Hypothyroid coma: mokhoa oa ho fana ka tlhokomelo ea boemo ba tšohanyetso?

Hypothyroidism ke lefu le kotsi. E mong oa mathata ho fetisisa khafetsa ke hypothyroid coma. Hangata ka ho fetisisa e etsahalang ka bakuli ba baholo, haholo-holo basali. Coma le hlaha ka hore sehlopha sa bakuli ba nang le mathata hypothyroidism, ba ne ba sa fumana kalafo hlokahala, kapa hore na e ne e phethahatsoa ka nako.

Lisosa tsa hypothyroidism

Boholo ba bakuli ba (95%) tsa hypothyroidism ho bakoa ke dithulaganyo pathological etsahalang ka thyroid tsoelesa e. Boemo ba tlhahiso ea li-hormone fokotseha, hypothyroidism mathomo develops.

Ha ditlolo stimulatory le taolo phello ea pituitary TSH le tireoliberina (kapa hypothalamic lokolla Ntlha e) tluoa tabeng hypothyroidism mahareng. The maqhubu a ya ketsahalo ea eona haholo tlaasana ho sa mathomo ho. Le ha e le hantle, 'me maemong a mang ha ho na lekaneng kalafo ka ntshetsa pele hypothyroid coma.

About hypothyroidism pheriferale potso ha e so rarolloa ka litsela tse ngata. Hore na e hlaha mabapi le maloetse tshilong ya dijo ka periphery ea thyroid li-hormone kapa ho e loketseng ho phokotsong nahanela ka makala le lisele tsa receptors tsa nyutlelie bakeng sa li-hormone thyroid?

E sala potso khang mabapi le hore na ho na le lilemo tsa bona-ho senyeha ha hormone thyroid ka mafu a ea metabolism pheriferale. Le hore na liketsahalo tsa etsolloa hlokometse ka thyroid tsoelesa mosebetsing oa ho botsofali?

Hypothyroid coma. mabaka a

Pathogenesis hypothyroid coma maemong a mangata, e bontša hore ho etsoa tse sa lokang kapa tšohanyetso kalafo ya hypothyroidism. Le karolo ea tlhaloso ea ka 'na ba lieha ho fumanoe. Khaello ea lihomone thyroid ka exacerbated ke ho hlakoloa ha baeti ba fihlelang ho ea levothyroxine kapa phelang tse hlokang ho eketseha tekanyetso ea li-hormone tloswa. Hypothyroid coma ka 'na kenya letsoho hore ho lintho tse' maloa:

• Hypothermia.

• mafu pataganeng (pelo tlhaselo, serame sa matšoafo, setorouku, bongata ba kokwanahloko, tšoaetso urogenital).

• A maholohali a lahleheloa ke mali, ho sithabela, mahlaseli phekolo, ho buuoa.

• X-ray hlahloba.

• Tsamaiso ya lithethefatsi tse depress sa tsamaiso ea methapo e bohareng.

• Large tekanyetso ea joala.

• Hypoglycemia.

• Hypoxia.

Ha plummets boemo ba li-hormone thyroid bokong decreases mosebetsi oa dithulaganyo tshilong ya dijo. Ka lebaka leo, e ntseng e eketseha hypoxia, haholo hataketse mefuta eohle ea metabolism, 'me ba bangata ea litšobotsi tsa makala haholo.

Matšoao a coma hypothyroid

coma ketsahalo e etsahalang butle-butle ho hōla, a hatela pele butle-butle. Qalong, mokhathala le hlaha, ho iphapanya ha batho, lethargy, ka nako eo o ile a re leoto coldness, omile, ho ruruha ba maoto, palo letlalo - litšobotsi tsena e tšoauoa ka coma hypothyroid. Boemo lokalis bontša lieha ho hema, bothata ba ho ntša metsi, matšoao a ha pelo. Lowers khatello ea mali, e bile ho hloka reflexes tendon. Ka ho hlahloba ka, ngaka mokuli hlokomela matšoao a latelang tsa coma hypothyroid:

• Oa soahlamana metabolism, 'mele oa boima ba' mele e ile ea eketseha ajoa, ae fokotsang lebelo, mocheso oela ho likhato tse 35.

• Ho na le meferefere tsamaisong ea pelo le methapo. Sekhahla pelo liehisa, ho na le pulse length thready, fokotseha khatello ea mali, edema ea pelo.

• Ho tlola ya mesebetsi ho hema. Fokotsa palo ea breaths, oela maling oksijene nakong robala le ka emisa ho hema.

• Tsela e sa tloaelehang ka ho tsamaiso ea methapo. Thibelo ea reflexes tendon, tsoelang pele stupor.

• matšoao a letlalo. Paleness, e omeletseng, waxy melumo letlalo, hyperkeratoses kopanetsoeng. Brittle manala. Moriri tahlehelo.

• Oela ka maling sodium. sefahleho le lipheletsong Matla ho ruruha.

• Khaello ea mali, 'me matšoao a tsohle tse tloaelehileng ho eona.

• Hypoglycemia.

• mafu a tshilong ya dijo. ileus. Eketseha sebete.

Tleliniki

Clinic hypothyroid coma e tjena: ho na le bofokoli, ho otsela, theolela mocheso ho likhato tse 35. Liehisa, mantsoe a bitsoa indistinctly, fokotswa Pono 'me ho utloeng. khatello ea mali e theolela, ho pulse length - otla 30 ka motsotso. Ho hema a sa tebang 'me ka seoelo. Ho tswa ho mala - bloating, pipitlelano, bohloko, ho hlatsa. Ho na le tsoelo-pele ea oliguria. Letlalo lerootho mosehla, e omeletseng. Ho ruruha ea sefahleho, lipheletsong. Pherekano, lethargy. The tendon reflexes ke le siyo. Fihla hypothyroid coma.

Mali. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, acidosis, hematocrit, TSH, T3 le T4 theolela k'holeseterole e eketsehileng.

Mathata: serame sa matšoafo, a hlobaetsang le letšehali ventricular hloleha, magazine, a hlobaetsang le ho hloleha renal, cardiac arrhythmias, setorouku, dementia ileus.

The thuso-tharabololo pele

Ha hypothyroid coma ea motho, tlhokomelo hlobaetsang-tharabololo e tjena:

1. Prehospital:

• Bitsa ngaka. Ho fana ka thuso ea tsa bongaka ea pele.

• Qetella likobo ho fokotsa 'mele mocheso.

• Ho felisa hypoxia ka catheters nasal fa humidified oksijene.

• Fana ka ho fihlella ho methapong ea sete mothapo catheter.

Ha hlomamisa hypothyroid coma maqiti mooki e lokela ho ba e hlakileng, e le kopanelo le Dr. - ka potlako, hlophisitsoeng hantle:

• Bakeng sa fumanoe la mathata a nka mali a dikahare thyroxine, thyroid Stimulating hormone, triiodothyronine, tsoekere, cortisol, chloride, sodium, AAR, khase sebopeho.

• E le hore ho laola diuresis tshwerweng senya catheterization.

• Ho thibela aspiration tsa mahlatseng e hlahiswa ka tube mala.

• Ho hlahloba mathata a - ECG boalosi sekhahla matšoafo, mocheso, hemodynamics. "Reopoligljukin" intravenous-rothele ea 500 di ml.

• Detoxification - tsoekere ea phaellana 40% w Le / jete - 20-30 di ml; ebe / rothele laolwa tsoekere 5% (500 ML).

2. Ka sepetlele:

• Bakeng sa haella tloswa hormona ka / jete laolwa mong le e mong lihora tse 6 250-500 mcg "Thyroxine" (kapa ka tsela gavage 100 ug "triiodothyronine") lateloa ke lihora tse 12 ho ea ho fokotsa lethal dose ea 25-100 micrograms.

• Ka Setšoantšo sa adrenal insufficiency ka / jete laolwa hydrocortisone hemisuccinate (50-100 mg,).

• Bakeng sa thibelo ya magazine 1 di ml vithamine B1.

• Bakeng sa edema bradycardia laolwa s.c. "atropine" 0,1% (0.5-1 di ml).

• Tlhotlheletso ya setsi sa matšoafo - "Kordiamin" (2-4 di ml).

• Ka Setšoantšo sa hypoxia bokong - "Mildronate" (250 mg,).

• Ho thibela tšoaetso ea - lithibela-mafu.

• Bakeng sa ho felisa hypoxia - phetha molao ventilation.

Hypothyroid coma: tlhokomelo ea boemo ba tšohanyetso

Ho fana ka thuso boemong ba tšohanyetso, tabeng efe kapa efe a ke ke a sebelisoa ho mofuthu mokuli warmers - sena ke ka lebaka la ho senyeha tsa hemodynamics. "Triiodothyronine" ha tshelwa entoe hang-hang ho qoba kotsi ea mathata a pelo le methapo. Kholo lethal dose "Levothyroxine" ea nang le bokhoni ba susumelletsang motho e hlobaetsang adrenal insufficiency.

Bookelong o etsoa ka boemo supine ka e matla unit trust tlhokomelo kapa lefapha la endocrinology.

Ha hlomamisa hypothyroid coma, hlokomela boemo ba tšohanyetso ka hora ea pele ka eona ke ka ho qaloa ho "triiodothyronine". phekolo oksijene e behiloeng. Entoe laolwa lithethefatsi prednisone, hydrocortisone. Tsamaiso e lithethefatsi hlokahala le pelo le methapo.

Ka mor'a halofo ea hora tla kena ATP, divithamini C, B. Haeba khatello ea ka holimo ho 90 mmHg. Bonono., O ile a etsa selelekela sa "Lasix". Ha khatello ea mali e ka tlase ho palo ena, o ile a sebelisa "corazole", "Mezaton", "Kordiamin".

Ho ekelletsa moo, mong le e mong lihora tse 4, ho itšetlehile ka boemo ba pelo, ka tjhelete e ya micrograms 25 laolwa "triiodothyronine". Hang ha ho otla ha pelo le mocheso li tsitsa, litekanyetso li behoa ea e fokotsehile. Ho ke ke ho hlokahala hore ba tsoele pele ho rewarming etseng letho ba le mamello, phekolo oksijene, tshebediso ya hydroxybutyrate sodium.

Haeba ho na le ho hloka taolo convulsive, entoe tshelwa "Seduxen".

Phekolo: Mothati oa 1

Phekolo ea coma hypothyroid, hangata ho akarelletsa ho mehato e 'maloa, ha ho qala hang-hang ka phekolo hormona Phetolo. Kalafo ea bakuli e phethahatsoa ka tieo tlas'a bookameli ba ngaka ka resuscitation ka matla unit trust tlhokomelo.

Mohato oa pele ke ho tsitsisa mesebetsi ka kakaretso ya mesebetsi bohlokoa ea bohlokoa ka letsatsi la pele kapa tse peli, ntle le ho sebedisa ho eketsehileng phekolo hormona Phetolo ke ke ua ba le phello e lakatsehang le ka 'na esita le sokelang bophelo ba mokuli

Ho boloka mesebetsi matšoafo. Ha mokuli a e khona ho hema ka boeena, le KSCHN litsupa lefisa, phepelo ea Uena ₂ (oksijene phekolo) o etsoa ka nasal cannula kapa sefahleho maske. Ka tloaelo ho, bakuli ba na le meferefere ea ho hema ho itlelang feela, carbon dioxide bakoang maling. sebelisa ya sesebediswa hlokahalang bakeng sa ventilation phetha molao feela. Ho stabilizes mali oksijene le carbon dioxide, ho thibela ntshetsopele ya hypoxia, felisa phello ea oona e mpe ho lisele tsohle le makala.

Phetoho volemic tahlehelo. Hypothyroid (myxedema) coma tšoauoa ka tshegetsa le go tlotla mokelikeli. Empa 'nete ke hore e bakoang ka libaka interstices, bethe vascular ka nako ena ea ho utloa bohloko,' me ha ho haelloa mokelikeli, ka lebaka lena, khatello ea mali a ka tepella. Khalemelo o entsoe ka tharollo hypertonic tsa NaCl, colloidal le brine. Nakong ea Tsamaiso e ke habohlokoa ho nahana ka boemo ba khatello ea bohareng venous. Display ka mefuta e fapaneng e tloaelehileng kapa che moya na dumella kena ha litha e le nngwe e fetang 'ngoe tharollo ka letsatsi. Ho seng joalo, ho ka qholotsa eketsehileng cardiac mojaro, le sodium maling marotholi haholo.

Etseng letho futhumatsang ea 'mele oa mokuli ka likobo kapa eketsa mocheso kamoreng ke lengolo la 1. Tabeng se mokuli a ke ke a tšoara futhumatsang a sebetsang a ke mokhoa oa ho e fapaneng chesang wraps, warmers. Sena se tla etsa hore motho a ntseng a mpefala tsa vasodilation pheriferale le hlaha vasodilation. khatello ea mali li ka fokotsoa ka ho eketsehileng ke hypovolemia e lekanyelitsoeng.

Khalemelo ea tsamaiso ea pelo le methapo. Hypothyroid coma ke bohloko bo tebileng boo ho tsamaiso ea pelo le methapo. Mohato oa pele ke ho phekola bradycardia, khatello ea mali tsitsisoa. Bakeng sa kalafo ya bradycardia M holinoblokatory sebediswa (mohlala, "atropine") ka 'na a sebelisa "aminophylline". Ha khatello ea mali li ke ke tsa fetola tsitsisa vascular hypovolemia, tšehetso ea lithethefatsi e ho hlokahala. Dirisega adrenaline, phenylephrine, norepinephrine. Mona o lokela ho ba hlokolosi ka ho fetisisa, hobane nahanela ya receptors e eketsehileng ea ho phekola ba thyroid li-hormone. Khoneha pelo morethetho ho hloka taolo, le ponahatso ea matšoao a fibrillation atrial kapa tachycardia.

Khalemelo electrolyte tshebetso (chloride, sodium, k'halsiamo, potassium), hammoho le boemo ba tsoekere mali.

Sebelisa (GCS) glucocorticosteroids. tekanyetso Khatello ea Kelello ho hlokahala bakeng sa mokhathala oa mosebetsi adrenocortical ka bakuli ba thyroiditis, se hlahileng ka semelo sa tšebeliso ea nako e telele-hormone, le ea fokotseha ka maemo a ho T3 le T4 litsupa, mafu tsamaisong hypothalamic-pituitary. Ka tloaelo ho, hydrocortisone e laolwa mong le e mong lihora tse tšeletseng ka lethal dose ea letsatsi le letsatsi ea mg, 200 ho 400. Hang ha ba le mamello e tsitsa, ka mor'a matsatsi a mabeli kapa a mararo, ho na le ea fokotseha ka lethal dose ea.

Hlobaetsang dialysis kapa Phetolo phekolo renal. E o ile a bontša bakeng sa bakuli ba oligoanuria e tsoetseng pele, e ntseng e eketseha creatinine, urea, potassium.

kalafo mokuli a se lokela ho qala hang-hang. Kapele ho tla ba bohato ba pele ba ho tsosolosa mesebetsi hlokahalang ea bophelo, kapele ho tla ba bonolo ho qala li-hormone Phetolo phekolo. Menyetla ea ho hlaphoheloa ba eketsehile ka makhetlo a mangata e fetang.

sethaleng 2

2 sethaleng kalafo ea boemo hypothyroid coma se na le tse ling. Sena se hloka hore motho a vicarious thyroid li-hormone phekolo.

Metsoako e ka sehloohong - litokisetso T4. "Levothyroxine" hangata ba abeloa ho lethal dose e le ba 1,8 mg, / lik'hilograma ka letsatsi. Se ka mor'a lihora tse 6 ketso e qala, 'me ka mor'a letsatsi le phello e tletseng e fihlellwa. Qalong hora ho bontšitsoe ho tloha micrograms 100 ho tse 500 tsa moriana. Ho feta moo, ka nako ya letsatsi le kenyelletsoa karolo e setseng ea lethal dose ea letsatsi le letsatsi. Ka mor'a moo, ho boloka lethal dose ka letsatsi ke 75-100 micrograms. Ka mor'a hore mokuli a ikutloe tsitsisoa "Levothyroxine" laolwa foromo Letlapa.

The mahlonoko tseo ho leng boemo T3 litokisetso laolwa 0,1 ho tse 0.6 mg, / lik'hilograma ka letsatsi. Ka letsatsi le letsatsi 75-100 mg, mong le e mong lihora tse 6 e hlahiswa 12.5-25 .mu.g. Ha mokuli a e na lefu la pelo, le lethal dose ea letsatsi le letsatsi e sebediswa bonyane - 25-50 mg,.

sethaleng 3

Ka mohato 3, ka mor'a hore ho tsitsisoa ba mokuli, qala kalafo ya lefu boo, e leng se ileng ho ntshetsopele ya coma. Sena e ka ba efe kapa efe tshwaetso kapa ho ruruha ea thyroid tsoelesa e, ho sithabela, le lintho tse ling.

Hypothyroid coma - mokuli a se beha bophelo kotsing boemo. keletso tsa bongaka lokela ho tieo o ile a re le kenngwa tshebetsong. Ho seng joalo, e ka etsahala mathata a tebileng, beha bophelo kotsing. Ba ikhopolang ho meriana tabeng ena e tieo thibetsoe. Ha ho pelaelo hore leha e le efe mabapi le matšoao a coma hang-hang batla ngakeng.

thyrotoxic coma

Hypothyroid coma, kapa maqakabetsi a thyrotoxic, e ka etsahala ho ba teng ha hyperthyroidism khōlō untreated thyrotoxic goiter. Hangata ka ho fetisisa ena le hlaha khahlanong le semelo le mathata a kelello a ka mor'a ho tlosa ho buoa tsa thyroid tsoelesa e. The pathogenesis ka sehloohong - ke ho re:

• The qhoma bohale thyroid li-hormone maling.

• Hypoxia.

• Endotoxemia.

• Chefo tshenyo ya tsamaiso la pelo le methapo ea kutlo, nadpochesnikov sebete.

• Tlōlo ea metabolism lisele le metsi le ho leka-lekana electrolyte.

Thyrotoxic maqakabetsi tlang pele ntshetsopele ya coma. Mokuli o na le matšoao a latelang a ile a re: hlapholang kelello, hangata a tsamaea le lipono, delusions. leoto tremor, tachycardia (ho fihlela ho 200 otla ka motsotso). 'Mele mocheso e hlaha ho likhato 38-41. Boima ho fufuleloa. Letšollo, ho hlatsa. Mohlomong u ka ponahalo ea nyooko.

Haeba ho na le ho na phekolo e lekaneng, boemo ba mokuli mpefala ka tsela e hlollang:

• theola khatello ea mali;

• letlalo omileng;

• atrial fibrillation;

• mydriasis;

• cyanosis;

• bulbar maloetse.

Etsahala khatello reflexes, mesifa molumo decreases, ho na le ho lahleheloa ke taolo senya, mafu a ilibana, coma. Diagnostic boleng ba le histori ya data bontšang ho ba teng ha thyrotoxicosis: tachycardia, feberu, phokotso boima, ho hlatsa, restlessness, profuse letšollo.

Ka ho hlahloba mali a fumana: eketsehileng ditefello tsa thyroid li-hormone, nang le protheine e tlangwa iodine litareng e, bilirubin (ka lebaka la ho timetsoa ha sebete chefo), 17-oksiketosteroidov, tshilong ya dijo acidosis.

Ka puso ena mokuli ke ho hlokahala hore ho fana ka thuso boemong ba tšohanyetso. mesebetsi e latelang di kenyelleditswe ho eona:

• Entoe laolwa isotonic sodium chloride tharollo ka palo ea litha e le nngwe 1.

• A tharollo of 5% tsoekere.

• "Hydrocortisone" ka litekanyetso li behoa ea mg, 350 ho tse 600.

• "Prednisolone" ho tloha 120 ho 180 mg,.

• "Korglikon" kapa "StrofantinK" 0.5-1 di ml.

• "Seduxen" kapa anticonvulsants tse ling.

• "Merkazolil" (antithyroid lithethefatsi) - 60-80 mg, ka ho ya ka letsatsi.

Ka ho hlwaya mokuli matšoao holimo lokela hang-hang bitsa "ambulense" le mamello sepetlele Lefapheng Endocrinology.