体外循环心脏手术对甲状腺功能的影响及干预治疗的意义

目的探讨体外循环（CPB）心脏手术对患者甲状腺功能的影响及其干预治疗的意义。方法观察50例行体外循环心脏手术的患者,测定其术前1d、术后1、4、7d血浆三碘甲状腺原氨酸（T3）、四碘甲状腺原氨酸（T4）及促甲状腺激素（TSH）的浓度。将术后第1天测得T3值低于术前水平70%的患者分为对照组（22例）与用药组（23例）。用药组从术后第1天连续7d给予口服甲状腺片0.5mg.kg-1.d-1,监测围手术期内两组患者多巴胺、多巴酚丁胺用量,比较术后ICU监护时间及术后至出院时间。结果全部患者术前T3、T4及TSH浓度都在正常值范围内,手术后有45例患者T3明显降低（低于术前水平的70%）。两组术后低T3患者术后（对照组第1天与第4天,用药组第1天）T3值明显低于术前T3值（P〈0.05）;用药组术后第4天与第7天T3值较同时相对照组明显增高（P〈0.05）;两组患者术后各时相T4及TSH与术前相比均无明显变化（P〉0.05）。术后用药组多巴胺、多巴酚丁胺用量,以及患者术后ICU监护时间、术后至出院时间均较对照组有所减少,但差别均无统计学意义。结论 CPB心脏手术可引起患者术后T3下降,术后短时间给予患者适量甲状腺素片治疗,可能有利于促进机体康复。

Significance of Cardiopulmonary Bypass on Thyroid Function and Intervention

Objective To explore effect of cardiopulmonary bypass（CPB） cardiac surgery on thyroid function and its significance on intervention.Methods Plasma Three triiodothyronine（T3）,four-triiodothyronine（T4） and thyroid stimulating hormone（TSH） were determined in 50 cases undergoing cardiopulmonary bypass at 1 d before operation and at 1,4,7 d after operation.50 cases were divided into control group（22 cases） and treatment group（23 cases）.Patients in treatment group took orally thyroid tablets 0.5 mg·kg-1·d-1 from the first day to the seventh day after operation.Results T3,T4 and TSH of all patients before operation were within the normal range.T3 in Postoperative patients with low T3（control group on day 1 and 4 days,the treatment group on day 1） was significantly lower than that before operation（P0.05）;T3 of treatment group at the 4th and 7th day was significantly higher than that of control group at the same time（P0.05）.Conclusion CPB cardiac surgery can decrease T3 level of patients.It may be beneficial for CPB preoperative patients to take proper amount thyroxine tablets in a short time,.