1、Word ListThyroid disorders 甲状腺病症Isthmus 峡部Thyroxine 甲状腺素Triiodothyronine 三碘甲状腺氨酸Parathyroid glands 甲状旁腺Calcitonin 降钙素Recurrent laryngeal nerve 喉返神经Hyperthyroidism 甲亢Hypothyroidism 甲减Goitre 甲状腺肿Exophthalmos 突眼症Tremor 震颤TSH 促甲状腺激素Thyroidectomy 甲状腺切除术Thyroid crisis 甲状腺危象A tracheostomy set 气管切开包Tetamy 手
2、足抽搐Thyroid GlandIt is a part of the endocrine(内分泌内分泌)system,plays a major role in regulating the bodys metabolism.Section 1Anatomy/physiology of thyroidPlaceBlood supplyNerves supplyFunctionsAnatomy/physiology of thyroid Located in the lower neck anterior to the trachea.Two lateral lobes connected b
3、y an isthmus（峡部）（峡部）Butterfly-shaped organ 5cm long ,3cm wide，30g The parathyroid glands（甲状旁腺）（甲状旁腺）lying on the dorsal side（背面）（背面）of the thyroid gland.Rich,from the superior and inferior thyroid artery.Artery:The arterial branches provide blood supply to other structures in the area.The interior t
4、hyroid artery provides branches to the pharynx,trachea and esophagus.Vein:1)The superior thyroid vein 2)The middle thyroid vein 3)The inferior thyroid vein The nerves supplying the thyroid originate from vagus(迷走神经）迷走神经）,innervate the epithelial cells（上皮细胞）（上皮细胞）of the follicles（滤（滤泡）泡）of the thyroi
5、d gland.One must be aware of the bilateral existence of a recurrent laryngeal nerve（喉（喉返神经）返神经）during dissection.Produces,Produces,synthesizes,stores,synthesizes,stores,and secretes and secretes Two HormonesTwo Hormones Called Called Thyroxine(T4)Thyroxine(T4)Thyronine(T3)Thyronine(T3)Regulates Meta
6、bolismRegulates Metabolism so Your Cells so Your Cells Function ProperlyFunction ProperlyAffects Every Cell in the BodyAffects Every Cell in the Body,necessary for normal growth and necessary for normal growth and developmentdevelopmentCommon disorder:A deficiency of iodine Other disorder:Autoimmune
7、 thyroid diseaseClassification:Hyperthyroidism(甲亢）甲亢）,hypothyroidism（甲减）（甲减）,tumours,cancer or goitre（甲状腺肿）（甲状腺肿）.When the Thyroid Doesnt WorkHyperthyroidism Too Much Thyroid Hormone Metabolism Speeds UpHypothyroidism Too Little Thyroid Hormone Metabolism Slows DownHyperthyroidism(甲状腺功能亢进）Definition
8、 Hyperthyroidism is an imbalance of metabolism caused by overproduction of thyroid hormone.Cause:Increased secretion of thyroid hormone.Females:males=4:1,it tends to affect males more severely.Incidence:20 40 years old group.Clinical ManifestationGoiterExophthalmos (突眼征）突眼征）Increased metabolic rateI
9、ncreased function of sympathetic nerve(交感神经）交感神经）Cardiovascular alteration The thyroid can be palpated for asymmetry(不对称）不对称）and size.It may enlarge 3-4 times to its normal size.It is called goitre.HyperthyroidismAs a result of increased thyroid hormone production,the client has an increased metabol
10、ic rate.Weight loss despite increased appetite,fatigue,poor tolerance to heat,and profuse perspiration,menstrual irregularities.Nervous,restlessness,irritability,difficulty concentrating,emotional liability,mood swings,personality changes.Fine tremors of the fingers and tongue,shaky handwriting,clum
11、siness,trouble in climbing stairs,or dyspnea possibly at rest.The skin is warm and moist,characteristic salmon colour(鲜肉色）鲜肉色）.The hair is fine and soft with premature grey and increased hair loss.The nails appear fragile with distal nail separation from the nail bed.Tachycardia:160 bpm and down to
12、80 bpm during sleep.Pulse pressure is widened.There can be muscular weakness and atrophy(萎缩）萎缩）,paralysis（瘫痪）（瘫痪）.Diagnostic TestsTSH（促甲状腺激素）（促甲状腺激素）T3,T4Radioactive iodine uptake（131131）Thyroid scanMensuration of basic metabolism rate(BMR)TSH(ThyroidStimulating Hormone)normal TSH reflect a euthyroi
13、d(甲状腺机能正甲状腺机能正常的）常的）state.Hyperthyroidism:TSH is low or absent.In mild forms of hyperthyroidism:slightly abnormal.Thyroid scan Scan are helpful in determining location,size,shape,and anatomic function of the thyroid gland.Mensuration of Basic Metabolism Rate (BMR)Conditions:Early in the morning,empt
14、y stomach,at the time of rest Basic Metabolism Rate =(Pulse rate+Pulse pressure)-111GradeNormal:10%Slightly abnormal:+20%+30%Moderately abnormal:+30%+60%Seriously abnormal:+60%TreatmentAntithyroid drugs,radioactive iodine,or thyroidectomy(甲状腺甲状腺切除术）切除术）.Individualized and depends on the age and gene
15、ral state of health，the size of the goiter and the ability to obtain follow-up care.Partial or complete thyroidectomy may be carried out as primary treatment.The type and extent of the surgery depend on the diagnosis,goal of surgery,and prognosis.Surgical IndicationsA very large goiter or a multinod
16、ular goiter with relatively low radioactive iodine uptakeMalignant thyroid nodule Psychologically or mentally incompetent patientsSurgeryA portion of the thyroid gland is removed,but a total thyroidectomy may be performed(expensive,risks).Indications for subtotal thyroidectomy:the main advantages ar
17、e rapid control of the disease and a lower incidence of hypothyroidism than can be achieved with radioiodine treatment.SurgeryIf a partial thyroidectomy is done,the remaining thyroid tissue should provide adequate amounts of thyroid hormones.If a complete thyroidectomy is done,the client will requir
18、e thyroid hormone r e p l a c e m e n t f o r a l i f e t i m e.The neck is extended and a symmetrical,gently curved incision is made 1 to 2 cm above the clavicle（锁骨）（锁骨）.Closure of the wound is accomplished by the strap muscles in the midline.A small suction catheter is usually inserted through a s
19、tab wound.Complications after surgeryDyspnea,asphyxiaInjury of laryngeal nerveSpasms Thyroid crisis（甲状腺危象）（甲状腺危象）HaemorrhageHaematoma(血肿）血肿）formation Tracheal collapse（气管塌陷）（气管塌陷）Tracheal mucous accumulationLaryngeal or local tissue edemaCauseComplications after surgery Respiratory distress and haem
20、orrhage.Difficulty in respiration which is the occurs within after the surgery.Management Surgical evacuation is required.The first aid by the bed A.cut off the suture B.opened the wound wide C.removed the hematoma The trachea is cut,apply oxygen Send to the operation room for further treatment.Prev
21、entive interventionsA tracheostomy set(气管切开包）气管切开包）is kept at the patients bedside at all times,and the surgeon is summoned at the first indication of respiratory distress.Injury of laryngeal nerveAny voice changes are noted because they might indicate injury to the recurrent laryngeal nerve（喉返神经）（喉
22、返神经）,which lies just behind the thyroid next to the trachea.Talk as little as possible.Can be cured spontaneously,or by physical therapy.Spasm The parathyroid glands may be injured or removed disturbance of the calcium metabolism of the body blood calcium level falls spasms of the hands and feet and
23、 muscular twitching “tetany”ManagementTemporaryLimit taking of meat,eggs which are high in phosphorus（磷）（磷）Use of the sedative to control the pain Intravenous administration of calcium g l u c o n a t e 葡 萄 糖 酸 钙葡 萄 糖 酸 钙 Thyroid crisis(storm)Reason:insufficient preoperative preparation,a release of
24、 large amounts of thyroid hormone,rare Outcome:can lead to cardiac,hepatic or renal failure.Stressful factors:surgery,infection or trauma,pregnancy.Time of occurring:the first 12 hours postoperative.Clinical manifestation:1.Tachycardia (130 bmp)2.T 39,sometimes 413.E x a g g e r a t e d s y m p t o
25、m s o f hyperthyroidism4.Disturbances of a major system u Gastrointestinal (diarrhea,abdominal pain)u Neurologic (psychosis,somnolence,coma)u Cardiovascular (edema,chest pain,dyspnea,palpitations)Fatalness:The client may develop congestive heart failure and die.Preventions:The key is to do the preop
26、erative preparation sufficiently,and perform the surgery until the BMR become normal.Medical ManagementThe physician must be informed immediately.Transfer the patient to the intensive care for closer monitoring Iodine is administered to decrease the output of thyroid hormone.Take KI solution 3ml ora
27、lly,or put 10%iodine sodium 5ml into in 10%glucose,and give iv injection to the patient.200400mg Hydrocortisone氢化可的松氢化可的松 is prescribed to treat shock or adrenal insufficiency.The usage of sedative(luminal鲁米纳鲁米纳 Q6-8h)Reduce body temperature and heart rate and to prevent vascular collapse(37).A larg
28、e amount of glucose are needed.nOxygen therapy:Humidified oxygen is administered to improve tissue oxygenation and meet the high metabolic demandsn Cardiac problems:arterial fibrillation,a n d c o n g e s t i v e h e a r t f a i l u re,sympatholytic agents may be administered,such as propranolol(心得安
29、心得安)Preoperative carePerfect preoperative careBaseline informationPharmacologic therapyMental supportNutritionInstruction Pharmacologic therapynIt is necessary for surgical treatment,but it can not act as a therapuetic medication.nEncourages the patient to take the medications as prescribed.Iodine p
30、reparations may have been prescribed 10 to 14 days before surgery to decrease thyroid vascularity and decrease bleeding.n 2 to 5 drops of potassium iodide solution(复方复方碘化钾碘化钾)or Lugols iodine solution(卢戈氏液卢戈氏液)are given in conjunction with propylthiouracil (丙基硫丙基硫尿嘧啶尿嘧啶)to decrease the friability an
31、d vascularity of the thyroid,it should be applied until the time of operation and the patient became euthyroid.nRequirement:euthyroid n Patients mood is steady,the sleep takes a favorable turn,gain weight,pulse rate 90 times/min,Basic Metabolism Rate +20%.n情绪稳定、睡眠正常、体重增加、心跳正常、代谢恢复情绪稳定、睡眠正常、体重增加、心跳正常
32、、代谢恢复NutritionnSeveral well-balanced meals of small amount,even up to six meals a day.n Highly seasoned foods and stimulants,such as coffee,tea,cola,and alcohol are discouraged.n High-calorie,high-protein foods are encouraged.Preoperative teachingnHow to support the neck with the hands after surgery
33、 to prevent stress on the incision.nEye care and protection may become necessary,correct instillation of eye drops or ointment prescribed to soothe the eyes and protect the exposed cornea.Postoperative carePositionObservationOxygenNutritionMedicationHealth instructionObservationn Cardiac and respira
34、tory function are assessed by measuring vital signs and cardiac output,ECG monitor,arterial blood gases.n Surgical dressing are assessed periodically and reinforced when necessary,especially at the back of the neck for bleeding.nIf there is a drain,approximately of drainage is expected at the 1st da
35、y.nIf there is no drainage,the drain must be checked forLaryngeal nerve:The nurse should encourage voice test for 48 hours postoperatively with voice checks every 2 to 4 hours to make certain there is no l a r y n g e a l n e r v e d a m a g e.Nutritionn Intravenous fluids are administered during th
36、e immediate postoperative period;water may be given by mouth as soon as nausea subsides.n Cold fluids and ice may be taken better than hot fluids.n No difficulty in swallowing,soft diet.Medicationsn KI(potassium iodine)should be taken 3 times a day,16 drops each time,reduce 1 drop day by day,until t
37、he condition being steady.n Sedative are administered as prescribed for pain.历史岳麓版第13课交通与通讯的变化资料精品课件欢迎使用自读教材自读教材填要点填要点 一、铁路，更多的铁路一、铁路，更多的铁路 1地位地位 铁路是铁路是 建设的重点，便于国计民生，成为国民经济建设的重点，便于国计民生，成为国民经济发展的动脉。发展的动脉。2出现出现 1881年，中国自建的第一条铁路年，中国自建的第一条铁路唐山唐山 至胥各庄铁至胥各庄铁路建成通车。路建成通车。1888年，年，宫廷宫廷专用铁路落成。专用铁路落成。交通运输交通运输开平
38、开平 3发展发展 (1)原因：原因：甲午战争以后列强激烈争夺在华铁路的甲午战争以后列强激烈争夺在华铁路的 。修路成为中国人修路成为中国人 的强烈愿望。的强烈愿望。(2)成果：成果：1909年年 建成通车；民国以后，各条商路修筑建成通车；民国以后，各条商路修筑权收归国有。权收归国有。4制约因素制约因素 政潮迭起，军阀混战，社会经济凋敝，铁路建设始终未入政潮迭起，军阀混战，社会经济凋敝，铁路建设始终未入正轨。正轨。修筑权修筑权救亡图存救亡图存京张铁路京张铁路 二、水运与航空二、水运与航空 1水运水运 (1)1872年年,正式成立，标志着中国新式航运业的诞生。正式成立，标志着中国新式航运业的诞生。(
39、2)1900年前后，民间兴办的各种轮船航运公司近百家，几乎都是年前后，民间兴办的各种轮船航运公司近百家，几乎都是在列强排挤中艰难求生。在列强排挤中艰难求生。2航空航空 (1)起步：起步：1918年，附设在福建马尾造船厂的海军飞机工程处开始年，附设在福建马尾造船厂的海军飞机工程处开始研制研制 。(2)发展：发展：1918年，北洋政府在交通部下设年，北洋政府在交通部下设“”；此后十年间，航空事业获得较快发展。；此后十年间，航空事业获得较快发展。轮船招商局轮船招商局水上飞机水上飞机筹办航空事宜筹办航空事宜处处 三、从驿传到邮政三、从驿传到邮政 1邮政邮政 (1)初办邮政：初办邮政：1896年成立年成
40、立“大清邮政局大清邮政局”，此后又设，此后又设 ，邮传正式脱离海关。邮传正式脱离海关。(2)进一步发展：进一步发展：1913年，北洋政府宣布裁撤全部驿站；年，北洋政府宣布裁撤全部驿站；1920年，中国首次参加年，中国首次参加 。邮传部邮传部万国邮联大会万国邮联大会 2电讯电讯 (1)开端：开端：1877年，福建巡抚在年，福建巡抚在 架设第一条电报线，成为中国自架设第一条电报线，成为中国自办电报的开端。办电报的开端。(2)特点：进程曲折，发展缓慢，直到特点：进程曲折，发展缓慢，直到20世纪世纪30年代情况才发生变年代情况才发生变化。化。3交通通讯变化的影响交通通讯变化的影响 (1)新式交通促进了
41、经济发展，改变了人们的通讯手段和新式交通促进了经济发展，改变了人们的通讯手段和 ，转变了人们的思想观念。转变了人们的思想观念。(2)交通近代化使中国同世界的联系大大增强，使异地传输更为便交通近代化使中国同世界的联系大大增强，使异地传输更为便捷。捷。(3)促进了中国的经济与社会发展，也使人们的生活促进了中国的经济与社会发展，也使人们的生活 。台湾台湾出行出行方式方式多姿多彩多姿多彩合作探究合作探究提认知提认知 电视剧电视剧闯关东闯关东讲述了济南章丘朱家峪人朱开山一家，讲述了济南章丘朱家峪人朱开山一家，从清末到九一八事变爆发闯关东的前尘往事。下图是朱开山从清末到九一八事变爆发闯关东的前尘往事。下图
42、是朱开山一家从山东辗转逃亡到东北途中可能用到的四种交通工具。一家从山东辗转逃亡到东北途中可能用到的四种交通工具。依据材料概括晚清中国交通方式的特点，并分析其成因。依据材料概括晚清中国交通方式的特点，并分析其成因。提示：提示：特点：新旧交通工具并存特点：新旧交通工具并存(或：传统的帆船、独轮车，或：传统的帆船、独轮车，近代的小火轮、火车同时使用近代的小火轮、火车同时使用)。原因：近代西方列强的侵略加剧了中国的贫困，阻碍社会发原因：近代西方列强的侵略加剧了中国的贫困，阻碍社会发展；西方工业文明的冲击与示范；中国民族工业的兴起与发展；展；西方工业文明的冲击与示范；中国民族工业的兴起与发展；政府及各阶
43、层人士的提倡与推动。政府及各阶层人士的提倡与推动。串点成面串点成面握全局握全局 一、近代交通业发展的原因、特点及影响一、近代交通业发展的原因、特点及影响 1原因原因 (1)先进的中国人为救国救民，积极兴办近代交通业，促先进的中国人为救国救民，积极兴办近代交通业，促进中国社会发展。进中国社会发展。(2)列强侵华的需要。为扩大在华利益，加强控制、镇压列强侵华的需要。为扩大在华利益，加强控制、镇压中国人民的反抗，控制和操纵中国交通建设。中国人民的反抗，控制和操纵中国交通建设。(3)工业革命的成果传入中国，为近代交通业的发展提供工业革命的成果传入中国，为近代交通业的发展提供了物质条件。了物质条件。2特
44、点特点 (1)近代中国交通业逐渐开始近代化的进程，铁路、水运和近代中国交通业逐渐开始近代化的进程，铁路、水运和航空都获得了一定程度的发展。航空都获得了一定程度的发展。(2)近代中国交通业受到西方列强的控制和操纵。近代中国交通业受到西方列强的控制和操纵。(3)地域之间的发展不平衡。地域之间的发展不平衡。3影响影响 (1)积极影响：促进了经济发展，改变了人们的出行方式，积极影响：促进了经济发展，改变了人们的出行方式，一定程度上转变了人们的思想观念；加强了中国与世界各地的一定程度上转变了人们的思想观念；加强了中国与世界各地的联系，丰富了人们的生活。联系，丰富了人们的生活。(2)消极影响：有利于西方列
45、强的政治侵略和经济掠夺。消极影响：有利于西方列强的政治侵略和经济掠夺。1李鸿章李鸿章1872年在上海创办轮船招商局，年在上海创办轮船招商局，“前前10年盈和，成年盈和，成为长江上重要商局，招商局和英商太古、怡和三家呈鼎立为长江上重要商局，招商局和英商太古、怡和三家呈鼎立之势之势”。这说明该企业的创办。这说明该企业的创办()A打破了外商对中国航运业的垄断打破了外商对中国航运业的垄断B阻止了外国对中国的经济侵略阻止了外国对中国的经济侵略C标志着中国近代化的起步标志着中国近代化的起步D使李鸿章转变为民族资本家使李鸿章转变为民族资本家解析：解析：李鸿章是地主阶级的代表，并未转化为民族资本家；李鸿章是地
46、主阶级的代表，并未转化为民族资本家；洋务运动标志着中国近代化的开端，但不是具体以某个企业洋务运动标志着中国近代化的开端，但不是具体以某个企业的创办为标志；洋务运动中民用企业的创办在一定程度上抵的创办为标志；洋务运动中民用企业的创办在一定程度上抵制了列强的经济侵略，但是并未能阻止其侵略。故制了列强的经济侵略，但是并未能阻止其侵略。故B、C、D三项表述都有错误。三项表述都有错误。答案：答案：A 二、近代以来交通、通讯工具的进步对人们社会生活的影二、近代以来交通、通讯工具的进步对人们社会生活的影响响 (1)交通工具和交通事业的发展，不仅推动各地经济文化交交通工具和交通事业的发展，不仅推动各地经济文化
47、交流和发展，而且也促进信息的传播，开阔人们的视野，加快流和发展，而且也促进信息的传播，开阔人们的视野，加快生活的节奏，对人们的社会生活产生了深刻影响。生活的节奏，对人们的社会生活产生了深刻影响。(2)通讯工具的变迁和电讯事业的发展，使信息的传递变得通讯工具的变迁和电讯事业的发展，使信息的传递变得快捷简便，深刻地改变着人们的思想观念，影响着人们的社快捷简便，深刻地改变着人们的思想观念，影响着人们的社会生活。会生活。2清朝黄遵宪曾作诗曰：清朝黄遵宪曾作诗曰：“钟声一及时，顷刻不少留。虽钟声一及时，顷刻不少留。虽有万钧柁，动如绕指柔。有万钧柁，动如绕指柔。”这是在描写这是在描写 ()A电话电话 B汽
48、车汽车C电报电报 D火车火车解析：解析：从从“万钧柁万钧柁”“动如绕指柔动如绕指柔”可推断为火车。可推断为火车。答案：答案：D典题例析典题例析 例例1上海世博会曾吸引了大批海内外人士利用各种上海世博会曾吸引了大批海内外人士利用各种交通工具前往参观。然而在交通工具前往参观。然而在19世纪七十年代，江苏沿江世纪七十年代，江苏沿江居民到上海，最有可能乘坐的交通工具是居民到上海，最有可能乘坐的交通工具是()A江南制造总局的汽车江南制造总局的汽车 B洋人发明的火车洋人发明的火车 C轮船招商局的轮船轮船招商局的轮船 D福州船政局的军舰福州船政局的军舰 解析解析由材料信息由材料信息“19世纪七十年代，由江苏
49、沿江居民世纪七十年代，由江苏沿江居民到上海到上海”可判断最有可能是轮船招商局的轮船。可判断最有可能是轮船招商局的轮船。答案答案C题组冲关题组冲关1中国近代史上首次打破列强垄断局面的交通行业是中国近代史上首次打破列强垄断局面的交通行业是()A公路运输公路运输 B铁路运输铁路运输C轮船运输轮船运输 D航空运输航空运输解析：解析：根据所学根据所学1872年李鸿章创办轮船招商局，这是洋务年李鸿章创办轮船招商局，这是洋务运动中由军工企业转向兼办民用企业、由官办转向官督商运动中由军工企业转向兼办民用企业、由官办转向官督商办的第一个企业。具有打破外轮垄断中国航运业的积极意办的第一个企业。具有打破外轮垄断中国
50、航运业的积极意义，这在一定程度上保护了中国的权利。据此本题选义，这在一定程度上保护了中国的权利。据此本题选C项。项。答案：答案：C2.右图是右图是1909年年民呼日报民呼日报上登载的上登载的一幅漫画，其要表达的主题是一幅漫画，其要表达的主题是()A帝国主义掠夺中国铁路权益帝国主义掠夺中国铁路权益B西方国家学习中国文化西方国家学习中国文化C西方列强掀起瓜分中国狂潮西方列强掀起瓜分中国狂潮D西方八国组成联军侵略中国西方八国组成联军侵略中国解析：解析：从图片中可以了解到各国举的灯笼是火车形状，从图片中可以了解到各国举的灯笼是火车形状，20世纪初的这一幅漫画正反映了帝国主义掠夺中国铁路世纪初的这一幅漫
