妊娠合并甲状腺功能亢进的围生期护理

报告32例妊娠合并甲状腺功能亢进的围生期护理。产前加强对孕妇及胎儿的监护，做好用药护理、心理护理；产时严密观察产程；产后积极预防甲状腺危象、感染，指导哺乳及对新生儿观察，能有效降低母婴并发症，保障母婴安全。     

1例结节性甲状腺肿伴甲状腺功能亢进术后并发甲状腺危象病人的护理

甲状腺切除是目前治疗甲状腺肿物常用而有效的方法,但术后可能出现一些并发症,甲状腺危象是严重并发症之一.2008年6月4日,我院1例病人在甲状腺大部切除术后出现甲状腺危象,经过及时抢救治疗和精心护理,病人转危为安.现将护理体会总结如下.     

一例妊娠高血压综合征合并心力衰竭甲状腺危象患者的护理

妊娠高血压综合征(Pregnancy-induced hypertension syndrome,PIH)是妊娠期特有的疾病,也是孕产妇及围生儿死亡的重要原因之一[1].甲状腺危象(Thyroid Storm)是可危及患者生命的严重并发症.本病不常见,但死亡率很高[2].2011年4月,本院成功救治1例妊娠高血压综合征合并心力衰竭、甲状腺危象的患者,现将护理报告如下.     

甲状腺危象

甲状腺危象是甲状腺功能亢进症（简称甲亢）最严重的并发症之一,临床如未及时发现或处理不当可导致死亡.目前随着诊断技术的发展以及治疗方法的改善,甲状腺危象的发病率已较前大为降低,预后也明显改善.     

第64例——甲亢性脑病患者的案例分析

甲状腺功能亢进(甲亢)危象是甲亢的危重并发症.不典型甲亢危象可仅以某一系统症状为突出表现.如甲亢伴神经系统损害表现为惊厥甚至昏迷称为甲亢性脑病,极易误诊~([1-2]).现介绍1例用药物成功救治甲亢性脑病的案例,为治疗甲亢性脑病合理用药提供依据.     

1例131I治疗分化型甲状腺癌并发甲状腺功能亢进危象患者的护理

131I治疗分化型甲状腺癌（welldifferentiatedthyroidcancer,DTC）的临床原理是利用131I放射出的B射线来破坏甲状腺及其转移灶,以达到治疗的目的,并且131I对DTC转移灶有较高的清除作用,且很少有严重并发症。甲状腺功能亢进危象常发生于甲状腺功能亢进的患者,甲状腺功能亢进危象较少见,死亡率可达50％~80％。     

一例卵巢囊肿剔除术后并发甲状腺危象患者的护理

甲状腺危象是甲状腺功能亢进最严重的并发症[1],多发生于未经治疗或虽然经治疗但病情未控制的条件下因某种诱因使病情突然加重,达到危及生命的状态.我科曾收治1例卵巢囊肿患者,术后因手术、创伤等因素并发甲状腺危象.经及时诊断与治疗,患者转危为安,现将护理体会介绍如下.     

预防甲亢术后危象的护理体会

甲状腺大部分切除术是治疗甲亢的一种有效方法，其术后并发症较常见，甲状腺危象是甲亢病人术后最为严重的并发症，如术前准备不充分，麻醉及手术操作粗暴、术后感染及精神创伤等均可诱发。我院自1998年10月至2004年10月共收治甲亢病人52例，均行甲状腺大部分切除术，术后无一例发生甲状腺危象。现将护理体会总结如下。     

黏液性水肿昏迷的诊疗

1概述1.1黏液性水肿昏迷是甲状腺功能严重减退、全身代谢和各系统功能下降所引起的临床综合征。它是甲状腺功能减退症的严重并发症,威胁生命,又称甲减危象。无论是原发性甲减还是继发性甲减,未适当治疗,病情发展到晚期均可发展为黏液性水肿性昏迷。     

甲状腺疾病危象的诊治

甲状腺疾病危象是甲状腺疾病在诊断和治疗过程中出现的一种危险状态,如抢救和治疗不及时可危及到生命.甲状腺疾病危象包括甲状腺功能亢进症(甲亢)危象,严重甲状腺功能减低(甲减)所致的粘液性水肿、昏迷及抗甲状腺药物所引起的粒细胞缺乏等.本文对临床较常见的甲亢危象、甲减危象和抗甲状腺药物所致粒细胞缺乏的临床表现、诊断及治疗等进行综合介绍.     

Clinical picture and differential diagnosis of the nephrotic crisis

The nephrotic crisis, a grave complication of the nephrotic syndrome (NS) with a possible progress to the hypovolemic shock, was observed in 62 (6.2%) out of 1000 patients with the NS of different etiology (chronic glomerulonephritis, lupus nephritis, amyloidosis and other nephropathies). The main clinical symptoms of different stages of the nephrotic crisis are described, namely of the abdominal painful crisis, migrating erysipelas-like erythemas and the hypovolemic shock (collapse). The spectrum of diseases requiring the differential diagnosis with the nephrotic crisis is established. The complex of measures for the prophylaxis and treatment of the nephrotic crisis is proposed.     

Left internal iliac artery and vein tear during microendoscopic lumbar discectomy - a case report.

As minimally invasive techniques have gained popularity across surgical specialties, microendoscopic discectomy has been hailed as one of the newest and best methods for disc removal. Although problems are unusual and infrequent, the complications that can be associated with this procedure should be realized. Iatrogenic major vascular injury is a rare but serious complication during microendoscopic discectomy, and early detection is difficult due to the surgical positions, the specific anatomy of the spine, and the subtle changes of signs and symptoms the patient manifests. Here, we present a female patient who suffered from left internal iliac artery and vein tear during microendoscopic lumbar discectomy. We conclude that both surgeons and anesthesiologists should be aware of the possibility of this complication during surgery. When this complication occurs, it is vitally important that the correct crisis resolution protocols, such as proper massive transfusion algorithm and successful surgical interventions, be applied immediately during the critical period.     

急性心肌梗死静脉溶栓治疗后的早期康复护理

目的：探讨早期康复护理对急性心肌梗死静脉溶栓治疗后的效果。方法：70例急性心肌梗死静脉溶栓治疗后（无严重合并症）的患者随机分为对照组和干预组各35例,2组均在药物治疗基础上按急性心肌梗死护理操作常规护理。于预组患者同时制定每日康复护理计划,循序渐进的配合早期康复护理,包括主被动翻身,活动肢体,床上或床边的ADL等,并进行心理护理和健康教育等。结果：经过2周治疗后,与对照组比较干预组患者不适应症状及并发症发生率明显减轻或降低（P＜0．05,0．01）;平均下床时间、住院天数明显缩短（P〈0．01）。结论：对急性心肌梗死静脉溶栓治疗后患者实行系统全面的早期康复护理是安全的,有利于促进患者的康复,降低复发事件。     

Transfusion reactions due to Yersinia enterocolitica

The transfusion of blood products has become increasingly safe over the last few years, but the procedure is not without risk. One rare, but serious, complication is sepsis related to the transfusion of blood contaminated with bacteria. This article discusses the risk, treatment, and prevention of this potential complication of transfusions.     

Three rheumatologic emergencies: a sore toe, a cough, hypertension

Patients often present to internists with symptoms that can represent a minor illness or a rheumatologic emergency. This paper discusses the recognition and treatment of three rheumatologic emergencies: septic arthritis, alveolar hemorrhage as a complication of systemic lupus erythematosus (SLE), and scleroderma renal crisis.     

老年血液透析患者诱导期心血管并发症的护理体会

目的：探讨老年血液透析患者诱导期心血管并发症的护理。方法：回顾性分析45例进行诱导期血液透析的患者各种操作方法和心血管常见并发症的观察、护理。结果：所有并发症得到及时处理，症状及时控制，无1例发生严重并发症。结论：诱导期恰当的透析方法、及时准确的病情观察、正确的处理是保证血液透析诱导期顺利进行的重要保障。     

A randomized and controlled study comparing immunoadsorption and plasma exchange in myasthenic crisis

Myasthenic crisis is the most serious life-threatening event in Myasthenia gravis patients, affecting up to 27% within the first two years after onset of disease. Extracorporeal removal of circulating autoantibodies against the nicotinic acetylcholine receptor (AChRAb) by methods of therapeutic apheresis, e.g. plasma exchange (PE) and immunoadsorption (IA) had been demonstrated as effective treatment especially in acute situations of myasthenic crisis. However, controlled data comparing clinical safety and efficacy of both methods in a clinical study were not available. Here the results of a prospective randomized controlled clinical trial are presented, investigating 19 patients with myasthenic crisis, who were randomized to receive either PE (n = 10) or IA (n = 9) in addition to combined drug treatment. Patients received 3 to 5 (mean 3.5 for PE, and 3.4 for IA) treatments over a period of 7 days with a predefined treatment volume of 1.5 l plasma (i.e., 20-25 ml/kg plasma representing 0.5-0.6 patients' plasma volumes). Clinical courses were monitored using disease specific clinical scores. After initiation of IA or PE the mean value of Myasthenia scores decreased equally until Day 14 of the post-treatment phase. Patients from both treatment groups improved to a stable clinical status of Oosterhuis Classes 1 and 2. Substantial reduction of AChRAb was documented after each session of PE or IA. In the treatment period 16 adverse effects (seven serious adverse events, SAE) in the PE and 10 (1 SAE) in the IA group were observed. In conclusion, IA proved to be equally effective compared with PE treatment in patients with myasthenic crisis. Three to five treatment sessions using low plasma volume dosage of 20-25 ml/kg were adequate to improve clinically relevant symptoms significantly in most patients.     

Local complications of the intestinal tract in patients with ulcerative colitis

Various types of local complication of the intestinal tract are recognized in patients with ulcerative colitis. Among those local complications, massive bleeding, perforation and toxic megacolon require emergent operation in order to avoid fetal condition. Stricture of the colon, fustura formation and intra-abdominal abscess are rare complication in patients with ulcerative colitis, but sometimes require surgical treatment. Colitic cancer is another serious complication which develops highly advanced stage. Surveillance of the colon by endoscopy is necessary to obtain early diagnosis of the colitic cancer.     

Depression and medical/surgical illness: "who wouldn't be depressed?

Depression is the most frequent psychiatric complication of serious medical illness, occurring in up to 20 per cent of cases. Criteria for its diagnosis and guidelines for its treatment are presented.     

Emerging resistant Gram-negative aerobic bacilli in hospital-acquired infections

The increasing emergence of serious multidrug-resistant (MDR) Gram-negative infections has led to a new health-care crisis. These infections predominately include MDR Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Enterobacteriaceae and MDR Acinetobacter baumannii. These organisms are present in a variety of clinical settings, but there is a distinct paucity of antibiotics to effectively treat these infections. The increasing use of broad-spectrum antibiotics and lack of good stewardship have contributed to the increase in these MDR organisms. This review focuses on the main MDR Gram-negative infections contributing to the current crisis in health care, their mechanisms of resistance and various treatment options for empiric therapy.