甲状腺疾病英文版课件

ThyroidDisordersWordListThyroiddisorders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ThyroidGlandItisapartoftheendocrine(内分泌)system,playsamajorroleinregulatingthebody'smetabolism.Section1Anatomy/physiologyofthyroidPlaceBloodsupplyNervessupplyFunctionsAnatomy/physiologyofthyroidLocatedinthelowerneckanteriortothetrachea.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)TheinferiorthyroidveinThenervessupplyingthethyroidoriginatefromvagus(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,necessaryfornormalgrowthanddevelopmentCommondisorder:AdeficiencyofiodineOtherdisorder:AutoimmunethyroiddiseaseClassification:Hyperthyroidism(甲亢）,hypothyroidism（甲减）,tumours,cancerorgoitre（甲状腺肿）.WhentheThyroidDoesn’tWorkHyperthyroidismTooMuchThyroidHormoneMetabolismSpeedsUpHypothyroidismTooLittleThyroidHormoneMetabolismSlowsDownHyperthyroidism

(甲状腺功能亢进）DefinitionHyperthyroidismisanimbalanceofmetabolismcausedbyoverproductionofthyroidhormone.Cause:Increasedsecretionofthyroidhormone.Females:males=4:1,ittendstoaffectmalesmoreseverely.Incidence:20~40yearsoldgroup.ClinicalManifestationGoiterExophthalmos(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）.DiagnosticTestsTSH（促甲状腺激素）T3,T4Radioactiveiodineuptake（Ⅰ131）ThyroidscanMensurationofbasicmetabolismrate(BMR)TSH(Thyroid–StimulatingHormone)normalTSHreflectaeuthyroid(甲状腺机能正常的）

state.Hyperthyroidism:TSHisloworabsent.Inmildformsofhyperthyroidism:slightlyabnormal.ThyroidscanScanarehelpfulindetermininglocation,size,shape,andanatomicfunctionofthethyroidgland.Mensurationof

BasicMetabolismRate(BMR)

Conditions:Earlyinthemorning,emptystomach,atthetimeofrestBasicMetabolismRate

=(Pulserate+Pulsepressure)-111GradeNormal:±10%Slightlyabnormal:+20%~+30%Moderatelyabnormal:+30%~+60%Seriouslyabnormal:＞+60%TreatmentAntithyroiddrugs,radioactiveiodine,orthyroidectomy(甲状腺切除术）.Individualizedanddependsontheageandgeneralstateofhealth，thesizeofthegoiterandtheabilitytoobtainfollow-upcare.Partialorcompletethyroidectomymaybecarriedoutasprimarytreatment.Thetypeandextentofthesurgerydependonthediagnosis,goalofsurgery,andprognosis.SurgicalIndicationsAverylargegoiteroramultinodulargoiterwithrelativelylowradioactiveiodineuptakeMalignantthyroidnodulePsychologicallyormentallyincompetentpatientsSurgeryAportionofthethyroidglandisremoved,butatotalthyroidectomymaybeperformed(expensive,risks).Indicationsforsubtotalthyroidectomy:themainadvantagesarerapidcontrolofthediseaseandalowerincidenceofhypothyroidismthancanbeachievedwithradioiodinetreatment.SurgeryIfapartialthyroidectomyisdone,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

CauseComplicationsaftersurgery

Respiratorydistressandhaemorrhage.Difficultyinrespiration

whichistheoccurswithinafterthesurgery.mostcriticalcomplication48hoursManagementSurgicalevacuationisrequired.

ThefirstaidbythebedA.cutoffthesutureB.openedthewoundwideC.removedthehematomaThetracheaiscut,applyoxygenSendtotheoperationroomforfurthertreatment.

Preventiveinterventions

Atracheostomyset(气管切开包）iskeptatthepatient’sbedsideatalltimes,andthesurgeonissummonedatthefirstindicationofrespiratorydistress.

InjuryoflaryngealnerveAnyvoicechangesarenotedbecausetheymightindicateinjurytotherecurrentlaryngealnerve（喉返神经）,whichliesjustbehindthethyroidnexttothetrachea.

Talkaslittleaspossible.Canbecuredspontaneously,orbyphysicaltherapy.SpasmTheparathyroidglandsmaybeinjuredorremoveddisturbanceofthecalciummetabolismofthebodybloodcalciumlevelfallsspasmsofthehandsandfeetandmusculartwitching“tetany”laryngospasmManagementTemporaryLimittakingofmeat,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)T＞39℃,sometimes＞41℃ExaggeratedsymptomsofhyperthyroidismDisturbancesofamajorsystem

Gastrointestinal

(diarrhea,abdominalpain)

Neurologic(psychosis,somnolence,coma)Cardiovascular

(edema,chestpain,dyspnea,palpitations)

Fatalness:Theclientmaydevelopcongestiveheartfailureanddie.Preventions:Thekeyistodothepreoperativepreparationsufficiently,andperformthesurgeryuntiltheBMRbecomenormal.MedicalManagementThephysicianmustbeinformedimmediately.TransferthepatienttotheintensivecareforclosermonitoringIodineisadministeredtodecreasetheoutputofthyroidhormone.TakeKIsolution3mlorally,orput10%iodinesodium5mlintoin10%glucose,andgiveivinjectiontothepatient.

200~400mgHydrocortisone氢化可的松

isprescribedtotreatshockoradrenalinsufficiency.Theusageofsedative(luminal鲁米纳Q6-8h)Reducebodytemperatureandheartrateandtopreventvascularcollapse(37℃).

Alargeamountofglucoseareneeded.Oxygentherapy:

Humidifiedoxygenisadministeredtoimprovetissueoxygenationandmeetthehighmetabolicdemands

Cardiacproblems:arterialfibrillation,andcongestiveheartfailure,sympatholyticagentsmaybeadministered,suchaspropranolol(心得安)PreoperativecarePerfectpreoperativecareBaselineinformationPharmacologictherapyMentalsupportNutritionInstructionPharmacologictherapy

Itisnecessaryforsurgicaltreatment,butitcannotactasatherapueticmedication.Encouragesthepatienttotakethemedicationsasprescribed.Iodinepreparationsmayhavebeenprescribed10to14daysbeforesurgerytodecreasethyroidvascularityanddecreasebleeding.

2to5dropsofpotassiumiodidesolution(复方碘化钾)orLugol’siodinesolution

(卢戈氏液)aregiveninconjunctionwithpropylthiouracil

(丙基硫尿嘧啶)todecreasethefriabilityandvascularityofthethyroid,itshouldbeapplieduntilthetimeofoperationandthepatientbecameeuthyroid..Requirement:euthyroidPatient'smoodissteady,thesleeptakesafavorableturn,gainweight,pulserate<90times/min,BasicMetabolismRate<+20%.情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复NutritionSeveralwell-balancedmealsofsmallamount,evenuptosixmealsaday.Highlyseasonedfoodsandstimulants,suchascoffee,tea,cola,andalcoholarediscouraged.High-calorie,high-proteinfoodsareencouraged.

PreoperativeteachingHowtosupporttheneckwiththehandsaftersurgerytopreventstressontheincision.Eyecareandprotectionmaybecomenecessary,correctinstillationofeyedropsorointmentprescribedtosoothetheeyesandprotecttheexposedcornea.

PostoperativecarePositionObservationOxygenNutritionMedicationHealthinstructionObservation

Cardiacandrespiratoryfunctionareassessedbymeasuringvitalsignsandcardiacoutput,ECGmonitor,arterialbloodgases.

Surgicaldressingareassessedperiodicallyandreinforcedwhennecessary,especiallyatthebackoftheneckforbleeding.Ifthereisadrain,approximatelyofdrainageisexpectedatthe1stday.Ifthereisnodrainage,thedrainmustbecheckedfor50mllinksorobstructionLaryngealnerve:Thenurseshouldencouragevoicetestfor48hourspostoperativelywithvoicechecksevery2to4hourstomakecertainthereisnolaryngealnervedamage.

Nutrition

Intravenousfluidsareadministeredduringtheimmediatepostoperativeperiod;watermaybegivenbymouthassoonasnauseasubsides.Coldfluidsandicemaybetakenbetterthanhotfluids.Nodifficultyinswallowing,softdiet.

Medications

KI(potassiumiodine)shouldbetaken3timesaday,16dropseachtime,reduce1drop

daybyday,untiltheconditionbeingsteady.

Sedativeareadministeredasprescribedforpain.历史ⅱ岳麓版第13课交通与通讯的变化资料精品课件欢迎使用[自读教材·填要点]一、铁路，更多的铁路1．地位铁路是

建设的重点，便于国计民生，成为国民经济发展的动脉。2．出现1881年，中国自建的第一条铁路——唐山

至胥各庄铁路建成通车。1888年，宫廷专用铁路落成。交通运输开平

3．发展(1)原因：①甲午战争以后列强激烈争夺在华铁路的

。②修路成为中国人

的强烈愿望。(2)成果：1909年

建成通车；民国以后，各条商路修筑权收归国有。4．制约因素政潮迭起，军阀混战，社会经济凋敝，铁路建设始终未入正轨。修筑权救亡图存京张铁路

二、水运与航空1．水运(1)1872年,

正式成立，标志着中国新式航运业的诞生。(2)1900年前后，民间兴办的各种轮船航运公司近百家，几乎都是在列强排挤中艰难求生。2．航空(1)起步：1918年，附设在福建马尾造船厂的海军飞机工程处开始研制

。(2)发展：1918年，北洋政府在交通部下设“

”；此后十年间，航空事业获得较快发展。轮船招商局水上飞机筹办航空事宜处三、从驿传到邮政1．邮政(1)初办邮政：1896年成立“大清邮政局”，此后又设

，邮传正式脱离海关。(2)进一步发展：1913年，北洋政府宣布裁撤全部驿站；1920年，中国首次参加

。邮传部万国邮联大会2．电讯(1)开端：1877年，福建巡抚在

架设第一条电报线，成为中国自办电报的开端。(2)特点：进程曲折，发展缓慢，直到20世纪30年代情况才发生变化。3．交通通讯变化的影响(1)新式交通促进了经济发展，改变了人们的通讯手段和

，

转变了人们的思想观念。(2)交通近代化使中国同世界的联系大大增强，使异地传输更为便捷。(3)促进了中国的经济与社会发展，也使人们的生活

。台湾出行方式多姿多彩[合作探究·提认知]

电视剧《闯关东》讲述了济南章丘朱家峪人朱开山一家，从清末到九一八事变爆发闯关东的前尘往事。下图是朱开山一家从山东辗转逃亡到东北途中可能用到的四种交通工具。依据材料概括晚清中国交通方式的特点，并分析其成因。

提示：特点：新旧交通工具并存(或：传统的帆船、独轮车，近代的小火轮、火车同时使用)。

原因：近代西方列强的侵略加剧了中国的贫困，阻碍社会发展；西方工业文明的冲击与示范；中国民族工业的兴起与发展；政府及各阶层人士的提倡与推动。[串点成面·握全局]

一、近代交通业发展的原因、特点及影响1．原因(1)先进的中国人为救国救民，积极兴办近代交通业，促进中国社会发展。(2)列强侵华的需要。为扩大在华利益，加强控制、镇压中国人民的反抗，控制和操纵中国交通建设。(3)工业革命的成果传入中国，为近代交通业的发展提供了物质条件。2．特点(1)近代中国交通业逐渐开始近代化的进程，铁路、水运和航空都获得了一定程度的发展。(2)近代中国交通业受到西方列强的控制和操纵。(3)地域之间的发展不平衡。3．影响(1)积极影响：促进了经济发展，改变了人们的出行方式，一定程度上转变了人们的思想观念；加强了中国与世界各地的联系，丰富了人们的生活。(2)消极影响：有利于西方列强的政治侵略和经济掠夺。1．李鸿章1872年在上海创办轮船招商局，“前10年盈和，成为长江上重要商局，招商局和英商太古、怡和三家呈鼎立之势”。这说明该企业的创办 (

)A．打破了外商对中国航运业的垄断B．阻止了外国对中国的经济侵略C．标志着中国近代化的起步D．使李鸿章转变为民族资本家解析：李鸿章是地主阶级的代表，并未转化为民族资本家；洋务运动标志着中国近代化的开端，但不是具体以某个企业的创办为标志；洋务运动中民用企业的创办在一定程度上抵制了列强的经济侵略，但是并未能阻止其侵略。故B、C、D三项表述都有错误。答案：A二、近代以来交通、通讯工具的进步对人们社会生活的影响(1)交通工具和交通事业的发展，不仅推动各地经济文化交流和发展，而且也促进信息的传播，开阔人们的视野，加快生活的节奏，对人们的社会生活产生了深刻影响。(2)通讯工具的变迁和电讯事业的发展，使信息的传递变得快捷简便，深刻地改变着人们的思想观念，影响着人们的社会生活。2．清朝黄遵宪曾作诗曰：“钟声一及时，顷刻不少留。虽有万钧柁，动如绕指柔。”这是在描写 (

)A．电话B．汽车C．电报 D．火车解析：从“万钧柁”“动如绕指柔”可推断为火车。答案：D[典题例析][例1]

上海世博会曾吸引了大批海内外人士利用各种交通工具前往参观。然而在19世纪七十年代，江苏沿江居民到上海，最有可能乘坐的交通工具是 (

)A．江南制造总局的汽车B．洋人发明的火车C．轮船招商局的轮船D．福州船政局的军舰[解析]由材料信息“19世纪七十年代，由江苏沿江居民到上海”可判断最有可能是轮船招商局的轮船。[答案]

C[题组冲关]1．中国近代史上首次打破列强垄断局面的交通行业是(

)A．公路运输 B．铁路运输C．轮船运输 D．航空运输解析：根据所学1872年李鸿章创办轮船招商局，这是洋务运动中由军工企业转向兼办民用企业、由官办转向官督商办的第一个企业。具有打破外轮垄断中