甲狀腺功能亢進癥病人的護理NursingofHyperthyroidismPatients97講解

甲狀腺功能亢進癥病人的護理Nursingof

Hyperthyroidism

Patients廣西衛(wèi)生職業(yè)技術(shù)學(xué)院內(nèi)科護理教研室DepartmentofMedicineNursing,GuangxiMedicalCollege實驗室檢查及其他LaboratoryexaminationandothersTSH測定

TSHdetermination

sTSH(敏感TSH測定）為篩查甲亢的第一線指標sTSH(sensitiveTSHdetermination)istheprimaryindicatorforscreeninghyperthyroidism血清TH測定SerumTHdeterminationFT3、FT4：首選，升高FT3,FT4:primary,elevatedTT3、TT4TT3,TT4實驗室檢查及其他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)抗體對甲狀腺細胞的刺激功能Notonlyreflectstheexistenceofantibodies,butalsothestimulatingfunctionofantibodiesonthyroidcellsTSH受體抗體(TRAb)TSHreceptorantibodies(TRAb)新診斷陽性檢出率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)腸道黏膜吸收進入血液Radioactiveiodineisabsorbedbytheintestinalmucosathenintotheblood碘治療可以特異性的作用于甲狀腺對于機體其他組織幾乎沒有副作用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保護角膜：夜間遮蓋Corneaprotection:coveratnight輕度復(fù)視：棱鏡糾正Milddiplopia:prismcorrection強制性戒煙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