Классификация варикозной болезни: как расшифровать диагноз?

В современном здравоохранении все заболевания группируются по определенным симптомам, тяжести течения и другим признакам. Не стал исключением и варикоз. Для чего же нужна классификация варикозной болезни?

Как зашифровать диагноз?

Для чего ввели непонятную классификацию? Заглядываешь в современную медицинскую карту, а там сплошные коды. То ли дело раньше, четким почерком доктора записывались все основные и сопутствующие диагнозы, которые можно было легко прочитать. Для чего современному здравоохранению вводить закодированные обозначения различных болезней?

  • зашифрованное название заболевания может прочитать только специалист, это важно для сохранения информации, которая не подлежит разглашению;
  • с развитием компьютерных технологий, большая часть информации для удобства систематизации, анализа заноситься в программы в виде буквенно-цифрового кода;
  • международная унификация, стандартизация кодов заболеваний позволяет расшифровать диагноз, даже если его поставили в другой стране.

Классификация болезней может быть как международной, принятой ВОЗ, так и принятой в масштабах здравоохранения конкретного государства.

МКБ – 10

Основной документ, которым пользуются врачи всего мира – МКБ–10, представляет собой последнюю пересмотренную, уточненную версию классификационной системы заболеваний различного характера. Цифра 10 означает, что Всемирная Организация Здравоохранения пересматривала и уточняла версию уже 10 раз.

По МКБ – 10 варикозная болезнь входит в IX класс под названием: «Болезни системы кровообращения». В нем представлен наиболее полный список диагнозов с осложнениями и без, которые можно поставить при наличии варикоза. Варикозные болезни нижних конечностей можно найти под трехзначным номером 183:

  • 183.9 – варикозная болезнь нижних конечностей без осложнений в виде трофических язв и воспалительного процесса;
  • 183.1 – варикозная болезнь нижних конечностей с воспалительным процессом;
  • 183.2 – варикозная болезнь нижних конечностей с некротическими трофическими язвами и воспалительным процессом;
  • 183.0 – варикозная болезнь нижних конечностей с трофическими язвами.

Таким образом, постановка диагноза по классификации МКБ – 10 сильно облегчает уточняющие нюансы диагностики заболевания. При этом – серьезные осложнения варикозной болезни зашифрованы другими трехзначными кодами:

  • 180.0 – 180.9 – разновидности осложнений в виде флебитов и тромбофлебитов локализованных на определенных участках;
  • 181 – 182 – эмболия, тромбоз крупных кровеносных сосудов;
  • 184.0 – 184.9 – различные виды геморроя с осложнениями и тромбозом;
  • 186.2 – 186.3 – варикозная болезнь вен промежности, малого таза.

Другие разновидности болезни, выведенные из IX класса:

  • 022.0 – варикозная болезнь нижних конечностей, осложненная беременностью;
  • 087.8 – варикозная болезнь в период кормления грудью.

Такие четкие, подробные формулировки, уточнение локализации, клинических проявлений почти не дают шансов ошибиться с постановкой диагноза.

Тромбофлебит

Большая часть осложнений варикоза представлена различными поражениями глубоких вен, в частности тромбофлебитом. Эта стадия характеризуется, как правило, воспалительными процессами венозной стенки, в результате которых образуется закупорка просвета тромбами. Это сильно ухудшает кровоток. Тромбофлебит – состояние, угрожающее отрывом тромба, которое может привести к закупорке жизненно важных кровеносных сосудов.

Для диагностики используют шифр МКБ – 10, который позволяет уточнить нюансы протекающих процессов, например, область локализации, наличие флотации, флотирующего хвоста тромба, остроту протекания. Классификацию тромбофлебитов производится по:

  • типу протекания процесса, например острый до одного месяца, подострый до трех, хронический тромбофлебит нижних конечностей – перерастает после трех месяцев от начала болезни;
  • происхождению, например, варикозная болезнь нижних конечностей, начавшийся на фоне осложнений во время беременности, осложненных родов, в результате гормонального сбоя, онкопатологии, аллергии, перенесенной инфекции, т.д.;
  • локализации, процесс, захватывающий поверхностные или глубокие вены нижних конечностей, малого таза;
  • характеру протекания: негнойный, гнойный.

Все эти классификационные формы внесены в МКБ – 10 под трехзначным цифровым кодом от 100 до 199, под общим названием «Болезни системы кровообращения».

На основе буквенно-цифрового шифрования созданы также другие классификации болезней, в частности варикозного расширения вен нижних конечностей.

По формам

Помимо международных классификаций, существуют специальные, которые разработаны и используются медиками разных стран. Например, в России была разработана собственная уточняющая классификация варикоза нижних конечностей, по форме заболевания. Она включает в себя несколько этапов развития с осложнениями и без:

  • сегментарный варикоз сосудов без рефлюкса;
  • сегментарный варикоз сосудов с патологическим сбросом жидкости по поверхностным, коммуникантным венам;
  • выраженный варикоз сосудов с патологическим сбросом жидкости по поверхностным, коммуникантным венам;
  • выраженный варикоз сосудов с патологическим сбросом жидкости по глубоким венам.

Такая классификация позволяет уточнить, как развивается варикозная болезнь нижних конечностей, 38-2характеризует поражение вен, сосудов и патологические нарушения кровотока.

По этой же классификации введены 4 степени хронической венозной недостаточности:

  • нулевая степень (0) – хроническая венозная недостаточность отсутствует;
  • вторая (2) – тяжесть в ногах, переходящая в отеки;
  • третья (3) – устойчивые, не проходящие отеки, склероз сосудистых стенок, гиперпигментация кожных покровов, дерматиты;
  • четвертая (4) – появление трофических изменений тканей, язвы.

К диагнозу принято добавлять осложнения в ходе лечения: различные кровотечения из сосудов, вен, появление тромбов, воспалительные процессы лимфатических узлов и сосудов, воспалительные процессы, осложненные бактериальной инфекцией, некрозы, трофические изменения прилежащих тканей, язвы, дерматиты, экземы.

По Савельеву

Достаточно востребованная отечественными медиками классификация, которая характеризует степени нарушения кровотока в варикозных конечностях:

  • компенсация отличается почти полным отсутствием симптомов болезни, кроме дискомфорта в местах поражения вен, сосудов;
  • стадия субкомпенсации представляет собой период, за который симптомы болезни усиливаются, визуально проявляются в виде ретикулярного рисунка, а симптоматически в виде отеков, покалывания, зуда, тяжести, судорог, прочих проявление варикозной болезни нижних конечностей. Очень усиливаются различные застойные явления в тканях, нарушается нормальный обмен, кровообращение;
  • стадия декомпенсации характеризуется появлением серьезных нарушений кровотока, появлением гиперпигментации, воспалительных процессов прилегающих тканей. Симптомы в этот период усиливаются, перерастая в постоянные болевые ощущения, могут появиться некротические поражения тканей, трофические язвы.

Анатомическая локализация

Существует классификация по анатомической локализации пораженных вен нижних конечностей, которая важна для постановки правильного диагноза:

  • варикозное расширение поверхностных сосудов большой подкожной вены;
  • варикозное расширение поверхностных сосудов малой подкожной вены;
  • варикозное расширение поверхностных сосудов большой и малой подкожных вен;
  • варикоз латеральной вены.

Регистрируется также недостаточность клапанов, которая подразделяется на относительную клапанную недостаточность поверхностных, глубоких, коммуникантных вен, общую всей системы клапанов.

Классы заболевания

Международная классификация варикоза, основывающаяся на симптомах и признаках проявления, так называемая международная классификация СЕАР:

  • С – клиническая картина болезни;
  • Е – этиология болезни;
  • А – анатомия расположения пораженных вен;
  • Р – механизмы развития варикозной болезни ног.

Врачи-клиницисты чаще пользуются разделом С этой международной классификации, ее принято 38-3подразделять на классы от 0 до 6. Каждой стадии клинической картины варикозного расширения нижних конечностей присваивается свой класс:

  • нулевой (0) – любые явные проявления варикоза нижних конечностей отсутствуют, хотя пациенты предъявляют жалобы на усталость и тяжесть ног;
  • первый (1) – на глаз можно определить появление ретикулярного рисунка, звездочек, сеточек, пациенты могут страдать от ночных судорог;
  • второй (2) – появляются явные расширения вен и сосудов, хорошо различимые глазом;
  • третий (3) – пациентов начинают беспокоить отеки нижних конечностей, пастозность тканей, другие симптомы варикоза, которые не исчезают после отдыха;
  • четвертый (4) – явно выраженные варикозные узлы и вены, гиперпигментация и воспаление прилежащих кожных покровов;
  • пятый (5) – характеризуется появлением язвенного поражения, симптомами тромбофлебита и некротических изменений;
  • шестой (6) – образование незаживающих некрозов и глубоких трофических язв.

С помощью классификации подразделов Е и А можно поставить уточняющий диагноз, при поражении глубоких, поверхностных, перфорантных вен и уточнить этиологию заболевания. Раздел Р позволяет уточнить наличие различных рефлюксов в пораженном участке венозного русла.

В данной классификации имеется шкала подсчета баллов, с помощью которой можно уточнить клиническую картину проявлений:

  • болевые ощущения: 0 – нет болевых ощущений, 1 – не требующая лекарственной коррекции, 2 – сильная;
  • отечность конечностей: 0 – нет отека, 1 –небольшой, 2 – сильно выраженный;
  • «венозная хромота»: 0 – нет, 1 – легкая форма, 2 – ярко выражена;
  • пигментация кожных покровов: 0 – отсутствует, 1 – ограниченная, 2 – распространенная;
  • липодерматосклероз: 0 – нет, 1 – есть, но ограничен; 2 – распространен;

Уточнению подлежит также наличие и количество язвенных изменений, размер язвы, количество времени, в течение которого существует язва; наличие рецидивов и их количество.

Уточнению подлежит также трудоспособность пациентов с варикозным расширением вен, которая производится по шкале снижения трудоспособности:

  • 0 – бессимптомное течение заболевания, не требующее ограничений работоспособности;
  • 1 – симптомы болезни, не требующие ограничения трудоспособности;
  • 2 – симптомы болезни не позволяют работать более 8 часов, обязательна корректирующая терапия;
  • 3 – полная нетрудоспособность.

Таким образом можно уточнить состояние заболевания на текущий момент, особенно если оно прогрессирует или, наоборот, никак себя не проявляет. Система классификации позволяет более полно сформулировать диагноз, уточнить наличие разного рода осложнений и т.д.

Система СЕАР наиболее полно характеризует варикозные болезни, но отличается большим количеством пунктов (около 40), что отражается на итоговом шифре. Чтобы облегчить постановку диагноза, ввели понятие основной и расширенной классификации. Первая включает в себя определение по клиническим признакам заболевания, по этиологии, анатомической локализации, причинам возникновения варикоза. Вторая включает в себя все пункты и показатели, для подробного уточнения диагноза, даже уровень обследования пациента. Этот пункт включает в себя клинические методы обследования: допплерографию, ультразвуковое сканирование, магнито-резонансную томографию и т.д.

Любая классификация варикоза – это, прежде всего, перечень заболеваний. Она позволяет наиболее точно определить и поставить диагноз, назначить и корректировать лечение варикозного расширения вен. Такая унификация, принятая на международном уровне, облегчает контакт врачей и пациентов из разных стран, позволяя без языкового барьера сориентироваться в медицинской карте или истории болезни. Кодировка цифровым шифром почти исключила ошибки в постановке диагноза, отклонения возможны только в пределах классификационной группы, которая принадлежит к одному виду заболеваний. Она значительно упростила внесение и подсчет статистических данных, облегчила их обработку.

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