Псориазмкб 10 L40Год утверждения (частота пересмотра) 2020

Название	Псориазмкб 10 L40Год утверждения (частота пересмотра) 2020
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5. Профилактика
Рекомендуется проводить пациентам с псориазом мероприятия по профилактике обострений псориаза (предупреждение стрессов,
простудных заболеваний, санации хронических очагов инфекции в организме) [1, 2].
Уровень убедительности рекомендаций С (уровень достоверности
доказательств – 5)
Диспансерное наблюдение пациентов с псориазом проводится специалистами врачами-дерматовенерологами в условиях кожно- венерологических диспансеров [164]
Уровень убедительности рекомендацийС (уровень достоверности доказательств – 5)
Организация оказания медицинской
помощи
Для определения критериев показания для госпитализации рекомендуется использовать индекс PASI:
значение индекса от 10 до 19 – показания для госпитализации в дневной стационар;
значение индекса 20 и выше – показания для госпитализации в круглосуточный стационар.
Дополнительные показания для госпитализации в медицинскую организацию:
дневной стационар:
- необходимость проведения поддерживающей терапии селективными иммунодепрессантами (ингибиторами фосфодиэстеразы-4, блокаторами януc-киназ), ингибиторами фактора некроза опухоли альфа (ФНО- альфа), ингибиторами интерлейкина;
круглосуточный стационар:
- неэффективность проводимого ранее лечения.
Показания к выписке пациента из медицинской организации:
- регресс высыпаний и/или уменьшение клинических проявлений.

6. Дополнительная информация,
влияющая на течение и исход
заболевания
Применение системных глюкокортикостероидов для лечения псориаза показано только в редких случаях (генерализованный пустулезный псориаз, псориатическая эритродермия). В этих случаях оправдано назначение единичных инъекций (инфузий) кортикостероидов короткого действия с целью купирования остроты процесса. Назначение глюкокортикостероидов длительными курсами, а также препаратов данной группы пролонгированного действия может привести к генерализации кожного процесса с развитием пустулезного псориаза и/или эритродермии,
а также торпидному течению заболевания. Требования к результатам лечения: частичный или полный регресс высыпаний; исчезновение или уменьшение выраженности субъективных ощущений (зуда, чувства стягивания кожи).
Тактика при отсутствии эффекта от лечения: назначение других видов топической, фото- и системной терапии или их комбинаций.
Оценка факторов риска неблагоприятных исходов: ухудшение течения заболевания – увеличение тяжести и распространенности псориатического процесса; развитие эритродермии или генерализованного пустулезного псориаза; резистентность к проводимой терапии средствами и (или)
методами с доказанной клинической эффективностью.

Критерии оценки качества
медицинской помощи
№
Критерий оценки качества
Оценка выполнения
1.
Выполнен общий (клинический) анализ крови: лейкоциты,
эритроциты, гемоглобин, гематокрит, тромбоциты, тромбокрит,
нейтрофилы палочкоядерные, нейтрофилы сегментоядерные,
эозинофилы, базофилы, лимфоциты, моноциты, скорость оседания эритроцитов
Да/Нет
2.
Выполнен анализ крови биохимический общетерапевтический:
общий белок, глюкоза, креатинин, мочевая кислота, билирубин общий, холестерин общий, триглицериды, аланин- аминотрансфераза, аспартат-аминотрансфераза
Да/Нет
3.
Выполнен общий (клинический) анализ мочи: цвет, прозрачность,
относительная плотность, реакция рН, глюкоза, белок, билирубин,
уробилиноиды, реакция на кровь, кетоновые тела, нитраты,
эпителий плоский, эпителий переходный, эпителий почечный,
лейкоциты, эритроциты, цилиндры гиалиновые, цилиндры зернистые, цилиндры восковидные, цилиндры эпителиальные,
цилиндры лейкоцитарные, цилиндры эритроцитарные, цилиндры пигментные, слизь, соли, бактерии
Да/Нет
4.
Проведена терапия глюкортикостероидами для местного лечения заболеваний кожи, и/или ретиноидами для лечении псориаза и/или иммунодепрессантами и/или метотрексатом и/или фототерапия
Да/Нет
5.
Достигнут частичный или полный регресс высыпаний
Да/Нет

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