Hypothyroid chikomokere: mmene kuwasamalira pangozi?

Hypothyroidism ndi matenda oopsa. Chimodzi mwa mavuto zambiri ndi hypothyroid chikomokere. Nthawi zambiri zimachitika odwala achikulire, makamaka akazi. Chikomokere amapezeka kuti gulu la odwala amene akuvutika hypothyroidism, sanalandire chithandizo zofunika, kapena ngati iyo inali ikuchitika nthawi.

Zimayambitsa hypothyroidism

Ambiri odwala (95%) a hypothyroidism amayamba ndi njira pathological zikuchitika mu chithokomiro England. Mlingo wa ulimi wa mahomoni amachepetsa, hypothyroidism yaikulu kwambiri.

Pamene kuyan'anila stimulatory ndi zolimbana zotsatira za pituitary TSH ndi tireoliberina (kapena hypothalamic kumasuka chinthu) amachokera hypothyroidism sekondale. Pafupipafupi pakuwonekera kwake mu kwakukulukulu wolephera yaikulu ya. Ndipo kwenikweni, ndipo nthawi zina pamene pali osakwanira chithandizo angathe hypothyroid chikomokere.

About hypothyroidism zotumphukira funso sichinayambe kuthetsedwa m'njira zambiri. Kaya ikutuluka mogwirizana ndi matenda kagayidwe kachakudya mu periphery ya chithokomiro timadzi kapena chifukwa kuchepetsa tilinazo mu ziwalo ndipo zimakhala za maselo nyukiliya kwa mahomoni chithokomiro?

Patsalanso funso maganizo ngati kuli m'badwo-kudzitsitsa mahomoni chithokomiro matenda a kagayidwe zotumphukira. Ndipo ngati zochitika sizingasinthe anati mu chithokomiro England mu ukalamba?

Hypothyroid chikomokere. zifukwa

Pathogenesis hypothyroid chikomokere nthawi zambiri, limasonyeza kuti adatengedwa zosayenera kapena mwadzidzidzi matenda a hypothyroidism. Part Pofotokoza mwina akuchedwa matenda. Chakuchepa mahomoni chithokomiro akhoza kulimbikitsa ndi kulipira phwando levothyroxine kapena chamoyo akufunika kuwonjezeka mlingo wa timadzi M'MALO. Hypothyroid chikomokere angapereke zifukwa zosiyanasiyana:

• Hypothermia.

• matenda Concomitant (mtima, chibayo, sitiroko, tizilombo, matenda urogenital).

• Chachikulu magazi imfa, zoopsa, cheza mankhwala opaleshoni.

• X-ray bwino.

• Administration mankhwala omwe nkhawa chapakati mantha dongosolo.

• Large Mlingo wa mowa.

• Hypoglycemia.

• Hypoxia.

Ngati plummets mlingo wa mahomoni chithokomiro mu ubongo amachepetsa ntchito njira kagayidwe kachakudya. Motero, kuwonjezeka hypoxia, kwambiri linaphwanya mitundu yonse ya kagayidwe, ndipo ambiri mwa zinthu ziwalo kwambiri.

Zizindikiro za chikomokere hypothyroid

chikomokere chodabwitsa zimachitika pang'onopang'ono kukula, patsogolo pang'onopang'ono. Poyamba, kutopa limapezeka, mphwayi, ulesi, ndiye anati nthambi kuzizira, dryness, kutupa mapazi, wotumbululuka khungu - makhalidwe amenewa amakhala ndi chikomokere hypothyroid. Momwe lokalis limasonyeza pang'onopang'ono kupuma, mavuto ndi pokodza, zizindikiro za matenda a mtima. Sachita magazi, wakhala chosowa bongo tendon. Kuzionetsetsa, dokotala wodwalayo anati zizindikiro zotsatirazi chikomokere hypothyroid:

• Chatsitsa kagayidwe, thupi kuchuluka makope kubweza, kutentha ikagwa madigiri 35.

• Pali chisokonezo dongosolo mtima. Mlingo mtima kubweza pansi, pali zimachitika thready, utachepa magazi, edema a mtima.

• Kuyan'anila za ntchito kupuma. Kuchepetsa chiwerengero cha mpweya, kugwa milingo magazi mpweya akagona akhoza kusiya kupuma.

• Kuvutika mu wamanjenje dongosolo. Chopinga wa bongo tendon, mwapang'onopang'ono stupor.

• Zizindikiro khungu. Paleness, wouma waxy malankhulidwe khungu, hyperkeratoses olowa. Chimaona misomali. Tsitsi imfa.

• Kugwa pa milingo magazi ndi sodium. nkhope ndi malekezero kwambiri kutupa.

• Magazi, ndi zizindikiro zonse zikusonyeza izo.

• Hypoglycemia.

• matenda m'mimba. ileus. Kuchuluka chiwindi.

chipatala

Clinic hypothyroid chikomokere chiri motere: pali kufooka, kugona, polowetsedwa kutentha kwa madigiri 35. Kubweza pansi, mawu ali kutchulidwa indistinctly, yafupika masomphenya kumva. magazi ndi adatchithisira, adzionere - kumenyedwa 30 pa mphindi. Kupuma osaya ndi osowa. Kuchokera m'mimba - bloating, kudzimbidwa, kupweteka, kusanza. Pali chitukuko cha oliguria. Khungu wotumbululuka chikasu, youma. Kutupa nkhope, m'makona. Chisokonezo, ulesi. The tendon bongo ndi kwina. Zimakwaniritsidwa hypothyroid chikomokere.

Magazi. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, acidosis, hematocrit, TSH, T3 ndi T4 adatchithisira mafuta kuchuluka.

Zovuta: chibayo, pachimake kumanzere yamitsempha yamagazi kulephera, encephalopathy, pachimake kulephera aimpso, mtima arrhythmias, sitiroko, maganizo, ileus.

Thandizo aligorivimu loyamba

Ngati hypothyroid chikomokere munthu, chisamaliro pachimake aligorivimu ndi motere:

1. Prehospital:

• Itanani dokotala. Kupereka chithandizo chamankhwala choyamba.

• Manga mabulangete kuchepetsa thupi kutentha.

• Kuthetsa hypoxia kudzera catheters m'mphuno kupereka humidified oxygen.

• Kupereka mwayi kwa mitsempha kuika mtsempha catheter.

Ngati anaika hypothyroid chikomokere machenjerero namwino iyenera kukhala yomveka bwino, mgwirizano ndi Dr. - mwamsanga, mwadongosolo:

• Kwa matenda a mavuto kutenga magazi zili thyroxine, chithokomiro zolimbikitsa timadzi, triiodothyronine, shuga, tochepa, enaake, sodium, AAR, mafuta zikuchokera.

• Pofuna kuchepetsa diuresis unachitikira chikhodzodzo catheterization.

• Pofuna kupewa kukhumba masanzi anadzetsa chubu m'mimba.

• Matenda zosokonezeka - ECG polojekiti mlingo kupuma, kutentha, hemodynamics. "Reopoligljukin" mtsempha-kukapanda kuleka a 500 ml.

• Detoxification - Shuga wa M'magazi 40% yakumadzulo / ndege - 20-30 ml ya; ndiye / kukapanda kuleka kutumikiridwa shuga 5% (500 ml).

2. Mu chipatala:

• Pakuti deficiencies M'MALO timadzi mu / ndege kutumikiridwa mawola 6 250-500 mcg "Thyroxine" (kapena kudzera gavage 100 ug "triiodothyronine") akutsatiridwa ndi maola 12 kuchepetsa mlingo wa 25-100 micrograms.

• Mpumulo wa adrenal insufficiency mu / ndege kutumikiridwa hydrocortisone hemisuccinate (50-100 mg).

• Kupewa encephalopathy 1 ml Vitamini B1.

• Pakuti edema bradycardia kutumikiridwa s.c. "atropine" 0.1% (0.5-1 ml).

• Kukondoweza kwa malo kupuma - "Kordiamin" (2-4 ml).

• Mpumulo wa hypoxia oziziritsa - "Mildronate" (250 mg).

• Pofuna kupewa matenda - mankhwala.

• Pakuti Kupha hypoxia - makina mpweya wabwino.

Hypothyroid chikomokere: chisamaliro mwadzidzidzi

Kupereka thandizo mwadzidzidzi, Mulimonsemo sangathe ntchito kulimbitsa mtima warmers - ichi ndi chifukwa kuwonongeka kwa hemodynamics. "Triiodothyronine" osati jekeseni kudzera m'mitsempha yomweyo kupewa ngozi ya mavuto mtima. Large mlingo "Levothyroxine" angathe n'zothandiza ndi pachimake adrenal insufficiency.

M'chipatala imagwiridwa mu malo supine mu odwala mwakayakaya kapena dipatimenti endocrinology.

Ngati anaika hypothyroid chikomokere, chisamaliro mwadzidzidzi mu Ora loyamba ndi chiyambi cha "triiodothyronine". mankhwala mpweya zakonzedwa. M'nsinga kutumikiridwa mankhwala prednisone, hydrocortisone. Administration ndi mankhwala zofunika ndi mtima.

Pambuyo theka la ola alowe ATP, mavitamini C, B. Ngati kuthamanga ndi pamwamba 90 mmHg. Art. Adapereka kumayambiriro "Lasix". Ngati magazi ndi zosakwana chithunzi ichi, ntchito "corazole", "Mezaton", "Kordiamin".

Komanso, mawola 4, malinga ndi chikhalidwe cha mtima, mu kuchuluka kwa micrograms 25 kutumikiridwa "triiodothyronine". Atangomva kugunda kwa mtima ndi kutentha ndi okhazikika, mlingo yafupika. M'pofunika kupitiriza rewarming chabe wodwala mankhwala mpweya, ntchito hydroxybutyrate ndi sodium.

Ngati pali matenda convulsive, m'nsinga jekeseni "Seduxen".

Chithandizo: Gawo 1

Chithandizo cha chikomokere hypothyroid, zimatanthauza zinthu zingapo, izo sayamba pomwepo ndi mankhwala timadzi m'malo. Kuchiza odwala ikuchitika mosamalitsa kuyang'aniridwa ndi dokotala kuwatsitsimula mu odwala mwakayakaya.

Sitepe yoyamba ndi ziziyenda ntchito ambiri a ntchito zofunika kwambiri tsiku loyamba kapena awiri, popanda ntchito zina mankhwala timadzi m'malo sadzakhala ndi zotsatira anakhumba ndi akhoza kusokoneza moyo wa wodwala

Kukhalabe ntchito kupuma. Ngati wodwala akhoza kupuma yekha, KSCHN zizindikiro kulipidwa, mwa kundipatsako kwa O ₂ (mpweya mankhwala) imagwiridwa kudzera m'mphuno cannula kapena nkhope chigoba. Childs, odwala ndi chisokonezo kupuma lachibadwa, mpweya woipa amasonkhana magazi. ntchito chipangizo chofunika kwa mpweya wabwino makina. Iwo limakhazikitsa magazi mpweya ndi carbon dioxide, kumathandiza chitukuko cha hypoxia, kuthetsa zotsatira zake zoipa zimakhala onse ndi ziwalo.

Kusintha volemic zomvetsa. Hypothyroid (myxedema) chikomokere yodziwika ndi posungira madzimadzi. Komabe kuti amasonkhana mu malo interstices, kama mtima pa nthawi ino kuvutika, ndipo pali kuchepekedwa madzimadzi, chifukwa ichi, magazi akhoza kusiya. Kuwongolera anapanga kudzera mwa njira hypertonic wa NaCl, colloidal ndi brine. Pa ndondomeko n'kofunika kuganizira mlingo wa kuthamanga chapakati venous. Sonyezani mu zosiyanasiyana zachilendo kapena ayi mpweya amalola kulowa kwa lita kuposa wina njira patsiku. Apo ayi, imfayo kuchuluka mtima katundu, ndi sodium wochuluka m'magazi madontho kwambiri.

Chabe Kutentha kwa thupi wodwala mwa mabulangete kapena kuonjezera firiji ndi digiri 1. Palibe wodwala akugwira Kutentha yogwira mwa osiyana otentha opangidwa, warmers. Izi zidzapangitsa kuti ndi akuchuluka wa vasodilation zotumphukira amapezeka vasodilation. magazi zikhoza kuchepetsedwa zina mwa hypovolemia wachibale.

Kuwukonza dongosolo mtima. Hypothyroid chikomokere ndi nkhonya kwambiri dongosolo mtima. Sitepe yoyamba ndi mankhwala a bradycardia, kuthamanga kwa magazi olimba. Zochizira bradycardia M holinoblokatory ntchito (mwachitsanzo, "atropine") angagwiritse ntchito "aminophylline". Ngati magazi sangakhoze kusintha kukhazika mtima hypovolemia, thandizo mankhwala chofunika. Ntchito zikuwonjezereka masiku ano, phenylephrine, norepinephrine. Apa muyenera kukhala wosamala kwambiri, chifukwa tilinazo zolandilira kwambiri chifukwa mankhwalawa chithokomiro timadzi. N'zotheka mtima mungoli matenda, kusonyeza zizindikiro za fibrillation matenda kapena tachycardia.

Kudzudzulidwa electrolyte ntchito (chlorine, sodium, calcium, potaziyamu), komanso msinkhu shuga magazi.

Kugwiritsa (GCS) glucocorticosteroids. Mlingo nkhawa ndi zofunika kutopa wa ntchito adrenocortical odwala ndi thyroiditis, amene anaonekera pa maziko a ntchito nthawi yaitali mahomoni, ndi kuchepa kaperekedwe ka T3 ndi T4 zizindikiro, matenda mu dongosolo hypothalamic-pituitary. Childs, hydrocortisone chikuyendetsedwera mawola asanu pa mlingo tsiku la mg wa 200 400. Pamene wodwala okhazikika, patapita masiku awiri kapena atatu, pali kuchepa mlingo.

Pachimake dialysis kapena m'malo mankhwala aimpso. Iwo anasonyeza odwala ndi oligoanuria zapamwamba, kuwonjezeka creatinine, urea, potaziyamu.

mankhwala wodwala ayenera anayamba nthawi yomweyo. Mwamsanga chidzakhala chinthu choyamba kutibwezeretsa ntchito ofunikira moyo, mwamsanga kudzakhala kotheka kuyamba timadzi m'malo mankhwala. The mwayi kuchira ndi kuchuluka kambirimbiri.

siteji 2

2 siteji mankhwala a udindo hypothyroid chikomokere kale zina. Izi zimafunika imfa yoopsa chithokomiro timadzi mankhwala.

The Gawo - kukonzekera T4. "Levothyroxine" kawirikawiri anapatsidwa pa mlingo wa 1.8 mg / kg pa patsiku. Kale pambuyo maola 6 kanthu akuyamba, ndipo patapita tsiku zotsatira zonse zimatheka. Poyamba ola ikusonyezera ku micrograms 100 mpaka 500 a mankhwala. Komanso, masana anayambitsa ena mlingo tsiku. Kenako, ntchito yokonza mlingo patsiku ndi 75-100 micrograms. Pambuyo wodwala olimba "Levothyroxine" kutumikiridwa mu mawonekedwe piritsi.

Yovutayi chikhalidwe T3 kukonzekera kutumikiridwa 0.1 kuti 0,6 mg / kg pa patsiku. Pa tsiku 75-100 mg wa mawola 6 umayamba 12.5-25 .mu.g. Ngati wodwalayo matenda a mtima, mlingo tsiku ntchito osachepera - 25-50 mg.

siteji 3

Mu sitepe 3, pambuyo olimba wodwala, anayamba chithandizo cha matenda vutoli, zomwe zinachititsa kuti pakhale chikomokere. Zimenezi zingakhale matenda alionse kapena kutupa kwa chithokomiro England, zoopsa, ndi zinthu zina.

Hypothyroid chikomokere - wodwalayo moyo pachiswe chikhalidwe. kuchipatala ayenera mosamalitsa anaona ndi zomwe zagwiridwa kale. Apo ayi, angagwe mavuto aakulu, moyo pachiswe. Self-mankhwala mu nkhani iyi ndi koletsedwa. Ngati kukayika kulikonse za zizindikiro chikomokere yomweyo kuchipatala.

thyrotoxic chikomokere

Hypothyroid chikomokere, kapena mavuto thyrotoxic, zingachitike pamaso pa hyperthyroidism kwambiri Popanda kuchitapo kanthu thyrotoxic Chotupa chija. Nthawi zambiri izi zimachitika ndi maziko a maganizo maganizo pambuyo kuchotsa opaleshoni ya chithokomiro England. The pathogenesis chachikulu - ndi:

• The kulumpha lakuthwa mu chithokomiro mahomoni m'magazi.

• Hypoxia.

• Endotoxemia.

• Otani kuwonongeka kwa dongosolo mtima ndi mantha, nadpochesnikov chiwindi.

• Kulakwila kagayidwe ma ndi madzi ndi bwino electrolyte.

Thyrotoxic mavuto patsogolo chitukuko cha chikomokere. Wodwala ali ndi zizindikiro zotsatirazi anati: chisangalalo maganizo, nthawi zambiri limodzi ndi kuyerekezera zinthu m'maganizo, zinyengo. nthambi kugwedeza, tachycardia (mpaka 200 kumenyedwa pamphindi). Thupi kutentha limatuluka digiri 38-41. Lolemera thukuta. M'mimba, kusanza. Mwina maonekedwe a matenda a chikasu ndiyo.

Ngati palibe mankhwala okwanira, alili worsens kwambiri:

• kutsitsa magazi;

• khungu youma;

• matenda fibrillation;

• mydriasis;

• cyanosis;

• bulbar matenda.

Chimachitika kuponderezana bongo, minofu kamvekedwe amachepetsa, pali imfa ya ulamuliro chikhodzodzo, matenda kutsitsimuka, chikomokere. Matenda mtengo ndi mbiri deta zikusonyeza kukhalapo kwa thyrotoxicosis: tachycardia, malungo, kuchepetsa thupi, kusanza, m'chikaiko chowakaikitsa, profuse m'mimba.

Mu kusanthula magazi anapeza: chinawonjezeka chiwerengero cha chithokomiro timadzi, mapuloteni-womangidwa ayodini, bilirubin (chifukwa cha kuwonongedwa kwa chiwindi poizoni), 17 oksiketosteroidov, kagayidwe kachakudya acidosis.

Mmenemonso wodwala n'kofunika kuti athandize mwadzidzidzi. ntchito zotsatirazi m'gulu kuti:

• M'nsinga kutumikiridwa isotonic sodium kolorayidi njira mu kuchuluka kwa 1 lita imodzi.

• A njira ya 5% shuga.

• "Hydrocortisone" mu mlingo wa mg wa 350 600.

• "Prednisolone" kuchokera 120 mpaka 180 mg.

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

• "Seduxen" kapena anticonvulsants ena.

• "Merkazolil" (antithyroid mankhwala) - 60-80 mg wa pa tsiku.

Kudziwa mtima zizindikiro pamwamba ayenera yomweyo kuitana "ambulansi" ndipo wodwalayo kuchipatala mu Dipatimenti Endocrinology.