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目的:提高对ICU正常甲状腺病态综合征(ESS)的临床诊断认识。方法:结合1例上消化道大出血心肺复苏后合并ESS患者的临床资料及文献复习,对本病的临床表现、实验室检查、诊断和治疗进行分析。结果:该患者在病程的早期即出现ESS,临床症状为表情淡漠、痴呆、智力低下、食欲不佳,TT3、TT4、FT3、FT4以及TSH明显下降,通过甲状腺素治疗后明显缓解。结论:生命体征稳定但表情淡漠反应迟钝的重症患者,在治疗效果不佳时要注意ESS的可能。
Objective: To improve the clinical diagnosis of ICU normal thyroid sick syndrome (ESS). Methods: The clinical data, literature review and review of one case of ESS complicated with upper gastrointestinal bleeding after cardiopulmonary resuscitation were performed to analyze the clinical manifestations, laboratory tests, diagnosis and treatment of this disease. Results: The patient developed ESS early in the course of his illness. His clinical symptoms were indifference, dementia, mental retardation, poor appetite, and significant decrease of TT3, TT4, FT3, FT4 and TSH, and obvious relief after thyroxine treatment. CONCLUSIONS: Severe patients with stable vital signs but indifferent expressions and unresponsiveness should pay attention to the possibility of ESS when the treatment effect is not good.