Hypothyroid amaghị onwe: otú enye mberede na-elekọta?

Hypothyroidism bụ a dị ize ndụ ọrịa. Otu n'ime ndị kasị ugboro ugboro nsogbu ya bụ hypothyroid amaghị onwe ya. Ọtụtụ mgbe ọ na-eme okenye ọrịa, karịsịa na nwanyi. Amaghị onwe n'akparamagwa na otu nke ndị ọrịa na-ata ahụhụ hypothyroidism, anatagh mkpa ọgwụgwọ, ma ọ bụ ma ọ e rụrụ na oge.

Akpata hypothyroidism

Ihe ka nnọọ ọtụtụ nke ọrịa (95%) nke hypothyroidism e mere site enweghị nchịkwa Filiks aa na thyroid gland. Larịị nke mmepụta nke homonụ ebelata, bụ isi hypothyroidism amalite.

Mgbe imebi stimulatory na usoro iwu mmetụta nke pituitary TSH na tireoliberina (ma ọ bụ hypothalamic atọhapụ akpata) abịa abụọ hypothyroidism. The ugboro ole nke ya omume na n'ụzọ dị ukwuu ala karịa ndị bụ isi. Ndien ke akpanikọ, na ndị ọzọ mgbe e nwere ezughi oke ọgwụgwọ nwere ike ịzụlite hypothyroid amaghị onwe ya.

About elu hypothyroidism ajụjụ bụghị e edozi na ọtụtụ ụzọ. Ma ọ na-ebilite na njikọ na metabolic ọrịa na mpụta nke thyroid hormone ma ọ bụ n'ihi na uche Mbelata na akụkụ na anụ ahụ nke nuclear anabata maka thyroid homonụ?

Ọ na-anọgide a controversial ajụjụ banyere ma ọ bụ afọ iri na-eweda ha ala nke thyroid homonụ na-anaghị ekwe nke elu metabolism. Na ma irreversible phenomena hụrụ na thyroid gland na ịka nká usoro?

Hypothyroid amaghị onwe ya. ihe

Pathogenesis hypothyroid amaghị onwe ọtụtụ mgbe, na-egosi na rụrụ na-ezighị ezi ma ọ bụ nnwụchu ọgwụgwọ nke hypothyroidism. Part nke nkọwa nwere ike na-egbu oge na nchoputa. Erughi nke thyroid homonụ nwere ike enwe nnukwu site kagbuo n'ikuku nke levothyroxine ma ọ bụ organism na mkpa nke na-amụba doses nke hormone nnọchi. Hypothyroid amaghị onwe pụrụ iso kpata ọtụtụ ihe:

• Hypothermia.

• Concomitant ọrịa na (nkụchi obi, oyi baa, ọrịa strok, malitere ịrịa, urogenital na-efe efe).

• Ọbara gwụrụ, trauma, radieshon ọrịa, ịwa.

• X-ray nyochaa.

• Administration nke ọgwụ ọjọọ nke akụda Central ụjọ usoro.

• Large doses mmanya.

• Hypoglycemia.

• Hypoxia.

Ọ bụrụ na plummets larịị nke thyroid homonụ na ụbụrụ mbelata ọrụ nke metabolic n'ibu. N'ihi ya, na-amụba hypoxia, budata mebiri nile di iche iche nke metabolism, na ọtụtụ n'ime akụkụ nke kasị akụkụ.

Mgbaàmà nke hypothyroid amaghị onwe

amaghị onwe onu etịbe nwayọọ nwayọọ na-eto eto, na-enwe ọganihu nke nta nke nta. Ná mmalite, ike ọgwụgwụ na-egosi, enweghị mmasị, lethargy, mgbe ahụ, hụrụ N'ịdị coldness, nkụ, ọzịza nke ụkwụ, icha mmirimmiri akpụkpọ - àgwà ndị a na e ji hypothyroid amaghị onwe ya. Status lokalis egosi onye na-adịghị na-eku ume, na nsogbu na-urination, mgbaàmà nke obi ọdịda. Lowers ọbara mgbali, kemgbe enweghị akaị-aghọ nkọ. On nnyocha, onye ọrịa ahụ dọkịta na-ekwu, ndị na-esonụ mgbaàmà nke hypothyroid amaghị onwe:

• -Adị njọ metabolism, ahu arọ ụba mgbasa slows, okpomọkụ dara 35 degrees.

• E nwere nsogbu na obi usoro. The obi ọnụego slows ala, e nwere a thready usu, ebelata ọbara mgbali, edema nke obi.

• Imebi nke akụkụ okuku ume na ọrụ. Mbenata ọnụ ọgụgụ nke ume, na-ada ọbara oxygen etoju n'oge na-ehi ụra nwere ike ịkwụsị na-eku ume.

• Abnormalities na ụjọ usoro. Mgbochi nke akaị na-aghọ nkọ, na-aga n'ihu stupor.

• Skin mgbaàmà. Paleness, akọrọ, waxy akpụkpọ-aj u, nkwonkwo hyperkeratoses. Kenkuwa mbọ. Hair ọnwụ.

• Dara ke ọbara sodium etoju. ihu na nsọtụ Oké ọzịza.

• Anaemia, na niile na-ahụkarị ihe mgbaàmà nke ya.

• Hypoglycemia.

• Digestive ọrịa. ileus. Mụbara imeju.

ọgwụ

Clinic hypothyroid amaghị onwe bụ dị ka ndị: n'ebe a adịghị ike, iro ụra, budara ihe okpomọkụ 35 degrees. Slows ala, okwu na-akpọ indistinctly, belata ọhụụ na-anụ. Ọbara mgbali na-lowered, na usu - 30 gafere kwa nkeji. Iku ume na-emighị emi ma obere. Si afo - bloating, afọ ntachi, ihe mgbu, vomiting. E nwere mmepe nke oliguria. Skin icha mmirimmiri odo, na-akọrọ. Ozizi nke ihu, nsọtụ. Aghara, lethargy. The akaị na-aghọ nkọ na-anọghị. Abịa hypothyroid amaghị onwe ya.

Ọbara. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, acidosis, hematocrit, TSH, T3 na T4 zie cholesterol ụba.

Nsogbu: oyi baa, nnukwu ekpe ventricular ọdịda, encephalopathy, nnukwu gbasara akụrụ odida, gbasara obi arrhythmias, ọrịa strok, mgbaka, ileus.

The algọridim mbụ enyemaka

Ọ bụrụ na a onye hypothyroid Coma, nnukwu na-elekọta algọridim bụ dị ka ndị:

1. Prehospital:

• Kpọọ a dibịa. Iji nye mbụ ọgwụ enyemaka.

• Kechie blanket iji belata ahụ okpomọkụ.

• Iji kpochapụ hypoxia site dịghị òkè catheters enye humidified oxygen.

• Enye ohere ka veins na akwara catheter set.

Ọ bụrụ na arụnyere hypothyroid amaghị onwe si eme nurse kwesịrị doro anya, a na mmekota na Dr. - ngwa ngwa, a haziri nke ọma:

• Maka nchoputa nke nsogbu iri ọbara content thyroxine, thyroid na-akpali akpali hormone, triiodothyronine, glucose, cortisol, chloride, sodium, AAR, ndị gas mejupụtara.

• Iji ịchịkwa diuresis ẹkenịmde eriri afo catheterization.

• Iji gbochie ọchịchọ nke igbo na ẹkenam n'ime afo tube.

• Nchọpụta nsogbu - ECG nlekota akụkụ okuku ume na ọnụego, okpomọkụ, hemodynamics. "Reopoligljukin" igba ogwu n'akwara-atanye nke 500 ml.

• Detoxification - Shuga Bụ Glucose 40% w / ugboelu - 20-30 ml; mgbe / ntapu ndinọ glucose 5% (500 ml).

2. N'ụlọ ọgwụ:

• Maka nnọchi hormone erughị eru na / ugboelu ndinọ ọ bụla 6 awa 250-500 mcg "Thyroxine" (ma ọ bụ site na gavage 100 ug "triiodothyronine") sotere 12 awa iji belata dose of 25-100 micrograms.

• N'ihi enyemaka nke adrenal insufficiency na / ugboelu ndinọ hydrocortisone hemisuccinate (50-100 mg).

• N'ihi mgbochi encephalopathy 1 ml Vitamin B1.

• Maka edema bradycardia ndinọ s.c. "atropine" 0,1% (0.5-1 ml).

• Mmalite nke akụkụ okuku ume center - "Kordiamin" (2-4 ml).

• N'ihi enyemaka nke ụbụrụ hypoxia - "Mildronate" (250 mg).

• Iji gbochie na-efe efe - ọgwụ nje.

• Mkpochapu hypoxia - n'ibu ventilashion.

Hypothyroid amaghị onwe: mberede elekọta

Inye na mberede aka, ihe ọ bụla ikpe enweghị ike-eji na-ọkụ ọrịa warmers - a bụ n'ihi na-arịa ọrịa nke hemodynamics. "Triiodothyronine" bụghị agbara intravenously ozugbo iji zere ihe ize ndụ nke obi nsogbu. Large dose "Levothyroxine" ike nke na-akpali iche nnukwu adrenal insufficiency.

Ụlọ ọgwụ a na-rụrụ ke supine itie ke ọzụzụ kpụ ọkụ n'ọnụ na-elekọta unit ma ọ bụ ngalaba nke Endocrinology.

Ọ bụrụ na arụnyere hypothyroid Coma, mberede-elekọta na mbụ hour bụ site iwebata "triiodothyronine". Oxygen ọgwụ a kara aka. Intravenously ndinọ ọgwụ ọjọọ prednisone, hydrocortisone. Administration dị mkpa na obi ọgwụ ọjọọ.

Mgbe ọkara awa ga na-abanye ATP, vitamin C, B. Ọ bụrụ na nsogbu bụ n'elu 90 mmHg. Art., Mere iwebata "Lasix". Ọ bụrụ na ọbara mgbali bụ na-erughị ihe a na ọnụ ọgụgụ, na-eji "corazole", "Mezaton", "Kordiamin".

Ọzọkwa, ọ bụla 4 awa, dabere na onodu nke obi, na-ego nke 25 micrograms ndinọ "triiodothyronine". Ozugbo obi ọnụego na okpomọkụ na-Nọsi'ike, na onunu ogwu na-ebelata. Ọ dị mkpa ịnọgide na-n'ezinụlọ rewarming onye ọrịa, oxygen ọgwụ, ojiji, nke sodium hydroxybutyrate.

Ọ bụrụ na e a convulsive aghara, intravenously agbara "Seduxen".

Ọgwụgwọ: Stage 1

Ọgwụgwọ nke hypothyroid Coma, na-agụnyekarị ọtụtụ nzọụkwụ, ọ na-adịghị na-amalite ozugbo na hormone nnọchi ọgwụ. Ọgwụgwọ nke ọrịa a rụrụ nditịm n'okpuru nlekọta nke a dọkịta na iji tụtee mmadụ na kpụ ọkụ n'ọnụ na-elekọta unit.

Nzọụkwụ mbụ bụ na-akawanye izugbe-eme nke dị mkpa dị mkpa na ọrụ na ụbọchị mbụ ma ọ bụ abụọ, enweghị n'ihu ojiji nke hormone nnọchi ọgwụ ga-enweghị chọrọ mmetụta na ike ọbụna yie ọrịa ndụ

Ịnọgide na-enwe akụkụ okuku ume ọrụ. Ọ bụrụ na onye ọrịa bụ ike iku ume ya onwe ya, na KSCHN egosi ụgwọ atụrụ, ọkọnọ nke O ₂ (oxygen ọgwụ) a rụrụ site na a dịghị òkè cannula ma ọ bụ ihu nkpuchi. A, ọrịa nwere nsogbu nke n'amaghi-eku ume, carbon dioxide accumulates na ọbara. iji nke ngwaọrụ chọrọ maka n'ibu ventilashion. Ọ stabilizes ọbara oxygen na carbon dioxide, na-egbochi mmepe nke hypoxia, kwụsị ya na-ezighị ezi mmetụta na niile anụ ahụ na akụkụ.

Ukpụhọde volemic losses. Hypothyroid (myxedema) amaghị onwe ji ọmụmụ njigide. Ma eziokwu bụ na ọ na accumulates na interstices oghere, na vaskụla bed n'oge a nke na-ata ahụhụ, na e nwere a ọmụmụ mpe, n'ihi nke a, ọbara mgbali nwere ike idebe. Mgbazi e mere site a hypertonic ngwọta nke NaCl, colloidal na brine. N'oge usoro, ọ dị mkpa ka a tụlee larịị nke Central venous nsogbu. Display na nkịtị nso ma ọ bụ na-inflated enye ohere ntinye nke ihe karịrị otu liter ngwọta kwa ụbọchị. Ma ọ bụghị ya, o nwere ike ikpasu ụba gbasara obi ibu, na sodium na ọbara tụlee budata.

N'ezinụlọ kpo oku nke ọrịa ahụ site blanket ma ọ bụ dịkwuo ụlọ okpomọkụ site 1 ogo. Na ọ bụrụ na ọrịa na-apụghị jide ifịk kpo oku site dị iche iche na-ekpo ọkụ eyiri, warmers. Nke a ga-eduga a na-akawanye njọ nke elu vasodilation emee vasodilation. Ọbara mgbali nwere ike belata nke ahụ site na ikwu hypovolemia.

Mgbazi nke obi usoro. Hypothyroid amaghị onwe bụ a oké njọ igbu maka obi usoro. Nzọụkwụ mbụ bụ ọgwụgwọ nke bradycardia, ọbara mgbali stabilization. Maka ọgwụgwọ nke bradycardia M holinoblokatory eji (e.g., "atropine") nwere ike iji "aminophylline". Ọ bụrụ na ọbara mgbali ike ịgbanwe akawanye vaskụla hypovolemia, ọgwụ support dị mkpa. Applied adrenaline, phenylephrine, nọrepinefrini. Ebe a ị ga-abụ nnọọ anya, n'ihi na uche nke na-anabata ya bụ ụba na ọgwụgwọ nke thyroid hormone. Ekwe Omume obi n'afọ iri na ụma aghara, a na-egosi na ihe mgbaàmà nke atrial fibrillation ma ọ bụ tachycardia.

Mgbazi electrolyte arụmọrụ (chlorine, sodium, calcium, potassium), nakwa dị ka ọbara glucose larịị.

Iji (GCS) glucocorticosteroids. Nchegbu doses na-mkpa ike ọgwụgwụ nke adrenocortical ọrụ ọrịa na thyroiditis, nke pụtara na ndabere nke ogologo oge nke homonụ, na a ọnụ na-etoju nke T3 na T4 egosi, ọrịa na hypothalamic-pituitary usoro. A, hydrocortisone na-ndinọ ọ bụla awa isii kwa kwa ụbọchị dose nke 200 na 400 mg. Ozugbo ọrịa Nọsi'ike, mgbe abụọ ma ọ bụ ụbọchị atọ, e nwere a ọnụ na dose.

Nnukwu dialysis ma ọ bụ gbasara akụrụ nnọchi ọgwụ. Ọ na-owụt maka ọrịa na elu oligoanuria, ịba ụba creatinine, urea, potassium.

onye ọrịa ahụ ọgwụgwọ a ga-malitere ozugbo. The mee elu mee ọ ga-abụ nzọụkwụ mbụ iji weghachi chọrọ ọrụ nke ndụ, na mee elu mee ya ga-ekwe omume na-amalite hormone nnọchi ọgwụ. Ohere nke mgbake na-ụba ọtụtụ ugboro.

ogbo 2

2 ogbo ọgwụgwọ nke hypothyroid amaghị onwe ọnọdụ ugbua nwere ndị ọzọ. Nke a na-achọ a vicarious thyroid hormone ọgwụ.

The isi mmiri - T4 preparations. "Levothyroxine" na-emekarị e kenyere na a dose nke 1.8 mg / n'arọ kwa ụbọchị. N'ime 6 awa ihe amalite, na mgbe a ụbọchị zuru mmetụta na-enweta. Ná mmalite hour gosiri site na 100 na 500 micrograms nke ọgwụ. Ọzọkwa, n'oge ụbọchị ẹkenam ndị ọzọ nke kwa ụbọchị dose. Mgbe nke ahụ gasịrị, mmezi dose kwa ụbọchị bụ 75-100 micrograms. Mgbe onye ọrịa stabilization "Levothyroxine" ndinọ na mbadamba ụdị.

The oké egwu ọnọdụ T3 preparations ndinọ 0,1 ka 0,6 mg / n'arọ kwa ụbọchị. Na kwa ụbọchị 75-100 mg 6 ọ bụla awa na ẹkenam 12.5-25 .mu.g. Ọ bụrụ na onye ọrịa nwere ọrịa obi, kwa ụbọchị dose a na-eji nke kacha nta - 25-50 mg.

ogbo 3

Na nzọụkwụ 3, mgbe stabilization onye ọrịa, na-amalite usoro ọgwụgwọ nke kpatara ọrịa, bụ nke mere ka mmepe nke amaghị onwe ya. Nke a pụrụ ịbụ ọ bụla ọrịa ma ọ bụ mbufụt nke thyroid gland, trauma, na ihe ndị ọzọ.

Hypothyroid amaghị onwe - onye ọrịa ahụ na-egbu ọnọdụ. Medical ndụmọdụ ga-nditịm hụrụ na-emejuputa atumatu. Ma ọ bụghị ya, nwere ike ime oké nsogbu,-eyi ndụ egwu. Self-ọgwụ na nke a na-nditịm ajuru aju. Ọ bụrụ na obi abụọ ọ bụla banyere amaghị onwe mgbaàmà ozugbo-achọ ọgwụ anya.

thyrotoxic amaghị onwe

Hypothyroid Coma, ma ọ bụ thyrotoxic nsogbu, nwere ike ime n'iru oké hyperthyroidism na untreated thyrotoxic goiter. Ọtụtụ mgbe nke a emee megide a ndabere nke psychological nchegbu mgbe ịwa ahụ mwepụ nke thyroid gland. Isi pathogenesis - bụ:

• The nkọ na-awụlikwa elu na thyroid homonụ na ọbara.

• Hypoxia.

• Endotoxemia.

• Nsí Achọ mmebi nke obi na ụjọ usoro, nadpochesnikov imeju.

• Mebiri nke cellular metabolism na mmiri na electrolyte itule.

Thyrotoxic nsogbu tupu mmepe nke amaghị onwe ya. Onye ọrịa nwere ndị na-esonụ mgbaàmà na-kwuru, sị: iche echiche obi ụtọ, na-esokarị site na ịmụ anya arọ nrọ, nkwenkwe ụgha. N'ịdị tremor, tachycardia (ruo 200 gafere kwa nkeji). Ahu okpomọkụ adahade 38-41 degrees. Arọ sweating. Afọ ọsịsa, vomiting. Ikekwe ọdịdị jaundice.

Ọ bụrụ na e nweghị ezigbo ọgwụ, ọrịa na-arịa njọ n'ike n'ike:

• ẹsụhọde ọbara mgbali;

• akọrọ akpụkpọ;

• atrial fibrillation;

• mydriasis;

• cyanosis;

• bulbar ọrịa.

Eme mmegbu na-aghọ nkọ, Akwara ụda mbelata, e nwere a ọnwụ nke eriri afo akara, nsụhọ ọrịa, amaghị onwe ya. Diagnostic uru nwere a akụkọ ihe mere eme data-egosi na ọnụnọ nke thyrotoxicosis: tachycardia, fever, ibu Mbelata, vomiting, erughị ala, profuse afọ ọsịsa.

Na analysis of ọbara hụrụ: nhapụ thyroid hormone, protein-agbụ ayodiin, bilirubin (n'ihi mbibi nke imeju nsí), 17 na-oksiketosteroidov, metabolic acidosis.

Na steeti a na-enwe ndidi dị mkpa iji nye mberede aka. Ndị na-esonụ na-eme na-gụnyere ke ya:

• Intravenously ndinọ isotonic sodium chloride ngwọta ke ichekwa 1 liter.

• A ngwọta nke 5% glucose.

• "Hydrocortisone" na a onunu ogwu nke 350 na 600 mg.

• "Prednisolone" si 120 ruo 180 mg.

• "Korglikon" ma ọ bụ "StrofantinK" 0.5-1 ml.

• "Seduxen" ma ọ bụ ndị ọzọ anticonvulsants.

• "Merkazolil" (antithyroid ọgwụ) - 60-80 mg kwa ụbọchị.

Na-akọwapụta onye ọrịa n'elu mgbaàmà kwesịrị ozugbo akpọ "ụgbọ ihe mberede" ma onye ọrịa n'ụlọ ọgwụ na Endocrinology Department.