития атеросклероза возрастает. Атеросклеротические изменения сосудов в той или иной мере наблюдаются у всех людей после 40-50 лет.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Пол. У мужчин развитие атеросклероза происходит на десять лет раньше и превышает показатель заболеваемости атеросклерозом среди женщин в 4 раза. После 50-55 лет уровень заболеваемости атеросклерозом среди женщин и мужчин выравнивается. Это объясняется снижением продукции эстрогенов и их защитной функции у женщин в период </span><a style=\"text-decoration-line: none;\" href=\"https://www.krasotaimedicina.ru/diseases/zabolevanija_gynaecology/climax\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">менопаузы</span></a><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наследственность. Нередко атеросклероз развивается у пациентов, чьи родственники страдают этой болезнью. </span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Устранимыми факторами атеросклероза считаются те, которые могут быть исключены самим человеком посредством изменения привычного образа жизни. К ним относятся:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Курение. Его влияние на развитие атеросклероза объясняется отрицательным воздействием никотина и смол на сосуды. Многолетнее курение в несколько раз увеличивает риск гиперлипидемии, артериальной гипертензии, ИБС.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Несбалансированное питание. Употребление в пищу большого количества жиров животного происхождения ускоряет развитие атеросклеротических изменений сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиподинамия. Ведение малоподвижного образа жизни способствует нарушению жирового обмена и развитию ожирения, сахарного диабета, атеросклероза сосудов.</span></p>\r\n</li>\r\n</ol>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt; padding: 0pt 0pt 11.25pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">К потенциально и частично устранимым факторам риска относят те хронические нарушения и заболевания, которые возможно скорректировать посредством назначенного лечения. Они включают:</span></p>\r\n<ol style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Артериальную гипертонию. На фоне повышенного артериального давления создаются условия для повышенного пропитывания сосудистой стенки жирами, что способствует формированию атеросклеротической бляшки. С другой стороны, снижение эластичности артерий при атеросклерозе способствует поддержанию повышенного кровяного давления.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Дислипидимию. Нарушение жирового обмена в организме, проявляющееся повышенным содержанием холестерина, триглицеридов и липопротеидов, играет ведущую роль в развитии атеросклероза.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Ожирение и сахарный диабет. Повышают вероятность атеросклероза в 5-7 раз. Это объясняется нарушением жирового обмена, лежащего в основе данных заболеваний и являющегося пусковым механизмом атеросклеротического поражения сосудов.</span></p>\r\n</li>\r\n<li style=\"list-style-type: decimal; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; text-align: justify; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Инфекции и интоксикации. Инфекционные и токсические агенты оказывают повреждающее воздействие на сосудистые стенки, способствуя их атеросклеротическим изменениям.</span></p>\r\n</li>\r\n</ol>",
"pathogenesis": "<p>Атеросклеротическая бляшка — это образование, состоящее из смеси жиров (в первую очередь, холестерина) и кальция.</p>\r\n<p>Со временем бляшка становится непрочной, на ее поверхности возникают дефекты. В месте дефекта на внутренней оболочке сосуда начинает образовываться тромб — скопление клеток, в основном, тромбоцитов (элементы крови, участвующие в процессе свертывания) и белков крови.</p>",
"diagnostics": "<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подозрении на атеросклероз врач может назначить:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">анализ крови на холестерин и сахар;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенологическое исследование;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ангиографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">МРТ;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ультразвуковую допплерографию;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ аорты;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ЭКГ.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.7999999999999998; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также при необходимости список обследований могут пополнить:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">кардиологические стресс-тесты для определения критической нагрузки на сердце;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">коронарография;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">липидограмма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; background-color: #ffffff; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #222328; background-color: #ffffff; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ органов брюшной полости.</span></p>\r\n</li>\r\n</ul>",
"treatment": "<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Для лечения атеросклероза применяют комплексные меры, которые включают в себя:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">диету, назначаемую с целью снизить уровень холестерина в крови и нормализовать липидный баланс;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">отказ от вредных привычек: курения и чрезмерного употребления спиртных напитков;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">умеренную физическую нагрузку, подходящую по возрасту и особенностям организма;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre; margin-left: 36pt;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">лекарственную терапию, которая: снижает выработку холестерина, выводит лишний холестерин из организма.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В рамках терапии обычно назначают:</span></p>\r\n<ul style=\"margin-top: 0px; margin-bottom: 0px; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">статины. Именно они существенно понижают уровень холестерина.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">средства, содержащие никотиновую кислоту. Она отвечает за нормализацию липидного уровня.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">фибраты. Благодаря им в организме уменьшается выработка жиров.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">секвестранты. Помогают кишечнику освободиться от желчных кислот.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эстрогены. В качестве ЗГТ для женщин в постменопаузу.</span></p>\r\n</li>\r\n</ul>\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; color: #222328; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">В некоторых случаях прибегают к хирургическому вмешательству посредством:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">ангиопластики;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">эндарэктомии;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">шунтирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">стентирования;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7pt; font-family: Verdana; color: #222328; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.2; margin-top: 0pt; margin-bottom: 8pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">сосудистого протезирования.</span></p>\r\n</li>\r\n</ul>",
"prevention": "<p>С целью предупреждение атеросклероза необходим отказ от курения, исключение стрессового фактора, переход на нежирную и бедную холестерином пищу, систематическая физическая активность соразмерно возможностям и возрасту, нормализация веса.</p>\r\n<p>Целесообразно включение в рацион продуктов, содержащих клетчатку, растительных жиров (льняного и оливкового масел), растворяющих холестериновые отложения.</p>\r\n<p>Прогрессирование атеросклероза можно замедлить приемом холестеринснижающих лекарственных препаратов.</p>",
"clinical_picture": "<p align=\"justify\">При атеросклерозе чаще страдают грудной и брюшной отделы аорты, коронарные, мезентериальные, почечные сосуды, а также артерии нижних конечностей и головного мозга.</p>\r\n<p align=\"justify\">В развитии атеросклероза различают доклинический (бессимптомный) и клинический периоды. В бессимптомном периоде в крови обнаруживается повышенное содержание β-липопротеидов или холестерина при отсутствии симптомов заболевания.</p>\r\n<p align=\"justify\">Клинически атеросклероз начинает себя проявлять, когда происходит <a title=\"Перейти на страницу симптома стеноз\" href=\"/symptom/stenoz/\">сужение</a> артериального просвета на 50% и более. В течении клинического периода выделяют три стадии: ишемическую, тромбонекротическую и фиброзную.</p>\r\n<p align=\"justify\">В стадии ишемии развивается недостаточность кровоснабжения того или иного органа (например, ишемия миокарда вследствие атеросклероза коронарных сосудов проявляется стенокардией). В тромбонекротической стадии присоединяется тромбоз измененных артерий (так, течение атеросклероза коронарных сосудов может осложниться инфарктом миокарда). На стадии фиброзных изменений происходит разрастание соединительной ткани в плохо кровоснабжаемых органах (так, атеросклероз коронарных артерий приводит к развитию атеросклеротического кардиосклероза).</p>\r\n<p align=\"justify\">Клинические симптомы атеросклероза зависят от вида пораженных артерий. Проявлением атеросклероза коронарных сосудов служат стенокардия, инфаркт миокарда и кардиосклероз, последовательно отражающие стадии недостаточности кровообращения сердца.</p>\r\n<p align=\"justify\">Течение атеросклероза аорты длительное и долгое время бессимптомное, даже в тяжелых формах. Клинически атеросклероз грудной аорты проявляется аорталгией – давящими или жгучими болями за грудиной, иррадиирующими в руки, спину, шею, верх живота. В отличие от болей при стенокардии <a title=\"Перейти на страницу симптома Боль в груди \" href=\"/symptom/bol_v_grudi/\">аорталгия</a> может длиться по несколько часов и дней, периодически ослабевая или усиливаясь. Снижение эластичности стенок аорты вызывает усиление работы сердца, приводя к гипертрофии миокарда левого желудочка.</p>\r\n<p align=\"justify\">Атеросклеротическое поражение брюшной аорты проявляется болями в области живота различной локализации, метеоризмом, запорами. При атеросклерозе бифуркации брюшной аорты наблюдается <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и похолодание ног, отек и <a title=\"Перейти на страницу симптома Покраснение кожи\" href=\"/symptom/pokrasnenie_kozhi/\">гиперемия</a> стоп, некрозы и язвы пальцев ног, перемежающаяся <a title=\"Перейти на страницу симптома Нарушения походки\" href=\"/symptom/narusheniya_pohodki/\">хромота</a>.</p>\r\n<p align=\"justify\">Проявлениями атеросклероза мезентериальных артерий служат приступы «брюшной жабы» и нарушение пищеварительной функции вследствие недостаточности кровоснабжения кишечника. У пациентов отмечается появление резких болей спустя несколько часов после еды. Боли локализуются в области пупка или верхних отделах живота. Продолжительность болевого приступа от нескольких минут до 1-3 часов, иногда болевой синдром купируется приемом нитроглицерина. Появляются <a title=\"Перейти на страницу симптома Метеоризм\" href=\"/symptom/meteorizm/\">вздутие</a> живота, <a title=\"Перейти на страницу симптома Отрыжка\" href=\"/symptom/otryzhka/\">отрыжка</a>, <a title=\"Перейти на страницу симптома Запор\" href=\"/symptom/zapor/\">запор</a>, <a title=\"Перейти на страницу симптома Нарушение сердечного ритма\" href=\"/symptom/narushenie_serdechnogo_ritma/\">сердцебиение</a>, повышение артериального давления. Позднее присоединяются зловонные поносы с фрагментами непереваренной пищи и неусвоенным жиром.</p>\r\n<p align=\"justify\">Атеросклероз почечных артерий ведет к развитию вазоренальной симптоматической артериальной гипертензии. В моче определяются эритроциты, белок, цилиндры. При одностороннем атеросклеротическом поражении артерий отмечается медленное прогрессирование гипертонии, сопровождающееся стойкими изменениями в моче и стойко высокими цифрами АД. Двустороннее поражение почечных артерий вызывает злокачественную артериальную гипертонию.</p>\r\n<p align=\"justify\">При атеросклерозе сосудов головного мозга отмечается снижение памяти, умственной и физической работоспособности, внимания, интеллекта, <a title=\"Перейти на страницу симптома Головокружение\" href=\"/symptom/golovokruzhenie/\">головокружение</a>, нарушения сна. В случаях выраженного атеросклероза сосудов мозга изменяется поведение и психика пациента. Атеросклероз артерий мозга может осложняться острым нарушением мозгового кровообращения, тромбозами, кровоизлияниями.</p>\r\n<p align=\"justify\">Проявлениями облитерирующего атеросклероза артерий нижних конечностей служат <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a> и боли в икроножных мышцах голени, <a title=\"Перейти на страницу симптома Онемение кожи\" href=\"/symptom/onemenie_kozhi/\">онемение</a> и зябкость ног. Характерно развитие синдрома «перемежающейся хромоты» (боли в икроножных мышцах возникают при ходьбе и стихают в покое). Отмечаются похолодание, бледность конечностей, трофические нарушения (<a title=\"Перейти на страницу симптома Шелушение кожи\" href=\"/symptom/shelushenie_kozhi/\">шелушение</a> и <a title=\"Перейти на страницу симптома Изменения структуры кожи\" href=\"/symptom/izmeneniya_struktury_kozhi/\">сухость кожи</a>, развитие трофических язв и сухой гангрены).</p>",
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"etiology": "<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;\">Причины развития геморроя</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Развитие варикозного расширения вен прямой кишки из-за сдавления их извне (опухоли органов малого таза или кишечника) с нарушением оттока по венам кишечника.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Нарушение оттока венозной крови от прямой кишки из-за патологий, не связанных с органами малого таза и кишечника (болезни печени).</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Дистрофия анатомических структур, отвечающих за эластичность венозной стенки.</span></li>\r\n</ul>\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;\">К провоцирующим факторам развития геморроя относятся:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Беременность и роды.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Дисплазия соединительной ткани.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Наследственная предрасположенность.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Гиподинамия, преимущественно сидячий образ жизни.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Нарушение моторики кишечника с преобладанием запоров.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Частый или постоянный прием слабительных препаратов, регулярное механическое раздражение слизистой прямой кишки.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Деятельность, связанная с избыточным мышечным напряжением (занятия тяжелой атлетикой, физически тяжелая работа).</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Преобладание в рационе пряной и острой пищи.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Частый анальный секс.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Заболевания органов малого таза, приводящие к сдавлению вен малого таза.</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Патология клапанного аппарата вен кишечника (в частности, прямокишечного сплетения).</span></li>\r\n<li><span style=\"font-size: 7pt; color: #000000; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Патология печени (например, цирроз) с развитием портальной гипертензии.</span></li>\r\n</ul>",
"pathogenesis": "<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;\">В области прямой кишки располагаются кавернозные вены, соединенные анастомозами с артериями прямой кишки. Эти сплетения обеспечивают удержание кала прямой кишкой и саму дефекацию, участвуют в ректальном иммунном барьере. Нарушение венозного оттока и увеличение артериального притока приводят к застою крови в малом тазу, перерастяжению стенки вен с образованием узлов.</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;\">Снижается трофика продольной мышцы подслизистой прямой кишки и в итоге формируется фиброзно-мышечный каркас геморроидального узла, смещающий его из анального канала наружно или в просвет кишки. Поначалу они выпадают и самостоятельно вправляются при натуживании, потом требуют ручного вправления, а в тяжелых случаях – хирургического лечения.</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;\">Алый цвет артериальной крови при геморроидальных кровотечениях объясняется наличием анастомозов между варикозно расширенными кавернозными венами и артериями прямой кишки.</span></p>",
"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;\">Диагностика начинается со сбора анамнеза, уточнения жалоб и осмотра врачом-проктологом. Пациент располагается в гинекологическом кресле с приведенными ногами, коленно-локтевом положении, реже – на боку.</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;\">Физикальное исследование проктолога включает:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #595959; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">пальцевое исследование прямой кишки;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #595959; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">аноскопию (для осмотра стенок анального канала и дистального отдела прямой кишки);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #595959; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">сфинктерометрию (при хроническом геморрое – слабость, а при остром – спазм сфинктера);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #595959; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">колоноскопию (для дифференциальной диагностики);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #595959; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">ректороманоскопию (диагностика сопутствующих заболеваний толстой кишки);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.999999999999999pt; font-family: Verdana; color: #595959; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">рентген толстой кишки с барием (клизма).</span></p>\r\n</li>\r\n</ul>\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;\">Эндоскопические исследования выполняются с обезболиванием, в ряде случаев – под общим наркозом.</span></p>\r\n<p><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;\"> </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;\">Если пациент своевременно обращается к врачу-проктологу, то на 1-й и 2-й стадиях заболевания используется консервативное лечение, позволяющее купировать боль, зуд и кровотечение, а затем и влиять на причины заболевания. Назначают препараты и диету для разжижения стула, при болях используется параректальная новокаиновая блокада.</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;\">Диета при геморрое включает потребление жидкости (от 2 литров в сутки), использование в рационе пищевых отрубей, морской капусты, льняного семени и семени подорожника. Диетотерапия применяется в сочетании с прочими методами лечения, самостоятельного клинического эффекта не дает.</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 лечения геморроя используют различные лекарственные формы.</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;\">Для местного лечения назначают ректальные гели, мази и свечи (суппозитории) от геморроя: например, ультрапрокт, флуокортолон, Релиф.</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;\">Гемостатические губки и свечи: спонгостан, коллагеновые гемостатические губки на основе фибриногена и тромбина, свечи и мази с гепарином, фенилэфрин, экстракт красавки.</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;\">Таблетированные препараты направлены на профилактику запоров, повышение венозного тонуса и стимуляцию крово- и лимфотока, восстановление микроциркуляции, борьбу с воспалением.</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;\">При запорах назначают ферменты, слабительные смягчающего и осмотического действия: препараты псиллиума, лактулозы и макрогола.</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;\">Рекомендуются ангиопротекторы и флеботропные препараты для нормализации гемодинамики, восстановления микроциркуляции. Из противовоспалительных применяют препараты группы нестероидных противовоспалительных средств, хотя в тяжелых случаях применяют и гормональные препараты (флуокортолон).</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;\">При тромбозе геморроидальных узлов рекомендованы биофлаваноиды; для снижения риска кровотечения – очищенная микрогенизированная флавоноидная фракция (диосмин + флавоноиды в пересчете на гесперидин) (МОФФ).</span></li>\r\n</ul>\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;\">Малоинвазивные вмешательства при геморрое</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;\">Малоинвазивные методы хирургического лечения геморроя применяются амбулаторно, не требуют общего наркоза, длительного периода реабилитации и обезболивания в послеоперационном периоде. К ним относятся склерозирование или легирование латексными кольцами геморроидальных узлов, дезартеризация терминальных ветвей верхней геморроидальной артерии, инфракрасная лазерная фотокоагуляция.</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;\">При III стадии в запущенных случаях применяется хирургическое лечение геморроя под общим наркозом – удаление узла (геморроидэктомия).</span></p>\r\n<p><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;\"> </span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Рекомендуется придерживаться сбалансированного питания, отказаться от вредных привычек, наладить регулярный стул без запоров и диареи, а также своевременно диагностировать заболевания, ведущие к ухудшению состояния сосудов, повышению внутрибрюшного давления или нарушению венозного оттока в малом тазу.</span></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;\">Клиническая картина геморроя зависит от стадии заболевания.</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 первой стадии геморроя характерны минимальные проявления, возможен дискомфорт при дефекации и болезненность геморроидальных узлов. При осмотре специалистом регистрируется расширение капилляров слизистой прямой кишки, что указывает на венозный застой, появление узлов и местное воспаление слизистой оболочки. Иногда при дефекации выделяется кровь.</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;\">Вторая стадия характеризуется выпадением геморроидальных узлов во время и после дефекации с возможностью их самопроизвольного вправления. При этом чаще возникают кровотечения и выделения слизи из прямой кишки, беспокоят зуд и дискомфорт в анальной области.</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;\">На третьей стадии геморроидальные узлы выпадают не только при дефекации, но и при натуживании, кашле и других действиях, ведущих к повышению внутрибрюшного давления (подъем тяжестей), и самопроизвольно не вправляются.</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;\">На четвертой стадии вправление узлов невозможно ни самопроизвольно, ни вручную. Эта стадия является самой опасной в плане развития осложнений: возможны длительные обильные кровотечения, грозящие развитием анемии (уменьшением уровня гемоглобина и количества эритроцитов, которые переносят кислород ко всем тканям, что, соответственно, отразится на всех органах), и тромбоз геморроидальных узлов.</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;\"> </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;\">Внутренний геморрой на ранних стадиях протекает бессимптомно, возможно появление ощущения инородного тела в прямой кишке или чувства неопорожненного кишечника. Выделения крови и слизи на этой стадии настолько скудные, что остаются незамеченными. В просвет прямой кишки геморроидальные узлы не выступают.</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;\">По мере увеличения геморроидальных узлов просвет кишки сужается, в связи с чем нарушается процесс выделения кала. Дефекация сопровождается болью и микротравмами слизистой оболочки, что ведет к воспалению и усугублению симптомов заболевания. На поздней стадии проявляется весь симптомокомплекс (кровотечения, боль, выделение из прямой кишки крови и слизи, выпадение узлов, дискомфорт в анальной области), повышается вероятность осложнений – анемии, тромбоза или присоединения вторичной инфекции с развитием парапроктита (воспалительного – часто гнойного – заболевания тканей, окружающих прямую кишку).</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;\">Наружный геморрой характеризуется появлением боли в области ануса после воздействия провоцирующих факторов (кашель, долгое сидение, поднятие тяжестей, натуживание, дефекация). При данной форме заболевания кровотечения возникают значительно реже, чем при внутреннем геморрое. Кровь при этом видна не на фекалиях, а на белье, туалетной бумаге и средствах личной гигиены. При осмотре и пальпации пораженной области обнаруживаются болезненные узлы.</span></p>",
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