{"id":5378,"date":"2016-06-30T14:44:48","date_gmt":"2016-06-30T12:44:48","guid":{"rendered":"http:\/\/spital.sf.treime.md\/?p=5378"},"modified":"2016-06-30T15:46:13","modified_gmt":"2016-06-30T13:46:13","slug":"managementul-medical-si-chirurgical-al-sinuzitei-cronice","status":"publish","type":"post","link":"https:\/\/treime.md\/ru\/managementul-medical-si-chirurgical-al-sinuzitei-cronice\/","title":{"rendered":"Managementul medical \u0219i chirurgical al sinuzitei cronice"},"content":{"rendered":"<p>[vc_row][vc_column][vc_images_carousel images=&#187;5355,5380,5383,5381,5384,5382&#8243; img_size=&#187;735&#215;250&#8243; autoplay=&#187;yes&#187;][vc_empty_space][vc_column_text]<a href=\"http:\/\/Semnele si simptomele de sinuzita cronic\u0103 :\" target=\"_blank\">PREZENTARE ILUSTRAT\u0102<\/a><\/p>\n<p><strong>Generalit\u0103\u021bi<\/strong><\/p>\n<p>Sinusurile paranazale sunt cavit\u0103\u021bi de aer goale \u00een oasele fe\u021bei \u0219i capului, care, probabil, exist\u0103 pentru a reduce greutatea craniului \u0219i a amortiza creierul \u00een timpul traumei  sinuzale, izoleaz\u0103 craniul, asigur\u0103 rezonan\u021ba \u00een momentul vorbirii, con\u021bin mecanisme de ap\u0103rare \u00eempotriva florei patogene.<\/p>\n<p>Exist\u0103 4 perechi de sinusuri &#8212; 2 sinusuri maxilare, 2 etmoidale, 2 frontale \u0219i 2 sfenoidale.<!--more--><\/p>\n<p><strong>Defini\u021bie<\/strong><\/p>\n<p><a href=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Cabac-Vasile.jpg\" rel=\"attachment wp-att-5379\"><img loading=\"lazy\" class=\"alignleft wp-image-5379\" src=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Cabac-Vasile.jpg\" alt=\"Cabac Vasile\" width=\"193\" height=\"289\" srcset=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Cabac-Vasile.jpg 427w, https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Cabac-Vasile-200x300.jpg 200w\" sizes=\"(max-width: 193px) 100vw, 193px\" \/><\/a>Sinuzita reprezint\u0103 inflama\u021bia sinusurilor paranazale, o afec\u021biune banal\u0103 la prima vedere, \u00eens\u0103 o afec\u021biune care genereaz\u0103 simptome foarte nepl\u0103cute, adesea mim\u00e2nd o r\u0103ceal\u0103, cu tuse, str\u0103nut, nas \u00eenfundat sau durere de cap persistent\u0103, refractar\u0103 la tratament.<\/p>\n<p><strong>Sinuzitele se clasific\u0103 \u00een raport cu durata, simptome \u015fi localizarea anatomic\u0103<\/strong><\/p>\n<p><strong>Sinuzita acut\u0103<\/strong> &#8212; inflamarea mucoasei  sinusale  cu apari\u021bia unei secre\u021bii purulente cu durata p\u00e2n\u0103 la 3 s\u0103pt\u0103m\u00e2ni<\/p>\n<p><strong>Sinuzita subacut\u0103<\/strong> &#8212; durata infec\u021biei \u00eentre 3 s\u0103pt\u0103m\u00e2ni \u0219i 3 luni<\/p>\n<p><strong>Sinuzita recidivant\u0103 <\/strong>&#8212; \u00eenregistrarea a 4 sau a mai multor epizoade de sinuzit\u0103 acut\u0103 cu o durat\u0103 de cel pu\u0163in 10 zile, \u015fi o vindecare complet\u0103 \u00eentre epizoade.<\/p>\n<p><strong>Sinuzita cronic\u0103<\/strong> &#8212; men\u021binerea inflama\u021biei mucoasei sinuzale \u0219i a unei secre\u021bii muco-purulente mai mult de  3 luni.<\/p>\n<p>Sinuzita poate sa afecteze doar un sinus ( cum ar fi sinuzita maxilar\u0103) &#8212; este cea mai frecvent\u0103 form\u0103 sau poate s\u0103 afecteze toate sinusurile &#8212; pansinuzit\u0103.<\/p>\n<p><strong>Generalit\u0103\u021bi<\/strong><\/p>\n<p>Rinosinuzita cronic\u0103 sub multiplele sale forme, constituie una dintre cele mai frecvente afec\u021biuni \u00eent\u00e2lnite \u00een medicin\u0103, iar \u00een tratament sunt implica\u021bi mai mul\u021bi speciali\u0219ti: medici de familie, medicina de urgen\u021b\u0103, pulmonologi, alergologi, otorinolaringologi, inclusiv interven\u021bioni\u0219ti \u0219i neurochirurgi, atunci c\u00e2nd au loc complica\u021bii severe.<\/p>\n<p><strong>Formele clinice<\/strong><\/p>\n<ul>\n<li>Rinosinusit\u0103 cronic\u0103 f\u0103r\u0103 polipi nazali<\/li>\n<li>Rinosinusit\u0103 cronic\u0103 cu polipi nazali<\/li>\n<li>Asociat\u0103 cu astm\u0103 bron\u0219ic<\/li>\n<li>Asociat\u0103 cu astm\u0103 bron\u0219ic \u0219i intoleran\u021b\u0103 la aspirin\u0103 (s-mul Vidal Samter)<\/li>\n<li>Rinosinusit\u0103 cronic\u0103 odontogen\u0103<\/li>\n<li>Rinosinusit\u0103 cronic\u0103 fungic\u0103<\/li>\n<\/ul>\n<p><strong>Generalit\u0103\u021bi<\/strong><\/p>\n<ul>\n<li>Prevalen\u021ba \u00een 7 &#8212; 14.7% din popula\u021bie<\/li>\n<li>Interesant, rata de prevalen\u021b\u0103 al RSC este \u00een mod substan\u021bial mai mare la femei, cu un raport femei \/ b\u0103rba\u021bi de 6\/4<\/li>\n<li>Prevalen\u021ba cre\u0219te cu varsta, cu o medie de 2,7% \u0219i 6,6% \u00een grupele de v\u00e2rst\u0103 20-29 \u0219i 50 de 59 ani, respectiv.<\/li>\n<li>Dup\u0103 v\u00e2rsta de 60 de ani nivelul prevalen\u021bei al RSC se stabilizeaz\u0103 la 4,7%<\/li>\n<\/ul>\n<p><strong>Rinosinusita cronic\u0103 cu polipi nazali<\/strong><\/p>\n<p>Prevalence aprox. \u00een 2- 4% din popula\u021bie sau 25% din RSC este asociat\u0103 cu polipi nazali<\/p>\n<p>Asthma este  asociat\u0103 \u00een aprox. 40-65%, la aceia\u0219i pacien\u021bi, dar interrela\u021bia lor nu este definit expres<\/p>\n<p>Intoleran\u021ba la Aspirin \u00een 10-15% (Triada Vidal-Samter)<\/p>\n<p><strong>Etiologie<\/strong><\/p>\n<p>Culturile nazale \u0219i sinusale. Bacteriologia sinuzitelor cronice nu este bine definit\u0103. Culturile sunt, \u00een general, nefolositoare pentru diagnosticarea sinuzitei cronice. Cu toate acestea, \u00een cazurile \u00een care boala nu r\u0103spunde la tratament sau progreseaz\u0103, culturile din secre\u021biile nazale pot ajuta la identificarea cauzei, care poate fi de natur\u0103 bacterian\u0103 sau fungic\u0103.<\/p>\n<p>Majoritatea pacien\u021bilor cu boala cronic\u0103, \u00een special cei care au fost supu\u0219i anterior interven\u021biilor chirurgicale pe sinusuri, prezint\u0103 culturi sinuzale pozitive pentru bacterii, fapt care are mai degrab\u0103 semnifica\u021bia unei coloniz\u0103ri dec\u00e2t a unei infec\u021bii. Pacien\u021bii care au efectuat mai multe cure de antibiotice pot fi coloniza\u021bi cu S. Aureus sau cu specii rezistente la bacili gram-negativi.<\/p>\n<p><strong>Factori predispozan\u021bi<\/strong><\/p>\n<p>\u00cen apari\u0163ia rinosinuzitei cronice pot fi incrimina\u0163i urm\u0103torii factori:<\/p>\n<p>&#8212; Precedarea unei infec\u0163ii  a c\u0103ilor respiratorii superioare, tratate incorect, ce se pot extinde<\/p>\n<p>&#8212; Prezen\u0163a infec\u0163iei concurente de vecin\u0103tate: corpi str\u0103ini nazali necunoscu\u0163i, adenoidit\u0103 \u0219i amigdalit\u0103 cronic\u0103, forma\u0163iuni tumorale nazosinusale;<\/p>\n<p>&#8212; Infec\u0163ia dentar\u0103 (cauzeaz\u0103 a\u015fa-numita sinuzit\u0103 odontogen\u0103);<\/p>\n<p>&#8212; Rinitele alergice, alergie respiratorie.<\/p>\n<p>&#8212; Deregl\u0103ri endocrine (diabetul saharat)<\/p>\n<p>Cauze generale: macro \u015fi microclimat nocive, fumatul, frigul \u015fi umezeal\u0103, barotraumatisme, gaze toxice, pulberi iritante, boli de nutri\u0163ie, anemie; poluarea mediului (deseori fumatul pasiv)<\/p>\n<p>Factori iatrogeni (ventilarea mecanic\u0103, prezen\u0163a unui tub nazogastral, tamponamentul nazal de durat\u0103),<\/p>\n<p>&#8212; Varia\u0163ii anatomice (hipertrofie adenoamigdalian\u0103, devia\u0163ie de sept nazal, particularit\u0103\u0163i anatomice ale complexului osteomeatal, polipi nazali, dehiscen\u0163a velopalatin\u0103)<\/p>\n<p>&#8212; \u00cenotul<\/p>\n<p>&#8212; Imunodificien\u0163a<\/p>\n<p>&#8212; Deregl\u0103ri secretorii (fibroza cistic\u0103)<\/p>\n<p>&#8212; Sindromul Kartagener &#8212; abnormalit\u0103\u0163i ale clirensului mucociliar<\/p>\n<p><strong>Semnele \u0219i simptomele de sinuzit\u0103 cronic\u0103<\/strong><\/p>\n<p>Semnele \u0219i simptomele sinuzitei cronice sunt asem\u0103n\u0103toare cu cele din sinuzita acut\u0103, \u00eens\u0103 acestea se men\u021bin o perioad\u0103 mai lung\u0103 (peste trei s\u0103pt\u0103m\u00e2ni) \u0219i produc o epuizare semnificativ\u0103 a organismului. De obicei, sinuzita cronic\u0103 nu se asociaz\u0103 cu febra.<\/p>\n<ul>\n<li>Durere la nivelul fe\u021bei \u0219i presiune \u00een zona frun\u021bii, t\u00e2mplelor, obrajilor, nasului \u0219i ochilor;<\/li>\n<li>Dificultate la respira\u021bia nazal\u0103;<\/li>\n<li>Evacuarea unor secre\u021bii de consisten\u021b\u0103 crescuta din nas;<\/li>\n<li>Tulbur\u0103ri ale mirosului \u0219i gustului;<\/li>\n<li>Obstruc\u021bie nazal\u0103 \u0219i congestie;<\/li>\n<li>Dureri la nivelul maxilarului;<\/li>\n<li>Dureri de din\u021bi;<\/li>\n<li>Tuse;<\/li>\n<li>Inflama\u021bia g\u00e2tului;<\/li>\n<\/ul>\n<p><strong>Semnele \u0219i simptomele de sinuzit\u0103 cronic\u0103 <\/strong><\/p>\n<p><em>inspec\u0163ia, palpa\u0163ia, examen instrumental<\/em><\/p>\n<ul>\n<li><strong><em>Fa\u0163a <\/em><\/strong>&#8212; edem \u015fi eritem\u0103 la nivelul sinusului afectat, hipersensibilitate la palpa\u0163ie<\/li>\n<li><strong><em>Ochii<\/em><\/strong> \u2013 edem periorbital<\/li>\n<li><strong><em>Nas<\/em><\/strong> \u2013 secre\u0163ii mucopurulente, edem \u015fi congestia pituitarei, o d\u00e2r\u0103 de puroi din meatul nazal mediu, prezen\u0163a variet\u0103\u0163ilor anatomice: devia\u0163ie de sept nazal, cornete voluminoase, corpi str\u0103ini,<\/li>\n<li><strong><em>Faringe<\/em><\/strong> \u2013 prelingerea secre\u0163iilor mucopurulente pe peretele posterior al faringelui<\/li>\n<li><strong><em>Cavitate bucal\u0103<\/em><\/strong> \u2013 din\u0163ii afla\u0163i \u00een vecin\u0103tate cu sinusurile maxilare sunt sensibili<\/li>\n<li><strong><em>Urechi<\/em><\/strong> \u2013 prezen\u0163a concomitent\u0103 a otitei acute, caracteristic pentru copii<\/li>\n<li><strong><em>G\u00e2t<\/em><\/strong> \u2013 limfadenopatie<\/li>\n<\/ul>\n<p><em><u>Not\u0103:  Durerea facial\u0103 izolat\u0103 nu indic\u0103 la o sinusit\u0103 <\/u><\/em><\/p>\n<p><strong>Cefaleea sinuzal\u0103<\/strong><\/p>\n<p>Cefalee de cauza sinusal\u0103 este o durere profund\u0103 \u0219i constant\u0103 la nivelul pome\u021bilor, frun\u021bii sau r\u0103d\u0103cinii nasului. Durerea de obicei se intensifica la mi\u0219carea brusc\u0103 a capului sau str\u0103nut \u0219i survine \u00een mod obi\u0219nuit acompaniat\u0103 de alte simptome sinusale, precum rinoree, urechi \u00eenfundate, febr\u0103, tumefiere a fe\u021bei.<\/p>\n<p><strong>Diagnosticul investiga\u0163ii<\/strong><\/p>\n<p><strong><em>Radiografia standard a<\/em><\/strong> sinusurilor paranazale pune \u00een eviden\u0163\u0103 nivel aero-lichidian sau opacitate cu o veridicitate \u00een circa 54% pentru adult, iar pentru copii p\u00e2n\u0103 la 12 ani informativitatea este mai joas\u0103<\/p>\n<p><strong>Diagnosticul investiga\u0163ii<\/strong><\/p>\n<p><strong><em>CT<\/em><\/strong> este mai informativ\u0103 \u015fi se recomand\u0103 de efectuat \u00een:<\/p>\n<ul>\n<li>Complica\u0163iile sinusitei acute<\/li>\n<li>Sinusite cronice, care nu se supun tratamentului<\/li>\n<li>\u00cen cazuri severe neclare, c\u00eend diagnosticul doar este suspectat<\/li>\n<li>Rezonan\u0163a magnitonuclear\u0103 ca regul\u0103 nu se recomand\u0103 \u00een sinuzite<\/li>\n<li>Investiga\u0163ii alergice<\/li>\n<\/ul>\n<p><strong><em><u>Not\u0103 diafanoscopia \u015fi ultrasonografia nu sunt recomandate \u00een sinuzite prin informativitatea redus\u0103<\/u><\/em><\/strong><\/p>\n<p><strong>Complica\u0163ii:<\/strong><\/p>\n<p>Orbitale<\/p>\n<p>Edem palpebral Celulita orbital\u0103<\/p>\n<p>Abces subperiostal<\/p>\n<p>Abces retrobulbar<\/p>\n<p><strong>Simptome<\/strong><\/p>\n<p>oftalmoplegie limitat\u0103<\/p>\n<p>exoftalmie reductibil\u0103<\/p>\n<p>diminuarea oculomotricit\u0103\u0163ii<\/p>\n<p><strong>Complica\u0163ii intracraniene<\/strong><\/p>\n<p>Tromboza sinusului cavernos<\/p>\n<p>Meningita rinosinusogen\u0103<\/p>\n<p>Abcesul lobului frontal<\/p>\n<p><strong>Obiectivele tratamentului medical  sunt:<\/strong><\/p>\n<ul>\n<li>a reduce edemul la nivelul mucoaselor<\/li>\n<li>a promova drenajul sinusurilor,<\/li>\n<li>a eradica infec\u021biile care pot fi prezente.<\/li>\n<\/ul>\n<p>Acest lucru necesit\u0103 adesea o combina\u021bie de glucocorticoizi topice sau orale, antibiotice, \u0219i de irigare salin\u0103 nazale.<\/p>\n<p>Rolul bacteriilor \u00een patogeneza sinuzitei cronice r\u0103m\u00e2ne discutabil; cu toate acestea, un diagnostic precoce \u0219i tratament intensiv cu antibiotice pe cale orala, steroizi nazali topici, decongestionante \u0219i spray-uri nazale saline reduc simptomele  la un num\u0103r semnificativ de pacien\u021bi, dintre care mul\u021bi pot fi vindeca\u021bi. Atunci c\u00e2nd terapia medical\u0103 e\u0219ueaz\u0103, pacientul este consultat pentru evaluare chirurgicale.<\/p>\n<p><strong>Tratament chirurgical<\/strong><\/p>\n<p>O interven\u021bie chirurgical\u0103 pentru sinuzita cronica este rezervata pentru pacien\u021bii care nu au r\u0103spuns la terapia medicala. Tratamentul medical ar trebui s\u0103 includ\u0103 3-6 s\u0103pt\u0103m\u00e2ni de antibiotice, steroizi nazale, \u0219i irig\u0103ri nazale saline.<\/p>\n<p>Gestionarea optim\u0103 chirurgical\u0103 a polipilor nazali nu a fost  \u00eenc\u0103 stabilit\u0103.  Interven\u021biile chirurgicale \u00een tratamentul polipilor nazali sunt lua\u021bi \u00een considerare pacien\u021bii la care procesul nu se amelioreaz\u0103 dup\u0103 un tratament medical maximal. Chirurgia func\u021bional endoscopic\u0103 a sinusurilor implic\u0103 \u00eenl\u0103turarea polipilor, a mucoasei polipoid modificat\u0103 \u0219i deschiderea ostiumului sinuzal, chiar \u0219i dup\u0103 aceast\u0103 chirurgie \u0219i  \u00eengrijire medical\u0103 postoperatorie optim\u0103, unii pacien\u021bi se vor prezenta cu recidive ale bolii.<\/p>\n<p><strong>Concluzii<\/strong><\/p>\n<ul>\n<li>Rhinosinusita cronic\u0103 este o patologie frecvent \u00eent\u00e2lnit\u0103 \u0219i deseori trecut\u0103 cu vederea<\/li>\n<li>Cauzele sunt complexe<\/li>\n<li>Tratamentul necesit\u0103 aprecierea cauzelor \u0219i o supraveghere atent\u0103<\/li>\n<li>Managementul practic medical este eficient \u00een majoritatea cazurilor 90%<\/li>\n<li>Chirurgia endoscopic\u0103 func\u021bional\u0103 este de ajutor \u00een sinuzita rezistent\u0103 la tratament medical adecvat 10%<\/li>\n<\/ul>\n<h3><strong><a href=\"https:\/\/treime.md\/wp-content\/uploads\/2013\/04\/Diagnsinusita_acuta_40_aniversare.pdf\" target=\"_blank\">PREZENTARE ILUSTRAT\u0102<\/a><\/strong><\/h3>\n<p>Dr., conferen\u0163iar universitar  Vasile Cabac[\/vc_column_text][vc_empty_space]<ul class=\"photostream clearfix page_margin_top\"><li class=\"gallery_box\"><img width=\"96\" height=\"96\" src=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/IMG_5581.CR2_-96x96.jpg\" class=\"attachment-medicenter-small-thumb size-medicenter-small-thumb\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/IMG_5581.CR2_-96x96.jpg 96w, https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/IMG_5581.CR2_-200x200.jpg 200w, https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/IMG_5581.CR2_-800x800.jpg 800w\" sizes=\"(max-width: 96px) 100vw, 96px\" \/><ul class=\"controls\">\n\t\t\t\t<li>\n\t\t\t\t\t<a href=\"http:\/\/spital.sf.treime.md\/wp-content\/uploads\/2016\/06\/IMG_5581.CR2_.jpg\" class=\"fancybox 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height=\"96\" src=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Untitled1-96x96.png\" class=\"attachment-medicenter-small-thumb size-medicenter-small-thumb\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Untitled1-96x96.png 96w, https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Untitled1-200x200.png 200w\" sizes=\"(max-width: 96px) 100vw, 96px\" \/><ul class=\"controls\">\n\t\t\t\t<li>\n\t\t\t\t\t<a href=\"http:\/\/spital.sf.treime.md\/wp-content\/uploads\/2016\/06\/Untitled1.png\" class=\"fancybox open_lightbox\" style=\"background-image: url('https:\/\/treime.md\/wp-content\/themes\/medicenter\/images\/icons_media\/blue_light\/image.png')\"><\/a>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/li><li class=\"gallery_box\"><img width=\"96\" height=\"96\" src=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Untitled-5-96x96.png\" class=\"attachment-medicenter-small-thumb size-medicenter-small-thumb\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Untitled-5-96x96.png 96w, https:\/\/treime.md\/wp-content\/uploads\/2016\/06\/Untitled-5-200x200.png 200w\" sizes=\"(max-width: 96px) 100vw, 96px\" \/><ul class=\"controls\">\n\t\t\t\t<li>\n\t\t\t\t\t<a href=\"http:\/\/spital.sf.treime.md\/wp-content\/uploads\/2016\/06\/Untitled-5.png\" class=\"fancybox open_lightbox\" style=\"background-image: url('https:\/\/treime.md\/wp-content\/themes\/medicenter\/images\/icons_media\/blue_light\/image.png')\"><\/a>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/li><\/ul>[\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_images_carousel images=&#187;5355,5380,5383,5381,5384,5382&#8243; img_size=&#187;735&#215;250&#8243; autoplay=&#187;yes&#187;][vc_empty_space][vc_column_text]PREZENTARE ILUSTRAT\u0102 Generalit\u0103\u021bi Sinusurile paranazale sunt cavit\u0103\u021bi de aer goale \u00een oasele fe\u021bei \u0219i capului, care, probabil, exist\u0103 pentru a reduce greutatea craniului \u0219i a amortiza creierul \u00een timpul traumei sinuzale, izoleaz\u0103 craniul, asigur\u0103 rezonan\u021ba \u00een momentul vorbirii, con\u021bin mecanisme de ap\u0103rare \u00eempotriva florei patogene. Exist\u0103 4 perechi de sinusuri &#8212; 2<\/p>\n","protected":false},"author":2,"featured_media":5383,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[53,2],"tags":[],"_links":{"self":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts\/5378"}],"collection":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/comments?post=5378"}],"version-history":[{"count":7,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts\/5378\/revisions"}],"predecessor-version":[{"id":5392,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/posts\/5378\/revisions\/5392"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/media\/5383"}],"wp:attachment":[{"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/media?parent=5378"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/categories?post=5378"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/treime.md\/ru\/wp-json\/wp\/v2\/tags?post=5378"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}