Hypothyroid coma: yadda za a samar da gaggawa kula?

Hypothyroidism ne mai hadarin gaske cuta. Daya daga cikin mafi m rikitarwa shi ne hypothyroid coma. Mafi sau da yawa da ta faru a mazan marasa lafiya, musamman a cikin mata. Coma auku a cikin wannan rukuni na marasa lafiya da suke shan wahala hypothyroidism, bai sami zama dole magani, ko shi da aka za'ayi a lokacin.

Sanadin hypothyroidism

Mafiya yawa na marasa lafiya (95%) na hypothyroidism ne ya sa ta pathological tafiyar matakai abin da ke faruwa a cikin thyroid gland shine yake. A matakin na samar da hormones tayi, primary hypothyroidism tasowa.

Lokacin da take hakki stimulatory da tsaiko sakamakon pituitary TSH da tireoliberina (ko hypothalamic sakewa factor) ya zo na biyu hypothyroidism. A mita na da ya faru a fi mayar da baya zuwa firamare. Kuma a gaskiya, da kuma a wasu lokuta idan akwai kasa magani iya ci gaba hypothyroid coma.

Game da gefe hypothyroidism tambaya ba a warware a hanyoyi masu yawa. Ko da shi ya taso ne dangane da rayuwa cuta a cikin periphery na thyroid hormone ko saboda da ýan rage a cikin gabobin da kyallen takarda da makaman nukiliya rabe ga thyroid hormones?

Ya zauna a rigima tambaya game da ko akwai shekaru-ƙasƙanci daga thyroid hormones a cuta daga gefe metabolism. Kuma ko babu ja mamaki lura a cikin thyroid gland shine yake a cikin tsufa tsari?

Hypothyroid coma. dalilai

Pathogenesis hypothyroid coma a mafi yawan lokuta, ya nuna cewa za'ayi m ko untimely lura da hypothyroidism. Sashe na daga cikin bayani na iya zama bata lokaci a cikin ganewar asali. Rashi na thyroid hormones iya dada tabarbare soke liyafar na levothyroxine ko kwayoyin na bukatar kara allurai na hormone canzawa. Hypothyroid coma iya taimakawa wajen da dalilai da dama:

• Hypothermia.

• Concomitant cututtuka (ciwon zuciya, ciwon huhu, bugun jini, kwayar, urogenital cututtuka).

• M jini hasara, rauni, radiation far, tiyata.

• X-ray jarrabawa.

• Administration na kwayoyi wanda depress da tsakiya m tsarin.

• Manyan allurai da barasa.

• Da qarancin ruwa da.

• Hypoxia.

Idan plummets matakin na thyroid hormones a cikin kwakwalwa da rage-rage na ayyuka na tafiyar matakai na rayuwa. A sakamakon, da kara hypoxia, muhimmanci keta duk wani nau'i na metabolism, da kuma da yawa daga cikin siffofin mafi gabobin.

Alamun hypothyroid coma

coma abu ya faru ta sannu a hankali girma, ci gaba sannu a hankali. Da farko, gajiya bayyana, apathy, lethargy, sa'an nan ya lura reshe sanyin cewa, rashin ruwa, kumburi da ƙafafunsa, kodadde fata - wadannan sifofi ne halin da hypothyroid coma. Status lokalis nuna jinkirin numfashi, da matsaloli tare da urination, cututtuka na zuciya rashin cin nasara. Lowers jini, ya kasance rashin agara reflexes. A jarrabawa, da haƙuri da likita gani da wadannan cututtuka da hypothyroid coma:

• Tabarbarewa.Idan metabolism, jiki nauyi ya karu dabam dabam slows, da zazzabi da dama zuwa 35 digiri.

• Akwai disturbances a cikin zuciya da jijiyoyin jini tsarin. The zuciya rate slows saukar, akwai wani thready bugun jini, rage hawan jini, edema na zuciya.

• Take hakki na numfashi ayyuka. Rage yawan breaths, fadowa jini oxygen matakan lokacin barci iya daina numfashi.

• Munanan a cikin juyayi tsarin. Hanawa na jijiya reflexes, m mãyen.

• Skin cututtuka. Paleness, bushe, waxy fata sautunan, hadin gwiwa hyperkeratoses. Gaggautsa kusoshi. Gashi hasara.

• Da dama a cikin jini sodium matakan. fuska da kuma extremities tsananin kumburi.

• Anemia, da kuma duk da hankula bayyanar cututtuka na shi.

• Da qarancin ruwa da.

• Narkewa kamar cuta. ileus. Karuwan hanta.

asibitin

Clinic hypothyroid coma ne kamar haka: akwai wani rauni, drowsiness, saukar da yawan zafin jiki zuwa 35 digiri. Slows saukar, kalmomin da aka furta indistinctly, rage hangen nesa da kuma ji. Jini da aka saukar da, da bugun jini - 30 lashe minti daya. Karsh m da kuma rare. Daga ciki - bloating, maƙarƙashiya, zafi, amai. Akwai cigaban oliguria. Skin kodadde rawaya, bushe. Kumburi na fuska, extremities. Rikice, lethargy. Agarar reflexes ne mãsu fakowa ba. Zo hypothyroid coma.

Jini. Hypoxia, hypercapnia, hyponatremia, da qarancin ruwa da acidosis, hematocrit, TSH, T3 da T4 saukar da cholesterol karu.

Matsalolin: ciwon huhu, m hagu na ramin zuciya rashin cin nasara, encephalopathy, m na koda gazawar, cardiac arrhythmias, bugun jini, gigin-tsufa, ileus.

A algorithm taimakon farko

Idan wani mutum ya hypothyroid coma, m kula algorithm ne kamar haka:

1. Prehospital:

• Kira likita. Don samar da farko likita agaji.

• Kunsa bargo, don rage jiki zafin rana.

• Don kawar hypoxia ta hanyar hanci catheters ba humidified oxygen.

• Samar da damar yin amfani da jijiyoyinmu a jijiya catheter sa.

Idan shigar hypothyroid coma dabara nas ya zama bayyananne, wani ha] in gwiwar tare da Dr. - mai sauri, da tsari sosai:

• Ga ganewar asali na rikitarwa dauki jini ciki thyroxine, thyroid haramta motsa hormone, triiodothyronine, glucose, cortisol, chloride, sodium, AAR, da gas abun da ke ciki.

• Domin sarrafa diuresis gudanar mafitsara catheterization.

• Don hana muradinta na aman da aka gabatar a cikin ciki tube.

• Don gane asali rikitarwa - ECG monitoring numfashi kudi, zazzabi, hemodynamics. "Reopoligljukin" igiyar jini-drip na 500 ml.

• Detoxification - glucosa 40% w / jet - 20-30 ml. sa'an nan / drip gudanar glucose 5% (500 ml).

2. A asibiti:

• Domin canzawa hormone ƙarara a / jet gudanar kowane 6 hours 250-500 mcg "Thyroxine" (ko via gavage 100 ug "triiodothyronine") bi ta 12 hours don rage kashi na 25-100 micrograms.

• Domin taimako na adrenal insufficiency a / jet gudanar hydrocortisone hemisuccinate (50-100 MG).

• Domin rigakafin encephalopathy 1 ml Vitamin B1.

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

• Ruri daga cikin numfashi cibiyar - "Kordiamin" (2-4 ml).

• Domin taimako na cerebral hypoxia - "Mildronate" (250 MG).

• Don hana cututtuka - maganin rigakafi.

• Domin kawar da hypoxia - inji iska.

Hypothyroid coma: gaggawa kula

Samar da gaggawa taimako, a wani hali ba za a iya amfani da su ji dimi haƙuri warmers - wannan shi ne saboda da tabarbarewar hemodynamics. "Triiodothyronine" ba allura intravenously nan da nan don kauce wa hadarin da cututtuka na zuciya da rikitarwa. Manyan kashi "Levothyroxine" iya sa wani m adrenal insufficiency.

Arin da aka yi a cikin supine matsayi a wani m kula naúrar ko sashen na endocrinology.

Idan shigar hypothyroid coma, gaggawa kula a farko hour ne ta hanyar bullo da "triiodothyronine". Oxygen far da aka nada. Intravenously gudanar kwayoyi prednisone, hydrocortisone. Administration wajibi ne da zuciya da jijiyoyin jini kwayoyi.

Bayan rabin sa'a Dole ne a shigar ATP, bitamin C, B. Idan matsa lamba ne bisa 90 mmHg. Art., Sanya gabatarwar "Lasix". Idan jini ne kasa da wannan adadi, amfani da "corazole", "Mezaton", "Kordiamin".

Bugu da ari, kowane 4 hours, dangane da yanayin zuciya, a cikin wani adadin 25 micrograms gudanar "triiodothyronine". Da zaran zuciya kudi da kuma yawan zafin jiki suna stabilized, da sashi ne rage. Wajibi ne a ci gaba da m rewarming na haƙuri, oxygen far, yin amfani da sodium hydroxybutyrate.

Idan akwai wani convulsive cuta, intravenously allura "Seduxen".

Jiyya: Stage 1

Jiyya na hypothyroid coma, unshi da dama matakai, ba za a fara nan da nan tare da hormone maye far. Jiyya na marasa lafiya ne da za'ayi tsananin karkashin kulawa na likita a farfado da a cikin m kula naúrar.

A mataki na farko shi ne don daidaita janar ayyukan muhimmanci da harshen damo a rana ta farko ko biyu, tare da kara yin amfani da hormone maye far ba zai yi da ake so sakamako da kuma iya ko da barazana da haƙuri da rai

Kasancewa numfashi ayyuka. Idan da mãsu haƙuri ne iya numfashi da kansa, da kuma KSCHN Manuniya cika, da wadata da na Yã ₂ (oxygen far) da aka yi ta hanyar hanci na cannula ko fuska mask. Yawanci, marasa lafiya da disturbances kwatsam numfashi, carbon dioxide accumulates a cikin jini. amfani da na'urar da ake bukata domin inji iska. Yana stabilizes jini oxygen da kuma carbon dioxide, ya hana ci gaban hypoxia, kawar da mummunan tasiri a kan duk tsokoki da kuma gabobin.

Gyara volemic hasarori. Hypothyroid (myxedema) coma halin da ruwa riƙewa. Amma gaskiyar ita ce, da shi accumulates a cikin interstices sarari, da jijiyoyin bugun gini gado a wannan lokaci na wahala, kuma akwai wani ruwa da kasawa, don wannan dalili, jini iya sauke. Gyara da aka yi ta wajen wani hypertonic bayani daga NaCl, colloidal da kuma brine. A lokacin hanya, yana da muhimmanci a yi la'akari da matakin na tsakiyar venous matsa lamba. Nuni a cikin al'ada iyaka ko ba inflated damar shigarwa na fiye da daya lita bayani a kowace rana. In ba haka ba, zai iya yiwuwa tsokane ta ƙara cardiac kaya, tare da sodium a cikin jini saukad da muhimmanci.

M dumama na haƙuri ta jiki ta hanyar bargo, ko kuma kara da dakin da zazzabi da 1 digiri. A wani hali da haƙuri ba zai iya rike da aiki dumama ta hanyar daban-daban zafi wraps, warmers. Wannan zai kai ga wani worsening da na gefe vasodilation auku vasodilation. Jini za a iya rage kara da zumunta hypovolemia.

Gyara na zuciya da jijiyoyin jini tsarin. Hypothyroid coma ne mai tsanani duka ga zuciya da jijiyoyin jini tsarin. A mataki na farko shi ne lura da bradycardia, jini karfafawa. Domin lura da bradycardia M holinoblokatory amfani (msl, "atropine") na iya amfani da "aminophylline". Idan jini ba za a iya gyara dattako jijiyoyin bugun gini hypovolemia, miyagun ƙwayoyi goyon bayan da ake bukata. Aiyuka adrenaline, phenylephrine, norepinephrine. A nan dole ka kasance musamman da hankali, saboda ji na ƙwarai rabe ne ta ƙara da magani daga thyroid hormone. Zai yiwu zuciya kari cuta, wata alama ce ta bayyanar cututtuka na atrial fibrillation ko tachycardia.

Gyara electrolyte yi (chlorine, sodium, alli, potassium), kazalika da jini glucose matakin.

Amfani (GCS) glucocorticosteroids. Danniya da allurai da ake bukata domin ci na adrenocortical aiki a marasa lafiya tare da thyroiditis, abin da ya bayyana a kan bango na dogon lokaci da yin amfani da hormones, tare da wani karu a cikin matakan T3 da T4 Manuniya, cuta a cikin hypothalamic-pituitary tsarin. Yawanci, hydrocortisone aka gudanar a kowace awa shida a kullum kashi na 200 zuwa 400 MG. Da zarar haƙuri ne stabilized, bayan kwana biyu ko uku, a can ne a karu a kashi.

M dialysis, ko na koda maye far. An nuna ga marasa lafiya da ci-gaba oligoanuria, kara creatinine, urea, potassium.

haƙuri da magani ya kamata a fara nan da nan. A jima shi zai zama mataki na farko mayar da ake bukata ayyuka na rayuwa, da jima da shi zai yiwu a fara hormone maye far. A chances na dawo da ake ta ƙara da yawa sau kan.

mataki 2

2 mataki magani daga hypothyroid coma matsayi riga yana sauran. Wannan na bukatar wani vicarious thyroid hormone far.

Babban aka gyara - T4 shirye-shirye. "Levothyroxine" yawanci sanya a kashi na 1.8 MG / kg per day. A cikin 6 hours da mataki fara, da kuma bayan wani yini cikakken sakamako da aka samu. Da farko hour misalta daga 100 zuwa 500 micrograms da miyagun ƙwayoyi. Bugu da ari, a lokacin rana ya gabatar da sauran kullum kashi. Bayan nan, da tabbatarwa kashi da rana ne 75-100 micrograms. Bayan da haƙuri karfafawa "Levothyroxine" gudanar a kwamfutar hannu tsari.

A mawuyacin hali T3 shirye-shirye gudanar 0.1 zuwa 0.6 MG / kg per day. A kullum 75-100 MG kowane 6 hours aka gabatar 12.5-25 .mu.g. Idan haƙuri yana da cututtukan zuciya da, da kullum kashi da aka yi amfani da mafi ƙarancin - 25-50 MG.

mataki 3

A mataki na 3, bayan da karfafawa na haƙuri, za a fara lura da tamkar cuta, wanda ya kai ga ci gaban da coma. Wannan na iya zama wani kamuwa da cuta, ko kumburi da thyroid gland shine yake, rauni, da kuma wasu dalilai.

Hypothyroid coma - haƙuri da rai barazana yanayin. Medical shawara ya kamata a tsananin lura da aiwatar. In ba haka ba, na iya faruwa tsanani da rikitarwa, rai barazana. Kai-magani a cikin wannan yanayin ne tsananin haramta. Idan wani shakka game da coma cututtuka nan da nan nemi magani.

thyrotoxic coma

Hypothyroid coma, ko thyrotoxic rikicin, na iya faruwa a gaban tsanani hyperthyroidism a untreated thyrotoxic goiter. Mafi sau da yawa wannan yakan faru da wani bango da m danniya bayan m kau na thyroid gland shine yake. Babban pathogenesis - shi ne:

• A kaifi Jump a thyroid hormones a cikin jini.

• Hypoxia.

• Endotoxemia.

• Mai guba lalacewar na zuciya da jijiyoyin jini da kuma juyayi tsarin, nadpochesnikov hanta.

• Take hakkin salula metabolism da ruwa da kuma electrolyte balance.

Thyrotoxic rikicin da ya biyo baya da ci gaban coma. A haƙuri yana da wadannan cututtuka suna lura: shafi tunanin mutum da tashin hankali, sau da yawa tare da hallucinations, rũɗi. reshe tremor, tachycardia (har zuwa 200 lashe da minti). Jiki zafin jiki yakan zuwa 38-41 digiri. Tã sweating. Zawo da amai. Zai yiwu bayyanar jaundice.

Idan babu isasshen far, haƙuri da yanayin worsens da cika fuska:

• ragewan jini;

• bushe fata.

• atrial fibrillation.

• mydriasis.

• cyanosis.

• bulbar cuta.

Faruwa zalunci da numfashinsa, tsoka sautin rage-rage, akwai wani asarar mafitsara iko, sani cuta, coma. Bincike darajar da tarihi data nuna gaban thyrotoxicosis: tachycardia, zazzabi, nauyi akan rage, amai, restlessness, profuse zawo.

A cikin bincike na jini samu: ƙãra rates na thyroid hormone, da furotin da-daure aidin, bilirubin (saboda halakar hanta da gubobi), 17-oksiketosteroidov, rayuwa acidosis.

A wannan jiha da mãsu haƙuri ne dole don samar da gaggawa taimako. Wadannan ayyuka suna kunshe a cikin ta:

• Intravenously gudanar isotonic sodium chloride bayani a cikin wani adadin lita 1.

• A bayani na 5% glucose.

• "Hydrocortisone" a wani sashi na 350 zuwa 600 MG.

• "Prednisolone" daga 120 zuwa 180 MG.

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

• "Seduxen" ko wasu anticonvulsants.

• "Merkazolil" (antithyroid miyagun ƙwayoyi) - 60-80 MG da rana.

A gano da haƙuri sama cututtuka kamata nan da nan kira "motar asibiti" da kuma haƙuri asibiti a Endocrinology Department.