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目的 提高对甲状腺危象的诊断和治疗水平 ,减少误诊 ,增加抢救成功率。方法 采用系统回顾的方法对我院 1994年 1月至 2 0 0 2年 12月的住院甲状腺功能亢进症伴甲状腺危象的患者 2 1例进行总结分析。结果 共住院甲状腺功能亢进症患者876例 ,合并甲状腺危象 2 1例 ,占全部患者的 2 .4 %。男 6例 ,女 15例 ( 1∶2 .5 ) ,年龄 18～ 6 5岁 ( 38.6 1± 13.6 1) ,病程 2个月～2 0年 ( 4 .5 4± 5 .2 1) ,有 2例为反复复发患者 ;6例合并糖尿病 ,其中 4例同时存在DKA。 2 0例有明确诱因可查 ,其中感染 7例( 4例为急性粒细胞缺乏症 ,1例有粒细胞减少症 ) ,5例为甲亢心心衰加重 ( 1例与感染并存共同诱发 ) ,2例为脑梗塞 ,放射治疗 2例 ,手术 2例 ,外伤 (骨折 ) 1例 ,妊娠分娩 1例。入院前有典型甲亢症状的 16例 ,入院时 (开始按甲状腺危象处理时 )体温升高者 17例 ( 38～ 4 1℃ ) ,体温正常者 2例 ,体温不升者 3例。 2例伴谵妄状态 ,淡漠 4例 ,昏迷或昏睡者 6例。并黄疸 3例。心率 90～ 190次·min-1( 15 7± 2 4 .14 ) ,BP :72～ 180 / 30～ 10 0mmHg。合并心律不齐 11例 ,有明显脱水征者 6例 (后有 4例证实合并DKA) ,右侧肢体偏瘫 2例 ,肌力 1～ 4级 ,合并周期性麻痹 1例 ,同时存在甲亢心 7例。根据协和内分泌
Objective To improve the diagnosis and treatment of thyroid crisis, reduce misdiagnosis and increase the success rate of rescue. Methods A retrospective review was conducted on 21 inpatients with thyroid hyperthyroidism and hyperthyroidism admitted to our hospital from January 1994 to December 2002. Results A total of 876 cases of hyperthyroidism were hospitalized with 21 cases of thyroid crisis, accounting for 2.4% of all cases. There were 6 males and 15 females (1: 2.5), aged 18 to 65 years (38.61 ± 13.61), duration of 2 months to 20 years (4.45 ± 5.21) 2 patients were recurrent patients; 6 patients with diabetes, including 4 cases of both DKA. Twenty cases had a clear incentive to investigate, including infection in 7 cases (4 cases of acute agranulocytosis, 1 cases of neutropenia), 5 cases of hyperthyroidism and heart failure (co-induced by coexisting with infection 1) 2 cases of cerebral infarction, radiotherapy in 2 cases, surgery in 2 cases, trauma (fracture) in 1 case, pregnancy and childbirth in 1 case. Before admission, there were 16 cases of typical hyperthyroidism symptoms. 17 cases (38-4 1 ℃) with body temperature rise at admission (beginning treatment of thyroid crisis), 2 cases with normal body temperature and 3 cases with ascending body temperature. 2 cases with delirium state, indifference in 4 cases, coma or sleeping in 6 cases. And jaundice in 3 cases. Heart rate of 90 to 190 times min-1 (15 7 ± 2 4 .14), BP: 72 ~ 180/30 ~ 10 0mmHg. There were 11 cases with arrhythmia, 6 cases with obvious dehydration sign (4 cases confirmed with DKA after), 2 cases with right hemiplegia, 1 ~ 4 cases with muscle strength, 1 case with cyclical paralysis, and hyperthyroid heart 7 example. According to Concord and endocrine