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甲状腺中毒危象是一种少见而危重的临床征象,需及时医治。本文报道1例在诊断甲状腺中毒危象之前出现严重的大脑功能障碍的患者,因合并其他疾病而使用β-受体阻滞剂治疗。患者男性,59岁。因冠心病伴发严重胸痛而入当地心脏医疗中心。患者既往无甲状腺中毒症状,体检亦未发现甲状腺肿大、眼球突出或心动过速等体征。心率为80/min,窦性节律,心电图及心脏酶检查均无异常,诊断为心绞痛。给予美多心安(metoprolol)和硝苯吡啶(nifedipine)治疗,因未能控制心绞痛而加大美多心安的剂量。入院后2周患者出现谵妄,并有中毒性精神紊乱症状。检查既无感染征象,亦无任何神经疾患的定位体征。脉率仍为窦性节律,无心动过速。有间歇热,但体温不超过38℃。病情继续恶化而转入我院特护病房。入院时患者谵妄,并有脱水和心房纤颤,140/min,并发右上叶肺炎。3天后作
Thyroidism crisis is a rare and critical clinical signs, need timely treatment. This article reports one patient who developed severe brain dysfunction prior to the diagnosis of a thyroid intoxication crisis and was treated with beta-blocker for other diseases. Male patient, 59 years old. Due to coronary heart disease with severe chest pain and into the local heart medical center. Patients without past symptoms of thyroid poisoning, physical examination did not find signs of goiter, prominent or tachycardia. Heart rate was 80 / min, sinus rhythm, ECG and cardiac enzyme tests were normal, the diagnosis of angina. Given metoprolol and nifedipine, Vital Dose is increased by failing to control angina pectoris. 2 weeks after admission, patients with delirium, and toxic mental disorders. Check neither signs of infection nor any signs of neurological disorders. Pulse rate is still sinus rhythm, no tachycardia. Intermittent fever, but the body temperature does not exceed 38 ℃. The condition continued to deteriorate and transferred to our intensive care unit. Patients on admission were delirious and had dehydration and atrial fibrillation, 140 / min, complicated by right upper lobe pneumonia. Made in 3 days