Kooma Hypothyroid: sida ay u bixiyaan daryeelka degdegga ah?

Hypothyroidism waa cudur khatar ah. Mid ka mid ah dhibaatooyinka ugu badan waa kooma hypothyroid. Inta badan waxaa ka dhaca bukaan ka weyn, gaar ahaan dumarka. Kooma ku dhacaa group in bukaanada la ildaran hypothyroidism, laakiin ma uu qaadan daaweynta lagama maarmaanka ah, ama haddii ay ka fulinayeen Magaalada time.

Sababaha hypothyroidism

Inta badan bukaanka (95%) ee hypothyroidism waxaa keena bahal geedi socodka ka dhaca qanjirka thyroid. Heerka wax soo saarka ee hoos hormoonnada, hypothyroidism hoose yeesho.

Marka xadgudubyada stimulatory iyo saamaynta sharciyeed ee TSH pituitary iyo tireoliberina (ama factor sii daayo hypothalamic) yimaado hypothyroidism sare. inta jeer ee ay dhacdo in inta badan liita hoose. Iyo in xaqiiqda, iyo xaaladaha kale marka ay jirto daaweyn ku filan waxaa laga yaabaa in kooma hypothyroid.

About hypothyroidism durugsan su'aal aan la xalin siyaabo badan. Haddii ay soo baxdo oo xidhiidh la leh cudurada dheefshiidka ee ubucda ah hormoonka thyroid ama ay sabab u tahay hoos u dareen in xubnaha iyo unugyada ee receptors nuclear for hormoonnada thyroid ka?

Waxaa weli su'aal muran ku saabsan in uu jiro da'da-nabaad hormoonnada thyroid in xanuunada shiid durugsan. Oo haddii ifafaale karin arkay qanjirka thyroid in nidaamka gabowga ah?

kooma Hypothyroid. sababaha

Pathogenesis kooma hypothyroid kiisaska intooda badan, waxay muujinaysaa in ay qaadeen daaweynta aan habboonayn ama dhicis hypothyroidism. Qayb ka mid ah sharaxaad laga yaabaa in dib u dhac in cudurka. Deficiency hormoonnada thyroid la sii dartay laga yaabaa in la joojiyo of dhaweynta ee Levothyroxine ama u shaqeeyo u baahan kordhaya qiyaasood oo la bedelay hormone. kooma Hypothyroid laga yaabaa in ay gacan ka dhawr arrimood:

• Barafowga.

• cudurada saameen (wadne, pneumonia, stroke, viral, cudurada Fistula).

• Dhiig bax aad u ballaaran, dhaawacyada, Dawaynta ilayska, qaliin.

• Baaritaanka X-ray.

• Maamulka daawooyinka oo ku tuuji habka dhexe ee neerfayaasha.

• qaadasho badan oo khamri ah.

• Hypoglycemia.

• Hypoxia.

Haddii xadhigga heerka hoormoonka thyroid maskaxda hoos u dhaqdhaqaaqa ee geeddi socodka dheefshiidka. Taa awgeed, sii kordhaya hypoxia, si weyn u xad cayn kasta oo shiid, iyo qaar badan oo ka mid ah muuqaalada xubnaha ugu.

Calaamadaha miyir hypothyroid

ifafaale kooma dhacdaa si tartiib ah u koraya, horumar tartiib tartiib ah. Markii hore, daal muuqataa, arxandarro, feejignaan xumo, ka dibna arkay jilcid addinka, qallayl, barar cagaha, caddaan maqaarka - sifooyinkaa waxaa lagu gartaa kooma hypothyroid. Status lokalis muujinaysaa neefsashada gaabis ah, dhibaatooyin la xiriira kaadi, calaamadaha wadnaha oo shaqadiisa gaba. Waxay yareeysaa cadaadiska dhiigga, ayaa la'aanta hummaag seed. On baaritaan, dhakhtarka bukaanka u ilaalisaa calaamadaha soo socda ee kooma hypothyroid:

• Dilaacda-shiid, miisaanka jidhka wareegga kor u gaabisaa, heerkulka uu hoos u dhaco ilaa 35 digrii.

• Waxaa jira rabshooyin nidaamka wadnaha. garaaca wadnaha ayaa hoos, waxaa jira a garaaca wadnaha thready, hoos u cadaadiska dhiigga, barar waxyaalaha qalbiga ku jira.

• Xadgudubyada hawlaha neefsashada. Yaraynta tirada neefsiga, ku dhacaan heerarka oksijiinka dhiiga inta la hurdo joojin kartaa neefsashada.

• Aan caadi ahayn in habka dareemayaasha jirka. Iscelin of hummaag seed, maskax hurudda horusocod ah.

• calaamadaha maqaarka. Cawlaan, qalalan, codadka maqaarka waxy, hyperkeratoses wadajir ah. musmaarro debcaan. timaha.

• Dhaco heerka sodium dhiigga. wejiga iyo jirka barar daran.

• Dhiig, iyo dhammaan calaamadaha caadiga ah waxaa ka mid ah.

• Hypoglycemia.

• cudurada dheefshiidka. ileus. beerka kordhay.

rugta caafimaadka

Clinic kooma hypothyroid waa sida soo socota: waxaa jira a daciifnimo, dawakhsanaan, hoos heerkulka ilaa 35 digrii. Hoos, erayadii waa la indistinctly dhawaaqaa, aragga, maqalka la dhimay. Cadaadiska dhiigga loo dhigi, garaaca wadnaha - 30 garaac daqiiqaddiiba. Neefsashada gacmeed iyo naadir ah. From caloosha - dibiro, calool xanuun, matag. Waxaa jira horumarinta oliguria. Maqaarka caddaan huruud ah, qalalan. Barar wajiga, jirka. Wareer, feejignaan xumo. hummaag seed ayaa maqan. Yimaado kooma hypothyroid.

Dhiig. Hypoxia, hypercapnia, hyponatremia, hypoglycemia, aysiidh, hiimotokiriit, TSH, T3 iyo T4 hoos kolestaroolka kordhay.

Dhibaha: pneumonia, ba'an failure ventricular bidix, encephalopathy, kelyaha ba'an, garaaca wadnaha, stroke, dementia, ileus.

The gargaarka degdegga geynta

Haddii qofka miyir hypothyroid, isku geynta daryeelka degdegga ah waa sida soo socota:

1. Prehospital:

• Wac dhakhtar. Si ay u bixiyaan gargaar caafimaad oo ugu horeeya.

• Ku duub buste si loo yareeyo kulaylka jirka.

• Si aad u baabi'iyo hypoxia dhex tuubooyin sanka siiyo oxygen humidified.

• Bixiyaan helitaanka xididka in set tuubo galaysa xidid dhiig ah.

Haddii lagu rakibay hypothyroid kalkaalisada xeeladaha kooma waa cad, wada shaqeyn la Dr. - deg deg ah, wanaagsan loo soo abaabulay,

• Waayo, ogaanshaha dhibaatooyinka qaadan tyroksiini dhiig content, thyroid stimulating hormone, triiodothyronine, glucose, cortisol, chloride, sodium, Aar, oo sideeda oo gaaska.

• In si loo xakameeyo diuresis qabtay sanka kaadi.

• Si looga hortago Doonidba mantag waxaa dawadu tube caloosha.

• Si loo ogaado dhibaatooyinka - socodka ECG heerka neefsashada, heerkulka, hemodynamics. "Reopoligljukin" xididka-faleebo of 500 ml.

• Naanin - Glucose 40% w / jet - 20-30 ml; markaas / faleebo maamula glucose 5% (500 mL).

2. In isbitaalka lagu dhigo:

• Waayo, waxaa dhiman hormone bedelay in / jet maamusho 6 saac oo kasta 250-500 mcg "tyroksiini" (ama via gavage 100 ug "triiodothyronine") raacay by 12 saacadood si loo yareeyo qiyaasta of 25-100 micrograms.

• Waayo, gargaarka kaafi adrenal in / jet maamula hemisuccinate hydrokortisoni (50-100 mg).

• Waayo, encephalopathy hortagga 1 ml Vitamin B1.

• Waayo, bradycardia bararka maamula s.c. "atropine" 0.1% (0.5-1 ml).

• Kicinta ee xarunta neef mareenka - "Kordiamin" (2-4 ml).

• Wixii caawimo ah ee hypoxia cerebral - "Mildronate" (250 mg).

• Si looga hortago cudurada - antibiotics.

• Waayo, tirtiridda hypoxia - hawo farsamo.

kooma Hypothyroid: daryeelka degdegga ah

Bixinta gargaar degdeg ah, kiis kasta oo aan loo isticmaali karaa in Kulaashaan kululeeya bukaanka - taasi waa ay sabab u tahay sii daraysa ee hemodynamics. "Triiodothyronine" ma duraa intravenously degdeg ah si looga fogaado khatarta dhibaatooyinka wadnaha. dose Large "Levothyroxine" awood xanaajin ah kaafi adrenal ba'an.

Isbitaal waxaa lagu qabtaa meel ku jiifo ee qaybta daryeelka degdegga ah ama waaxda of endocrinology.

Haddii lagu rakibay kooma hypothyroid, daryeelka degdegga ah ee saacaddii ugu horreeyey waa kan dhex hordhaca ah ee "triiodothyronine". daweynta oksijiinta loo magacaabay. Intravenously maamula dawooyinka prednisone, hydrokortisoni. Maamulka waa daawooyinka lagama maarmaanka ah iyo wadnaha.

Ka dib markii nus saac ah waa soo geli ATP, fitamiinada C, B. Haddii cadaadiska ka sarreeya 90 mmHg. Art., Ka dhigay hordhaca ah ee "Lasix". Haddii cadaadiska dhiigga uu ka yar yahay tan tiradaasi, loo isticmaalo "corazole", "Mezaton", "Kordiamin".

Dheeraad ah, 4 saacadood kasta, taas oo ku xidhan xaalad wadnaha, qadarkuu of 25 micrograms maamulo "triiodothyronine". Sida ugu dhakhsaha badan garaaca wadnaha iyo heerkulka ayaa lagu xasilin, qiyaasta waa la dhimay. loo baahan yahay in ay sii wadaan in ay rewarming dadban ee bukaanka, daweynta oksijiinta, isticmaalka hydroxybutyrate sodium.

Haddii ay jirto jirro convulsive, intravenously duraa "Seduxen".

Daaweynta: Stage 1

Daaweynta kooma hypothyroid, sida caadiga ah ku lug leh dhowr tallaabo, isla markiiba waxa aanu bilowdo hormone replacement therapy ma. Daaweynta bukaan waxaa lagu fuliyaa si adag iyada oo ay kormeerayaan dhakhtar ee dib u soo kicinta ee qaybta daryeelka degdegga ah.

Tallaabada ugu horreysa waa in la xasiliyo hawlaha guud ee laga maarmin muhiim maalinteedii kowaad ama laba, iyadoo aan la isticmaalin dheeraad ah oo hormone replacement therapy kuma yeelan doono saamayn la doonayo oo laga yaabaa in xataa ay halis gelin nolosha bukaanka

Joogtaynta hawlaha neefsashada. Haddii bukaanka waa awoodaa inuu isaga qudhiisu aad neefsato, iyo tilmaamayaasha KSCHN magdhow, sahayda O ₂ (daweynta oksijiinta) waxaa la sameeyaa mudayo sanka ama maaskaro. Sida caadiga ah, bukaan leeyihiin rabshooyin ah neefsashada oo lama filaan ah, carbon dioxide ururayaa in dhiigga. isticmaalaan qalabka loo baahan yahay hawo farsamo. Waxaa degto oxygen dhiigga iyo carbon dioxide, ka hortagtaa horumarinta hypoxia, la baabi'iyo ay saamayn xun ku dhammaan unugyada iyo xubnaha.

Qabsiga khasaaraha volemic. Hypothyroid (myxedema) kooma lagu gartaa dareeraha. Laakiin xaqiiqada ah waa in ururayaa in Toostaan interstices, sariirta vascular waqtigan dhibaato, iyo uu jiro khasaare dheecaan, sababtan awgeed, cadaadiska dhiigga tagi karaan. Correction la sameeyo taasi oo ka xal hypertonic of NaCl, Kolloidol iyo marmar. Inta lagu guda jiro nidaamka waa muhiim in la tixgeliyo heerka cadaadiska arooriyaha dhexe. Display ee heerka caadiga ah ama aan laga badbadiyay oo u ogolaanaya galo ka badan hal xal liter maalin kasta. Haddii kale, waxaa laga yaabaa in ka cadhaysiinina kordhay load wadnaha, kula sodium in dhiigga si weyn dhibciyo.

kululaynta dadban ee jirka bukaanka iyadoo adeegsanayo bustayaal ama la kordhiyo heerkulka qolka by 1 degree. Xaaladdan oo kale ma bukaanka ma qaban karo kululaynta firfircoon oo macneheedu yahay dhanbiilaha kala duwan kulul, kululeeya. Tani waxay keeni doontaa in vasodilation sii xumaanaysa ee vasodilation durugsan dhacdaa. Cadaadiska dhiigga la sii yarayn karo by hypovolemia qaraabada.

Correction nidaamka wadnaha. kooma Hypothyroid waa dharbaaxo xun nidaamka wadnaha. Tallaabada ugu horreysa waa daaweynta bradycardia, xasilinta cadaadiska dhiigga. Wixii lagu daaweyn jiray bradycardia M holinoblokatory isticmaalo (tus, "atropine") isticmaali karaan "aminophylline". Haddii dhiig karka oo aan la hagaajin karo xasilin hypovolemia vascular, waxaa loo baahan yahay taageero daroogada. adrenaline Applied, phenylephrine, norepinephrine. Halkan waxa aad u leeyihiin in ay aad u taxaddar, sababta oo ah dareenka ee receptors bateen daaweynta hormoonka thyroid. disorder garaaca wadnaha ee suurtogalka ah, muujinta ah oo ka mid ah calaamadaha wadne ama tachycardia.

waxqabadka Correction elektrolytka (chlorine, sodium, calcium, potassium), iyo sidoo kale heerka sonkorta dhiigga.

Isticmaalka glucocorticosteroids (GCS). qaadasho Stress ayaa loo baahan yahay, waayo, daal of function binyrebarkhormon in bukaanka qaba Graves, kaas oo u muuqday on asalka isticmaalka muddada-dheer ee hormoonnada, la hoos u dhac in heerarka tilmaamayaasha T3 iyo T4, cudurada nidaamka hypothalamic-pituitary. Sida caadiga ah, hydrokortisoni waxaa maamula lix saacadood kasta halkii dose maalin walba 200 ilaa 400 mg. Marka bukaanka la dejiyo, laba ama saddex maalmood ka dib, waxaa jira hoos u dhac in qiyaasta.

dialysis Ba'an ama Daaweyn laguugu beddelo kelyaha. Waxaa la tilmaamay bukaanka qaba oligoanuria sare, sii kordhaya kariyaatiniin, HOL, potassium.

daaweynta bukaan-socodka waa in isla markiiba bilaabay. The si degdeg ah waxa uu noqon doonaa talaabada ugu horeysa si loo soo celiyo hawlaha loo baahan yahay ee nolosha, ay si degdeg ah waxa uu noqon doonaa suurto gal ah in ay bilaabaan hormone replacement therapy. Fursadaha soo kabashada waa sii korodhay marar badan ka weyn.

stage 2

daaweynta 2 stage of xaaladda kooma hypothyroid hore oo kale. Tani waxay u baahan therapy ah hormoonka thyroid Maynee.

Tiirarka ugu muhiimsan - diyaarinta T4. "Levothyroxine" caadi ahaan loo xilsaaray at dose oo ah 1.8 mg / kg maalintii. Horeba 6 saacadood ka dib markii tallaabo la bilaabin, iyo maalin ka dib markii saameyn buuxda waxaa lagu gaarayaa. Markii hore saacad ka 100 ilaa 500 micrograms daroogada lagu muujiyey. Dheeraad ah, inta lagu jiro maalinta bandhigay inta kale ee qiyaasta maalinlaha ah. Intaas ka dib, dose dayactirka maalin kasta waa 75-100 micrograms. Ka dib markii xasilinta "Levothyroxine" bukaanka maamulo qaab kiniin ah.

The diyaarinta T3 xaalad halis ah ay maamusho 0.1 si 0.6 mg / kg maalintii. Ugu maalin kasta 75-100 mg 6 saac oo kasta waxaa soo bandhigay 12.5-25 .mu.g. Haddii bukaanku leeyahay cudurrada wadnaha, qiyaasta maalin kasta waxaa loo isticmaalaa ugu yaraan - 25-50 mg.

stage 3

In talaabo 3, ka dib markii xasilinta ee bukaanka, la bilaabo daweynta cudurka sababaya, taas oo keentay in horumarinta kooma. Tani waxay noqon kartaa wax kasta oo jeermis ama barar ah qanjirka thyroid, dhaawacyada, iyo arrimo kale.

kooma Hypothyroid - xaalad naf-gooyada ah bukaan-socodka. talo caafimaad waa in si adag loo arkay iyo fulin. Haddii kale, laga yaabaa inuu dhaco dhibaatooyin halis ah, naf-gooyada ah. Is-daawo kiiskan gebi ahaanba la mamnuucay. Haddii wax shaki ah oo ku saabsan calaamadaha kooma si degdeg ah raadsataa daryeel caafimaad.

kooma thyrotoxic

kooma Hypothyroid, ama dhibaatooyinka thyrotoxic, dhici kara in joogitaanka tayroodh daran ee aan la daaweyn goiter thyrotoxic. Inta badan waxa ay ka dhacdaa dhanka ah asalka ah oo ah walaaca nafsi ah ka dib saarista qalliinka ee qanjirka thyroid. pathogenesis ugu weyn - waa:

• boodi fiiqan ee thyroid hormoonnada ah ee dhiigga.

• Hypoxia.

• Endotoxemia.

• waxyeello sun ah nidaamka wadnaha iyo neerfaha, nadpochesnikov beerka.

• Xadgudubka shiid gacanta iyo biyaha iyo dheelitirka elektrolytka.

dhibaatada Thyrotoxic horreeyaa horumarinta kooma. Bukaanku waxaa uu calaamadaha soo socda lagu arkay: farax maskaxda, inta badan la socda dhalanteed, waaxaan Dhagar ahayn. gariirka addinka, tachycardia (ilaa 200 garaac daqiiqaddiiba). heerkulka jirka gaartay 38-41 degrees. dhidid culus. Shuban, matag. Waxaa laga yaabaa in muuqaalka kore ee cagaarshow.

Haddii aanu jirin therapy ku filan, xaaladda bukaanka si weyn uga sii:

• hoos u cadaadiska dhiigga;

• maqaarka qalalan,

• wadne-;

• mydriasis;

• dhiigrooraan;

• xanuunada bulbar.

Dhaca hummaag dulmi, cabirida xaalada muruqa hoos u, waxaa jira khasaaro ah kontoroolka kaadiheysta, xanuunada miyirka, kooma. qiimaha Baarista haysaa xogta taariikh muujinaysa jiritaanka thyrotoxicosis: tachycardia, qandho, miisaan yareynta, matag, deganaansho la'aan, shuban miidhan.

In falanqaynta dhiigga helay: kordhay heerka hormoonka thyroid, iodine protein-ku xidhay, bilirubin (sabab u ah burburinta sunta beerka), 17-oksiketosteroidov, aysiidh dheefshiidka.

In gobolka this bukaanka waa lagama maarmaan si ay u bixiyaan gargaar degdeg ah. hawlaha soo socda ayaa ku jira waxa ku jira:

• Intravenously maamula xal sodium chloride isotonic qadarkuu of 1 litir.

• Xalka of 5% glucose.

• "Hydrokortisoni" in qiyaasta ah 350 600 mg.

• "Prednisolone" ka 120 ilaa 180 mg.

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

• "Seduxen" ama anticonvulsants kale.

• "Merkazolil" (daroogada antithyroid) - 60-80 mg maalintii.

In la aqoonsado bukaanka astaamaha kor ku xusan waa in isla markiiba wac "ambulance" iyo bukaanka cusbitaalka ee Waaxda Endocrinology ah.