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甲型流感感染相关的甲状腺风暴导致小儿气道受压:一例报告。

Pediatric airway compromise due to thyroid storm associated with influenza A infection: A case report.

作者信息

Higaki Taiki, Tsukahara Kohei, Obara Takafumi, Nojima Tsuyoshi, Yamamoto Hirotsugu, Osako Takaaki, Naito Hiromichi, Nakao Atsunori

机构信息

Department of Emergency, Critical Care and Disaster Medicine, Okayama University, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.

出版信息

Respir Med Case Rep. 2020 Aug 4;31:101182. doi: 10.1016/j.rmcr.2020.101182. eCollection 2020.

Abstract

Thyroid storm is a potentially fatal intensification of thyrotoxicosis normally marked by tachycardia, hyperthermia, impaired mental status, and severe agitation. It can be initiated by numerous causes. Failure to promptly diagnose the condition may lead to high mortality. Early diagnosis and treatment of thyroid storm are essential to prevent further life-threatening complications. A 10-year-old girl was admitted to our emergency center for intensive care. The patient presented tachypnea with stridor, paradoxical abdominal breathing, and "barking" cough. The patient was diagnosed as upper airway obstruction complicated by thyroid storm associated with influenza infection. Following immediate airway management, the patient was administered a short-acting beta-blocker, hydrocortisone, thiamazole, and saturated solution of potassium iodide was initiated. The patient was extubated on day 8 and transferred to a local hospital on day 11 without adverse complications. When examining patients with influenza infection, emergency doctors should be more attentive not to miss other critical diagnoses. The present case was initially diagnosed as croup due to influenza infection. Sharing our experience may help emergency physicians treat similar cases of pediatric airway compromise due to thyroid storm.

摘要

甲状腺危象是甲状腺毒症的一种潜在致命性加剧,通常表现为心动过速、高热、精神状态受损和严重躁动。它可由多种原因引发。未能及时诊断该病可能导致高死亡率。甲状腺危象的早期诊断和治疗对于预防进一步危及生命的并发症至关重要。一名10岁女孩因重症监护被收治入我们的急救中心。患者出现呼吸急促伴喘鸣、反常腹式呼吸和“犬吠样”咳嗽。该患者被诊断为上气道梗阻并发与流感感染相关的甲状腺危象。在立即进行气道管理后,给予患者短效β受体阻滞剂、氢化可的松、甲巯咪唑,并开始使用碘化钾饱和溶液。患者于第8天拔管,并于第11天转至当地医院,未出现不良并发症。在检查流感感染患者时,急诊医生应更加留意,以免漏诊其他关键诊断。本病例最初因流感感染被诊断为哮吼。分享我们的经验可能有助于急诊医生治疗因甲状腺危象导致的小儿气道受损的类似病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1507/7417938/37d0efbea47d/gr1.jpg

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