甲状腺功能亢进症病人的护理NursingofHyperthyroidismPatients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临床表现

Symptomsandsigns

甲状腺毒症表现Thyrotoxicosismanifestations甲状腺肿Goiter眼部表现Ocularmanifestations特殊类型GDSpecialtypeGD

甲状腺毒症表现ThyrotoxicosisManifestationsT3、T4分泌过多导致交感神经兴奋性增高和新陈代谢加速：疲乏无力、怕热多汗、低热、多食善饥、消瘦…ExcessivesecretionofT3andT4leadstoincreasedsympatheticnerveexcitabilityandacceleratedmetabolism:fatigue,

fearofheat,perspiration,lowfever,feelhungryfrequentlywithenormousappetite,weightreduction...1、高代谢综合征HypermetabolicSyndrome甲状腺毒症表现ThyrotoxicosisManifestations表现为兴奋/抑郁，以兴奋为主。神经过敏、多言好动、焦躁易怒、失眠、紧张不安、注意力不集中、手、眼睑和舌震颤Manifestedasexcitement/depression,mainlyexcitement,neuroticism,hyperactivity,irritability,insomnia,nervousness,lackofconcentration,tremorsofhands,eyelids,andtongue2、精神神经系统MentalNervousSystem甲状腺毒症表现ThyrotoxicosisManifestations甲状腺毒症表现ThyrotoxicosisManifestations心悸气短、心动过速（静息仍增快），脉压增大，心律失常（房颤最常见），心脏增大，心力衰竭….Palpitations,shortnessofbreath,tachycardia(stillfastatrest),increasedpulsepressure,arrhythmia(atrialfibrillationisthemostcommonsymptom),cardiomegaly,heartfailure….食欲亢进、肠蠕动加快、腹泻Excessiveappetite,increasedbowelmovements,diarrhea心血管系统3.CardiovascularSystem4、消化系统DigestiveSystem甲状腺毒症性周期性瘫痪TPPThyrotoxicPeriodicParalysisTPP5、骨骼肌肉系统MusculoskeletalSystem6、生殖系统ReproductiveSystem7、造血系统HematopoieticSystem月经减少、闭经、阳痿…Spanomenorrhea,Amenorrhea,Impotence…白细胞总数偏低、淋巴细胞及单核细胞增多、血小板寿命缩短，可出现紫癜。Thetotalnumberofwhitebloodcellsislow,withtheincreasingamountoflymphocytesandmonocytes.

Thelifespanofplateletsisshortened,andpurpuramayappear.甲状腺毒症表现ThyrotoxicosisManifestations8、皮肤肢端表现CutaneousAcralManifestations9、甲状腺危象ThyroidStorm胫前粘液性水肿Pretibialmyxedema短时间内大量T3、T4释放入血AlargeamountofT3andT4arereleasedintothebloodinashortperiodoftime甲状腺毒症表现ThyrotoxicosisManifestations胫前黏液性水肿Pretibialmyxedema甲状腺危象ThyroidStorm应激状态（感染、手术、放射性碘治疗、精神刺激、过度劳累、急性创伤等）Stressstates(infection,surgery,radioiodinetherapy,mentalstimulation,overwork,acutetrauma,etc.)严重躯体疾病：心衰、败血症等Seriousphysicaldiseases:cardiacfailure,hematosepsis,etc.常见诱因Commoninducements甲状腺危象ThyroidStorm口服过量TH制剂OraloverdoseofTHpreparations甲状腺手术准备不充分或术中过度挤压甲状腺等Inadequatepreparationforthyroidsurgeryorexcessivecompressionofthethyroidglandduringsurgery,etc.常见诱因Commoninducements甲状腺肿大Goiter弥漫性对称性，随吞咽动作上下移动；Diffusesymmetry,movingupanddownwithswallowing;肿大程度与甲亢轻重无明显关系Thereisnosignificantrelationshipbetweenthedegreeofgoiterandtheseverityofhyperthyroidism甲状腺血流增多，可触及震颤、闻及血管杂音，为GD的特异性体征。ThespecificsignsofGDarebasicallyincreasedbloodflowofthyroidgland,palpabletremor,andaudiblevascularmurmur.眼部表现Eyesymptoms眼球向前突出，一般不超过18mm；瞬目减少；上眼睑挛缩，睑裂增宽；双眼向下看时，上眼睑不能随眼球下落；向上看时，前额皮肤不能皱起；两眼看近物时，眼球辐辏不良。Exophthalmos,generallynomorethan18mm;blinksarereduced;uppereyelidscontractures,widenpalpebralfissures;uppereyelidscannotfallwiththeeyeballswhenbotheyeslookdown;foreheadskincannotbewrinkledwhenlookingupwards;theeyeballsareinpoorconvergencewhenlookingatnearbyobjects.1、单纯性突眼Simpleexophthalmos眼部表现Eyesymptoms男性多见，单眼受累病人占10%-20%，除上述外，常有眼睑肿胀肥厚，结膜充血水肿；眼球突出大于18mm；自述视力下降、视野缩小、眼内异物感、畏光、复视、眼部胀痛、刺痛、流泪。Frequentlyoccursinmale,and10%-20%ofpatientsonlysufferoneeyeball.Inadditiontotheabove,thereareoftenswellingandhypertrophyoftheeyelidwithconjunctivalhyperemiaandedema;exophthalmosgreaterthan18mm;self-reportedvisionloss,reducedvisualfield,intraocularforeignbodysensation,photophobia,diplopia,eyepain,tingling,tearing.2.浸润性突眼Infiltrativeexophthalmos眼部表现Eyesymptoms眼部表现Eyesymptoms眼部表现Eyesymptoms特殊类型SpecialtypeT3型甲状腺毒症：T3显著多于T4T3thyrotoxicosis:significantlymorethanT4淡漠型甲亢：多见于老年人，症状重Apathetichyperthyroidism:frequentlyoccursintheelderly,withseveresymptoms亚临床型甲亢：T3\T4正常，TSH降低，无症状或症状轻微Subclinicalhyperthyroidism:normalT3/T4,lowTSH,nosymptomsormildsymptoms妊娠期甲状腺功能亢进症Hyperthyroidismduringpregnancy临床表现

Symptomsandsigns

甲状腺毒症表现ThyrotoxicosisManifestations高代谢、精神神经、心血管、消化、肌肉与骨骼、生殖、造血、皮肤、甲亢危象Hypermetabolism,neuropsychiatric,cardiovascular,digestion,musculoskeletal,reproduction,hematopoietic,skin,hyperthyroidcrisis甲状腺肿

Goiter

弥漫性对称性Diffusesymmetry程度与甲亢轻重无关Thedegreehasnorelationshipbetweentheseverityofhyperthyroidism特殊类型GD

SpecialtypeGD

T3型甲状腺毒症、淡漠型甲亢T3thyrotoxicosis,Apathetichyperthyroidism亚临床型甲亢Subclinicalhyperthyroid