Pōroa, Hypothyroid: me pehea ki te whakarato i te atawhai whawhati tata?

Hypothyroidism Ko te mate kino. Ko tētahi o nga pōauautanga tino auau ko reira pōroa hypothyroid. Nuinga o ngā wā tupu te reira i roto i te tūroro pakeke, rawa i roto i nga wahine. puta pōroa i roto i taua rōpū o tūroro e te mauiui hypothyroidism, kihai i riro te maimoatanga tika, ahakoa i kawea te reira i roto i roto i te wa ranei.

Take o te hypothyroidism

meinga te nuinga o tūroro (95%) o te hypothyroidism e tukanga pathological tupu i roto i te repe thyroid. Ko te taumata o te hanga o hormones heke, whakawhanake hypothyroidism tuatahi.

A, no te maumaui stimulatory me te pānga ture o te rapae o TSH me tireoliberina (ranei hypothalamic tuku take) mai hypothyroidism tuarua. Ko te auau o tona tupu i roto i te nuinga hoki iho ki te tuatahi. A i roto i te meka, a i roto i te tahi atu te wā ka reira he iti maimoatanga kia whakawhanake pōroa hypothyroid.

Mō hypothyroidism piringa kore i pātai i faatiti'aifarohia i roto i ngā huarahi maha. Ahakoa whakatika te reira i roto i te hononga ki te disorders pūkoro tinana i roto i te taha o te taiaki thyroid ranei e tika ana ki te whakaiti tūtohutanga i roto i nga whekau, me te kopa o receptors karihi mō hormones thyroid?

tonu te reira i te pātai i tautohetia e pā ana ki ranei reira he tau-kinonga o hormones thyroid i roto i disorders o pākia e piringa. A ahakoa ari tina heke kitea i roto i te repe thyroid i roto i te tukanga hoholo?

pōroa Hypothyroid. take

Pathogenesis pōroa, hypothyroid i roto i nuinga o te wā, tohu e te kawea maimoatanga ta'etotonú mea mate ranei o te hypothyroidism. Wāhanga o te whakamārama kia roa i roto i te tātaritanga. Hē o hormones thyroid kia kino ake ngaa e te whakakorenga o te fariiraa o te levothyroxine kaiao ranei i hiahia o te whakanui ake pota o taiaki whakauru. kia whai wāhi pōroa, Hypothyroid ki te maha o ngā āhuatanga:

• Hauhauaitu.

• mate te rere (whakaeke ngakau, kakā, patu, viral, mate urogenital).

• mate nui toto, whētuki, radiation therapy, pokanga.

• whakamātautau X-ray.

• Whakahaere o raau taero e lōmekina te pūnaha io pokapū.

• pota nui o te waipiro.

• E suka.

• Hypoxia.

Ki te heke kohatu whakatika taumata o hormones thyroid i roto i te roro i te mahi o ngā tukanga pūkoro tinana. Ka rite ki te putanga, te whakanui ake hypoxia, tino takahia momo katoa o te pākia, a he tokomaha o nga āhuatanga o te nuinga o whēkau.

Tohu o te coma hypothyroid

coma tītohunga e tupu āta tipu, ahu āta. I te tīmatanga, puta rohirohi, tau'a, lethargy, ka kite e alangá mo makariri, maroke, pupuhi o waewae, koma kiri - āhuatanga enei huanga e pōroa hypothyroid. Tūnga lokalis tohu manawa puhoi, raruraru ki urination, tohu o te kore ngakau. Whakahekea pēhanga toto, kua kore o reflexes iohere kua. I te whakamātautau, he whakaaro tākuta o te manawanui nga tohu e whai ake nei o te coma hypothyroid:

• Ino roa pākia, pōturi nui haere tohanga taimaha tinana, te pāmahana taka ki 35 nekehanga.

• He raruraru i roto i te pūnaha Cardiovascular. Ko te auau ngakau pōturi iho, i reira te mea he pini thready, heke pēhanga toto, edema o te ngakau.

• Maumaui o ngā mahi romahā. Whakaiti i te maha o te whakahā, hinga taumata toto hāora i roto i te moe kia mutu te kupukupu.

• Abnormalities i roto i te pūnaha io. Inhibition o reflexes iohere, hiamoe ahu whakamua.

• tohu kiri. Koma, maroke, pepe kiri parikoriko, hyperkeratoses tahi. whao he pakarukaru. mate Hair.

• Taka i roto i ngā taumata toto konutai. mata me te pito tetere Pākaha.

• Anemia, me nga tohu angamaheni katoa o reira.

• E suka.

• disorders kūnatu. ileus. ate nui ake.

whare hauora

Hauora pōroa, hypothyroid ko e whai ake: i reira ko te ngoikore, momoe, tuku iho te pāmahana ki te 35 nekehanga. Pōturi iho, e korerotia nga kupu hakiri, heke kite me te rongo. Kei te tuku iho te pēhanga toto, te pini - 30 kapakapa ki te meneti. Kupukupu pāpaku , me te onge. Mai i te puku - bloating, kōroke, te mamae, ruaki. He ko te whanaketanga o oliguria. koma kōwhai, maroke kiri. Huamo o te mata, topito. Whakama, lethargy. he mea motu nga reflexes iohere. Mai pōroa hypothyroid.

Toto. nui haere Hypoxia, hypercapnia, hyponatremia, suka, acidosis, hematocrit, TSH, T3 me T4 tuku iho cholesterol.

Fifi: kakā, whakapeka kore ventricular maui, encephalopathy, whakapeka täkihi, arrhythmias cardiac, patu, tupu, ileus.

Ko te āwhina tuatahi hātepe

Ki te coma hypothyroid o te tangata, Hātepe tiaki whakapeka ko e whai ake:

1. Prehospital:

• Karangatia he rata. Hei whakarato āwhina tuatahi hauora.

• Roropi paraikete ki te whakaiti i te wera tinana.

• Hei whakakore i hypoxia roto catheters nasal hoatu hāora humidified.

• Te whakarato wāhi ki te uaua i roto i te huinga rua pū tōngāmimi.

Ki te kia kia mārama tāuta hypothyroid tātai pōroa nēhi, he mahi tahi ki Dr. - tere, pai-whakaritea:

• Hoki te tātaritanga o pōauautanga tango ihirangi thyroxine toto, thyroid whakaongaonga taiki, triiodothyronine, kūhuka, cortisol, pūhaumāota, konutai, AAR, te hanganga hau.

• I roto i te tikanga ki te whakahaere i tū diuresis tōngāmimi catheterization.

• Kia kore ai e whakaurua wawata o ruaki ki te ngongo puku.

• Hei whakatau pōauautanga - ECG aroturuki auau romahā, te pāmahana, hemodynamics. "Reopoligljukin" rō-uaua-maturuturu o 500 ml.

• Detoxification - kūhuka 40% w / jet - 20-30 ml; Na / maturuturu whakahaere kūhuka 5% (500 mL).

2. I roto i te hōhipera:

• Hoki hē whakauru taiki i roto i / jet whakahaere katoa 6 haora 250-500 mcg "Thyroxine" (ranei mā gavage 100 UG "triiodothyronine") aru e 12 haora ki te whakaiti i te horopeta o 25-100 micrograms.

• Hoki te tauturu o te iti hoki adrenal i roto i te / jet hemisuccinate hydrocortisone whakahaere (50-100 mg).

• Hoki te ārai encephalopathy 1 ml Huaora B1.

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

• Whakaongaonga o te pokapū romahā - "Kordiamin" (2-4 ml).

• Hoki te tauturu o te hypoxia kaka - "Mildronate" (250 mg).

• Hei ārai mate - paturopi.

• Hoki te whakakorenga o te hypoxia - ventilation aunoa.

pōroa, Hypothyroid: tiaki whawhati tata

Whakarato āwhina ohotata, i roto i tetahi take e kore e taea te whakamahi ki te whakamahana i te karapu manawanui - he tika ki te ino o hemodynamics tenei. "Triiodothyronine" kore patia e pâmuhia tonu ki te karo i te tūpono o pōauautanga Cardiovascular. Nui horopeta "Levothyroxine" nehenehe o whakapataritari he iti hoki adrenal whakapeka.

whakamana hohipera kei roto i te tūranga te maungārongo i roto i te kōwae whāomo tari o te mātai repe ranei.

Ki te tāuta pōroa hypothyroid, tiaki ohotata i roto i te haora tuatahi ko roto i te introduction o "triiodothyronine". i whakaritea hāora therapy te. Pâmuhia whakahaere taero prednisone, hydrocortisone. Whakahaere Ko taero e tika ana, me te Cardiovascular.

I muri me te hawhe haora tomo ATP, huaora C, B. Ki te kei i runga 90 mmHg te pēhanga. Art., Hanga te whakataki o "Lasix". Ki te he iti iho i tenei ahua, whakamahia "corazole" pēhanga toto, "Mezaton", "Kordiamin".

I tua atu, nga 4 haora, i runga i te huru o te ngakau rānei, i roto i te nui o 25 micrograms whakahaeretia "triiodothyronine". Ka rite ki te auau ngakau, me te pāmahana e ähuareka, heke te inenga te. He mea tika ki te haere tonu ki te rewarming hāngū o te manawanui, te hāora therapy, te whakamahi o te konutai hydroxybutyrate.

Ki te reira te mea he mate takiri, e pâmuhia "Seduxen".

Treatment: Kaupae 1

Maimoatanga o te coma hypothyroid, te tikanga whai wāhi te maha o ngā kaupae, e kore e timata i te reira tonu ki te taiki whakakapinga therapy. kawea maimoatanga o tūroro i roto i tino i raro i te mātakitaki o te tākuta i whakaora i roto i te kōwae tiaki kaha.

Ko te mahi tuatahi, ko te ki te ū te mahi whānui o ngā mahi faufaa nui i roto i te ra tuatahi ranei e rua, kahore te whakamahi atu o te taiaki whakakapinga therapy kore e whai i te pānga e hiahiatia ana, a kia ara whakawehi ora o te manawanui

Te pupuri i ngā mahi romahā. Ki te te manawanui e taea ki te manawa ia, ka utua KSCHN tohu, whakamana te supply o e ₂ (hāora therapy) te roto i te pūkawe ihu kanohi mata ranei. Tikanga, tūroro i raruraru o manawa noa, piki waro hāorarua i roto i te toto. whakamahi o te pūrere e hiahiatia ana mō te ventilation aunoa. stabilizes te reira i te toto hāora me te hauhā, ārai te whanaketanga o hypoxia, faaore i tona pānga kino i runga i te kopa me okana katoa.

Whakarerekētanga parekura volemic. Hypothyroid (myxedema) coma āhuatanga e pupuri inu. Ko te meka ko e piki ai i roto i te wāhi interstices, te moenga iaia i tenei wa o te mamae, me i reira ko te nama inu, mo tenei take, ka taea e te pēhanga toto maturuturu. hanga te ako e te tikanga o te otinga hypertonic o NaCl, colloidal me te tote. I roto i te tukanga ko reira nui ki te whakaaro i te taumata o te pēhanga venous pokapū. Whakaatu i roto i te awhe noa e kore ranei rimurapa taea urunga o neke atu i te kotahi otinga rita ia ra. Kore, kia whakapataritari nui haere te reira kawenga cardiac, ki te konutai makaka tino i roto i te toto.

whakawera hāngū o te tinana o te manawanui e tikanga o paraikete ranei ake i te pāmahana rūma e 1 tohu. I roto i kore take e kore e taea e te manawanui mau te whakawera kaha i te tikanga o rerekē wera komehe, karapu. Tenei ka arahi ki te vasodilation ähua o vasodilation piringa puta. Ka taea te heke te pēhanga toto atu e te hypovolemia whanaunga.

Te ako o te pūnaha Cardiovascular. pōroa, Hypothyroid Ko te pupuhi nui mo te pūnaha Cardiovascular. Ko te mahi tuatahi ko te maimoatanga o te bradycardia, te pēhanga toto stabilization. Hoki te maimoatanga o te bradycardia M holinoblokatory whakamahia (hei tauira, "atropine") kia whakamahi "aminophylline". Ki te kore e taea te whakaritea te pēhanga toto e faaau hypovolemia iaia, e hiahiatia ana te tautoko tarukino. Adrenaline tīpakongia, phenylephrine, norepinephrine. Here whai koe ki te kia tino tupato, no te mea nui haere te tūtohutanga o receptors e i roto i te maimoatanga o te thyroid taiki. Pea mate manawataki ngakau, he faaiteraa o nga tohu o te fibrillation Atrial tachycardia ranei.

mahi ako kawehiko (māota, konutai, konupūmā, pāhare pāporo), me te taumata toto kūhuka.

Mā te (GCS) glucocorticosteroids. E hiahiatia ana pota Stress mō te rohirohi o te mahi adrenocortical i roto i te tūroro ki te thyroiditis, i puta i runga i te whakamārama o te whakamahi wā roa-o hormones, ki te hekenga i roto i te taumata o te T3 me T4 tohu, disorders i roto i te pūnaha hypothalamic-rapae o. Tikanga, whakahaeretia hydrocortisone te katoa haora e ono ia horopeta ia rā o 200 ki te 400 mg. Kia ähuareka te manawanui ko, i muri i rua ranei e toru nga ra, i reira te mea he heke i roto i te horopeta.

tātari whakapeka ranei therapy whakakapinga tākihi. Kei te tohua te reira mō ngā tūroro ki oligoanuria matatau, te whakanui ake i creatinine, Urea, pāhare pāporo.

kia tīmata tonu maimoatanga o te manawanui. Ko te wawe ka waiho te taahiraa tuatahi ki te whakahoki i te mahi e hiahiatia ana o te ora, te wawe ka waiho reira taea ki te timata taiki whakakapinga therapy. Ko te tūpono o te ora e maha nga wa nui haere ki runga.

atamira 2

2 wā maimoatanga o te mana pōroa hypothyroid kua he te tahi atu. Me whiwhi tēnei te therapy thyroid ira fakafofonga.

Ko te wāhanga matua - taka T4. "Levothyroxine" te tikanga whakaritea i te horopeta o 1.8 mg / kg ia ra. Kua i muri i 6 haora tīmata te mahi, a i muri i te ra tutuki pānga tonu te. I te tīmatanga whakaahua haora i 100 ki te 500 micrograms o te tarukino. I tua atu, i roto i te ra whakaurua te toenga o te horopeta ia rā. I muri iho, te horopeta tiaki ia ra ko 75-100 micrograms. I muri i te manawanui stabilization "Levothyroxine" faaterehia i roto i te puka papa.

Ko nga whakatakataka huru T3 tino whakahaere 0.1 ki te 0.6 mg / kg ia ra. I ia rā 75-100 mg whakaurua nga 6 haora te 12.5-25 .mu.g. Ki te he mate Cardiovascular te manawanui, whakamahia te horopeta rā ko te iti rawa - 25-50 mg.

atamira 3

I roto i te taahiraa 3, i muri i te stabilization o te manawanui, timata maimoatanga o te mate e whāriki ana, i arahina ki te whanaketanga o te pōroa. taea e tetahi mate mumura ranei o te repe thyroid, whētuki, me ētahi atu āhuatanga tenei.

pōroa, Hypothyroid - huru ora-te whakawehi o te manawanui. tohutohu Medical kia tino kitea, ka whakatinana. Kore, kia puta pōauautanga nui, te ora-te whakawehi. Whaiaro-rongoā i roto i tenei take e tino rāhuitia. Ki te rapu tonu i tetahi feaa e pā ana ki te tohu pōroa aro hauora.

pōroa, thyrotoxic

pōroa Hypothyroid, ranei raruraru thyrotoxic, kia puta i roto i te aroaro o te hyperthyroidism nui i roto i kāore goiter thyrotoxic. Nuinga o ngā wā puta tenei ki te whakamārama o te ahotea hinengaro i muri i tango hāparapara o te repe thyroid. Ko te pathogenesis matua - ko:

• Te peke koi i roto i te thyroid taiaki i te toto.

• Hypoxia.

• Endotoxemia.

• kino paitini o te pūnaha Cardiovascular me io, nadpochesnikov ate.

• Tūkinotanga o pākia pūtau me te wai, me te kawehiko toenga.

raruraru Thyrotoxic mua te whanaketanga o te pōroa. He e kitea nga tohu e whai ake nei i te manawanui: oaoa hinengaro, maha haere tahi e te moemoea, horihori. faaati e alangá, tachycardia (ki runga ki te 200 kapakapa ki te meneti). e whakatika pāmahana Body ki 38-41 nekehanga. sweating taumaha. Korere, ruaki. Pea te ahua o te jaundice.

Ki te kahore he therapy tika, worsens tino huru o te manawanui:

• tukupu pēhanga toto;

• kiri maroke;

• fibrillation Atrial;

• mydriasis;

• cyanosis;

• disorders bulbar.

Tupu reflexes tukino, heke oro uaua, i reira te mea he mate o mana tōngāmimi, disorders mahara, pōroa. uara Tātaritanga i te raraunga hītori tohu i te aroaro o te thyrotoxicosis: tachycardia, kirika, whakaiti taimaha, ruaki, tahurihuri kau, korere auau.

I roto i te tātari o te toto kitea: nui haere reiti o thyroid taiki, iodine pūmua-herea, bilirubin (e tika ana ki te whakangaromanga o tāoke ate), 17-oksiketosteroidov, acidosis pūkoro.

I roto i tenei ahua, ko te tika i te manawanui ki te whakarato āwhina whawhati tata. Kei ngā nga mahi e whai ake nei i roto i reira:

• Pâmuhia whakahaere isotonic otinga konutai pūhaumāota i roto i te nui o te 1 rita.

• He otinga o te 5% te kūhuka i.

• "Hydrocortisone" i roto i te inenga o te 350 ki te 600 mg.

• "Prednisolone" i 120 ki te 180 mg.

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

• "Seduxen" atu anticonvulsants ranei.

• "Merkazolil" (tarukino antithyroid) - 60-80 mg ia ra.

I roto i te tāutu i te manawanui kia karanga tonu nga tohu i runga ake "waka tūroro" me te manawanui falemahaki i roto i te Tari Endocrinology.