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甲状腺大部切除后48小时内,需注意最危急的并发症为()

单选题
2021-12-28 09:18
A、喉上神经内侧支损伤
B、喉返神经单侧损伤
C、呼吸困难和窒息
D、甲状腺危象
E、手足抽搐
查看答案

正确答案
C

试题解析
(1)甲状腺大部切除术后呼吸困难和窒息多发生在术后48小时内,是术后最危急的并发症。原因:①切口内出血压迫气管,因手术时止血(特别是腺体断面止血)不完善,或血管结扎线滑脱所引起。②喉头水肿,主要是手术创伤所致,也可因气管插管引起。③气管塌陷,是气管壁长期受肿大甲状腺压迫,发生软化,切除甲状腺体的大部分后软化的气管壁失去支撑的结果。④双侧喉返神经损伤。后三种情况的病人,由于气道堵塞可出现喘鸣及急性呼吸道梗阻;(2)喉返神经损伤发生率约0.5%,大多数是因手术处理甲状腺下极时,不慎将喉返神经切断、缝扎或挫夹、牵拉造成永久性或暂时性损伤所致;(3)喉上神经损伤多发生于处理甲状腺上极时,离腺体太远,分离不仔细和将神经与周围组织一同大束结扎所引起;(4)手足抽搐因手术时误伤及甲状旁腺或其血液供给受累所致,多在术后1~3天出现手足抽搐。(5)甲状腺危象是甲亢的严重合并症。临床娩察发现,危象发生与术前准备不够、甲亢症状未能很好控制及手术应激有关。

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