摘要
目的观察妊娠期亚临床甲减患者甲状腺素剂量调整的时机和规律,实施早期护理治疗干预,达到优生优育的目的。方法将90例就诊时间为孕32～51d患者按孕前是否有甲状腺病史分组,A组45人为妊娠前已知甲减,替代治疗后仍为甲状腺功能减退患者,B组45人为早孕检查时初发亚临床甲状腺功能减退患者。分析治疗期间药物剂量调整及开始药物替代治疗前后甲状腺素的变化和生化、血脂等指标变化规律,及时予以护理干预及治疗。结果 2组患者甲状腺激素初始治疗剂量不同,达标时(孕3月)的剂量也有统计学差异(P<0.05)。激素剂量早期逐渐增多,在孕7个月后增加不明显,从2组比较看不同组之间虽然孕月相同,但甲状腺激素所需的剂量是不同的(P<0.01),A组所需的剂量明显高于B组。促甲状腺素在孕2月明显下降(P<0.01),孕3月达治疗标准。游离三碘甲状腺原氨酸第2孕月已经明显升高(P<0.01),孕3月达治疗标准。结论妊娠早期应尽快明确甲状腺功能,对亚临床甲减患者应尽快补充甲状腺激素,确保孕3月时达标,可有效改善甲状腺激素减退导致的妊娠不良结局和后代智力受损。
Objective To observe the opportunity and law of thyroxine dose adjustment in pregnant women with subclimcal hypothyroidism in order to implement nursing intervention early and achieve the purpose of eugenic and superior nurture. Methods According to the pregnant have thyropathy before or not, to divide 90 pregnants who were pregnant at 32 - 51 d into two groups, 45 pregnants who got subclinical hypothyroidism before pregnancy were group A, and in group B 45 pregnants found that they got sub- clinical hypothyroidism after pregnancy.Analysis drug dose adjustment during treatment and the change of indexes such as thyroxine, biochemical, blood lipid and so on before and after the thyroid hormone replacement therapy, and give nursing intervention and treatment timely. Results Patients have different initial dose in thyroid hormone treatment in two groups, standard （pregnant march） dose also has statistically significant （P〈O.05） is increases gradually early, the seventh months after pregnancy hormone doses increase unconspicuous, at the same month thyroid hormone needed dose is different （P〈0.01） in two groups, the dose of group A was higher than group B. Thyrotropin declined obviously in the second month（P〈0.01）, and reach treatment standard at the third month. Free triiodothyronine increased significantly in the second month（P〈O.01）, and march the treatment standard at the third month. Conclusion The thyroid function should be clearly as soon as possible in early stage,and supplement the thyroid to pregnant women with subclinical hypothyroidism with the least delay possible,if we could do that,can we avoid adverse outcome in pregnancy and intellectual damage in offspring.
关键词
妊娠
亚临床甲减
甲状腺素
剂量
护理
Pregnant women
Subclinical hypothyroidism
Thyroid hormone
Doses
Nursing
