Ikhoma Hypothyroid: kanjani ukunikeza usizo oluphuthumayo?

I-Hypothyroidism yisifo esiyingozi. Enye yezinkinga zayo njalo i-hypothyroid coma. Ngokuvame ukwenzeka kubagulayo asebekhulile, ikakhulukazi kwabesifazane. I-coma iqala kulelo qembu leziguli, ezihlukunyezwa yi-hypothyroidism, ezingazange zithole ukwelashwa okudingekayo, noma zenziwa ngendlela engafanele.

Izimbangela ze-hypothyroidism

Esikhathini esiningi iziguli (kuze kube ngu-95%) i-hypothyroidism ibangelwa izinqubo ze-pathological ezenzeka ku-gland yegciwane. Izinga lokukhiqiza kwe-hormone liyehla, i-hypothyroidism eyinhloko iqala.

Ukwephula imiphumela evuselelayo neyokulawula ye-pituitary thyrotropin, kanye ne-thyroidiborin (noma i-hypothalamic release factor), i- hypothyroidism yesibili ikhona . Ukuvama kwesimo salo kukhulu kakhulu ngaphansi kokuqala. Futhi kulokho, futhi kwezinye izimo ezingenokwanele ukwelashwa, i-hypothyroid coma ingahlakulela.

E-peripheral hypothyroidism, umbuzo awukaxazululwa ngezindlela eziningi. Ingabe iphakama ngokuphathelene nokuphazamiseka kwamagciwane emkhakheni we-hormone yegciwane noma ngenxa yokunciphisa ubuzwe ezithombeni nasezicukwaneni ze-nuclear reactor kuya kumahomoni e-thyroid?

Umbuzo uhlala ukuthi ukudilizwa okuhlobene nobudala we-hormone ye-thyroid kwenzeka enkingeni ye-metabolism yangaphakathi. Futhi ingabe zikhona izinto ezingenakuphika ezingqondweni ezingakapheli ekuguleni kwegciwane ekugugeni?

I-Hypothyroid coma. Izimbangela

I-pathogenesis ye-hypothyroid coma ezimweni eziningi ibonisa ukuthi ukwenziwa kokwelashwa okwanele noma okungakafiki kwe-hypothyroidism. Ngokuvamile incazelo ingase ibe isifo sokuxilongwa. Ukwehluleka kwamahomoni e-thyroid kungagxila ngokuxoshwa kwe-levothyroxine noma isidingo somzimba sokwanda kwamanani ama-hormone asetshenzisiwe. I-Hypothyroid coma ingabangela izici eziningana:

• Ukuhlukumeza.

• Izifo ezihambisanayo (ukushaya kwenhliziyo, ukuphazamiseka kwesifo sofuba, ukushaywa yisifo sofuba, ukwelashwa kwegciwane, ukutheleleka kwe-urogenital).

• Ukulahleka kwegazi okukhulu, ukuhlukumezeka, ukwelashwa kwemisebe, ukungenelela kokuhlinzwa.

• Ukuhlolwa kwe-X-ray.

• Ukuthatha imithi ecindezela isimiso sezinzwa eziphakathi.

• Izindleko ezinkulu ezidakayo.

• Hypoglycemia.

• I-Hypoxia.

Uma izinga lamahomoni e-thyroid liwela ngokuqinile, umsebenzi wezinqubo ze-metabolic wehla ebuchosheni. Ngenxa yalokho, i-hypoxia iyanda, zonke izinhlobo ze-metabolism nemisebenzi eminingi yezinhlobo eziningi zingasebenzi kahle.

Izimpawu ze-hypothyroid coma

I-phenomenon ye-coma ivela kancane kancane, iyanda, iqhubeka kancane kancane. Ekuqaleni, ukukhathala, ukungazwakali, ukuvimbela ukubonakala, ukushisa kwamalungu, ukuma, ukukhukhumeza kwezinyawo, ubuhlungu besikhumba - lezi zimpawu zibhekwa yi-hypothyroid coma. Isimo se-localis sibonisa ukuphefumula okuphuthumayo, inkathazo ngokuchama, ukubonakaliswa kokuhluleka kwenhliziyo. Ukucindezela komzimba kunciphisa, ukungabi khona kwethenda ye-tendon reflexes kuqinisekisiwe. Lapho ehlola isiguli, udokotela ubona lezi zimpawu ezilandelayo ze-hypothyroid coma:

• I-metabolism iyadlula, isisindo somzimba sanda, ukujikeleza kwehla, izinga lokushisa lihla emazingeni angu-35.

• Kukhona ukwephulwa esimisweni senhliziyo. Izinga lentliziyo liyehla, umshini onjengezintambo, ukwehla kwengcindezi yegazi, kubika inhliziyo enhle.

• Ukungasebenzi komsebenzi wokuphefumula. Inombolo yokuphefumulela-ukuphefumula kuncishisiwe, izinga le-oksijini egazini liyancipha, ngesikhathi sokulala, ukuphefumula kuyayeka.

• Ukuphulwa kwemisebenzi yesimiso sezinzwa. Ukuvinjelwa kwe-tendon reflexes, ukuqhubekela phambili okuqhubekayo.

• Izimpawu zesikhumba. I-peal, eyomile, i-waxy tones tones, i-articular hyperkeratosis. Ukuhlukana kwezipikili. Ukulahlekelwa izinwele.

• Izinga le-sodium egazini lehla. Kuthiwa i-edema ebusweni nasemaphethelweni.

• I-anemia nazo zonke izimpawu zayo.

• Hypoglycemia.

• Ukuphazamiseka kokugaya. Ukuvimbela emathunjini. Isibindi esandisiwe.

Umtholampilo

Umtholampilo we-hypothyroid coma kanje: ubuthakathaka, ukulala, izinga lokushisa liyehla ku-degrees 35. Inkulumo iyancipha, amazwi akhulunywa ngokucacile, umbono nokuphuluka kwezindlebe. Ukucindezela komzimba kunciphisa, ukushayela - kuya ku-30 ukushaya ngomzuzu. Ukuphefumula kuyinto engavamile futhi engavamile. Kusukela emgodleni wokugaya - flatulence, ukuqotshwa, ubuhlungu, ukuhlanza. Kukhona ukuthuthukiswa kwe-oliguria. Isikhumba siphuziphukile, somile. Ukuvuvukala ubuso, izitho. Ukudideka, ukuvimbela. I-Tendon reflexes ayitholakali. Iza ne-coma hypothyroid.

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

Izinkinga: i- pneumonia, ukwehluleka okukhulu kwe-ventricular kwesokunxele, ukuphazamiseka kwengqondo, i-arthritis, ukuphazamiseka kwenhliziyo, i-ONMI, ukucindezeleka kwengqondo, ukuvimbela emathunjini.

I-Algorithm yokunakekelwa okuphuthumayo

Uma umuntu ene-hyparoid coma, i-algorithm yesikhashana esiphuthumayo inokulandelayo:

1. Isigaba sangaphambi kwesibhedlela:

• Shayela udokotela. Nikeza usizo lokuqala lwezokwelapha.

• Gcoba umzimba ngezingubo ukuze unciphise ukushisa kokushisa.

• Ukuqeda i-hypoxia nge-catheters yama-nasal inikeza umoya-mpilo omanzi.

• Nikeza ukufinyelela emithanjeni, sakha i-catheter ye-vein.

Uma kutholakala i-hypothyroid coma, amaqhinga womhlengikazi kufanele ahlanzeke, esebenza kanye nodokotela - okusheshayo, oqondiswe kahle:

• Ukuze uhlolisise izinkinga, thatha i-blood okuqukethwe kwe-thyroxine, thyrotropin, i-triiodothyronine, i-glucose, i-cortisol, i-chloride, i-sodium, i-KCHR, isakhi segesi.

• Ukuqapha i-diuresis, isilonda sinamakhemikhali.

• Ukuvimbela isifiso sokuhlanza, i-probe ifakwe esiswini.

• Ukuze kutholakale izinkinga - ECG, ukuqapha i-HDR, izinga lokushisa, i-hemodynamics. "I-Reopoliglyukin" engena-500 ml.

• Ukwehliswa kwegazi - i-glucose 40% ngaphakathi / ku-jet - 20-30 ml; Khona-ke i-iv glucose i-5% (500 ml) ifakwe ngaphakathi kwangaphakathi.

Esibhedlela:

• Ukufaka esikhundleni sokuntuleka kwama-hormone ku / struino njalo ngamahora angu-6 250-500 μg we-thyroxin (noma nge- probe yesisu engu-100 μg ye-Triiodothyronine) ijojowe, bese emva kwamahora angu-12 umthamo uyancipha ube ngu-25-100 μg.

• Ukuze kutholakale ukungenwa kahle kwe-adrenal in / i-hydrocortisone ijojected hydrocortisone hemisuccinate (50-100 mg).

• Ukuze kuvikelwe ukwelashwa kwe-encephalopathy 1 ml we-vitamin B1.

• Ukubopha i-bradycardia, injectedly "Atropine" 0.1% (0.5-1 ml).

• Ukukhuthazwa kwesikhungo sokuphefumula - "Cordiamin" (2-4 ml).

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

• Ukuze kuvikelwe izifo - ama-antibiotics.

• Ukuqeda i-hypoxia - umoya wokuvuthwa wokufakelwa.

I-Hypothyroid coma: ukunakekelwa okuphuthumayo

Ukuhlinzeka ngosizo oluphuthumayo, kungenjalo kungashushumbisa izifudumala zokusebenzisa iziguli - lokhu kungenxa yokuwohloka kwe-hemodynamics. "I-Triiodothyronine" ayitholakali ngokushesha ngenhloso yokugwema ingozi yezinkinga zenhliziyo. Umthamo omkhulu we "Levothyroxine" ungabangela ukungaqiniseki okunamandla okunamandla.

Ukwakhiwa kwezibhedlela kunesimo esithandwayo esikhungweni sokunakekelwa okujulile noma emnyangweni we-endocrinology.

Uma kutholakala i-hypothyroid coma, usizo oluphuthumayo ehoreni lokuqala luhlinzekwa ngokusungulwa kwe "Triiodothyronine". Ukwelashwa kwe-oksijeni kunqunywe. Izidakamizwa ezilawulwa ngokungenakudliwa prednisolone, i-hydrocortisone. Kudingeka futhi ukwethula izidakamizwa zenhliziyo.

Ngemuva kwesigamu sehora, kuyadingeka ukwethula i-ATP, amavithamini C, B. Uma ingcindezi ingaphezulu kuka 90 mm Hg. Ukwethulwa kwe "Lasix" kwenziwa. Uma ingcindezi yegazi ingaphansi kwalesi sibonakaliso, "Corazol", "Mezaton", "Cordiamin" isetshenziswa.

Khona-ke, njalo amahora amane, kuye ngokuthi isimo senhliziyo, ngesamba sama 25 μg sethula "i-Triiodothyronine". Uma iziphazamiso zenhliziyo kanye nokushisa kuzinzile, umthamo wehlisa. Kubalulekile ukuqhubeka nokufudumala isiguli, ukwelapha oksijini, ukusebenzisa i-oxybutyrate ye-sodium.

Uma kukhona i-convulsive syndrome, i- "Seduxen" ijojowe ngaphakathi.

Ukwelashwa: Isigaba 1

Ukwelashwa kwe-hypothyroid coma, njengomthetho, kuhlanganisa izigaba eziningana, akuqali ngokushesha nge-hormone therapy esikhundleni. Ukwelashwa kweziguli kwenziwa ngokucophelela ngaphansi kokuqondiswa komuntu ovuselelekile ekamelweni lokunakekelwa okukhulu.

Esigabeni sokuqala, izinyathelo ezijwayelekile zithathwa ukuze kuqiniswe imisebenzi ebalulekile ebalulekile ngosuku lokuqala noma ezimbili, ngaphandle kokusetshenziswa kwazo kwe-hormone yokwelashwa esikhundleni sokuthi ngeke kube nomphumela omuhle futhi kungasongela impilo yesiguli

Ukugcinwa kwemisebenzi yokuphefumula. Uma isiguli ngokwakhe sikwazi ukuphefumula futhi imingcele ye-KSHN ihlawuliswa, ukunikezwa kwe-O ₂ (ukwelapha oksijini) kwenziwa nge-cannula yomlomo noma ubuso obuso. Njengomthetho, iziguli zithola ukuphazamiseka kokuziphefumula, i-carbon dioxide iqoqa egazini. Kudingeka ukuthi usebenzise idivaysi ye-ventilation yokufakelwa. Lokhu kugcizelela izinga le-oxygen ne-carbon dioxide egazini, kuvimbela ukuthuthukiswa kwe-hypoxia, kuqeda umthelela omubi kuzo zonke izicubu nezitho.

Ukulungiswa kokulahlekelwa kwe-vollemic . I-Hypothyroid (i-myxedematous) i-coma ibonakala ngokugcina amanzi. Kodwa iqiniso liwukuthi liqoqa ezindaweni zokuhlala, umbhede wamathambo ngalesi sikhathi uhlupheka, futhi kukhona ukuntuleka kwamanzi, ngakho-ke, ukucindezeleka kwegazi kungase kwehle. Ukulungiswa kwenziwa ngesisombululo se-hypertonic se-NaCl, izixazululo ze-colloidal nosawoti. Phakathi nenqubo kubalulekile ukucabangela izinga lokucindezela okuphakathi komzimba. I-indicator ngaphakathi kwemingcele yesijwayelekile noma i-overestimated ivumela ukungena ngosuku ngaphandle kweyodwa ilitha lesisombululo. Uma kungenjalo, kungenzeka ukuvusa umthwalo wenhliziyo okhulayo, kanti i-sodium egazini izokwehla kakhulu.

Ukushisa okunamandla komzimba wesiguli ngamabhodlela noma ukwandisa izinga lokushisa lomoya ekamelweni ngezinga eli-1. Ngaphandle kwalokho kungaba ukufudumala okusebenzayo kwesiguli esinamafutha ahlukahlukene atshisayo, ama-heaters. Lokhu kuzoholela ekukhusheni kwe-vipidal veterdilation, i-vasodilation izokwenzeka. Ukucindezela komzimba kunganciphisa ngisho nangaphezulu nge-hypovolemia ehlobene.

Ukulungiswa kwesimiso senhliziyo . I-Hypothyroid coma iyisimo esibi kakhulu esimisweni senhliziyo. Esigabeni sokuqala, kubalulekile ukuphatha i-bradycardia, ukuqiniswa kwengcindezi yegazi. Ukuze uthole ukwelashwa kwe-bradycardia, i-M-holinoblokatory (isibonelo, "Atropin") isetshenziselwa, kungenzeka ukusebenzisa i- "Eufillina". Uma ukucindezeleka kwegazi kungenakuqiniswa ngokulungiswa kwe-vascular hypovolemia, ukusekela izidakamizwa kuyadingeka. Faka isicelo se-epinephrine, i-mezaton, ne-noradrenaline. Nakhu kuyadingeka ukukhombisa ukunakwa okukhulu, ngoba ukuzwela kwe-receptors kwandiswe ukwelapha ngamahomoni wegciwane le-thyroid. Ukuphazanyiswa okungenzeka komculo wenhliziyo, ukubonakaliswa kwezimpawu ze-fibrillation ye-atrial noma i-tachycardia.

Ukulungisa ama-indices e-electrolyte (i-chlorine, i-sodium, i-calcium, i-potassium), kanye namazinga we-glucose wegazi.

Sebenzisa (GCS) ye- glucocorticosteroids. Izindleko zokucindezeleka ziyadingeka lapho imisebenzi ye-cortex ephezulu iphela ezigulini ezine-thyroiditis, ezavela ngemuva kokusetshenziswa kwama-hormone isikhathi eside, ngokunciphisa emazingeni ka-T3 no-T4, ngokungajwayelekile ohlelweni lwe-hypothalamic-pituitary. Ngokuvamile, i-hydrocortisone ilawulwa njalo amahora ayisithupha ekubalweni komthamo wansuku zonke we-200 kuya ku-400 mg. Ngemuva kokuthi isimo sesiguli sizinzile, emva kwezinsuku ezimbili noma ezintathu, umthamo wehlisa.

I-hemodialysis elula, noma ukwelashwa kwe-renal. Kuboniswa iziguli ezine-oligoanuria eziphambili, ngokukhula kwe-creatinine, izinga le-urea, i-potassium.

Isiguli kufanele siphathwe ngokushesha. Esikhathini esidlule sidlula esigabeni sokuqala, imisebenzi ebalulekile ibuyiselwa, ngokushesha kuzokwazi ukuqala ukwelashwa kwe-hormone esikhundleni. Amathuba okuvuselela akhula izikhathi eziningi.

2 isigaba

Esigabeni 2 sokwelashwa, isimo se-hypothyroid coma sesivele sinomunye. Lapha, kudingeka ukwelapha i-hormone ye-thyroid.

Izingxenye eziyinhloko yizilungiso ze-T4. "I-Levothyroxine" ivame ukuphathwa ngesilinganiso sika 1.8 μg / kg ngosuku. Emva kwamahora angu-6, isenzo siqala, futhi umphumela ogcwele utholakala ngosuku. Ekuqaleni kungakapheli ihora eliboniswe kusuka ku-100 ukuya ku-500 μg yomuthi. Ukuqhubeka phakathi nosuku, i-dose yansuku zonke esele ilawulwa. Ngemuva kwalokho, umthamo wesondlo ngosuku nguku-75-100 μg. Emva kokuqinisa isiguli, "Levothyroxine" inqunywe kwifomu yethebhulethi.

Esimweni esinzima, izidakamizwa ze-T3 zenziwa kusukela ku-0.1 ukuya ku-0.6 μg / kg ngosuku. Lapho usuka ku-75-100 mcg njalo ngamahora angu-12, i-12.5-25 mcg ifakwe. Uma isiguli sinesifo senhliziyo, i-dose yansuku zonke isetshenziswa okungenani - 25-50 mcg.

Isigaba 3

Esigabeni sesithathu, emva kokuqiniswa kwesimo sesiguli, ukwelashwa kwesifo esiyisisekelo kuqala, okwaholela ekuthuthukiseni i-coma. Kungaba yisiphi isifo esithathelwanayo noma sokuvuvukala kwegciwane le-thyroid, ukuhlukunyezwa nezinye izici.

I-Hypothyroid coma yisimo esongela impilo yesiguli. Izincomo zezokwelapha kumele zigcinwe ngokucophelela futhi zisetshenziswe. Uma kungenjalo, izinkinga ezinkulu ezisongela ukuphila zingase zenzeke. Ukuzivocavoca kuleli cala akuvumelekile neze. Uma usola izimpawu ze-coma, funa usizo lwezokwelapha ngokushesha.

I-coma ye-thyrotoxic

I-Hypothyroid coma, noma inkinga ye-thyrotoxic, ingenzeka ngokumelene nesizinda se-thyrotoxicosis enzima ku- goiter ye-thyrotoxic engelashwa . Ngokuvamile kwenzeka ngemuva kwezinkinga ze-neuropsychic, ngemva kokukhishwa kwe-gland yegciwane. Izixhumanisi eziyinhloko ze-pathogenesis ziyi:

• Ukugxuma okubukhali emahomoni wegciwane egazini.

• I-Hypoxia.

• Endotoxicosis.

• Ukunqotshwa okunobuthi kwesimiso senhliziyo nesishukela, isifo sofuba, isibindi.

• Ukuphazanyiswa kwesimiso se-cell kanye nesilinganiso samanzi-electrolyte.

Inkinga ye-thyrotoxic ingaphambi kokuthuthukiswa kwe-coma. Isiguli sinempawu elandelayo: ukucindezeleka kwengqondo, okuvame ukuhambisana nama-hallucinations, delirium. Ukudabuka kwamaphethelo, i-tachycardia (kuze kube ngu-200 beats ngomzuzu). Ukushisa komzimba kuphakama ku-38-41 degrees. Ukuthuthumela okukhulu. Uhudo, ukuhlanza. Kungase kube no-jaundice.

Uma kungekho ukwelashwa okwanele, isimo sesiguli sibheka ngokuphawulekayo:

• Ukunciphisa ukucindezelwa kwegazi;

• Isikhumba esomile;

• I-fibrillation ye-Atrial;

• I-Mydriasis;

• I-Cyanosis;

• Izinkinga ze-bulbar.

Happens ukucindezelwa ikhaliphe, imisipha ithoni incipha, kukhona ukulahlekelwa ukulawula esinyeni, ukwazi neziyaluyalu, equlekile. Inani Yokucwaninga abe idatha umlando eveza khona thyrotoxicosis: tachycardia, imfiva, isisindo ukunciphisa, ukuhlanza, ukungahlaliseki, uhudo kakhulu.

Ekuhlaziyeni wegazi wathola: anda amanani we-hormone yegilo, iodine amaprotheni-bound, bilirubin (ngenxa ukubhujiswa ubuthi kwesibindi), 17-oksiketosteroidov, lactic umzimba.

Kuleli zinga isiguli kuyadingeka ukuze sinikeze usizo oluphuthumayo. Lemisebenti lelandzelako afakiwe kuwo:

• Ngemithambo yegazi iqondiswa isotonic isixazululo sodium chloride e isamba 1 ilitha.

• Isixazululo 5% glucose.

• "Hydrocortisone" endaweni umthamo mg 350 kuya kwangu-600.

• "Prednisolone" kusuka 120 kuya ku-180 mg.

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

• "Seduxen" noma ezinye anticonvulsants.

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

Ekukhombeni isiguli izimpawu ngenhla kufanele ngokushesha shayela "ambulensi" kanti isiguli esibhedlela uMnyango Endocrinology.