Hypothyroid chaanoziva: sei kupa nechimbichimbi kutarisirwa?

Hypothyroidism ndiyo chirwere ane ngozi. Chimwe chezvinhu kakawanda matambudziko zviri hypothyroid pakoma. Kakawanda zvinoitika muna varwere vakwegura, kunyanya vakadzi. Chaanoziva kunoitika pakuti boka varwere vari kutambura hypothyroidism, havana kugamuchira zvakafanira kurapwa, kana zvakanzi kuitwa nguva.

Zvinokonzera hypothyroidism

Ruzhinji varwere (95%) kubva hypothyroidism kunokonzerwa pathological pezvakaitwa kuitika thyroid shwanu. Padanho kugadzirwa mahormone kunodzikira, chikuru hypothyroidism hwapedyo.

Kana kutyorwa stimulatory uye pamutemo mugumisiro pituitary TSH uye tireoliberina (kana hypothalamic kusunungura chinhu) anouya hypothyroidism yechipiri. The kakawanda parinowanika mu zvikuru muduku zvikuru. Uye chokwadi, uye mune zvimwe zviitiko apo pane kukwana kurapwa kunogona kuva hypothyroid pakoma.

About peripheral hypothyroidism mubvunzo asina kugadziriswa nenzira dzakawanda. Kana kuchimuka nezvichaitika metabolic nepfungwa iri arikunze pamusoro thyroid kemikari kana nokuda utetsa rutapudzo ari nhengo uye nyama zvenyukireya receptors kuti thyroid mahormone?

Ichingori mubvunzo nharo pamusoro kana pane zera-kudzikisirana kuti thyroid mahormone mune kusagadzikana peripheral muviri. Uye kana kusingarapiki mananara kuchengetwa ari thyroid shwanu ari zvokukwegura kwacho?

Hypothyroid pakoma. zvikonzero

Pathogenesis hypothyroid chaanoziva kazhinji, kunoratidza kuti vakatakura kurapwa kukodzera kana rukamukurumidzira kuti hypothyroidism. Part of tsananguro zvive kunonoka kuongorora chirwere. Kushayikwa thyroid mahormone anogona yakawedzera kubudikidza Kudzimwa kwechikwereti negashiro levothyroxine kana muviri vachida kuwedzera mishonga kuti kemikari kuzvitsinhanisa. Hypothyroid chaanoziva anogona kukonzera zvinoverengeka:

• Hypothermia.

• Concomitant zvirwere (mwoyo kurwisa, mabayo, sitiroko, nemavhairasi, urogenital noutachiona).

• Wandisa kurasikirwa neropa, kunotevera, nemwaranzi marapirwo, kuvhiya.

• X-ray kuzviongorora.

• Administration zvinodhaka izvo inoodza mwoyo musimboti tsinga.

• mishonga Large doro.

• Yomuropa.

• Hypoxia.

Kana plummets pamwero thyroid mahormone muuropi zvinoderedza basa metabolic kwendangariro. Somugumisiro, kuwedzera hypoxia, yekudyidzana chibharo mhando dzose muviri, uye vazhinji zvinoitwa nhengo dzakawanda.

Zviratidzo hypothyroid chaanoziva

chaanoziva Fani rikauya zvishoma nezvishoma kukura, kufambira mberi zvishoma nezvishoma. Pakutanga, kurukutika sokuti, kusakendenga, lethargy, ipapo vakachengeta muzvidimbu pasava noushamwari, kuoma, kuzvimba tsoka, hapana ganda - unhu izvi kunoratidzwa hypothyroid pakoma. Status lokalis anoratidza kunonoka kufema, nezvinetso weti, zviratidzo mwoyo kukundikana. Lowers BP, yave kushaya mudzira hunenge. On kuongororwa, chiremba murwere anoona zvinotevera zviratidzo hypothyroid chaanoziva:

• Kuipa muviri, uremu muviri wakawedzera akaparadzirwa DZEMUNHU DZINODZORA, tembiricha chinozova madhigirii 35.

• Kune kuvhiringidzika kumwoyo. The kwemwoyo DZEMUNHU DZINODZORA, pane thready kupomba, kunoderedza BP, edema mwoyo.

• Kutyorwa kufema mabasa. Kuderedza uwandu kundosvikira, akawira ropa wokufema pakurara anogona kurega kufema.

• Abnormalities mu tsinga. Chinovhiringidza pamusoro mudzira hunenge, mberi vadhakwa.

• Skin zviratidzo. Paleness, akaoma, waxy ganda pasi, vagari hyperkeratoses. Pfava zvipikiri. Hair kurasikirwa.

• Inowira muropa yavaibvisa mumatunhu. chiso uye migumo Zvakakomba kuzvimba.

• Kupererwa, uye zvose hwokufananidzira zviratidzo nayo.

• Yomuropa.

• Nomudumbu. ileus. Inosimudzira chiropa.

kiriniki

Clinic hypothyroid chaanoziva iri sezvinotevera: pane utera, hope, kutura tembiricha kuti madhigirii 35. DZEMUNHU DZINODZORA, mashoko ari kutaurwa indistinctly, akaderedza chiratidzo uye kunzwa. BP akatura, kurova kwemwoyo - anorova 30 paminiti. Kufema kudzika uye isingawanzowanikwi. Kubva mudumbu - bloating, kupatira, marwadzo, kurutsa. Pane kugadzira oliguria. Skin hapana tsvuku, yakaoma. Kuzvimba kumeso, migumo. Kuvhiringidzika, lethargy. The mudzira hunenge hatisi. Kunobva hypothyroid pakoma.

Ropa. Hypoxia, hypercapnia, hyponatremia, yomuropa, acidosis, hematocrit, TSH, T3 uye T4 kutura remafuta akawandisa zvawanzwa.

Matambudziko: nemabayo, chenjera kuruboshwe ventricular kukundikana, encephalopathy, chenjera renal kukundikana, cardiac arrhythmias, sitiroko, dementia, ileus.

The algorithm rubatsiro rwekutanga

Kana munhu hypothyroid pakoma, rikwanise kutarisirwa algorithm iri sezvinotevera:

1. Prehospital:

• Dana chiremba. Kupa rwekutanga zvokurapa.

• Putira magumbeze kuderedza kupisa muviri.

• Kubvisa hypoxia kuburikidza nasal catheters kupa humidified okisijeni.

• Goverai kuwana mutsinga dziri tsinga anobudisa mushonga zvishoma nezvishoma yakatarwa.

Kana waisa hypothyroid chaanoziva nzira mukoti anofanira kuva akajeka, ari pamwe chete Dr. - nokukurumidza, rakanyatsorongwa:

• Nokuti nechirwere yematambudziko kutora ropa kugutsikana thyroxine, thyroid anotokonya kemikari, triiodothyronine, shuga, cortisol, chloride, yavaibvisa, AAR, gasi akafanana.

• Kuti kuzvidzora diuresis akabata dundira catheterization.

• Kuti adzivise chido namarutsi kutaurwa mudumbu chubhu.

• Rokuongorora yematambudziko - ECG zvichiongororwa respiratoria, tembiricha, hemodynamics. "Reopoligljukin" intravenous-donha 500 Rine mamiririta.

• Detoxification - Shuga 40% w / ndege - 20-30 Rine mamiririta; Saka / inodonha raitongwa shuga 5% (500 ML).

2. muchipatara:

• Nokuti kuzvitsinhanisa kemikari pokuperevedza mu / ndege raitongwa 6 maawa ose 250-500 mcg "Thyroxine" (kana Via gavage 100 ug "triiodothyronine") achiteverwa maawa 12 kuti kuderedza dose pamusoro 25-100 micrograms.

• Kusunungurwa kubva adrenal insufficiency mu / ndege raitongwa hydrocortisone hemisuccinate (50-100 MG).

• For Kudzivirira encephalopathy 1 Rine mamiririta Vitamin B1.

• Nokuti edema bradycardia raitongwa s.c. "atropine" 0.1% (0.5-1 Rine mamiririta).

• Kukuchidzira of kufema centre - "Kordiamin" (2-4 Rine mamiririta).

• Kusunungurwa kubva chepfungwa hypoxia - "Mildronate" (250 MG).

• To kudzivirira utachiona - inorwisa mabhakitiriya.

• Nokuti kuchaitwa hypoxia - zvokuimba kufefetedza.

Hypothyroid chaanoziva: nechimbichimbi kutarisirwa

Kupa chimbichimbi rubatsiro, chero zvazvingava hazvigoni kushandiswa ushamwari murwere warmers - izvi nokuda Kuipa hemodynamics. "Triiodothyronine" kwete jekiseni nomutsinga pakarepo kuti tinzvenge ngozi zvemwoyo yematambudziko. Large dose "Levothyroxine" vanokwanisa afunge kusachengeteka kukuru adrenal insufficiency.

Muchipatara rinoitwa munyika supine nzvimbo muimba yevanenge kana wedhipatimendi momuviri.

Kana waisa hypothyroid pakoma, nechimbichimbi hanya awa rokutanga riri kuburikidza pakatanga "triiodothyronine". Okisijeni kurapa anogadzwa. Nomutsinga raitongwa mishonga prednisone, hydrocortisone. Administration ndiyo mishonga zvakakodzera uye zvemwoyo.

Mushure hafu yeawa anofanira kupinda ATP, mavhitaminzi C, B. Kana kufurirwa rinopfuura 90 mmHg. Art., Akaita pakatanga "Lasix". Kana BP idukusa mufananidzo uyu, kushandiswa "corazole", "Mezaton", "Kordiamin".

Uyezve, mumwe 4 maawa, zvichienderana ezvinhu mwoyo, mune mari 25 micrograms raitongwa "triiodothyronine". Pangosvika kwemwoyo uye tembiricha vari akagadzikana, kuti chipimo chemushonga ipfupi. Zvakakosha kuramba pusa rewarming murwere, okisijeni kurapa, kushandiswa yavaibvisa hydroxybutyrate.

Kana paine convulsive chirwere, nomutsinga jekiseni "Seduxen".

Treatment: Stage 1

Mabatirwo hypothyroid pakoma, zvinowanzosanganisira matanho akawanda, hazvina kutanga pakarepo kemikari yokutsiva mishonga. Kurapa varwere rinoitwa zvakasimba pasi pokudzora chiremba nokumutswa ari yevanenge.

Danho rokutanga kudzikamisa mukuru mabasa anokosha anokosha rokutanga zuva kana maviri, pasina humwe kushandiswa kemikari yokutsiva kurapa haambovi zvinozoita uye vangatoona kukanganisa upenyu murwere

Kuramba kufema mabasa. Kana murwere anogona kufema pachake, uye KSCHN zviratidzi ndanyarara hangu, kugoverwa O ₂ (okisijeni kurapa) rinoitwa kuburikidza nasal cannula kana kumeso. Kazhinji, varwere vane nenyonganiso pamusoro vaingoerekana kufema, carbon dioxide rinoungana muropa. Kushandisa mudziyo zvaidiwa zvokuimba kufefetedza. It nechokumusoro ropa okisijeni uye carbon dioxide, kunotadzisa kukura hypoxia, kutsakatisa zvayo inokanganisa masero ose uye nhengo.

Kuchinja volemic varasikirwa. Hypothyroid (myxedema) chaanoziva dzinoratidzwa mvura mvura chengetedzo. Asi chokwadi ndechokuti rinoungana iri interstices dzezvimwe, asi vascular mubhedha panguva ino kutambura, uye pane mvura dhefisiti, nokuda kwechikonzero ichi, BP zvinogona donha. Kururamiswa chinoitwa achishandisa hypertonic mhinduro kuna NaCl, colloidal uye brine. Panguva nzira zvakakosha kufunga pamwero nechepakati venous kumanikidzwa. Ratidza ari chakaipa siyana kana kwete inflated anobvumira panopindwa vanopfuura mumwe fő mhinduro pazuva. Zvikasadaro, zvinogona kunetsa wakawedzera cardiac mutoro, pamwe yavaibvisa muropa anodonhedza yekudyidzana.

Pusa kudziyisa muviri murwere achishandisa magumbezi kana kuwedzera kamuri tembiricha 1 dhigirii. Hapana nyaya murwere havagoni abate basa kudziyisa pachishandiswa akasiyana inopisa Achiputira, warmers. Izvi zvichaita kuti kuwedzera pamusoro peripheral vasodilation kunoitika vasodilation. BP zvinogona kuderedzwa mberi nokuda hama hypovolemia.

Nokururamiswa kumwoyo. Hypothyroid chaanoziva kwakakomba akundwa kumwoyo. Danho rokutanga kurapa bradycardia, BP Kudzikamiswa. Nokuti kurapa bradycardia M holinoblokatory inoshandiswa (semuenzaniso, "atropine") anogona kushandisa "aminophylline". Kana BP usingagoni kuchinjwa dzikamisa vascular hypovolemia, zvinodhaka rubatsiro kunodiwa. Isai adrenaline mezaton, norepinephrine. Pano unofanira kungwarira zvikuru nokuti aikanganiswa pamusoro receptors ichiwedzerwa pakurapa thyroid kemikari. Possible mwoyo mutinhimira nyonganyonga, nokuratidzwa zviratidzo atrial fibrillation kana tachycardia.

Kururamiswa electrolyte waivako (kuiisa chlorine, yavaibvisa, calcium, potassium), uyewo ropa shuga pamwero.

Kushandisa (GCS) glucocorticosteroids. Stress mishonga inodiwa kuti kuneta nokuda adrenocortical basa iri varwere thyroiditis, yakabuda pamusoro pakanyorwa kushandiswa mahormone kwenguva refu, aine vasanyanye kwevari T3 uye T4 zviratidzo, zvirwere zviri hypothalamic-pituitary hurongwa. Kazhinji, hydrocortisone chinotarisirwa ose maawa matanhatu chete dose zuva nezuva MG 200 kusvika 400. Kana murwere akagadzikana, pashure pemazuva maviri kana matatu, pane kuderera mune dose.

Chenjera dialysis kana renal yokutsiva mishonga. It zvinoratidzwa kuti varwere yepamusoro oligoanuria, kuwedzera creatinine, urea, potassium.

kurapwa murwere anofanira chatangwa. Nokukurumidza uchava danho rokutanga kudzorera zvaida kushanda muupenyu, nokukurumidza izvozvo zvichaita kuti atange kemikari yokutsiva mishonga. Mikana kupora zvadarika kakawanda.

Danho 2

2 pavaipfuura Mabatirwo hypothyroid chaanoziva mamiriro anotova vamwe. Izvi kunoda zvazova thyroid kemikari mishonga.

Huru zvinoriumba - T4 gadziriro. "Levothyroxine" kazhinji basa pane imwe dose pamusoro 1,8 MG / makirogiramu pazuva. Nechekare pashure maawa 6 chiito kunotanga, uye pashure rimwe zuva rizere mugumisiro kunokwanisika. Pakutanga awa mifananidzo kubvira 100 kusvika 500 micrograms zvinodhaka. Uyezve, panguva zuva akasuma vasara daily dose. Zvadaro, kwerunyararo dose pazuva iri 75-100 micrograms. Mushure murwere Kudzikamiswa "Levothyroxine" raitongwa mu piritsi fomu.

The dzinonetsa nezvevakafa T3 kugadzirira raitongwa 0.1 kusvika 0,6 MG / makirogiramu pazuva. At daily 75-100 MG ose 6 maawa hunosumwa 12.5-25 .mu.g. Kana murwere ane zvemwoyo chirwere, nezuva dose rinoshandiswa shoma - 25-50 MG.

Danho 3

In danho 3, mushure Kudzikamiswa murwere, kutanga kurapwa chaicho chirwere, izvo zvakazoita kuti kukura pakoma. Izvi zvinogona kuva chirwere chipi kana kuzvimba thyroid shwanu, kunotevera, uye zvimwewo.

Hypothyroid chaanoziva - murwere nemamiriro upenyu pangozi. zano Medical kunofanira takanyatsoomerera uye rakatangwa. Zvikasadaro, anogona kuitika zvakakomba matambudziko, upenyu pangozi. Self-mishonga iyi nyaya iri zvachose wairambidza. Kana mubvunzo pamusoro chaanoziva zviratidzo pakarepo kwachiremba.

thyrotoxic chaanoziva

Hypothyroid pakoma, kana thyrotoxic dambudziko, anogona kuitika pamberi kwazvo hyperthyroidism mu untreated thyrotoxic goiter. Kakawanda izvi zvinoitika pamusoro yaitwa mupfungwa kunokonzerwa pashure kuvhiya nokubviswa thyroid shwanu. The chikuru pathogenesis - ndiko:

• The unopinza kusvetuka mu thyroid Makemikari muropa.

• Hypoxia.

• Endotoxemia.

• Hunokachidza kuzotadzira zvemwoyo uye tsinga, nadpochesnikov chiropa.

• Kutyora cellular muviri uye mvura uye electrolyte mwero.

Thyrotoxic dambudziko kunotangira kukura pakoma. Murwere ane zvinotevera zviratidzo zvinochengetwa: mupfungwa mufaro, kazhinji achiperekedzwa zvisipo, zvinovadadira. muzvidimbu tremor, tachycardia (anorova anosvika 200 paminiti). tembiricha muviri achisimuka 38-41 inegumi. Heavy vangadikitira. Manyoka, kurutsa. Zvichida chitarisiko jaundice.

Kana pasina zvakakwana kurapa, murwere ezvinhu Zvinoipisisa zvinoshamisa:

• BP;

• ganda rakaoma;

• atrial fibrillation;

• mydriasis;

• cyanosis;

• bulbar zvirwere.

Pane kuora mwoyo kwemafungiro, misoro yekutema inoderedzwa, kusadzora kudzora urination, kuora mwoyo kwekuziva, coma. Kukosha kwekutarisa kune dhiyabhorosi munhoroondo, zvichiratidza kuvapo kwe thyrotoxicosis: tachycardia, fever, kuora kurasikirwa, kurutsa, kushungurudzika, chirwere chakanyanya.

Apo kuongorora ropa, kune: kuwedzera hormone yekemikari inobatanidza neprotheni yeIodine, bilirubin (nemhaka yekukuvadza kwehupukisi hwechiropa), 17-oxyketosteroid, metabolic acidosis.

Mumamiriro ezvinhu aya, murwere anofanira kupa rubatsiro rwekukurumidza. Inosanganisira mabasa anotevera:

• Intravenously injected isotonic sodium chloride solution mumwero we 1 litre.

• Glucose solution 5%.

• "Hydrocortisone" muyero ye 350 kusvika 600 mg.

• "Prednisolone" kubva 120 kusvika 180 mg.

• "Korglikon" kana kuti "StrofantinK" 0,5-1 ml.

• "Seduxen" kana mamwe anticonvulsants.

• "Mercazolil" (drug antithyroid) - 60-80 mg pazuva.

Kana murwere ane zviratidzo izvi, zvinokurumidza kudana "ambulensi" uye kugarisa murwere mune dhipatimendi ye endocrinology.