Isiqaqa Hypothyroid: indlela ukunika ukhathalelo olungxamisekileyo?

I-Hypothyroidism isifo esiyingozi. Enye yeengxaki zayo rhoqo i-hypothyroid coma. Ngokuqhelekileyo kubakho kwizigulane ezigugile, ngakumbi kubafazi. I-coma ikhula kweli qela lezigulane, ezibangelwa yi-hypothyroidism, azizange zithole unyango olufunekayo, okanye zenziwa ngokungafanelekanga.

Izizathu ze-hypothyroidism

Kwininzi yezigulane (ukuya kwi-95%) i-hypothyroidism ibangelwa iinkqubo ze-pathological occurring in theroid gland. Umgangatho wemveliso ye-hormone iyancipha, i-hypothyroidism ephambili ikhula.

Ukuphulwa kweempembelelo ezikhuthazayo nezilawulayo ze-pituitary thyrotropin, kunye ne-thyroidiborin (okanye i-hypothalamic release factor), i- hypothyroidism yesibili ivela . Ixesha eliqhelekileyo lokuvela kwalo likhulu kakhulu ngaphantsi komgangatho oyintloko. Kwaye, kunye nakwezinye iimeko ngokungenayo imveliso, i-hypothyroid coma iyakhula.

Kwi-peripheral hypothyroidism, umbuzo awuzange usombululwe ngeendlela ezininzi. Ingaba ivela malunga nokuphazamiseka kwamagciwane kwi-hormone ye-thyroid okanye ngenxa yokunciphisa ubuzwe kwizitho kunye nezicubu zeemenyu zamandla enyukliya kwi-hormone ye-thyroid?

Umbuzo uhleli nokuba ulwaphulo olunxulumene nobudala bee-hormone ze-thyroid lwenzeka kwiimeko zokuphazamiseka kwe-metabolism. Ngaba zikhona izinto ezingenakuphikelela kwi-thyroid gland ekugugeni?

Hypothyroid coma. Izizathu

I-pathogenesis ye-hypothyroid coma kumaxesha amaninzi ibonisa ukuba unyango olungonelanga okanye olungalindelekanga lwe-hypothyroidism lwenziwa. Ngokuqhelekileyo inkcazo inokuba yi-diagnosis. Ukuntuleka kwe-hormone ye-thyroid kunokunyanzeliswa ngokurhoxiswa kwe-levothyroxine okanye isidingo somzimba sokwanda kwimizi ye-hormone yokutshintsha. I-Hypothyroid coma inokufaka isandla kwizinto eziliqela:

• Ukuxutywa kwamanzi.

• Izifo ezidibeneyo (ukuhlaselwa yintliziyo, ukukhupha i-pneumonia, ukuphazamiseka kwentsholongwane, i-viral, ukusulelwa kwe-urogenital).

• Ukulahleka okukhulu kwegazi, ukunyamekela, unyango lwe-radiation, ukungenelela kokugonywa.

• Iimviwo ze-X-ray.

• Ukuthatha unyango oludityanisiweyo kwinkqubo yesantya.

• Amaniselo amakhulu.

• Hypoglycemia.

• Hypoxia.

Ukuba izinga le-hormone ye-thyroid liwa ngokukhawuleza, umsebenzi weendlela zokuxilonga unciphisa ebuchosheni. Ngenxa yoko, i-hypoxia iyanda, zonke iintlobo zemetabolism kunye nemisebenzi emininzi yamalungu ayinakukhubazeka.

Iimpawu ze-hypothyroid coma

Ingqungquthela ye-coma ibonakala ngokukhawuleza, ukwanda, iqhubela phambili kancane. Ekuqaleni, ukukhathala, ukungaboni, ukungabonakali kwemvelo, kubonakala kubunzima bezitho, ukuma, ukukhukhuma kweenyawo, ukugquma kwesikhumba - le miqondiso ibonakaliswe yi-hypothyroid coma. Isimo sendawo sikhombisa ukuphefumula, ukukhathazeka ngokuvuthwa, ukubonakaliswa kwentliziyo. Uxinzelelo lomngcipheko luyancipha, ukungabikho kwe-tendon reflexes kuqinisekiswa. Xa uhlolisisa isigulane, ugqirha ubona ezi zilandelayo iimpawu ze-hypothyroid coma:

• I-metabolism ibuhlungu, ubunzima bomzimba buyanda, ukujikeleza kwehlisa, ukushisa kwehla kuya kuma-35 degrees.

• Kukho ukuphulwa kwenkqubo ye-cardiovascular system. Inqanaba lentliziyo linciphisa, umpompo ofana nentambo, ukwehla kwexinzelelo lwegazi, ukuphazamiseka kwentliziyo kuyabonwa.

• Ukungasebenzi komsebenzi wokuphefumula. Inani lokuphefumula linciphisa, izinga le-oksijini egazini lehla, ngexesha lokulala, ukuphefumula kuyayeka.

• Ukuchithwa kwemisebenzi yenkqubo yesantya. Inhibition of tendon reflexes, inkqubela phambili.

• Izimpawu zesikhumba. I-peal, eyomile, i-waxy tones tones, i-articular hyperkeratosis. Ukuthotywa kwezipikili. Ukulahleka kweenwele.

• Izinga le-sodium egazini lehla. Ukuvakalisa i-edema yobuso kunye nemida.

• I-anemia kunye nayo yonke impawu zayo.

• Hypoglycemia.

• Imiba yokugaya. Isithintelo esiswini. Ukwanda kwebindi.

I klinikhi

Iklinikhi ye-hypothyroid coma ilandelayo: ubuthathaka, ukulala, ukushisa kwehla kuya kuma-35 degrees. Intetho iyancipha, amagama akhulunywa ngokucacileyo, umbono kunye nokuncipha kweendlebe. Uxinzelelo lwe-arterial liyancipha, lushisa-ukuya kwi-30 beats ngomzuzu. Ukuphefumula kungenasiphelo kwaye kunqabile. Ukusuka kwindlela yokugaya - ukuzithemba, ukumbamba, intlungu, ukuhlanza. Kukho uphuhliso lweoliguria. Ikhumba liluhlaza okwesibhakabhaka, elomileyo. Ukuvuvukala ubuso, izitho. Ukudideka, ukuvinjelwa. I-Tendon reflexes ayikho. Iza kunye ne-hypothyroid coma.

Igazi. I-Hypoxia, i-hypercapnia, hyponatremia, i-hypoglycemia, i-acidosis, i-hematocrit, i-TTG, i-T3 kunye ne-T4 iyancipha, i-cholesterol iphakanyisiwe.

Iingxaki: i- pneumonia, ukungaphumeleli kwe-ventricular kwesokunxele, ukukhulelwa kwegazi, i-arthritis, ukuphazamiseka kwentliziyo, i-ONMI, ukunyamezeka kwengqondo, isithintelo semathumbu.

I-Algorithm yokunyamekela ngoncedo

Ukuba umntu une-hyparoid coma, uncedo olungxamisekileyo lwe-algorithm linalo:

1. Isibhedlele sangaphambi kwesibhedlele:

• Shayela ugqirha. Ukubonelela ngoncedo lokuqala lwezonyango.

• Gquba umzimba ngeengubo zokunciphisa ukutshatyalaliswa kobushushu.

• Ukuphelisa i-hypoxia ngokusebenzisa i-catheters ye-nasal inike i-oksijini enomzimba.

• Ukubonelela ukufikelela kwimifuno, kusekwe i-catheter ye-vein.

Ukuba kukho i-hypothyroid coma, amaqhinga omongikazi kufuneka acacile, esebenzisana kunye nogqirha-ngokukhawuleza, ehambelana kakuhle:

• Ukufumanisa iingxaki, uthathe igazi ngenxa ye-thyroxine, thyrotropin, triiodothyronine, i-glucose, i-cortisol, i-chloride, i-sodium, i-KCHR, i-gas composition.

• Ukubeka iliso kwi-diuresis, i-vestile iyakhonjwa.

• Ukukhusela ukufuna ukuhlanza, iprobethi ifakwe kwisisu.

• Ukuxilongwa kweengxaki - ECG, ukubeka esweni i-HDR, ubushushu, i-hemodynamics. "Reopoliglyukin" nge-intravenously-drop 500 ml.

• Ukuchithwa kwempahla - i-glucose 40% kwi / jet - 20-30 ml; Emva koko iv ivluluji 5% (500 ml) ijojowe ngaphakathi.

2. esibhedlele:

• Ukutshintsha i-hormone ye-hormone kwi / struino zonke iiyure ezingama-6 ukuya ku-250 ukuya ku-250 μg ye-thyroxin (okanye nge- probe yesisu 100 μg ye-Triiodothyronine) injected, emva koko emva kweeyure eziyi-12 le dosi yancitshiswa ibe yi-25-100 μg.

• Ukuxhaswa kwe-adrenal insufficiency / kwi-hydrocortisone ifakwe i-hydrocortisone hemisuccinate (50-100 mg).

• Ukuthintelwa kwe-encephalopathy 1 ml ye-vitamin B1.

• Ukubamba i-bradycardia, injenge-Atropine "0.1% (0.5-1 ml).

• Ukukhuthazwa kweziko lokuphefumula - "Cordiamin" (2-4 ml).

• Ukumisa i-hypoxia yengqondo - "I-Mildronate" (250 mg).

• Ukuthintela ukuthintela izifo-antibiotics.

• Ukuphelisa i-hypoxia - ukuvelisa umoya.

I-Hypothyroid coma: unonophelo lwengxamiseko

Ukubonelela ngoncedo olukhawulezileyo, akukho nhlobo inokufudumala isigulane ukufudumala-oku kubangelwa ukutshabalalisa i-hemodynamics. "I-Triiodothyronine" ayilawulwa ngokukhawuleza ngokukhawuleza ukuphepha umngcipheko weengxaki zentliziyo. I dose enkulu ye "Levothyroxine" inokubangela ukungaqiniseki kancinci.

Izibhedlele zenziwa kwiindawo eziphathekayo kwiyunithi yonyango okanye kwi-endocrinoyi yesebe.

Ukuba i-coma ye-hypothyroid isungulwa, uncedo olukhawulezileyo kwiyure lokuqala lunikezelwa ngokuqaliswa kwe "Triiodothyronine". Ulwaphulo lwe-oksijeni lubekwe. Izidakamizwa ezilawulwe ngokungapheliyo kwi-prednisolone, i-hydrocortisone. Kwakhona kuyimfuneko ukuvelisa iziyobisi zentliziyo.

Emva kwesigama seyure, kuyimfuneko ukuzisa ii-ATP, iiVithamini C, B. Ukuba uxinzelelo lungaphezu kwe 90 mm Hg. Ukuqaliswa kwe "Lasix" kwenziwa. Ukuba uxinzelelo lwegazi lingaphantsi kwalolu hlobo, "iCorazol", "Mezaton", "Cordiamin" isetyenziswe.

Emva koko, iiyure ezingama-4, ngokuxhomekeke kwimeko yentliziyo, kwisixa sama-25 μg sungeza "i-Triiodothyronine". Xa ukuphazamiseka kwemizimba kunye neqondo lokushisa lizinzile, i-dosage iyancipha. Kubalulekile ukuqhubeka nokufudumala isigulane, unyango lwe-oxygen, ukusebenzisa i-oxybutyrate ye-sodium.

Ukuba kukho i-convulsive syndrome, "i-Seduxen" ijojowe ngaphakathi.

Unyango: Isigaba 1

Unyango lwe-hypothyroid coma, njengomgaqo, uquka izigaba eziliqela, awuqali ngokukhawuleza nge-hormone yonyango yokutshintshwa. Unyango lwezigulane lwenziwa ngokuthe ngqo phantsi kolawulo lomqhubi kwinqununu yokunyamekela.

Kwinqanaba lokuqala, amanyathelo aqhelekileyo athatyathwa ukuzinzisa imisebenzi ebalulekileyo ebalulekileyo ngosuku lokuqala okanye ezimbini, ngaphandle kokusetyenziswa kwe-hormone yonyango ekutshintshelweni kwakhona kuya kuba nefuthe elifanelekileyo kwaye lunokusongela ubomi bomguli

Ukugcinwa kwemisebenzi yokuphefumula. Ukuba isigulane ngokwakhe sikwazi ukuphefumula kwaye iiparameters ze-KSHN zihlawulwa, ukunikezelwa kwe-O ₂ (unyango lwe-oksijini) lwenziwa ngombhobho wamanzi okanye ubuso buso. Njengomthetho, izigulane zifumana ukuphazamiseka kokuphefumula, i-carbon dioxide iqokelela egazini. Kufuneka ukuba isebenzise idivaysi yokufakelwa umoya. Oku kuzinzisa izinga le-oksijeni ne-carbon dioxide egazini, kuthintela uphuhliso lwe-hypoxia, luphelise impembelelo yalo emibi kwiimfucu kunye namalungu.

Ukulungiswa kwelahleko ze-vollemic . I-Hypothyroid (i-myxedematous) i-coma ibonakala ngokugcinwa kwamanzi. Kodwa inyaniso kukuba iqokelela kwiindawo eziphakathi, umbhede we-vascular ngeli xesha uhlupheka, kwaye kukho ukungabikho kwamanzi, ngenxa yeso sizathu, uxinzelelo lwegazi lungawa. Ulungiso lwenziwa ngesisombululo se-hypertonic se-NaCl, isisombululo se-colloidal kunye neetyuwa. Ngethuba lokubaluleka kubalulekile ukuqwalasela umgangatho weengcinezelo eziphambili. Isalathisi ngaphakathi kwemida yesiqhelo okanye i-overestimated ivumela ukuba ungene ngosuku ngaphandle kweyitha enye yesisombululo. Ngaphandle koko, kunokwenzeka ukukhupha umthwalo wenhliziyo okhulayo, ngelixa i-sodium egazini iya kuncipha kakhulu.

Ukufudumeza komzimba wesigulane ngeengubo okanye ukunyusa izinga lokushisa lomoya kwigumbi nge-1 degree. Akunjalo nantoni na inokufudumala okugulisayo kwesigulane ngeendlela ezahlukahlukeneyo ezitshisayo, ama-heaters. Oku kuya kubangela ukuhlaselwa kwe-pipeline vasodilation, i-vasodilation iya kwenzeka. Uxinzelelo lwe-arterial lunganciphisa ngakumbi nge-hypovolemia esondeleyo.

Ukulungiswa kwesimo senhliziyo . I-Hypothyroid coma iyingozi kakhulu kwinkqubo ye-cardiovascular system. Kwinqanaba lokuqala, kuyimfuneko ukuphatha i-bradycardia, ukuzinzisa uxinzelelo lwegazi. Ukuze unyango lwe-bradycardia, i-M-holinoblokatory (umzekelo, "i-Atropin") isetyenziswe, kungenzeka ukuba usebenzise i- "Eufillina". Ukuba uxinzelelo lwegazi alukwazi ukuzinza ngokulungiswa kwe-vascular hypovolemia, inkxaso yonyango iyimfuneko. Faka isicelo se-epinephrine, mezaton, noradrenaline. Nanku kuyimfuneko ukubonisa ingqwalasela enkulu, kuba uvelwano lwabafumana i-receptors lonyuswa ngonyango ngamahomoni we-thyroid gland. Ukuphazamiseka okunokwenzeka kwintliziyo yesigqirha, ukubonakaliswa kweempawu ze-fibrillation ye-orrial okanye i-tachycardia.

Ukulungiswa kweendleko ze-electrolyte (i-chlorine, i-sodium, i-calcium, i-potassium), kunye namazinga e-glucose egazi.

Sebenzisa (GCS) ye- glucocorticosteroids. Udweliso lwamaxinzelelo luyadingeka xa imisebenzi ye-correnx ye-adrenal igqityiweyo kwizigulane ezine-thyroiditis, ezavela kwimvelaphi yokusebenzisa ixesha elide lama-hormone, ngokuncipha kumazinga e-T3 kunye ne-T4, kunye nokuphulwa kwi-hypothalamic-pituitary system. Ngokuqhelekileyo, i-hydrocortisone ilawulwa nganye iiyure ezintandathu ekubaleni kwimizuzu emibini ye-200 ukuya ku-400 mg. Emva kokuba imeko yesigulane izinzile, emva kweentsuku ezimbini okanye ezintathu, idosi iyancipha.

I-hemodialysis ecacileyo, okanye unyango lwe-renal. Kuboniswa kwizigulane ezine-oligoanuria eziphambili, kunye nokukhula kwe-creinine, izinga le-urea, i-potassium.

Isigulane kufuneka siphathwe ngokukhawuleza. Ekuqaleni kudlula isigaba sokuqala, imisebenzi ebalulekileyo ibuyiselwa, ngokukhawuleza kuya kukhangela ukuqala unyango lwama-hormone. Amathuba okuphucula ayenyuka amaninzi.

2 isigaba

Kwinqanaba le-2 lonyango, imeko ye-hypothyroid coma isele enye. Apha, unyango lwe-hormone ye-thyroid iyadingeka.

Izixhobo eziphambili zilungiselelwe i-T4. "I-Levothyroxine" idla ngokulawulwa kwi-dose ye-1.8 μg / kg ngosuku. Emva kweeyure ezingama-6, isenzo siqala, kwaye umphumo opheleleyo ufezekileyo ngosuku. Ekuqaleni ngaphakathi kweyure kuboniswe kwi-100 ukuya kuma-500 μg yesilwanyana. Ukuqhubela phambili ngemini, i-dose yemihla ngemihla ihlala ilawulwa. Emva koko, umthamo wesondlo ngosuku u-75-100 μg. Emva kokuzinzisa isigulane, "Levothyroxine" imiselwe kwifomthi yefomati.

Kwimeko enzima, izidakamizwa ze-T3 zilawulwa ukusuka kwi-0.1 ukuya kwi-0.6 μg / kg ngosuku. Xa usuka kwi-75-100 mcg nganye iiyure ezili-12, i-12.5-25 mcg injected. Ukuba isigulane sinentsholongwane yomzimba, i-dose yemihla ngemihla isetyenziswa ubuncinci - 25-50 mcg.

Isigaba 3

Kwinqanaba lesi-3, emva kokuzinza kwesigulane sesigulane, unyango lwesifo esisisiseko luqala, obakhokelela ekuphuhliseni i-coma. Ingaba nayiphi na isifo esithintekayo okanye sokuvuvukala kwe-thyroid, intlungu kunye nezinye izinto.

I-Hypothyroid coma yimeko yokusongela isigulane. Iziphakamiso zonyango kufuneka ziqwalaselwe ngokuthe ngqo kwaye ziphunyezwe. Ngaphandle koko, iingxaki ezinzulu ezisongela ubomi zingenzeka. Ukuzivocavoca kweli phepha kuvinjelwe. Ukuba ukrokrela nayiphi na imiqondiso ye-coma, khangela uncedo lwezonyango ngokukhawuleza.

I-comrotoxic coma

I-Hypothyroid coma, okanye i- thyrotoxic crisis, inokuthi ingabikho kwimvelaphi ye-thyrotoxicosis enzima kwi- goiter ye-thyrotoxic engapheliyo . Ngokuqhelekileyo kuvela kwimvelaphi yeengxaki ze-neuropsychic, emva kokutshatyalaliswa kokugonywa kwe-thyroid gland. Iinkalo eziphambili ze-pathogenesis zi:

• Ukuxhuma ngokukhawuleza kumahomoni e-thyroid egazini.

• Hypoxia.

• Endotoxicosis.

• Ukutshatyalaliswa okunobungozi kwenkqubo ye-cardiovascular and nervous, i-supratrices, isibindi.

• Ukuphazamiseka kwamathambo kunye nokulinganisela kwamanzi-electrolyte.

Inkinga ye-thyrotoxic ilandele ukuphuhliswa kwe-coma. Isigulane sinempawu elandelayo: ukunyusa kwengqondo, ngokuhlala ihamba kunye neengcamango, i-delirium. Ukugubha kweengcambu, i-tachycardia (ukuya kwi-beats 200 ngomzuzu). Ubushushu bomzimba buya kuma-38-41 degrees. Ukukhupha okukhulu. Uhudo, ukuhlanza. Ku nokuba no-jaundice.

Ukuba akukho nonyango olwaneleyo, imeko yesigulane ibuhlungu kakhulu:

• Ukunciphisa uxinzelelo lwegazi;

• Isikhumba esomileyo;

• I-fibrillation ye-Atrial;

• Mydriasis;

• Cyanosis;

• Izibandezelo zeBharbar.

Kwenzeka ikhaliphe ingcinezelo, kwezihlunu kunciphisa, kukho ilahleko wolawulo isinyi, ukuphazamiseka isiqaqa, ukufa isiqaqa. ixabiso sokuhlola lwedatha imbali ebonisa ubukho thyrotoxicosis: tachycardia, ifiva, ukuncitshiswa ubunzima, ukugabha, iveze, urhudo lweenkcukacha.

Ekuhlalutyeni igazi abakufumana; kwenyuka of ihomoni, ayodini iiproteins-wambopha, yibilirubin (ngenxa kokutshatyalaliswa ityhefu kwesibindi), 17-oksiketosteroidov, lactic metabolic.

Kule meko isigulana kuyimfuneko ukubonelela uncedo olungxamisekileyo. Le misebenzi ilandelayo zifakwe kuwo:

• Yegazi ilawulwa isisombululo sodium chloride isotonic xa isixa welitha 1.

• Isisombululo se-5% glucose.

• "Hydrocortisone" xa kukho umthamo mg 350 ukuya 600.

• "Prednisolone" ukusuka 120 ukuya 180 mg.

• "Korglikon" okanye "StrofantinK" 0.5-1 ml.

• "Seduxen" okanye ezinye anticonvulsants.

• "Merkazolil" (iziyobisi antithyroid) - 60-80 mg ngosuku.

Ekuchongeni ogulayo mpawu zingasentla kufuneka ngoko nangoko call 'zeenqwelo zezigulane' kwaye isigulane esibhedlele kwi hormone kwiSebe.