Hypothyroid coma: pehea e i pilikia mālama?

Hypothyroidism mea he pilikia maʻi. Kekahi o ka loa pinepine complications ia mea hypothyroid coma. Loa pinepine ia ka hana i loko o mua nā mea maʻi, o ka oi aku i na wahine. Coma ia lŘlŘ ma ia pae ana o nā mea maʻi i mea e loaa ana hypothyroidism, i loaa i ka mea e pono lapaʻau, ai paha ka mea i lawe mai i ka manawa.

Kumu o ka hypothyroidism

Ke uie kekahi hapanui hewahewa o nā mea maʻi (95%) o ka hypothyroidism ua kena ae la ia e pathological keʻano o ka hanaʻana 'ia i loko o ka thyroid gland. I ka nui o ka? Iecaianoaaiiuo o hormones emi iho, iniiaiie hypothyroidism e hoʻomōhala ai.

aʻe 'stimulatory a hoʻokonukonu hopena o ka pituitary TSH a me ka tireoliberina (a hypothalamic ka hoʻokuʻu' ololi) mai ka wā haumāna hypothyroidism. Ke alapine (frequency) o kona hanana i pili kēia wahi emi mahope o ka puke Paipala. A ma ka mea, a me nā hihia ia he mea lawa lapaʻau e hoʻomōhala hypothyroid coma.

Aboutʻike ākea hypothyroidism nīnau i ole, ua Wehewehe i nā hāʻina ma na aoao. E noonoo pono oukou kupu ana ma ka pili me ka metabolic kāna hana i loko o ka periphery o ka thyroid hōmona paha no a hiki i ka pā lonoaʻili ka ho'ēmiʻana i loko o nā nā loko a me nā'aʻaʻa o nukelea receptors no thyroid hormones?

Ua koe he controversial nīnau e pili ana ina paha he nui na makahiki-hoʻololi iho o ka thyroid hormones i loko o kāna hana o kaʻike ākea pūnao. A ina paha irreversibleʻike manaʻo ike i loko o ka thyroid gland i loko o ka poe oo hoi kaʻina?

Hypothyroid coma. kumu

Pathogenesis hypothyroid coma i loko o ka hapanui hoopii, Hōʻike i ka lawe kūpono 'ole untimely kanaka o ka hypothyroidism. Part o ka wehewehe i e kali hou aku ma kaʻike,. Deficiency o thyroid hormones i ke exacerbated ma ka ke kāpaeʻana o? Eaia o levothyroxine a meaola ma ka pono o ka hoʻoulu nā māhele o ka hōmona hakahaka. Hypothyroid coma e hoʻonui i kekahi mau aʻe:

• Hypothermia.

• Concomitant maʻi (naau maluna, pneumonia, hahauʻana, mea hoʻomaʻi, urogenital nā mea palahēhē).

• Papakaukau koko poho, trauma, pāhawewe Inc,ʻoki kino.

• X-Ray ninaninau.

• Aaieieno? O ai 'a e kaumaha ana i ka Central ko mākou hopohopo nenoaiu.

• Nui nā māhele o ka waiʻona.

• Hypoglycemia.

• Hypoxia.

Inā mea kaupauna nui o ka thyroid hormones i loko o ka lolo emi ka ha awina o metabolic keʻano o ka hanaʻana. E like me ia i kaʻilihune, mahuahua hypoxia, me ka nui loa hana kue i kela ano keia ano o ka pūnao, a me na mea he nui o ka hiʻona o ka hapanui o nā loko.

Symptoms o hypothyroid coma

coma kŰia mākaukau kaua paha ma lohi e ulu ana, i holopono nō i nā. Initially, luhi akaka, apathy, lethargy, laila, nānāʻana aku i lala coldness, dryness, haanou ana o na wawae, paleʻili - kēia kailaʻae ua wehewehe aku ma hypothyroid coma. Kūlana lokalis Hōʻike kali hanu, pilikia me ka urination, symptoms o ka naʻau ole. Emi ke koko, i Ua nele o tendon reflexes. Ma hookolokolo, i ke ahonui o ka kauka E nńnń pono i ka hope o symptoms o hypothyroid coma:

• Deteriorates pūnao, kino ke kaupaonaʻana mahuahua holo 'aʻole hoʻi, ka mahana, e hina ia i 35 degere.

• Aia mau haunaele i loko o ka mea'ōnaehana mānowai koko nenoaiu. Ka naau i kela 'aʻole hoʻi ia, aia no he thready pana, ua hoʻemi ke koko, edema o ka naau.

• Aʻe 'o naehana hana. Hoemi i ka helu ana o breaths, haule iho la ia i ke koko o oxygen pae i ka hiamoe i hooki ha.

• Abnormalities ma ka'emi ko kahua. Inhibition o tendon reflexes, e holumua ai, nanea ana.

• Skin symptoms. Mae, maloo, waxy ili nanahe, ami hyperkeratoses. Brittle mākia. Hair me keia poho.

• Moe i loko o ke koko paʻakai pae. maka a me nāʻaoʻao loa nani.

• Anemia, a pau i ka typical symptoms o ia.

• Hypoglycemia.

• Digestive kāna hana. ileus. Mahuahua akepaʻa.

? aaieou

Ke Kalinika hypothyroid coma mea like penei: aia no he nawaliwali, drowsiness, kuu iho la ka mahana i 35 degere. 'Aʻole hoʻi ia, e hai indistinctly i nā hua'ōlelo, hoemiia hihio a me ka lohe ana. Ke koko, ua kuu iho la, i ka lāʻau ikiʻai wale - 30 kui iho oe a no minuke. Ha pāpaʻu a me ka pohihihi. Mai ka opu - bloating, constipation,ʻeha, ka luaʻi. Aia i ka ulu ana o oliguria. Skin pale melemele, maloo. Haanou ana o ka maka,ʻaoʻao. Ka hilahila, lethargy. Ke tendon reflexes ma kahi e. Comes hypothyroid coma.

Ke koko. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, acidosis, hematocrit, TSH, T3 a me T4 kuu iho naʻokoko mahuahua.

Complications: pneumonia, huʻi hema ventricular e hemahema, encephalopathy, huʻiʻaʻa puʻuwai e hemahema, cardiac arrhythmias, hahauʻana, dementia, ileus.

Ke algorithm mua kōkua

Inā he kanaka ka hypothyroid coma, huʻi mālama algorithm mea like penei:

1. Prehospital:

• E kahea aku i ke kauka. I ka hoʻolako mua 'inikua kōkua.

• Uhi blankets e ho'ēmi i ke kino wela.

• E hoʻopau hypoxia ma nasal catheters haawi humidified ka oxygen.

• Hōʻike i ke kōkua o ke na aa koko i loko o ka aa koko catheter huapalapala.

Inā hoʻouka kekahi hypothyroid coma nā kaʻa mokulele kahu e e hala ole, he laulima me Dr. - ola, pono-i hoʻonohonoho 'ia:

• No ka meaʻike, o complications lawe koko maʻiʻo thyroxine, thyroid noho haumāna kahi hōmona, triiodothyronine, monakō koko, cortisol, koloriside, paʻakai, AAR, ke kinoea haku mele 'ana.

• I mea e kū diuresis paʻa bladder catheterization.

• E pale ai wehena o ka luaʻi ua hoʻolauna i loko o ka'ōpū Tube.

• E diagnose complications - ECG ka mālamaʻana naehana hanu ana, ana wela, hemodynamics. "Reopoligljukin" intravenous-drip o 500 ml.

• Detoxification - monakō koko 40% w / mokulele hēkī - 20-30 ml; laila / drip lawelawe monakō koko 5% (500 ML).

2. Ma ka haukapila.

• No ka hakahaka hōmona ia wā i loko o / mokulele hēkī lawelawe kela 6 hola 250-500 mcg "Thyroxine" (ole Via gavage 100 ug "triiodothyronine") ma hope o ka 12 hola e emi i ka mahele lāʻau o 25-100 micrograms.

• No ka kokua o adrenal insufficiency ma ka / mokulele hēkī lawelawe hydrocortisone hemisuccinate (50-100 mg).

• No ka Kāohi encephalopathy 1 ml wikamina B1.

• No ka edema bradycardia lawelawe s.c. "atropine" 0,1% (0.5-1 ml).

• Stimulation o ka ÷ naehana hanu-oaio? A - "Kordiamin" (2-4 ml).

• No ka kokua o cerebral hypoxia - "Mildronate" (250 mg).

• E pale aku nā mea palahēhē - antibiotics.

• No ka hoʻopau o ka hypoxia - me mechanical hoʻokomo ea.

Hypothyroid coma: pilikia mālama

E hoomanao e pilikia kokua, ma kekahi hihia hiki ole ke hoʻohana 'ia i mahana aʻe i ka hoʻomanawanui' Ākau - keia mea ku pono i ka mea hōʻemi o hemodynamics. "Triiodothyronine" i injected intravenously koke e pale i ka pilikia o ka mea'ōnaehana mānowai koko complications. Nui mahele lāʻau "Levothyroxine" hiki o ka hoʻonāukiuki ka huʻi adrenal insufficiency.

Hospitalization ua hana i loko o ka supine manao i loko o ka mālama nui malama pa alima a me ka oihana o ka endocrinology.

Inā hoʻouka kekahi hypothyroid coma, pilikia mālama i loko o ka hora mua o ma ka hoike ana o "triiodothyronine". Oxygen ma Inc ua hoonohoia. Intravenously lawelawe ai 'prednisone, hydrocortisone. Aaieieno? Mea e pono ai a me ka mea'ōnaehana mānowai koko ai '.

Ma hope o ka hapalua o ka hora pono e komo aku ai ATP, nā wikamina C, B. Inā ka'aloʻahiʻa mea ma luna o 90 mmHg. Art., I ka hoʻokomo 'ia' o "Lasix". Inā ke koko, ua emi mai o keia huahelu, hoʻohana ' "corazole", "Mezaton", "Kordiamin".

Eia, o kela kanaka 4 hola, ke kaumaha ma muli o ka ano o ka naau, ma ka nui o ka 25 micrograms lawelawe "triiodothyronine". A hiki i ka naʻau ana, a me ka wela i stabilized, ua hoemiia ka laʻau heluna. He mea pono e hoʻomau i ka OE rewarming o ke hoomanawanui, o oxygen Inc, hoʻohana o ka paʻakai hydroxybutyrate.

Inā he mea he convulsive kāna hana, intravenously injected "Seduxen".

Lapaʻau: ke kahua 1

Lapaʻau o hypothyroid coma, IeAUPIIe, IAa IO kŰia mau kapuwai, ka mea, 'aʻole i hoʻomaka koke me ka hōmona hope Inc. Iapaau ana o nā mea maʻi ua lawe mai ikaika ma lalo o ka hooponopono ana o ke kauka i loko o resuscitation i loko o ka mālama nui malama pa alima.

Ke anu u mua mea e stabilize i ka mau hana o ka nui e pōʻino oihana i loko o ka lā mua a elua, me ka hou ana o ka hōmona hope Inc,ʻaʻole e i ka makemake keia, a e hiki hooweliweli i ke ahonui o ka ola

Malama ana naehana hana. Inā ka hoʻomanawanui mea hiki ke hanu ia iho, a me KSCHN nā hoailona compensated, i ke kokuaia mai e O ₂ (oxygen Inc) ua hana ma ka nasal cannula a maka ea paha. Nō kāu, hoʻomanawanui iki mai i ka haunaele o ka noho'na makaainana i ulu hanu, o carbon dioxide accumulates i loko o ke koko. hana o ka mea i koi 'ia no ka me mechanical hoʻokomo ea. Ua stabilizes koko o oxygen, a i carbon dioxide, ua ālai 'ka hooulu ana o ka hypoxia, hoʻopau kona io kanawai ma luna o nā mea a pau nā'aʻaʻa a me nā loko.

Hoʻoponopono volemic poho. Hypothyroid (myxedema) coma wehewehe aku ma ka loliʻana. Akā, i ka oiaio o ia mea accumulates i loko o nā interstices hakahaka, i ka vascular moe i keia manawa o ka ehaeha, a me he mea he loli nele, no keia mea, ke koko, ke papa. ? Iaea ua i ka mea o kekahi hypertonic pāʻoihana a NaCl, colloidal a me ka brine. Iloko o ke kaʻina hana ia mea nui, e noonoo i ke kiʻekiʻe o Central venous puʻe. E hōʻike i ka maʻamau huahelu paha i inflated e leie aku e komo aku ai o ka oi ma mua o kekahi hano pāʻoihana no ka lā. I ole ia, ka mea, i ka hoʻonāukiukiʻana, a mahuahua nui cardiac haawe ana, me ka paʻakai i loko o ke koko paka ua me ka nui loa.

OE paio hahana maoli nō o ka hoʻomanawanui ka kino ma ka mea o blankets a hoonui i ka mehana ma ka 1 loa. I ole hihia i ka hoʻomanawanui hiki ole ke hoopaa i kaʻeleu paio hahana maoli nō ma ka mea o ka okoa anal wahī mai, 'Ākau. Kēia, e alakai i ka vasodilation worsening o kaʻike ākea vasodilation ia lŘlŘ. hiki ke hoemi hou ia ke koko, ma ka pili hypovolemia.

? Iaea o ka mea'ōnaehana mānowai koko nenoaiu. Hypothyroid coma mea he nui loa no ka mea'ōnaehana mānowai koko nenoaiu. Keʻanuʻu mua o ka iapaau ana o ka bradycardia, ke koko, noaaeeecaoee. No ka iapaau ana o ka bradycardia M holinoblokatory hoʻohana (e laʻa me, "atropine") e hoʻohana "aminophylline". Inā ke koko, hiki ole e like stabilize vascular hypovolemia, lāʻau kākoʻo ua pono. Haʻapili adrenaline, phenylephrine, norepinephrine. Here oe i ke e loa akahele, no ka mea, ua mahuahua ka pā lonoaʻili o receptors ma ka iapaau ana o ka thyroid hōmona. Hiki naau pāpana kāna hana, i ka hoike ana o na symptoms o atrial fibrillation a tachycardia.

? Iaea electrolyte hana ana (chlorine, paʻakai, kalipuna, potasiuma), e like me ke koko monakō koko pae.

E ho ohana i (GCS) glucocorticosteroids. Ka hoʻonaʻauao nā māhele i pono no ka exhaustion o adrenocortical hana i loko o nā mea maʻi me ka thyroiditis, iʻikeʻia ma luna o ke kāʻei kua o ka lōʻihi-makahiki hoʻohana o hormones, a me ka emi ana ma na pae o ka T3 a me ka T4 nā hoailona, kāna hana i loko o ka hypothalamic-pituitary kahua. Nō kāu, hydrocortisone ua lawelawe iho la no kela mea keia eono hola no kela la i keia mahele lāʻau o ka 200 a hiki i 400 mg. Once ka hoʻomanawanui ua stabilized, ma hope o elua a ekolu lā, he mea he emi i loko o ka mahele lāʻau.

Huʻi dialysis aʻaʻa puʻuwai hope Inc. Ua ua hōʻike no nā mea maʻi me ka holomua oligoanuria, mahuahua creatinine, urea, potasiuma.

ke hoʻomanawanui i ka iapaau ana e ke hoʻomaka koke. Ka koke ia e ia i ka mua ka anu u, e hoihoi i ka koi 'mana o ke ola, ka koke ia ka mea e e hiki, e hoʻomaka hōmona hope Inc. I ka manawa o ke ola, ua hoʻonuiʻia na manawa he nui no.

ke kahua me 2

2 kahua lapaʻau o hypothyroid coma kūlana haʻahaʻa ano 'ē mai. Kēia pono o ka vicarious thyroid hōmona Inc.

Na ka papa kuhikuhiE eiiiiiaiou - T4 hoomakaukau. "Levothyroxine" ana ia ma ka mahele lāʻau o 1.8 mg / kg no ka lā. Kela manawa, ma hope o 6 hola o ka hana hoʻomaka, a ma hope o ka lā piha ia ua loaʻa. Initially hola ia manaʻo mai ka 100 a hiki i 500 micrograms o ka lāʻau. Eia, i ka lā hoʻolauna i ke koena o na kela la i keia mahele lāʻau. Mahope, i ka malama mahele lāʻau no ka lā, he 75-100 micrograms. Ma hope o ka hoʻomanawanui noaaeeecaoee "Levothyroxine" lawelawe ma ka papa palapala.

Ka pilikia ano T3 hoomakaukau lawelawe 0,1 e 0,6 mg / kg no ka lā. I kela la i keia 75-100 mg kela 6 hola ua hoʻolauna 12.5-25 .mu.g. Inā ka hoʻomanawanui i mea'ōnaehana mānowai koko maʻi, i ka i kela la mahele lāʻau ua hoʻohana 'ia ka palena iki - 25-50 mg.

ke kahua 3

Ma ka anu u 3, ma hope o ka noaaeeecaoee o ka hoomanawanui, hoʻomaka lapaau o ka nń ku maʻi, a alakai ai i ka ulu ana o coma. Kēia hiki e kekahi maʻiʻaʻai a li nui o ka thyroid gland, trauma, a me nā aʻe.

Hypothyroid coma - ka hoʻomanawanui ka ola-hooweliweli ana ia kulana. Lapaʻau aʻo E e malama ikaika i a me ka hoʻokō. I ole ia, e hana complications mea, ola-na olelo hooweliweli au. Pakiko-ka lapaʻauʻia i loko o keia hihia ua pololei ole. Inā kekahi kanalua e pili ana i ka coma symptoms koke imi 'inikua noonoo.

thyrotoxic coma

Hypothyroid coma, a thyrotoxic ka hoʻoponopono ulia, e ana i loko o ke alo o ka loa hyperthyroidism ma untreated thyrotoxic goiter. Loa pinepine keia ia lŘlŘ ku ei ke kāʻei kua o ka manaʻoʻike stress ma hope oʻoki lāʻau lapaʻau ana o ka thyroid gland. Na ka papa kuhikuhiE pathogenesis - nei:

• Ka oi Lele i thyroid hormones i loko o ke koko.

• Hypoxia.

• Endotoxemia.

• ʻawahia poino o ka mea'ōnaehana mānowai koko a me ko mākou hopohopo'ōnaehana, nadpochesnikov akepaʻa.

• 'Aʻe' ana i ke kelepona hele pūnao a me ka wai a me ka electrolyte koena.

Thyrotoxic ulia ma mua o ka hooulu ana o coma. Ke hoomanawanui i ka kēia mau symptoms i malama: noʻonoʻo pīhoihoi, pinepine pu ma hallucinations, delusions. lala tremor, tachycardia (i ka 200 kui iho oe a no minuke). Kino mehana i 38-41 degere. Kaumaha sweating. Diarrhea, ka luaʻi. Paha i keʻano o ka jaundice.

Inā he mea ole e pono Inc, ke hoʻomanawanui i ka ke ano worsens dramatically:

• hakumakuma ke koko;

• malooʻili;

• atrial fibrillation;

• mydriasis;

• cyanosis;

• bulbar kāna hana.

Ka hana hoʻoluhi hewa reflexes, Muscle leo emi, aia no he lilo o ka bladder ana, ike paka i kāna hana, coma. PalekanaEND_LINK waiwai i ka mōʻaukalaʻikepili hoike ana i ke alo o ka thyrotoxicosis: tachycardia, kuni, ke kaupaonaʻana ka ho'ēmiʻana, ka luaʻi, restlessness, profuse diarrhea.

Ma ke Ka Ikepili o ke koko i loaʻa: a mahuahua nui holo 'awelika o ka thyroid hōmona, kumuʻiʻo-e paa ana iodine, bilirubin (aie a hiki i ka make ana o ke akepaa toxins), 17-oksiketosteroidov, metabolic acidosis.

Ma keia wahi i ka hoʻomanawanui mea pono i ka i pilikia kōkua. ʻO kēia nā hana i komo i loko o ia:

• Intravenously lawelawe isotonic paʻakai koloriside pāʻoihana ma ka nui o ka 1 hano.

• A pāʻoihana o 5% monakō koko.

• "Hydrocortisone" i loko o ka laʻau heluna o 350 a hiki i 600 mg.

• "Prednisolone" mai ka 120 a hiki i 180 mg.

• "Korglikon" a me "StrofantinK" 0.5-1 ml.

• "Seduxen" 'ole' ē aʻe anticonvulsants.

• "Merkazolil" (antithyroid lāʻau) - 60-80 mg no ka lā.

Ma nä ka hoʻomanawanui i ka luna symptoms lakou e ike koke i kapa aku ai "ambulance" a me ke ahonui hospitalized i loko o ka 'Oihana Endocrinology.