甲亢危象23例诊治分析及经验报道  

Analysis of the diagnosis and treatment of hyperthyroidism crisis: a report of 23 cases

作　　者：刘安平[1] 王安石 叶鹏[1] 宋仁杰[1] 吴开莉[1] 张天喜[1] 

机构地区：[1]遵义医学院附属医院急诊科,贵州遵义563099

出　　处：《遵义医学院学报》2017年第5期557-559,共3页Journal of Zunyi Medical University

摘　　要：目的回顾分析我院10年甲状腺危象(以下简称甲亢危象)的临床特征、预后及逐年发病率变化等,增强临床医师对甲亢危象的认识,减少漏诊和误诊,以便提高抢救成功率。方法收集我院近10年甲亢危象患者23例,分析患者首诊时主要临床特征、诱发加重因素及预后等特点;统计我院同期甲亢患者及全院总住院患者人数,分析甲亢危象发病率变化特点。结果甲亢危象患者均急诊入院,首发症状:意识障碍9例,其中3例伴抽搐发作;发热、心悸、乏力10例;腹泻、呕吐4例。首诊考虑:感染诱发加重8例,甲亢未控制7例,脑出血或脑梗死3例,心力衰竭2例,脑外伤1例,妊娠1例,酮症酸中毒1例。急诊诊断:确定甲亢危象诊断13例,未确定诊断10例(43.48%)。住院期间死亡3例,另6例放弃治疗出院后随访均死亡,死亡率39.1%,其余患者预后良好。10年内甲亢危象平均发病率占甲亢患者的0.17‰,占全院总住院患者的0.04‰。结论甲亢危象发病率低,临床表现复杂多变,临床不易识别,极易漏诊及误诊,早期识别和早期治疗是成功抢救甲亢危象的关键。Objective To retrospectively analyze the clinical features, prognosis and the morbidity of hyperthy- roidism crisis in Zunyi Medical University in 10 years and enhance the clinician＇ s understanding of hyperthyroid ism crisis and reduce misdiagnosis and further improve the success rate of rescue. Methods Twenty - three cases of hyperthyroidism crisis in recent 10 years were collected. The main clinical features, inducing factors and prognosis were analyzed. At the same time, the total number of hyperthyroidism patients and inpatients in Zunyi Medical University during the same time was collected to analyze the characteristics of the morbidity of hyperthyroidism crisis. Results All patients were admitted to the hospital in emergency with 9 cases of consciousness, in which 3 cases with convulsions;10 cases of fever, palpitation and fatigue; 4 cases of diarrhea and vomiting. Eight cases became serious cause infection, 7 cases of hyperthyroidism were not controlled and 3 cases of cerebral hemorrhage Qr cerebral infarction, 2 cases of heart failure, 1 case of brain trauma, 1 case of pregnancy and 1 case of ketoacidosis were shown. Emergency diagnosis included 13 cases diagnosis of hyperthyroidism crisis in emergency and 10 cases undetermined diagnosis （43.48%）. In addition, three patients died during hospitaliza- tion and 6 patients chose discharge before recovery and the follow - up indicated that those patients died after dis- charge. The mortality rate was 39.1% and the remaining patients received good prognosis. The average morbidity of hyperthyroidism crisis accounted for 0.17%o of hyperthyroidism, which accounted for 0.04%~ of all inpatients in 10 years. Conclusion The morbidity of hyperthyroidism crisis is low and hyperthyroidism crisis always happens with complicated clinical manifestations, uneasy identification and misdiagnosis. Thus, early recognition and early treatment is necessary to successfully rescue hyperthyroidism crisis.

关 键 词：甲亢危象 急诊 发病率 临床特点 漏诊 

分 类 号：R581.1[医药卫生—内分泌]