甲状腺功能亢进症病人的护理NursingofHyperthyroidismPatients97讲解

甲状腺功能亢进症病人的护理Nursingof

Hyperthyroidism

Patients广西卫生职业技术学院内科护理教研室DepartmentofMedicineNursing,GuangxiMedicalCollege实验室检查及其他LaboratoryexaminationandothersTSH测定

TSHdetermination

sTSH(敏感TSH测定）为筛查甲亢的第一线指标sTSH(sensitiveTSHdetermination)istheprimaryindicatorforscreeninghyperthyroidism血清TH测定SerumTHdeterminationFT3、FT4：首选，升高FT3,FT4:primary,elevatedTT3、TT4TT3,TT4实验室检查及其他LaboratoryexaminationandothersTSH受体刺激性抗体(TSAb)TSHReceptorStimulatingAntibodies(TSAb)未经治疗检出率85%-100%85%-100%untreateddetectionrate不但能反应有抗体存在，还能反应抗体对甲状腺细胞的刺激功能Notonlyreflectstheexistenceofantibodies,butalsothestimulatingfunctionofantibodiesonthyroidcellsTSH受体抗体(TRAb)TSHreceptorantibodies(TRAb)新诊断阳性检出率75%-90%75%-90%newdiagnosispositivedetectionrate能反应有抗体存在，但不能反应抗体的功能Reflectstheantibodiespresence,notthefunction治疗方法

Treatment

AABBCC药物治疗DrugTherapy手术治疗SurgicalTreatment放射性131I治疗Radioactive131ITherapy药物治疗

DrugTherapy

适应证：轻中度、孕妇、20岁以下、术前、其余两种方法不适合者Indications:mildtomoderatecondition,pregnantwomen,patientsunder20yearsold,preoperative,patientswhoarenotsuitablefortheothertwomethods

一、抗甲状腺药物治疗Antithyroiddrugstherapy药物治疗

DrugTherapy

一、抗甲状腺药物治疗I.Antithyroiddrugstherapy常用药物

硫脲类：丙硫氧嘧啶PTU、甲硫氧嘧啶MTU

咪唑类：甲巯咪唑MMI、卡比马唑CMZPTU可作为严重病例或甲状腺危象的首选药物CommonlyuseddrugsThioureas:PropylthiouracilPTU,MethylthiouracilMTUImidazoles:MethimazoleMMI,CarbimazoleCMZPTUmaybetheprimarychoiceforseverecasesorthyroidstorm一、抗甲状腺药物治疗Antithyroiddrugstherapy药物治疗

DrugTherapy

一、抗甲状腺药物治疗I.Antithyroiddrugstherapy治疗方案与疗程初治期：至症状缓解或血TH恢复正常时减量减量期：待症状消失、体征明显好转减至最小维持量维持期：维持12～18个月TreatmentplanandcoursePrimarytreatment:reducethedoseuntilsymptomsarerelievedorbloodTHreturnstonormalReductionperiod:reducetotheminimummaintenancedosewhensymptomsdisappearandphysicalsignsimprovesignificantlyMaintenanceperiod:12to18months一、抗甲状腺药物治疗Antithyroiddrugstherapy药物治疗

DrugTherapy

一、抗甲状腺药物治疗I.Antithyroiddrugstherapy复方碘口服溶液Compoundiodineoralsolutionβ受体阻断药β-receptorblockers二、其他药物治疗II.Otherdrugstherapy二、其他药物治疗Otherdrugstherapy手术治疗SurgicalTreatment手术治疗

SurgicalTreatment

放射性131I治疗

Radioactive131

ITherapy

CC患者服下液状或者胶囊状的放射性碘Thepatienttakesliquidorcapsuleradioactiveiodine放射性碘经肠道黏膜吸收进入血液Radioactiveiodineisabsorbedbytheintestinalmucosathenintotheblood碘治疗可以特异性的作用于甲状腺对于机体其他组织几乎没有副作用Iodinetherapyhasaspecificactiononthethyroidglandandfewsideeffectsonothertissuesofthebody甲状腺可特异性摄碘，因此放射性碘几乎全被甲状腺摄取.Duetothespecificiodineuptakeofthyroid,almostallradioactiveiodineistakenup.放射性碘损伤甲状腺滤泡细胞Radioactiveiodinedamagesthyroidfollicularcells放射性131I治疗Radioactive131ITherapy治疗方法

Treatment

治愈率：40%复发率：50-60%副作用：粒细胞减少药疹、其他Curerate:40%Recurrencerate:50-60%Sideeffects:neutropenic,drugeruption,etc.治愈率：85%以上复发率：＜1%副作用：甲减、放射性甲状腺炎、浸润性突眼恶化Curerate:morethan85%Sideeffects:Recurrencerate:<1%Hypothyroidism,radiationthyroiditis,deteriorationofinfiltrativeexophthalmos治愈率：70%以上复发率：8%副作用：甲状旁腺功能减退、喉返神经损伤Curerate:morethan70%Recurrencerate:8%Sideeffects:hypoparathyroidism,recurrentlaryngealnerveinjury药物治疗DrugTherapy131I治疗131ITherapy手术治疗SurgicalTreatment甲状腺危象的防治

Thyroidstormpreventionandtreatment

避免和去除诱因Avoidandremovecauses抑制TH合成：首选PTUInhibitTHsynthesis:PTUpreferred抑制TH释放：复方碘InhibitTHrelease:compoundiodineβ受体阻断药：普萘洛尔抑制外周组织T4转向T3βreceptor-blockingdrug:propranololinhibitsperipheralT4turntoT3甲状腺危象的防治

Thyroidstormpreventionandtreatment

糖皮质激素Glucocorticoids降低和清除血浆TH：腹透、血透、血浆置换ReductionandclearanceofplasmaTH:peritonealdialysis,hemodialysis,plasmapheresis支持疗法：降温、给氧、防治感染Supportivetherapy:hypothermy,oxygenadministration,infectionprevention突眼防治

ExophthalmosPrevention

体位：高枕卧位Bodyposition:Highoccipitalposition饮食：限制水钠Diet:Limitwaterandsodiumintake畏光：戴有色眼镜Photophobia:weartintedglasses角膜异物感：人工泪液Cornealforeignbodysensation:artificialtears保护角膜：夜间遮盖Corneaprotection:coveratnight轻度复视：棱镜纠正Milddiplopia:prismcorrection强制性戒烟MandatorySmokingCessation有效控制甲亢是基础治疗：抗甲状腺药+免疫抑制剂+眶放射Ef