Hypothyroid coma: yuav ua li cas muab thaum muaj xwm ceev kho mob?

Congenital Hypothyroidism yog ib tug txaus ntshai tus kab mob. Ib tug ntawm cov feem ntau heev teeb meem nws yog hypothyroid coma. Feem ntau cov feem ntau nws yuav tshwm sim nyob rau hauv cov laus cov neeg mob, tshwj xeeb tshaj yog nyob rau hauv cov poj niam. Coma tshwm sim nyob rau hauv hais tias pab pawg neeg ntawm cov neeg mob uas raug kev txom nyem hypothyroidism, tsis tau txais cov kev kho mob, los yog hais tias nws twb nqa tawm nyob rau hauv lub sij hawm.

Ua rau hypothyroidism

Feem coob ntawm cov neeg mob (95%) ntawm cov hypothyroidism yog tshwm sim los ntawm pathological dab tshwm sim nyob rau hauv lub qog caj pas. Cov theem ntawm zus tau tej cov tshuaj hormones decreases, thawj hypothyroidism tsim.

Thaum ua txhaum stimulatory thiab ntxawg nyhuv ntawm pituitary TSH thiab tireoliberina (los yog hypothalamic tso tau) los theem nrab hypothyroidism. Tus zaus ntawm nws tshwm sim nyob rau hauv kev lom zem ntau tsis tau zoo tus thawj. Thiab nyob rau hauv qhov tseeb, thiab nyob rau hauv lwm tus neeg mob thaum muaj tsis txaus kho mob tej zaum tsim hypothyroid coma.

Hais txog peripheral hypothyroidism lo lus nug twb tsis tau solved nyob rau hauv ntau txoj kev. Seb nws tshwm sim nyob rau hauv kev twb kev txuas nrog metabolic mob nyob rau hauv lub periphery ntawm lub qog hormone los yog vim qhov rhiab heev yuav txo tau nyob rau hauv lub nruab nrog cev thiab cov nqaij mos ntawm nuclear receptors rau cov thyroid hormones?

Nws tseem yog ib tug muaj teeb meem lo lus nug txog seb puas muaj yog muaj hnub nyoog-degradation ntawm lub qog hormones nyob rau hauv mob ntawm peripheral metabolism. Thiab seb puas irreversible phenomena cai nyob rau hauv cov thyroid caj pas nyob rau hauv cov laus txheej txheem?

Hypothyroid coma. yog vim li cas

Pathogenesis hypothyroid coma nyob rau hauv Feem ntau, qhia hais tias tus nqa kev los yog untimely kev kho mob ntawm hypothyroidism. Ib feem ntawm tus piav tej zaum yuav ncua sij hawm nyob rau hauv mob. Deficiency ntawm lub qog hormones tej zaum yuav exacerbated los ntawm cov kev tshem ntawm txais tos ntawm levothyroxine los yog kab mob nyob rau hauv kev xav tau ntawm ua koob tshuaj lawm hloov chaw. Hypothyroid coma yuav pab mus rau ob peb yam tseem ceeb:

• Hypothermia.

• Concomitant kab mob (lub plawv nres, mob ntsws, mob stroke, kis, urogenital kab mob).

• Loj heev ntshav poob, kev poob plig, tawg txoj kev kho, kev phais.

• X-ray xeem.

• Cov thawj coj ntawm cov tshuaj uas mluas lub hauv paus poob siab system.

• Loj koob tshuaj haus dej cawv.

• Hypoglycemia.

• Hypoxia.

Yog hais tias plummets theem ntawm lub qog hormones nyob rau hauv lub hlwb txo cov kev ua ntawm metabolic dab. Raws li ib tug tsim nyog tau, ua hypoxia, ho ua txhaum tag nrho cov hom ntawm cov metabolism hauv, thiab ntau yam ntawm cov yam ntxwv ntawm feem ntau kabmob.

Cov tsos mob ntawm hypothyroid coma

coma phenomenon tshwm sim maj mam loj hlob, progressing maj. Chiv, qaug zog zoo nkaus li, apathy, nkees, ces cai povtseg coldness, dryness, o ntawm ob txhais taw, daj tawv nqaij - tej cwj pwm no yog yus muaj los ntawm hypothyroid coma. Raws li txoj cai lokalis qhia qeeb ua tsis taus pa, muaj teeb meem nrog tso zis, cov tsos mob ntawm lub plawv tsis ua hauj lwm. Txo cov ntshav siab, tau tsis muaj txog leeg reflexes. Nyob rau kev xeem, tus neeg mob tus kws kho mob pom qhov nram qab no cov tsos mob ntawm hypothyroid coma:

• Deteriorates metabolism, lub cev hnyav nce kev slows, qhov kub thiab txias ntog rau 35 degrees.

• Muaj teeb nyob rau hauv cov hlab plawv system. Lub plawv dhia slows, muaj yog ib tug thready mem tes, tsis muaj ntshav siab, edema ntawm lub plawv.

• Kev ua txhaum ntawm kev ua pa zog. Txo tus naj npawb ntawm cov pa, ntog ntshav oxygen theem thaum lub sij hawm pw tsaug zog yuav tsis ua pa lawm.

• Kev txawv txav nyob rau hauv lub paj hlwb. Inhibition ntawm txog leeg reflexes, hnyav stupor.

• Ntawm daim tawv nqaij muaj mob. Tawv nqaij dawb, qhuav, waxy daim tawv nqaij tones, ob leeg hyperkeratoses. Nkig tes. Cov plaub hau tsis.

• Ntog rau hauv cov ntshav sodium theem. lub ntsej muag thiab extremities loj o.

• Ntshav Puas Txaus, thiab tag nrho cov raug cov tsos mob ntawm nws.

• Hypoglycemia.

• Digestive ntshawv siab. ileus. Nce siab.

lub tsev kho mob

Clinic hypothyroid coma yog raws li nram no: muaj ib tug tsis muaj zog, nkees nkees, nws txo qis kub rau 35 degrees. Slows cia, cov lus no yog cov lus hais indistinctly, txo tsis pom kev zoo thiab lub rooj sib hais. Ntshav siab yog nws txo qis, cov mem tes - 30 yeej ib feeb. Ua pa ntiav ntiav thiab tsis tshua muaj. Los ntawm lub plab - tsam plab, quav tawv, mob, ntuav. Muaj txoj kev loj hlob ntawm oliguria. Daim tawv nqaij daj daj, qhuav. O ntawm lub ntsej muag, extremities. Feeb tsis meej, nkees. Lub txog leeg reflexes yog tsis tuaj kawm ntawv. Los hypothyroid coma.

Cov ntshav. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, acidosis, hematocrit, TSH, T3 thiab T4 nws txo qis cholesterol ntau zog.

Teeb meem: mob ntsws, mob laug ventricular tsis ua hauj lwm, encephalopathy, mob raum tsis ua hauj lwm, mob arrhythmias, mob stroke, dementia, ileus.

Lub algorithm thawj pab

Yog hais tias ib tug neeg hypothyroid coma, mob mob algorithm yog raws li nram no:

1. Prehospital:

• Hu rau ib tug kws kho mob. Yuav kom muab thawj kev kho mob pab.

• Qhwv pam los txo lub cev thaum tshav kub kub.

• Yuav kom tshem tawm hypoxia los ntawm qhov ntswg catheters muab humidified oxygen.

• Muab kev nkag mus rau cov leeg nyob rau hauv lub hlab ntsha catheter teeb.

Yog hais tias ntsia hypothyroid coma tactics nurse yuav tsum muaj tseeb, ib tug koom tes nrog Dr. - ceev, zoo-ncaav:

• Rau cov mob ntawm cov teeb meem coj cov ntshav cov ntsiab lus thyroxine, thyroid stimulating lawm, triiodothyronine, qabzib, cortisol, chloride, sodium, AAR, cov roj muaj pes tsawg leeg.

• Nyob rau hauv thiaj li yuav tswj tau diuresis muaj zais zis hnab cug zis.

• Yuav kom tiv thaiv aspiration ntawm ntuav yog nkag tau rau hauv lub plab yas.

• Yuav kom kuaj mob - ECG xyuas pa nqi, kub, hemodynamics. "Reopoligljukin" tso dej-txia ntawm 500 ml.

• Detoxification - qabzib 40% w / dav hlau - 20-30 ml; ces / txia muab zib 5% (500 mL).

2. Nyob rau hauv lub tsev kho mob:

• Rau hloov lawm raug nyob rau hauv / dav hlau muab txhua txhua 6 teev 250-500 mcg "Thyroxine" (los ntawm gavage 100 ug "triiodothyronine") raws li los ntawm 12 teev rau tau cov tshuaj tsawg ntawm 25-100 micrograms.

• Kev pab ntawm adrenal insufficiency nyob rau hauv / dav hlau muab hydrocortisone hemisuccinate (50-100 mg).

• Rau kev tiv thaiv encephalopathy 1 ml Vitamin B1.

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

• Stimulation ntawm cov pa chaw - "Kordiamin" (2-4 ml).

• Kev pab ntawm cerebral hypoxia - "Mildronate" (250 mg).

• Yuav kom tiv thaiv kab mob - tshuaj tua kab mob.

• Rau cov tshem tawm ntawm hypoxia - txhua yam cua.

Hypothyroid coma: thaum muaj xwm ceev kho mob

Muab thaum muaj xwm ceev kev pab, nyob rau hauv txhua rooj plaub yuav siv tsis tau kom sov tus neeg mob warmers - qhov no yog vim lub deterioration ntawm hemodynamics. "Triiodothyronine" tsis txhaj intravenously tam sim ntawd kom tsis txhob qhov uas yuav ntawm cov hlab plawv tus teeb meem. Loj koob "Levothyroxine" muaj peev xwm ntawm provoking ib tug mob adrenal insufficiency.

Pw tsev kho mob yog ua nyob rau hauv lub supine txoj hauj lwm nyob rau hauv ib tug intensive saib xyuas tsev los yog department ntawm endocrinology.

Yog hais tias ntsia hypothyroid coma, thaum muaj xwm ceev kho mob nyob rau hauv tus thawj teev yog los ntawm cov kev taw qhia ntawm "triiodothyronine". Pa txoj kev kho yog tsa. Intravenously muab tshuaj prednisone, hydrocortisone. Administration yog tsim nyog thiab kab tshuaj.

Tom qab ib nrab ib teev yuav tsum nkag mus rau ATP, vitamins C, B. Yog hais tias lub siab yog saum toj no 90 mmHg. Art., Ua cov kev taw qhia ntawm "Lasix". Yog hais tias cov ntshav siab yog tsawg tshaj qhov no daim duab, siv "corazole", "Mezaton", "Kordiamin".

Ntxiv mus, txhua txhua 4 teev, nyob ntawm seb tus mob ntawm lub plawv, nyob rau hauv ib tug npaum li ntawm 25 micrograms muab "triiodothyronine". Sai li sai tau raws li lub plawv dhia thiab kub no stabilized, ntau npaum yuav txo. Nws yog tsim nyog mus txuas ntxiv mus passive rewarming ntawm tus neeg mob, cov pa txoj kev kho, kev siv ntawm sodium hydroxybutyrate.

Yog hais tias muaj yog ib tug convulsive teeb meem, intravenously txhaj "Seduxen".

Kev Kho Mob: Theem 1

Kev kho mob ntawm hypothyroid coma, feem ntau yuav ob peb kauj ruam, nws tsis pib tam sim ntawd nrog hormone hloov txoj kev kho. Kev kho mob ntawm cov neeg mob yog nqa tawm nruj me ntsis nyob rau hauv lub saib xyuas ntawm ib tug kws kho mob nyob rau hauv resuscitation nyob rau hauv lub intensive kev saib xyuas unit.

Thawj kauj ruam yog mus rau stabilize qhov general ua ub no ntawm ib qho tseem ceeb qhov tseem ceeb heev functions nyob rau hauv thawj hnub los yog ob tug, tsis muaj ntxiv lawm siv hormone hloov txoj kev kho yuav tsis muaj lub nyhuv thiab tej zaum yuav txawm tso hem thawj rau tus neeg mob lub neej

Tswj pa zog. Yog hais tias tus neeg mob tseem ua taus pa nws tus kheej, thiab KSCHN ntsuas compensated, lub mov ntawm O ₂ (oxygen txoj kev kho) yog ua los ntawm ib tug ntswg cannula los yog lub ntsej muag daim npog qhov ncauj. Feem ntau, cov neeg mob muaj teeb ntawm txawj ua tsis taus pa, pa roj carbon dioxide accumulates nyob rau hauv cov ntshav. siv lub ntaus ntawv yuav tsum tau rau cov neeg kho tshuab cua. Nws stabilizes ntshav oxygen thiab carbon dioxide, tiv thaiv cov kev loj hlob ntawm hypoxia, tshem tawm nws tsis zoo rau tag nrho cov ntaub so ntswg thiab kabmob.

Hloov volemic losses. Hypothyroid (myxedema) coma yus muaj los ntawm cov kua tuav tseg. Tab sis qhov tseeb yog hais tias nws accumulates nyob rau hauv lub interstices tej qhov chaw, lub vascular pw ntawm lub sij hawm no ntawm kev txom nyem, thiab muaj ib tug dej tshaj, rau qhov no yog vim li cas, cov ntshav siab yuav poob. Kho yog tsim los ntawm txhais tau tias ntawm ib tug hypertonic tshuaj ntawm NaCl, colloidal thiab brine. Thaum lub sij hawm txoj kev nws yog ib qho tseem ceeb yuav tau xav txog lub theem ntawm central venous siab. Zaub nyob rau hauv lub cev ntau los yog tsis inflated tso cai nkag teb chaws ntawm ntau tshaj ib tug liter tshuaj ib hnub twg. Txwv tsis pub, tej zaum nws yuav ntxias nce mob load, nrog sodium nyob rau hauv cov ntshav dauv ho.

Passive cua kub ntawm tus neeg mob lub cev los ntawm txoj kev pam los yog ua rau kom cov chav tsev kub ntawm 1 degree. Nyob rau hauv tsis muaj cov ntaub ntawv rau tus neeg mob yuav tsis tuav lub active cua kub los ntawm txoj kev sib txawv kub ntaub yas, warmers. Qhov no yuav ua rau ib tug ntsuas ntawm peripheral vasodilation tshwm sim vasodilation. Ntshav siab yuav txo tau ntxiv los ntawm cov txheeb ze hypovolemia.

Kho ntawm cov hlab plawv system. Hypothyroid coma yog ib tug loj lub tshuab rau cov hlab plawv system. Thawj kauj ruam yog cov kev kho mob ntawm bradycardia, ntshav siab stabilization. Rau cov kev kho mob ntawm bradycardia M holinoblokatory siv (e.g., "atropine") tej zaum yuav siv "aminophylline". Yog hais tias cov ntshav siab yuav tsis tau tom tswj vascular hypovolemia, tshuaj nyiaj yug uas yuav tsum tau. Applied adrenaline, phenylephrine, norepinephrine. Ntawm no koj yuav tsum tau ceev faj heev, vim hais tias cov rhiab heev ntawm receptors yog nce nyob rau hauv cov kev kho mob ntawm lub qog hormone. Tau lub plawv atherosclerosis tsis meej, ib tug manifestation ntawm cov tsos mob ntawm atrial fibrillation los yog tachycardia.

Kho ntsha kev kawm (tshuaj, sodium, calcium, poov tshuaj), raws li zoo raws li cov ntshav qab zib theem.

Siv (GCS) glucocorticosteroids. Kev nyuaj siab koob tshuaj uas yuav tsum tau rau qaug ntawm adrenocortical muaj nuj nqi nyob rau hauv cov neeg mob uas thyroiditis, uas nyob rau hauv lub keeb kwm yav dhau ntawm ntev-lub sij hawm siv ntawm cov tshuaj hormones, nrog ib tug txo nyob rau hauv lub theem ntawm T3 thiab T4 indicators, As, mob nyob rau hauv lub hypothalamic-pituitary system. Feem ntau, hydrocortisone yog xeem txhua txhua rau lub sij hawm ib hnub koob tshuaj ntawm 200 rau 400 mg. Thaum tus neeg mob yog stabilized, tom qab ob los yog peb hnub, muaj ib tug txo nyob rau hauv lub koob.

Mob lim ntshav los yog lub raum hloov txoj kev kho. Nws yog qhia rau cov neeg mob nrog advanced oligoanuria, ua creatinine, urea, poov tshuaj.

tus neeg mob txoj kev kho mob yuav tsum tau pib tam sim ntawd. Tus hais tam sim nws yuav yog thawj kauj ruam mus rau restore qhov yuav tsum tau kev tso cai ntawm lub neej, lub ntxov nws yuav tau mus pib hormone hloov txoj kev kho. Cov uas yuav muaj rov qab yog nce ntau zaus lawm.

theem 2

2 theem kev kho mob ntawm hypothyroid coma raws li txoj cai twb muaj lwm yam. Qhov no yuav tsum tau ib tug sawv thyroid hormone txoj kev kho.

Lub ntsiab Cheebtsam - T4 npaj. "Levothyroxine" feem ntau yog muab ntawm ib koob tshuaj ntawm 1.8 mg / kg ib hnub twg. Twb tom qab 6 teev qhov kev txiav txim pib, thiab tom qab ib hnub twg tag nrho cov nyhuv yog tiav. Chiv teev illustrated ntawm 100 mus rau 500 micrograms ntawm cov tshuaj. Ntxiv mus, thaum lub sij hawm lub hnub ua tswvcuab tus so ntawm lub hnub koob tshuaj. Tom qab ntawd, tus txij nkawm koob tshuaj ib hnub twg yog 75-100 micrograms. Tom qab tus neeg mob stabilization "Levothyroxine" muab nyob rau hauv cov ntsiav tshuaj daim ntawv.

Cov qho tseem ceeb mob T3 npaj muab 0.1 rau 0.6 mg / kg ib hnub twg. Thaum hnub 75-100 mg txhua txhua 6 teev yog tswvcuab 12.5-25 .mu.g. Yog hais tias tus neeg mob muaj kab mob plawv, txhua hnub koob tshuaj no yog siv qhov tsawg kawg nkaus - 25-50 mg.

theem 3

Nyob rau hauv kauj ruam 3, tom qab lub stabilization ntawm tus neeg mob, pib kho mob ntawm lub qhov pib kab mob, uas coj mus rau txoj kev loj hlob ntawm coma. Qhov no yuav ua tau tej kab mob los yog mob ntawm lub qog caj pas, kev poob plig, thiab lwm yam.

Hypothyroid coma - tus neeg mob lub sia mob. Medical tswv yim yuav tsum tau nruj me ntsis pom thiab muab los siv. Txwv tsis pub, tej zaum yuav tshwm sim loj heev teeb meem, tuag taus. Self-tshuaj nyob rau hauv cov ntaub ntawv no yog txwv tsis pub. Yog hais tias tej kev ua xyem xyav txog qhov coma cov tsos mob tam sim ntawd mus nrhiav kev pab kho mob.

thyrotoxic coma

Hypothyroid coma, los yog thyrotoxic ntsoog, tej zaum yuav tshwm sim nyob rau hauv lub xub ntiag ntawm mob loj heev hyperthyroidism nyob rau hauv tsis kho thyrotoxic goiter. Feem ntau cov feem ntau qhov no tshwm sim tiv thaiv ib tug tom qab ntawm lub hlwb kev nyuaj siab tom qab kev phais tshem tawm ntawm lub qog caj pas. Lub ntsiab pathogenesis - yog:

• Tus ntse dhia nyob rau hauv lub qog cov tshuaj hormones rau hauv cov ntshav.

• Hypoxia.

• Endotoxemia.

• Toxic kev puas tsuaj ntawm cov hlab plawv thiab lub paj hlwb, nadpochesnikov siab.

• Kev ua txhaum ntawm cellular metabolism thiab dej electrolyte tshuav nyiaj li cas.

Thyrotoxic ntsoog precedes txoj kev loj hlob ntawm coma. Tus neeg mob muaj cov nram qab cov tsos mob muaj cai: puas siab puas ntsws zoo siab, feem ntau nrog los ntawm hallucinations, delusions. povtseg co, tachycardia (mus txog 200 neeg ntaus ib feeb). Lub cev kub ntawm lub nce mus 38-41 degrees. Heavy tawm hws. Zawv plab, ntuav. Tej zaum cov tsos ntawm daj ntseg.

Yog hais tias muaj yog tsis muaj txaus txoj kev kho, tus neeg mob tus mob worsens dramatically:

• txos cov ntshav siab;

• qhuav daim tawv nqaij;

• atrial fibrillation;

• mydriasis;

• cyanosis;

• bulbar ntshawv siab.

Tshwm Sim oppression reflexes, nqaij laus decreases, muaj yog ib tug tsis ntawm lub zais zis tswj, nco qab mob, coma. Diagnostic nqi muaj ib tug keeb kwm ntaub ntawv qhia lub xub ntiag ntawm thyrotoxicosis: tachycardia, kub taub hau, yuag, ntuav, nyob tsis tswm, profuse raws plab.

Nyob rau hauv lub tsom xam ntawm cov ntshav nyob: nce cov nqi ntawm cov thyroid hormones, protein-ua txhua yam iodine, bilirubin (vim kev puas tsuaj ntawm daim siab toxins), 17-oksiketosteroidov, metabolic acidosis.

Nyob rau hauv lub xeev no rau tus neeg mob yog tsim nyog los muab thaum muaj xwm ceev cov kev pab. Cov nram qab no yog muaj nyob rau hauv nws:

• Intravenously muab isotonic sodium tshuaj dawb tov nyob rau hauv ib tug npaum li ntawm 1 liter.

• Ib tug tov ntawm 5% qabzib.

• "Hydrocortisone" nyob rau hauv ib tug ntau npaum ntawm 350 rau 600 mg.

• "Prednisolone" los ntawm 120 mus rau 180 mg.

• "Korglikon" los yog "StrofantinK" 0.5-1 ml.

• "Seduxen" los yog lwm yam anticonvulsants.

• "Merkazolil" (antithyroid yeeb tshuaj) - 60-80 mg ib hnub twg.

Nyob rau hauv paub tus neeg mob lub saum toj no cov tsos mob yuav tsum tam sim ntawd hu rau "tsheb thauj neeg mob" thiab tus neeg mob pw tsev kho mob nyob rau hauv lub endocrinology Department.