甲狀腺功能亢進(jìn)癥病人的護(hù)理NursingofHyperthyroidismPatients97講解

甲狀腺功能亢進(jìn)癥病人的護(hù)理Nursingof

Hyperthyroidism

Patients廣西衛(wèi)生職業(yè)技術(shù)學(xué)院內(nèi)科護(hù)理教研室DepartmentofMedicineNursing,GuangxiMedicalCollege實(shí)驗(yàn)室檢查及其他LaboratoryexaminationandothersTSH測(cè)定

TSHdetermination

sTSH(敏感TSH測(cè)定）為篩查甲亢的第一線指標(biāo)sTSH(sensitiveTSHdetermination)istheprimaryindicatorforscreeninghyperthyroidism血清TH測(cè)定SerumTHdeterminationFT3、FT4：首選，升高FT3,FT4:primary,elevatedTT3、TT4TT3,TT4實(shí)驗(yàn)室檢查及其他LaboratoryexaminationandothersTSH受體刺激性抗體(TSAb)TSHReceptorStimulatingAntibodies(TSAb)未經(jīng)治療檢出率85%-100%85%-100%untreateddetectionrate不但能反應(yīng)有抗體存在，還能反應(yīng)抗體對(duì)甲狀腺細(xì)胞的刺激功能Notonlyreflectstheexistenceofantibodies,butalsothestimulatingfunctionofantibodiesonthyroidcellsTSH受體抗體(TRAb)TSHreceptorantibodies(TRAb)新診斷陽(yáng)性檢出率75%-90%75%-90%newdiagnosispositivedetectionrate能反應(yīng)有抗體存在，但不能反應(yīng)抗體的功能Reflectstheantibodiespresence,notthefunction治療方法

Treatment

AABBCC藥物治療DrugTherapy手術(shù)治療SurgicalTreatment放射性131I治療Radioactive131ITherapy藥物治療

DrugTherapy

適應(yīng)證：輕中度、孕婦、20歲以下、術(shù)前、其余兩種方法不適合者Indications:mildtomoderatecondition,pregnantwomen,patientsunder20yearsold,preoperative,patientswhoarenotsuitablefortheothertwomethods

一、抗甲狀腺藥物治療Antithyroiddrugstherapy藥物治療

DrugTherapy

一、抗甲狀腺藥物治療I.Antithyroiddrugstherapy常用藥物

硫脲類：丙硫氧嘧啶PTU、甲硫氧嘧啶MTU

咪唑類：甲巰咪唑MMI、卡比馬唑CMZPTU可作為嚴(yán)重病例或甲狀腺危象的首選藥物CommonlyuseddrugsThioureas:PropylthiouracilPTU,MethylthiouracilMTUImidazoles:MethimazoleMMI,CarbimazoleCMZPTUmaybetheprimarychoiceforseverecasesorthyroidstorm一、抗甲狀腺藥物治療Antithyroiddrugstherapy藥物治療

DrugTherapy

一、抗甲狀腺藥物治療I.Antithyroiddrugstherapy治療方案與療程初治期：至癥狀緩解或血TH恢復(fù)正常時(shí)減量減量期：待癥狀消失、體征明顯好轉(zhuǎn)減至最小維持量維持期：維持12～18個(gè)月TreatmentplanandcoursePrimarytreatment:reducethedoseuntilsymptomsarerelievedorbloodTHreturnstonormalReductionperiod:reducetotheminimummaintenancedosewhensymptomsdisappearandphysicalsignsimprovesignificantlyMaintenanceperiod:12to18months一、抗甲狀腺藥物治療Antithyroiddrugstherapy藥物治療

DrugTherapy

一、抗甲狀腺藥物治療I.Antithyroiddrugstherapy復(fù)方碘口服溶液Compoundiodineoralsolutionβ受體阻斷藥β-receptorblockers二、其他藥物治療II.Otherdrugstherapy二、其他藥物治療Otherdrugstherapy手術(shù)治療SurgicalTreatment手術(shù)治療

SurgicalTreatment

放射性131I治療

Radioactive131

ITherapy

CC患者服下液狀或者膠囊狀的放射性碘Thepatienttakesliquidorcapsuleradioactiveiodine放射性碘經(jīng)腸道黏膜吸收進(jìn)入血液Radioactiveiodineisabsorbedbytheintestinalmucosathenintotheblood碘治療可以特異性的作用于甲狀腺對(duì)于機(jī)體其他組織幾乎沒(méi)有副作用Iodinetherapyhasaspecificactiononthethyroidglandandfewsideeffectsonothertissuesofthebody甲狀腺可特異性攝碘，因此放射性碘幾乎全被甲狀腺攝取.Duetothespecificiodineuptakeofthyroid,almostallradioactiveiodineistakenup.放射性碘損傷甲狀腺濾泡細(xì)胞Radioactiveiodinedamagesthyroidfollicularcells放射性131I治療Radioactive131ITherapy治療方法

Treatment

治愈率：40%復(fù)發(fā)率：50-60%副作用：粒細(xì)胞減少藥疹、其他Curerate:40%Recurrencerate:50-60%Sideeffects:neutropenic,drugeruption,etc.治愈率：85%以上復(fù)發(fā)率：＜1%副作用：甲減、放射性甲狀腺炎、浸潤(rùn)性突眼惡化Curerate:morethan85%Sideeffects:Recurrencerate:<1%Hypothyroidism,radiationthyroiditis,deteriorationofinfiltrativeexophthalmos治愈率：70%以上復(fù)發(fā)率：8%副作用：甲狀旁腺功能減退、喉返神經(jīng)損傷Curerate:morethan70%Recurrencerate:8%Sideeffects:hypoparathyroidism,recurrentlaryngealnerveinjury藥物治療DrugTherapy131I治療131ITherapy手術(shù)治療SurgicalTreatment甲狀腺危象的防治

Thyroidstormpreventionandtreatment

避免和去除誘因Avoidandremovecauses抑制TH合成：首選PTUInhibitTHsynthesis:PTUpreferred抑制TH釋放：復(fù)方碘InhibitTHrelease:compoundiodineβ受體阻斷藥：普萘洛爾抑制外周組織T4轉(zhuǎn)向T3βreceptor-blockingdrug:propranololinhibitsperipheralT4turntoT3甲狀腺危象的防治

Thyroidstormpreventionandtreatment

糖皮質(zhì)激素Glucocorticoids降低和清除血漿TH：腹透、血透、血漿置換ReductionandclearanceofplasmaTH:peritonealdialysis,hemodialysis,plasmapheresis支持療法：降溫、給氧、防治感染Supportivetherapy:hypothermy,oxygenadministration,infectionprevention突眼防治

ExophthalmosPrevention

體位：高枕臥位Bodyposition:Highoccipitalposition飲食：限制水鈉Diet:Limitwaterandsodiumintake畏光：戴有色眼鏡Photophobia:weartintedglasses角膜異物感：人工淚液Cornealforeignbodysensation:artificialtears保護(hù)角膜：夜間遮蓋Corneaprotection:coveratnight輕度復(fù)視：棱鏡糾正Milddiplopia:prismcorrection強(qiáng)制性戒煙MandatorySmokingCessation有效控制甲亢是基礎(chǔ)治療：抗甲狀腺藥+免疫抑制劑+眶放射Ef