Hypothyroidism yog ib yam kab mob txaus ntshai. Ib qho ntawm nws cov teeb meem nquag yog hypothyroid coma. Nws feem ntau tshwm sim hauv cov neeg laus, tshwj xeeb tshaj yog cov poj niam. Coma tshwm sim nyob rau hauv pab pawg neeg ntawm cov neeg mob uas, muaj kev txom nyem los ntawm hypothyroidism, tsis tau txais kev kho mob tsim nyog, los yog nws twb nqa tawm lub sij hawm.
Ua rau hypothyroidism
Hauv feem coob ntawm cov neeg mob (txog 95%), hypothyroidism yog tshwm sim los ntawm cov txheej txheem pathological tshwm sim hauv cov thyroid caj pas. Cov qib ntawm cov tshuaj hormones txo qis, thawj hypothyroidism tsim.
Ua txhaum ntawm kev txhawb nqa thiab tswj cov teebmeem ntawm pituitary thyrotropin, nrog rau thyreoliberin (los yog hypothalamic releasing factor), theem nrab hypothyroidism tshwm sim. Qhov zaus ntawm nws qhov tshwm sim yog qhov qis dua rau qhov pib. Hauv ob qho xwm txheej, nrog kev kho mob tsis txaus, qhov mob hypothyroid coma tuaj yeem tshwm sim.
Hais txog peripheral hypothyroidism, qhov teeb meem tseem tsis tau daws tau ntau yam. Nws puas tshwm sim vim muaj cov kab mob metabolic hauvLub periphery ntawm cov thyroid hormones los yog vim qhov txo qis hauv cov khoom nruab nrog cev thiab cov ntaub so ntswg ntawm nuclear receptors rau cov thyroid hormones?
Nws tseem yog cov lus nug tsis txaus ntseeg seb puas muaj hnub nyoog cuam tshuam txog qib ntawm cov thyroid hormones tshwm sim hauv kev ua txhaum ntawm peripheral metabolism. Thiab puas yog qhov tshwm sim tsis tuaj yeem pom hauv cov thyroid caj pas thaum laus?
Hypothyroid coma. Yog vim li cas
Lub pathogenesis ntawm hypothyroid coma feem ntau qhia tau tias kev kho mob tsis txaus lossis tsis raws sijhawm ntawm hypothyroidism tau ua tiav. Feem ntau cov lus piav qhia tuaj yeem yog qhov kev kuaj mob qeeb. Cov thyroid hormone deficiency tuaj yeem ua rau hnyav dua los ntawm kev tshem tawm ntawm levothyroxine lossis lub cev xav tau kev nce ntxiv ntawm cov tshuaj hormones hloov. Ntau yam tuaj yeem ua rau hypothyroid coma:
- Hypercooling.
-
Cov kab mob sib kis (lub plawv nres, mob ntsws, mob stroke, kab mob, kab mob urogenital).
- ntshav poob ntau, raug mob, xov tooj cua, phais.
- X-ray kev xeem.
- Kev noj tshuaj uas ua rau lub hauv siab hauv nruab siab.
- High alcohol doses.
- Hypoglycemia.
- Hypoxia.
Yog tias qib ntawm cov thyroid hormones poob qis, cov haujlwm ntawm cov txheej txheem metabolic hauv lub hlwb txo qis. Raws li qhov tshwm sim, hypoxia nce ntxiv, txhua yam ntawm cov metabolism thiab ntau lub zog cuam tshuam loj heev.feem ntau lub cev.
Cov tsos mob ntawm hypothyroid coma
Qhov tshwm sim ntawm coma tshwm sim maj mam, nce, nce zuj zus. Thaum pib, qaug zog, apathy, lethargy tshwm sim, tom qab uas muaj ib tug txias ntawm extremities, dryness, o ntawm txhais taw, pallor ntawm daim tawv nqaij - cov cim qhia ntawm hypothyroid coma. Cov xwm txheej ntawm localis qhia tias ua pa qeeb, teeb meem nrog kev tso zis, tshwm sim ntawm lub plawv tsis ua haujlwm. Arterial siab txo qis, qhov tsis muaj tendon reflexes tau hais. Thaum kuaj tus neeg mob, tus kws kho mob saib cov tsos mob hauv qab no ntawm hypothyroid coma:
- Metabolism zuj zus, lub cev hnyav nce, ntshav ncig qeeb, ntsuas kub poob mus rau 35 degrees.
- Muaj kev cuam tshuam hauv cov hlab plawv. Lub plawv dhia qeeb qeeb, muaj cov xov paj hlwb, txo cov ntshav siab, lub plawv dhia.
- Ua pa tsis ua haujlwm. Tus naj npawb ntawm kev ua tsis taus pa txo, theem ntawm cov pa oxygen hauv cov ntshav poob, ua tsis taus pa thaum pw tsaug zog.
- Kev cuam tshuam hauv kev ua haujlwm ntawm lub paj hlwb. Inhibition ntawm tendon reflexes, nce stupor.
- Cov tsos mob ntawm daim tawv nqaij. Paleness, dryness, waxy daim tawv nqaij tones, articular hyperkeratosis. Cov ntsia hlau. Cov plaub hau poob.
- Qib sodium hauv cov ntshav poob. Qhov mob o ntawm lub ntsej muag thiab ceg ceg.
- Anemia thiab tag nrho nws cov tsos mob.
- Hypoglycemia.
- Kev tsis sib haum xeebkev zom zaub mov. plab hnyuv obstruction. Lub siab loj.
Clinic
Lub tsev kho mob ntawm hypothyroid coma yog raws li nram no: qaug zog, tsaug zog tshwm sim, qhov kub thiab txias poob mus rau 35 degrees. Kev hais lus qeeb qeeb, cov lus tsis txaus ntseeg, tsis pom kev thiab hnov lus qis. Arterial siab yog qis, mem tes - txog 30 neeg ntaus ib feeb. Ua tsis taus pa yog ntiav thiab tsawg. Los ntawm txoj hnyuv - flatulence, cem quav, mob, ntuav. Kev loj hlob ntawm oliguria tau pom. Cov tawv nqaij yog daj ntseg daj, qhuav. o ntawm lub ntsej muag, caj dab. Tsis meej pem ntawm kev nco qab, lethargy. Tendon reflexes tsis tuaj. Hypothyroid coma teeb nyob rau hauv.
ntshav. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, acidosis, hematocrit, TSH, T3 thiab T4 txo qis, cov roj cholesterol yog nce.
Cov Teeb Meem: mob ntsws, mob sab laug ventricular tsis ua haujlwm, encephalopathy, mob raum tsis ua haujlwm, mob plawv arrhythmias, mob stroke, dementia, plab hnyuv obstruction.
Kev kub ntxhov ceev
Yog tias ib tus neeg muaj mob hypothyroid coma, cov txheej txheem saib xyuas xwm txheej ceev yog raws li hauv qab no:
1. Prehospital:
- Hu rau tus kws kho mob. Muab kev pab thawj zaug.
- Muab koj lub cev rau hauv daim pam kom txo tau cov cua sov.
- Txhawm rau tshem tawm cov hypoxia, muab cov pa oxygen los ntawm qhov ntswg catheters.
- Tau nkag mus rau cov leeg, tso catheter rau hauv cov leeg.
Yog tias tus mob hypothyroid coma tau tsim, cov tswv yim ntawm tus kws saib xyuas neeg mob yuav tsum paub meej, kev sib koom tes nrog tus kws kho mob yuav tsum ceev,zoo-coordinated:
- txhawm rau kuaj mob, noj ntshav rau cov ntsiab lus ntawm thyroxine, thyrotropin, triiodothyronine, qabzib, cortisol, chlorides, sodium, KShchR, roj muaj pes tsawg leeg.
- Lub zais zis catheterization yog ua los tswj diuresis.
- Yuav kom tiv thaiv kom ntuav, ib qho kev sojntsuam muab tso rau hauv plab.
- Rau qhov kev kuaj mob ntawm cov teeb meem - ECG, tswj kev ua pa, ntsuas kub, hemodynamics. "Reopoliglyukin" intravenous drip 500 ml.
- Detoxification - qabzib 40% IV bolus - 20-30 ml; Tom qab ntawd cov piam thaj 5% (500 ml) yog txhaj rau hauv txoj hlab ntshav.
2. Tus neeg mob nyob hauv:
- Txhawm rau hloov qhov tsis txaus ntawm cov tshuaj hormones, 250-500 mcg ntawm "Thyroxin" yog muab tso rau hauv txhua 6 teev (los yog 100 mcg ntawm "Triiodothyronine" los ntawm lub plab hnyuv), tom qab 12 teev cov koob tshuaj txo qis rau 25 teev. -100 mcg.
- Rau qhov kev pab ntawm adrenal insufficiency, hydrocortisone hemisuccinate (50-100 mg) yog txhaj rau hauv txoj hlab ntshav.
- Kev tiv thaiv kab mob encephalopathy 1 ml ntawm vitamin B1.
- Rau qhov nyem ntawm bradycardia, "Atropine" 0.1% (0.5-1 ml) yog txhaj subcutaneously.
- Txhim kho qhov chaw ua pa - "Cordiamin" (2-4 ml).
- Rau qhov kho ntawm cerebral hypoxia - "Mildronate" (250 mg).
- Kev tiv thaiv kab mob - tshuaj tua kab mob.
- Kho kom tshem tawm hypoxia - kev ua pa ntawm lub ntsws.
Hypothyroid coma: kev saib xyuas xwm txheej ceev
Thaum muab kev saib xyuas xwm txheej ceev, tsis muaj teeb meem koj yuav tsum siv cov ntaub qhwv cua sov kom sov tus neeg mob - qhov no yog vim qhov tsis zoo ntawm hemodynamics. "Triiodothyronine" tsis yog siv tam sim ntawd intravenously kom tsis txhob muaj kev pheej hmoo ntawm kev mob plawv. Ib koob tshuaj loj ntawm Levothyroxine tuaj yeem ua rau mob qog adrenal tsis txaus.
Tsev kho mob tau ua nyob rau hauv txoj hauj lwm supine hauv chav saib xyuas mob hnyav lossis chav haujlwm endocrinology.
Yog tias tus mob hypothyroid coma tau tsim, kev saib xyuas xwm txheej ceev hauv thawj teev yog muab los ntawm kev qhia txog "Triiodothyronine". Kev kho cov pa oxygen yog sau tseg. Prednisolone, hydrocortisone npaj tau muab tso rau hauv cov hlab ntsha. Kev qhia txog cov tshuaj mob plawv kuj tsim nyog.
Tom qab ib nrab teev lossis ib teev, nws yuav tsum tau qhia ATP, vitamins C, B. Yog tias lub siab siab dua 90 mm Hg. Art., kev taw qhia ntawm "Lasix". Yog tias ntshav siab tsawg dua qhov ntsuas no, siv Corazol, Mezaton, Cordiamin.
Ntxiv mus, txhua 4 teev, nyob ntawm qhov xwm txheej ntawm lub plawv, "Triiodothyronine" yog siv rau hauv qhov nyiaj ntawm 25 mcg. Thaum lub plawv contractions thiab kub stabilize, qhov ntau npaum li cas yog txo. Nws yog ib qho tsim nyog yuav tsum tau ua kom sov so ntawm tus neeg mob, kev kho cov pa oxygen, siv sodium oxybutyrate.
Yog tias muaj tus mob convulsive tshwm sim, Seduxen tau muab tso rau hauv cov hlab ntsha.
Kev Kho Mob: Theem 1
Kev kho mobhypothyroid coma, raws li txoj cai, suav nrog ntau theem, tsis pib tam sim nrog kev kho tshuaj hormone hloov. Kev kho mob ntawm cov neeg mob tau ua nruj me ntsis raws li kev saib xyuas ntawm tus kws kho mob hauv lub tsev kho mob hnyav.
Thaum thawj theem, kev ntsuas dav dav tau coj los tswj cov haujlwm tseem ceeb hauv thawj hnub lossis ob zaug, yam tsis muaj lawv, ntxiv kev siv tshuaj hormone hloov pauv yuav tsis muaj qhov xav tau thiab tseem tuaj yeem ua rau tus neeg mob lub neej
Txoj kev ua pa ua pa. Yog tias tus neeg mob muaj peev xwm ua pa ntawm nws tus kheej, thiab cov ntsuas ntawm CSF tau them nyiaj, ces cov khoom ntawm O2 (kev kho oxygen) yog ua los ntawm qhov ntswg cannulas lossis daim npog ntsej muag. Raws li txoj cai, cov neeg mob muaj kev ua txhaum ntawm kev ua tsis taus pa, carbon dioxide accumulates hauv cov ntshav. Yuav tsum siv lub tshuab ua pa. Qhov no txhim kho qib ntawm cov pa oxygen thiab carbon dioxide hauv cov ntshav, tiv thaiv kev txhim kho hypoxia, thiab tshem tawm nws qhov cuam tshuam tsis zoo rau tag nrho cov ntaub so ntswg thiab lub cev.
Volemic poob kho. Hypothyroid (myxedematous) coma yog tus cwj pwm los ntawm kev tuav dej. Tab sis qhov tseeb yog tias nws accumulates nyob rau hauv interstitial qhov chaw, lub vascular txaj raug kev txom nyem nyob rau lub sij hawm no, thiab muaj ib tug tsis txaus dej, vim li no, ntshav siab yuav txo. Kev kho yog ua los ntawm kev siv cov tshuaj hypertonic ntawm NaCl, colloidal thiab saline daws. Thaum ua tiav cov txheej txheem, nws yog ib qho tseem ceeb uas yuav tsum tau coj mus rau hauv tus account theem ntawm central venous siab. Qhov ntsuas nyob rau hauv qhov ib txwm muaj lossis overestimated tso cai rau koj nkag mus tsis ntau tshaj li ib liter ntawm kev daws ib hnub. ATtxwv tsis pub, nws tuaj yeem ua rau muaj kev nce siab hauv plawv, thaum sodium hauv cov ntshav yuav txo qis.
Cov cua kub ntawm tus neeg mob lub cev nrog cov pam vov lossis nce cua kub hauv chav los ntawm 1 degree. Nyob rau hauv tsis muaj cov ntaub ntawv yuav tsum tau lub active cua sov ntawm tus neeg mob yuav tsum tau nqa tawm nrog kev pab los ntawm ntau yam kub wraps, cua sov pads. Qhov no yuav ua rau kom muaj kev cuam tshuam ntawm peripheral vasodilation, vasodilation yuav tshwm sim. Ntshav siab tuaj yeem poob ntxiv los ntawm tus txheeb ze hypovolemia.
Kho cov kab mob plawv. Hypothyroid coma ua rau mob hnyav rau cov hlab plawv. Hauv thawj theem, nws yog ib qho tsim nyog los kho bradycardia thiab ua kom ntshav siab. Rau kev kho mob ntawm bradycardia, M-anticholinergics yog siv (piv txwv li, Atropine), tuaj yeem siv Eufillin. Yog tias ntshav siab tsis tuaj yeem ua kom ruaj khov los ntawm kev kho cov vascular hypovolemia, yuav tsum muaj kev pab kho mob. Adrenaline, mezaton, norepinephrine yog siv. Ntawm no koj yuav tsum tau siv kev saib xyuas hnyav, txij li qhov kev nkag siab ntawm cov receptors nce thaum kho nrog cov thyroid hormones. Muaj peev xwm ua rau lub plawv dhia tsis zoo, cov tsos mob ntawm atrial fibrillation lossis tachycardia.
Kho cov tshuaj electrolyte (chlorine, sodium, calcium, potassium), nrog rau qib ntshav qabzib.
Siv (GCS) ntawm glucocorticosteroids. Cov koob tshuaj kev ntxhov siab yog qhov tsim nyog thaum lub luag haujlwm ntawm adrenal cortex depleted nyob rau hauv cov neeg mob uas muaj thyroiditis, uas tshwm sim nyob rau hauv lub keeb kwm yav dhau ntawm kev siv mus sij hawm ntev ntawm cov tshuaj hormones, nrog ib tug txo nyob rau hauv cov tshuaj.theem ntawm cov ntsuas T3 thiab T4, nrog rau kev tsis sib haum xeeb hauv cov kab mob hypothalamic-pituitary. Hydrocortisone feem ntau yog tswj hwm txhua rau 6 teev nyob rau hauv kev suav ntawm ib hnub koob tshuaj ntawm 200 mus rau 400 mg. Tom qab tus neeg mob tus mob zoo li qub, koob tshuaj txo qis tom qab ob mus rau peb hnub.
mob hemodialysis, lossis kho raum. Nws tau qhia rau cov neeg mob uas tsim oligoanuria, nrog kev nce hauv creatinine, urea, potassium.
Kev kho tus neeg mob yuav tsum pib tam sim ntawd. Qhov sai dua nws dhau thawj theem, cov haujlwm tseem ceeb uas tsim nyog tau rov qab los, sai dua nws yuav muaj peev xwm pib kho cov tshuaj hormone hloov. Txoj hauv kev yuav rov qab tau ntau zaus dua.
2 theem
Nyob rau theem 2 ntawm kev kho mob, hypothyroid coma twb muaj xwm txheej sib txawv. Yuav tsum tau kho cov thyroid hloov pauv ntawm no.
Cov khoom tseem ceeb yog T4 npaj. "Levothyroxine" feem ntau yog tshuaj ntawm koob tshuaj 1.8 mcg / kg ib hnub. Tom qab 6 teev, qhov kev txiav txim pib, thiab tom qab ib hnub cov nyhuv tag nrho yog tiav. Thaum pib, los ntawm 100 mus rau 500 mcg ntawm cov tshuaj tau pom nyob rau hauv ib teev. Tom qab ntawd, thoob plaws ib hnub, cov tshuaj ntxiv txhua hnub yog muab. Tom qab ntawd, cov tshuaj noj ib hnub yog 75-100 mcg. Tom qab tus neeg mob stabilization, "Levothyroxine" yog sau rau hauv daim ntawv ntsiav tshuaj.
Hauv qhov mob hnyav, cov tshuaj T3 tau muab tshuaj ntawm 0.1 txog 0.6 mcg / kg ib hnub. Nrog rau ib hnub 75-100 mcg, 12.5-25 mcg yog muab txhua 6 teev. Yog hais tias tus neeg mob muaj kab mob plawv pathologies, noj txhua hnubYam tsawg kawg nkaus thov - 25-50 mcg.
3 theem
Nyob rau theem 3, tom qab kev ruaj ntseg ntawm tus neeg mob tus mob, kev kho mob ntawm tus kab mob pib pib, uas ua rau kev loj hlob ntawm coma. Qhov no tej zaum yuav yog qee yam kab mob lossis kab mob ntawm cov thyroid caj pas, kev raug mob thiab lwm yam.
Hypothyroid coma yog ib yam mob uas yuav ua rau tus neeg mob tuag taus. Cov lus pom zoo kho mob yuav tsum tau ua nruj me ntsis thiab ua raws. Txwv tsis pub, cov teeb meem loj uas ua rau muaj kev hem thawj rau lub neej tuaj yeem tshwm sim. Kev noj tshuaj rau tus kheej hauv qhov no yog txwv nruj heev. Nrhiav kev kho mob tam sim yog tias koj xav tias cov tsos mob ntawm tus mob coma.
YThyrotoxic coma
Hypothyroid coma, lossis thyroid teebmeem, tuaj yeem tshwm sim tawm tsam keeb kwm ntawm thyrotoxicosis hnyav nrog kev kho mob thyrotoxic goiter. Feem ntau qhov no tshwm sim tawm tsam keeb kwm ntawm kev ntxhov siab neuropsychic, tom qab kev phais tshem tawm ntawm cov thyroid caj pas. Lub ntsiab txuas ntawm pathogenesis yog:
- Kev dhia nrawm hauv cov thyroid hormones hauv cov ntshav.
- Hypoxia.
- Endotoxicosis.
- Kev puas tsuaj rau cov hlab plawv thiab lub paj hlwb, qog adrenal, siab.
- Impaired cell metabolism thiab dej thiab electrolyte tshuav.
Thyrotoxic ntsoog ua ntej kev loj hlob ntawm coma. Tus neeg mob muaj cov tsos mob hauv qab no: kev puas siab puas ntsws overexcitation, feem ntau nrog kev hnov lus, delusions. tremor ntawm extremities, tachycardia (txog 200 neeg ntaus ib feeb). Lub cev kubnce mus rau 38-41 degrees. Muaj zog tawm hws. Mob plab, ntuav. Possible jaundice.
Yog tias tsis muaj kev kho mob txaus, tus neeg mob tus mob deteriorates sharply:
- txo qis ntshav siab;
- tawv nqaij;
- atrial fibrillation;
- mydriasis;
- cyanosis;
- bulbar teeb meem.
Reflexes yog inhibited, cov leeg nqaij txo qis, tswj tsis tau tso zis, mob hlwb, coma tau pom. Ntawm qhov kev kuaj mob tus nqi yog cov ntaub ntawv nyob rau hauv anamnesis, qhia tias muaj thyrotoxicosis: tachycardia, kub taub hau, poob phaus, ntuav, agitation, profuse raws plab.
Kev kuaj ntshav qhia: nce qib ntawm cov thyroid hormone khi rau iodine protein, bilirubin (vim kev puas tsuaj los ntawm daim siab co toxins), 17-hydroxyketosteroids, metabolic acidosis.
Nyob rau hauv tus mob no, tus neeg mob xav tau kev saib xyuas xwm txheej ceev. Nws suav nrog cov haujlwm hauv qab no:
- Kev txhaj tshuaj rau hauv cov hlab ntsha isotonic sodium chloride tov hauv qhov nyiaj ntawm 1 l.
- Glucose daws 5%.
- "Hydrocortisone" ntawm qhov ntau npaum ntawm 350 txog 600 mg.
- "Prednisolone" los ntawm 120 txog 180 mg.
- "Korglikon" lossis "StrophanthinK" 0, 5-1 ml.
- Seduxen lossis lwm yam tshuaj tiv thaiv.
- "Mercazolil" (cov tshuaj tiv thaiv kab mob) - 60-80 mgib hnub.
Yog tus neeg mob muaj cov tsos mob saum toj no, nws yog qhov ceev kom hu rau lub tsheb thauj neeg mob thiab mus pw hauv tsev kho mob tus neeg mob hauv chav haujlwm endocrinology.
