甲状腺疾病(英文版)ppt课件

.,ThyroidDisorders,.,WordList,Thyroiddisorders甲状腺病症Isthmus峡部Thyroxine甲状腺素Triiodothyronine三碘甲状腺氨酸Parathyroidglands甲状旁腺Calcitonin降钙素,.,Recurrentlaryngealnerve喉返神经Hyperthyroidism甲亢Hypothyroidism甲减Goitre甲状腺肿Exophthalmos突眼症Tremor震颤TSH促甲状腺激素,.,Thyroidectomy甲状腺切除术Thyroidcrisis甲状腺危象Atracheostomyset气管切开包Tetamy手足抽搐,ThyroidGland,Itisapartoftheendocrine(内分泌)system,playsamajorroleinregulatingthebodysmetabolism.,.,Section1,Anatomy/physiologyofthyroid,.,PlaceBloodsupplyNervessupplyFunctions,Anatomy/physiologyofthyroid,.,Locatedinthelowerneckanteriortothetrachea.Twolaterallobesconnectedbyanisthmus（峡部）Butterfly-shapedorgan5cmlong,3cmwide，30gTheparathyroidglands（甲状旁腺）lyingonthedorsalside（背面）ofthethyroidgland.,.,Rich,fromthesuperiorandinferiorthyroidartery.Artery:Thearterialbranchesprovidebloodsupplytootherstructuresinthearea.Theinteriorthyroidarteryprovidesbranchestothepharynx,tracheaandesophagus.Vein:1)Thesuperiorthyroidvein2)Themiddlethyroidvein3)Theinferiorthyroidvein,.,Thenervessupplyingthethyroidoriginatefromvagus(迷走神经）,innervatetheepithelialcells（上皮细胞）ofthefollicles（滤泡）ofthethyroidgland.Onemustbeawareofthebilateralexistenceofarecurrentlaryngealnerve（喉返神经）duringdissection.,.,Produces,synthesizes,stores,andsecretesTwoHormonesCalledThyroxine(T4)Thyronine(T3)RegulatesMetabolismsoYourCellsFunctionProperlyAffectsEveryCellintheBody,necessaryfornormalgrowthanddevelopment,.,Commondisorder:AdeficiencyofiodineOtherdisorder:AutoimmunethyroiddiseaseClassification:Hyperthyroidism(甲亢）,hypothyroidism（甲减）,tumours,cancerorgoitre（甲状腺肿）.,.,WhentheThyroidDoesntWork,HyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUp,HypothyroidismTooLittleThyroidHormoneMetabolismSlowsDown,.,Hyperthyroidism(甲状腺功能亢进）,.,Definition,Hyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.,.,Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:2040yearsoldgroup.,.,ClinicalManifestation,GoiterExophthalmos(突眼征）IncreasedmetabolicrateIncreasedfunctionofsympatheticnerve(交感神经）Cardiovascularalteration,.,Thethyroidcanbepalpatedforasymmetry(不对称）andsize.Itmayenlarge3-4timestoitsnormalsize.Itiscalledgoitre.,Hyperthyroidism,.,.,Asaresultofincreasedthyroidhormoneproduction,theclienthasanincreasedmetabolicrate.Weightlossdespiteincreasedappetite,fatigue,poortolerancetoheat,andprofuseperspiration,menstrualirregularities.,.,Nervous,restlessness,irritability,difficultyconcentrating,emotionalliability,moodswings,personalitychanges.Finetremorsofthefingersandtongue,shakyhandwriting,clumsiness,troubleinclimbingstairs,ordyspneapossiblyatrest.,.,Theskiniswarmandmoist,characteristicsalmoncolour(鲜肉色）.Thehairisfineandsoftwithprematuregreyandincreasedhairloss.Thenailsappearfragilewithdistalnailseparationfromthenailbed.,.,Tachycardia:160bpmanddownto80bpmduringsleep.Pulsepressureiswidened.Therecanbemuscularweaknessandatrophy(萎缩）,paralysis（瘫痪）.,.,DiagnosticTests,TSH（促甲状腺激素）T3,T4Radioactiveiodineuptake（131）ThyroidscanMensurationofbasicmetabolismrate(BMR),.,TSH(ThyroidStimulatingHormone)normalTSHreflectaeuthyroid(甲状腺机能正常的）state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.,ThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.,.,MensurationofBasicMetabolismRate(BMR),Conditions:Earlyinthemorning,emptystomach,atthetimeofrestBasicMetabolismRate=(Pulserate+Pulsepressure)-111,.,Grade,Normal:10%Slightlyabnormal:+20%+30%Moderatelyabnormal:+30%+60%Seriouslyabnormal:+60%,.,Treatment,Antithyroiddrugs,radioactiveiodine,orthyroidectomy(甲状腺切除术）.Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.,.,Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.,.,SurgicalIndications,AverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatients,.,Surgery,Aportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.,.,Surgery,Ifapartialthyroidectomyisdone,theremainingthyroidtissueshouldprovideadequateamountsofthyroidhormones.Ifacompletethyroidectomyisdone,theclientwillrequirethyroidhormonereplacementforalifetime.,.,Theneckisextendedandasymmetrical,gentlycurvedincisionismade1to2cmabovetheclavicle（锁骨）.,Closureofthewoundisaccomplishedbythestrapmusclesinthemidline.Asmallsuctioncatheterisusuallyinsertedthroughastabwound.,.,Complicationsaftersurgery,Dyspnea,asphyxiaInjuryoflaryngealnerveSpasmsThyroidcrisis（甲状腺危象）,.,HaemorrhageHaematoma(血肿）formationTrachealcollapse（气管塌陷）TrachealmucousaccumulationLaryngealorlocaltissueedema,Cause,.,Complicationsaftersurgery,Respiratorydistressandhaemorrhage.Difficultyinrespirationwhichistheoccurswithinafterthesurgery.,mostcriticalcomplication,48hours,.,Management,Surgicalevacuationisrequired.ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.,.,Preventiveinterventions,Atracheostomyset(气管切开包）iskeptatthepatientsbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.,.,Injuryoflaryngealnerve,Anyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神经）,whichliesjustbehindthethyroidnexttothetrachea.Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.,.,Spasm,Theparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”,laryngospasm,.,Management,TemporaryLimittakingofmeat,eggswhicharehighinphosphorus（磷）UseofthesedativetocontrolthepainIntravenousadministrationofcalciumgluconate葡萄糖酸钙,.,Thyroidcrisis(storm),Reason:insufficientpreoperativepreparation,areleaseoflargeamountsofthyroidhormone,rareOutcome:canleadtocardiac,hepaticorrenalfailure.Stressfulfactors:surgery,infectionortrauma,pregnancy.,.,Timeofoccurring:thefirst12hourspostoperative.Clinicalmanifestation:Tachycardia(130bmp)T39,sometimes41ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem,.,Gastrointestinal(diarrhea,abdominalpain)Neurologic(psychosis,somnolence,coma)Cardiovascular(edema,chestpain,dyspnea,palpitations),.,Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.,.,MedicalManagement,Thephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.,.,200400mgHydrocortisone氢化可的松isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal鲁米纳Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37).Alargeamountofglucoseareneeded.,.,Oxygentherapy:HumidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemandsCardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安),.,Preoperativecare,PerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstruction,.,Pharmacologictherapy,Itisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.,.,2to5dropsofpotassiumiodidesolution(复方碘化钾)orLugolsiodinesolution(卢戈氏液)aregiveninconjunctionwithpropylthiouracil(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid.,.,Requirement:euthyroidPatientsmoodissteady,thesleeptakesafavorableturn,gainweight,pulserate90times/min,BasicMetabolismRate+20%.情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复,.,Nutrition,Severalwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.,.,Preoperativeteaching,Howtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.Eyecareandprotectionmaybecomenecessary,correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea.,.,Postoperativecare,PositionObservationOxygenNutritionMedicationHealthinstruction,.,Observation,Cardiacan