ÀâòîÀâòîìàòèçàöèÿÀðõèòåêòóðàÀñòðîíîìèÿÀóäèòÁèîëîãèÿÁóõãàëòåðèÿÂîåííîå äåëîÃåíåòèêàÃåîãðàôèÿÃåîëîãèÿÃîñóäàðñòâîÄîìÄðóãîåÆóðíàëèñòèêà è ÑÌÈÈçîáðåòàòåëüñòâîÈíîñòðàííûå ÿçûêèÈíôîðìàòèêàÈñêóññòâîÈñòîðèÿÊîìïüþòåðûÊóëèíàðèÿÊóëüòóðàËåêñèêîëîãèÿËèòåðàòóðàËîãèêàÌàðêåòèíãÌàòåìàòèêàÌàøèíîñòðîåíèåÌåäèöèíàÌåíåäæìåíòÌåòàëëû è ÑâàðêàÌåõàíèêàÌóçûêàÍàñåëåíèåÎáðàçîâàíèåÎõðàíà áåçîïàñíîñòè æèçíèÎõðàíà ÒðóäàÏåäàãîãèêàÏîëèòèêàÏðàâîÏðèáîðîñòðîåíèåÏðîãðàììèðîâàíèåÏðîèçâîäñòâîÏðîìûøëåííîñòüÏñèõîëîãèÿÐàäèîÐåãèëèÿÑâÿçüÑîöèîëîãèÿÑïîðòÑòàíäàðòèçàöèÿÑòðîèòåëüñòâîÒåõíîëîãèèÒîðãîâëÿÒóðèçìÔèçèêàÔèçèîëîãèÿÔèëîñîôèÿÔèíàíñûÕèìèÿÕîçÿéñòâîÖåííîîáðàçîâàíèå×åð÷åíèåÝêîëîãèÿÝêîíîìåòðèêàÝêîíîìèêàÝëåêòðîíèêàÞðèñïóíäåíêöèÿ

Ñèìïàòè÷åñêàÿ ñèñòåìà

×èòàéòå òàêæå:
  1. A) Ìàãí³òîåëåêòðè÷íà ñèñòåìà.
  2. B) Åëåêòðîìàãí³òíà ñèñòåìà.
  3. C) Åëåêòðîäèíàì³÷íà ñèñòåìà.
  4. E) ²íäóêö³éíà ñèñòåìà.
  5. IV. Öåíòðàëüíà íåðâîâà ñèñòåìà. ×åðåïí³ íåðâè. Îðãàíè ÷óòòÿ.
  6. V2: Æåíñêàÿ ïîëîâàÿ ñèñòåìà. Îñîáåííîñòè æåíñêîé ïîëîâîé ñèñòåìû íîâîðîæäåííîé. Ïðîìåæíîñòü.
  7. V2: Ìóæñêàÿ ïîëîâàÿ ñèñòåìà. Îñîáåííîñòè ìóæñêîé ïîëîâîé ñèñòåìû íîâîðîæäåííîãî.
  8. Áàíêè òà áàíê³âñüêà ñèñòåìà.
  9. Áàíê³âñüêà ñèñòåìà.
  10. Áàíê³âñüêà ñèñòåìà. Ïðîöåñ «ñòâîðåííÿ» áàíê³âñüêèõ ãðîøåé.
  11. Áàíêîâñêàÿ ñèñòåìà.
  12. Áëîê 7. Îðãàíè ÷óòòÿ ³ åíäîêðèííà ñèñòåìà.

Öåíòðàëüíûå ñèìïàòè÷åñêèå ïóòè. Ñèìïà­òè÷åñêèé òðàêò ìîæåò áûòü ïîâðåæäåí íà ðàç­ëè÷íûõ óðîâíÿõ. Ïðè ýòîì íåçàâèñèìî îò óðîâ­íÿ ïîðàæåíèÿ ðàçâèâàåòñÿ ñèíäðîì Ãîðíåðà.

Õàðàêòåðíûìè ÷åðòàìè ýòîãî ñèíäðîìà ÿâ­ëÿþòñÿ:

1. Ìèîç ñî ñòîðîíû ïîðàæåíèÿ, ÿâëÿþùèé­
ñÿ ñëåäñòâèåì ïàðàëè÷à äèëÿòàòîðà.

2. Íàðóøåíèå ðàñøèðåíèÿ çðà÷êà â òåìíîòå.

3. ×àñòè÷íûé ïòîç, ðàçâèâàþùèéñÿ â ðå­
çóëüòàòå ïàðàëè÷à ìþëëåðîâñêîé ÷àñòè ëåâà-
òîðà âåðõíåãî âåêà.

4. Àíãèäðîç ëèöà âñëåäñòâèå îòñóñòâèÿ ñòè­
ìóëÿöèè ïîòîâûõ æåëåç.

5. Ýíîôòàëüì â ðåçóëüòàòå ïàðåçà ãëàäêèõ
ìûøö ãëàçíèöû, âêëþ÷àÿ ìûøöó Ìþëëåðà
[454, 483].

Äåñòðóêòèâíûå ïàòîëîãè÷åñêèå ïðîöåññû, ðàçðóøàþùèå ñòðóêòóðû ìîñòà, ñïèííîãî ìîç­ãà, âûçâàþò îäíîñòîðîííèé ñèíäðîì Ãîðíåðà.  òî æå âðåìÿ ïðîöåññû, «ðàçäðàæàþùèå» ýòè ñòðóêòóðû, ïðèâîäÿò ê ðàçâèòèþ ñèíäðî­ìà Áåðíàðäà—Ãîðíåðà (Bernard—Homer), êî-


òîðûé ñâîèìè êëèíè÷åñêèìè ïðîÿâëåíèÿìè ïðî­òèâîïîëîæåí ïðåäûäóùåìó. Ïðè ýòîì çðà÷îê è ãëàçíûå ùåëè ðàñøèðåíû, óâåëè÷åíî ïîòîîòäå­ëåíèå, ïðîñâåò ñîñóäîâ íà ñòîðîíå ïîâðåæäå­íèÿ ñóæåí.

Âðîæäåííûé ñèíäðîì Ãîðíåðà ÷àñòî îáíàðó­æèâàåòñÿ îäíîâðåìåííî ñ ãåòåðîõðîìèåé ðà­äóæíîé îáîëî÷êè. Ïðè ýòîì ñíèæåíà ïèãìåí­òàöèÿ ðàäóæêè ñî ñòîðîíû ïîðàæåíèÿ. Ãèïî-ïèãìåíòàöèÿ ñâÿçàíà ñ òåì, ÷òî ñòðîìàëüíûå ìåëàíîöèòû ñîäåðæàò íåáîëüøîå êîëè÷åñòâî çåðåí ìåëàíèíà. Ïðåäïîëàãàþò, ÷òî ðàçâèòèå ãåòåðîõðîìèè ñâÿçàíî ñ íåäîñòàòêîì òèðîçèíà-çû, íàñòóïàþùèé â ðåçóëüòàòå àäðåíåðãè÷åñêîé äåíåðâàöèè [489, 549]. Ïðè ýòîì äåïèãìåíòàöèÿ íå ðàñïðîñòðàíÿåòñÿ íà íåâóñíûå êëåòêè ðà­äóæêè. Ïàðàëè÷ Êëóìïà ðàçâèâàåòñÿ ïîñëå ðî­äîâîé òðàâìû â ðåçóëüòàòå ïîâðåæäåíèÿ äâèãà­òåëüíûõ êîðåøêîâ.

Öåíòðàëüíûå ïîðàæåíèÿ ñèìïàòè÷åñêîé ñèñòåìû íàèáîëåå ÷àñòî ñâÿçàíû ñ îêêëþçèåé çàäíåé íèæíåé ìîçæå÷êîâîé àðòåðèè (ñèíäðîì Âàëëåíáåðãà). Ïðè ýòîì âûÿâëÿþòñÿ:

1. Ñèíäðîì Ãîðíåðà ñî ñòîðîíû ïîðàæåíèÿ.

2. Äèñôàãèÿ (ïàðàëè÷ IX, X íåðâîâ).

3. Àíàëãåçèÿ êîæè ëèöà ñî ñòîðîíû ïîðàæå­
íèÿ (ñïèííîé ïóòü è ÿäðà òðîéíè÷íîãî íåðâà) è
àíàëãåçèÿ òóëîâèùà è êîíå÷íîñòåé ñ ïðîòèâî­
ïîëîæíîé ñòîðîíû (âîñõîäÿùèé ñïèííî-òàëàìè-
÷åñêèé ïóòü).

4. Ìîçæå÷êîâàÿ àòàêñèÿ ñî ñòîðîíû ïîðà­
æåíèÿ è ðîòàòîðíûé íèñòàãì (âåñòèáóëÿðíûå
ÿäðà). Öåíòðàëüíûå òðàêòû, ëîêàëèçîâàííûå íà
óðîâíå ñïèííîãî ìîçãà, íàèáîëåå ÷àñòî ïîâðåæ­
äàþòñÿ â ðåçóëüòàòå òðàâìû, ðàçâèòèÿ îïóõî­
ëåé, ñèðèíãîìèåëèè è ïðè äåìèåëèíèçèðóþùèõ
çàáîëåâàíèÿõ.

Ïðåãàíãëèîíàðíûå ïîðàæåíèÿ. Ïîðàæåíèå ïðåãàíãëèîíàðíûõ âîëîêîí (êîðåøêîâûå ïî­ðàæåíèÿ) ìîæåò ðàçâèòüñÿ â ðåçóëüòàòå ðî­äîâîé òðàâìû è àññîöèèðóåòñÿ ñ ïàðàëè÷îì ðóêè, ðàçâèâàþùåìñÿ ñî ñòîðîíû ïîðàæåíèÿ (ñèíäðîì Êëþìïêå). Îïóõîëè âåðõóøêè ëåãêî­ãî èëè âåðõíåé ÷àñòè ñðåäîñòåíèÿ òàêæå ïðèâî­äÿò ê ïîâðåæäåíèþ ïðåãàíãëèîíàðíûõ âîëîêîí íà óðîâíå Ò, (ñèíäðîì Ïàíêîàñòà; Pancoast).  îáëàñòè øåè âîëîêíà ïîðàæàþòñÿ ïðè ðàç­âèòèè îïóõîëåâûõ, âîñïàëèòåëüíûõ, òðàâìàòè­÷åñêèõ çàáîëåâàíèé, óâåëè÷åíèè ëèìôàòè÷åñêèõ óçëîâ. Îïèñàíû è ñëó÷àè ïîâðåæäåíèÿ âîëîêîí ïðè ïðîâåäåíèè õèðóðãè÷åñêèõ âìåøàòåëüñòâ è êàðîòèäíîé àíãèîãðàôèè. Õàðàêòåðèçóåòñÿ ñèí­äðîì ðàçâèòèåì ñèëüíûõ áîëåé â ïëå÷å, ïàðåçà è àòðîôèè ìûøö ðóêè â ñî÷åòàíèè ñ ëåãêèì ýíîôòàëüìîì, ïòîçîì è ìèîçîì. Íåðåäêî âîçíè­êàþò ýðîçèè â îáëàñòè òðåòüåãî ðåáðà.

Ïîñòãàíãëèîíàðíûå ïîðàæåíèÿ. Ïîñòãàíã-ëèîíàðíûå ïîðàæåíèÿ íå ñîïðîâîæäàþòñÿ àí-ãèäðîçîì êîæè ëèöà.

Âíóòðåííÿÿ ñîííàÿ àðòåðèÿ. Àíåâðèçìû îñíîâíîãî ñòâîëà âíóòðåííåé ñîííîé àðòåðèè è åå âåòâåé âûçûâàþò ðàñøèðåíèå çðà÷êà. Ïðè


Âåãåòàòèâíàÿ (àâòîíîìíàÿ) èííåðâàöèÿ ãëàçà



 


ýòîì ìîãóò áûòü âîâëå÷åíû îáà êîìïîíåíòà àâòîíîìíîé íåðâíîé ñèñòåìû. Ïàðàëè÷ ñèìïà­òè÷åñêîé ñèñòåìû ïðèâîäèò ê ìèîçó, óâåëè÷å­íèþ ñëåçîîòäåëåíèÿ, ãîëîâíûì áîëÿì (ñèíäðîì Íîðòîíà). Ãîëîâíàÿ áîëü ìîæåò ñîïðîâîæäàòü­ñÿ ïòîçîì.

Ïàðàñèìïàòè÷åñêàÿ è ñèìïàòè÷åñêàÿ èííåð­âàöèÿ íåðåäêî íàðóøåíà è ïðè âîñïàëèòåëü­íûõ ïðîöåññàõ â îáëàñòè âåðõíåé ãëàçíè÷íîé ùåëè. Âðîæäåííûé ñèíäðîì Ãîðíåðà ðàçâèâà­åòñÿ íàèáîëåå ÷àñòî ïðè ðîäîâîé òðàâìå ïëå÷å­âîãî íåðâíîãî ñïëåòåíèÿ. Ïðè ýòîì íàðóøåíèå èííåðâàöèè ðàäóæêè ïðèâîäèò ê âîçíèêíîâå­íèþ ãåòåðîõðîìèè â ðåçóëüòàòå íàðóøåíèÿ ïèã­ìåíòàöèè ïîðàæåííîãî ãëàçà.

 çàêëþ÷åíèå íåîáõîäèìî îòìåòèòü, ÷òî âû­ÿâèòü óðîâåíü ïîðàæåíèÿ ñèìïàòè÷åñêîé ñèñòå­ìû, ïðèâîäÿùèé ê ðàçâèòèþ ñèíäðîìà Ãîðíåðà, âîçìîæíî íà îñíîâàíèè èñïîëüçîâàíèÿ êîêàèíà è ãèäðîêñèàìôåòàìèíà. Ïðèáëèçèòåëüíî 90% íîðýïèíåôðèíà, âûäåëÿþùåãîñÿ â íåðâíî-ìû­øå÷íûõ ñîåäèíåíèÿõ äèëÿòàòîðà ðàäóæêè, çàíî­âî ïîãëàùàåòñÿ ïðåñèíàïòè÷åñêèìè îêîí÷àíèÿ­ìè. Êîêàèí áëîêèðóåò ìåõàíèçì îáðàòíîãî ïî­ãëîùåíèÿ íîðýïèíåôðèíà. Ñîõðàíÿþùàÿñÿ âû-


ñîêàÿ êîíöåíòðàöèÿ íîðýïèíåôðèíà ñòèìóëèðó­åò ìûøå÷íûå êëåòêè.  ðåçóëüòàòå ýòîãî ìåõà­íèçìà, ó ïàöèåíòà áåç ïîðàæåíèÿ ñèìïàòè÷åñ­êîãî òðàêòà çðà÷îê ðàñøèðèòñÿ.  òî æå âðåìÿ ó áîëüíîãî ñèíäðîìîì Ãîðíåðà çðà÷îê ðàñøè­ðèòñÿ íåçíà÷èòåëüíî, ïîñêîëüêó íîðýïèíåôðèí âîîáùå íå âûñâîáîæäàåòñÿ â ïðåñèíàïòè÷åñ-êóþ ùåëü. Êàê óêàçàíî âûøå, óòî÷íèòü óðîâåíü ïîðàæåíèÿ âîçìîæíî ïðè èñïîëüçîâàíèè ãèäðî­êñèàìôåòàìèíà (1% ðàñòâîð). Ãèäðîêñèàìôåòà-ìèí ñïîñîáñòâóåò âûñâîáîæäåíèþ â ïðåñèíàï-òè÷åñêóþ ùåëü íîðýïèíåôðèíà. Ïî ýòîé ïðè÷è­íå ó çäîðîâûõ ïàöèåíòîâ ýòîò ïðåïàðàò ðàñøè­ðÿåò çðà÷îê. Ïðè ïîñòãàíãëèîíàðíîì ñèíäðîìå Ãîðíåðà îòìå÷àåòñÿ äåãåíåðàöèÿ íåðâíûõ îêîí­÷àíèé. Ïî ýòîé ïðè÷èíå çðà÷îê ðàñøèðèòñÿ íå­çíà÷èòåëüíî. Ïðè ïðåãàíãëèîíàðíîì ñèíäðîìå Ãîðíåðà ïîñòãàíãëèîíàðíûé íåéðîí ñîõðàíÿåò­ñÿ, â ñâÿçè ñ ÷åì ïðè ââåäåíèè ãèäðîêñèàìôåòà­ìèíà çðà÷îê ðàñøèðÿåòñÿ. Èñïîëüçîâàíèå àíà­ëèçà ðåàêöèè çðà÷êà ïðè ïðîâåäåíèè èññëåäîâà­íèÿ ñ èñïîëüçîâàíèåì êîêàèíà è ãèäðîêñèàìôå­òàìèíà â äîñòàòî÷íî áîëüøîì ÷èñëå ñëó÷àåâ ìîæåò óòî÷íèòü óðîâåíü ïîðàæåíèÿ, ÷òî èìååò áîëüøîå êëèíè÷åñêîå çíà÷åíèå (ðèñ. 4.5.15).


 


                   
   
   
   
         
 

(Íîðìà)

Ýôôåðåíòíûé

ñèìïàòè÷åñêèé

òðàêò


Ïðåãàíãëèî-íàðíûå âîëîêíà


Ïîñòãàíãëèî-íàðíûå âîëîêíà


Áàçîâàÿ

Êîêàèí

Ýïèíåôðèí

Ãèäðîêñè-àìôåòàìèí


Ñèíäðîì Ãîðíåðà:

— ïòîç;

— ìèîç;

— ýíîôòàëüì;

— ðàñøèðåíèå ñîñóäîâ;

— îòñóòñòâèå ñåêðåöèè

Ðèñ. 4.5.15. Ñòðóêòóðíàÿ îðãàíèçàöèÿ ñèì­ïàòè÷åñêîé èííåðâàöèè ãëàçà è ãëàçíèöû è îñîáåííîñòè ðåàêöèè çðà÷êà íà ðàçëè÷íûå ôàðìàêîëîãè÷åñêèå ïðåïàðàòû ïðè ïîâðåæ­äåíèè ñèìïàòè÷åñêîãî òðàêòà:

âåðõíÿÿ ñòðîêà òàáëèöû èëëþñòðèðóåò ñîñòîÿíèå çðà÷êà ïðè ïîâðåæäåíèè ñèìïàòè÷åñêîãî òðàêòà íà ðàçëè÷íûõ óðîâíÿõ äî ïðèìåíåíèÿ ïðåïàðàòîâ. Îñ­òàëüíûå òðè ñòðîêè èëëþñòðèðóþò èçìåíåíèå ðàç­ìåðà çðà÷êîâ ïðè èíñòèëëÿöèè êîêàèíà, ýïèíåôðè-íà è ãèäðîêñèàìôåòàìèíà. Îáðàùàåò íà ñåáÿ âíè­ìàíèå òî, ÷òî èñïîëüçîâàíèå ãèäðîêñèàìôåòàìèíà ïîçâîëÿåò ÷àùå (íà 16%) äèôôåðåíöèðîâàòü ïîñò-ãàíãëèîíàðíûå ïîðàæåíèÿ îò ïðåãàíãëèîíàðíûõ (/ — ïîäáóãîðíàÿ îáëàñòü (ãèïîòàëàìóñ); 2 — ìîñò; 3 — ïðîäîëãîâàòûé ìîçã; 4 — ïîäêëþ÷è÷íàÿ àðòå­ðèÿ; 5 — âíóòðåííåå ñîííîå ñïëåòåíèå; 6 — íàðóæ­íûå ñîííûå âîëîêíà; 7 — ñîííàÿ àðòåðèÿ)



Ãëàâà 4. ÃÎËÎÂÍÎÉ ÌÎÇÃ È ÃËÀÇ


 


Ëèòåðàòóðà

Õ.Àðáèá Ì. Ìåòàôèçè÷åñêèé ìîçã. — Ì.: Ìèð, 1978.— 295 ñ.

2. Áûêîâ Â. JI. Öèòîëîãèÿ è îáùàÿ áèîëîãèÿ. —
Ñïá.: ÑÎÒÈÑ, 1999.— 519 ñ.

3. Áûêîâ Â. J1. ×àñòíàÿ ãèñòîëîãèÿ ÷åëîâåêà. —
Ñïá.: ÑÎÒÈÑ, 1997.— 300 ñ.

4. Âîðîáüåâ Â. Ï. Àòëàñ àíàòîìèè ÷åëîâåêà. — Ì.:
Õàðâåñò, 2001. — 1477 ñ.

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