冠状动脉搭桥围手术期甲状腺激素代谢变化的研究

目的 研究冠状动脉搭桥患者术前、术中、术后甲状腺激素的动态变化.方法 对30名健康志愿者于空腹时、62例冠心病患者于术前、术中及术后定时采血,用化学发光法及放射免疫法测定TT3,TT4、FT3、FT4、TSH、rT3水平,并以SPSS 10.0进行统计分析.结果 术前患者的甲状腺激素水平与正常对照组之间差异无统计学意义;术中肝素化后10 min及60 min时,TT4、FT4水平显著高于术前(P<.01),而术后2 h TT3、,TT4、FT3、FT4、rT3、TSH水平无显著变化;术后24 h和72 h TT3、TT4、FT3、FT4、TSH水平显著低于术前(P<0.01),24 hTT3,FT3,较术前分别下降了52.7%和46.6%,而rT3水平显著高于术前(P<0.01);术后7 dTT3、rT3水平显著低于术前(P<0.01),TT4、FT3、FT4、TSH浓度仍未恢复到术前正常浓度水平.结论 冠状动脉搭桥术中患者的血清TT4、FT4水平升高,术后血清TT3,FT3,水平降低可能提示预后不良.

Study of serum thyroid hormone levels changes in perioperation patients accepted coronary artery bypass grafts

Objective To clarify the change of serum thyroid hormone levels during periopreation period of coronary artery bypass grafts (CABG).Methods The levels of serum thyroid hormones (TT3,TT4,FT3,FT4,TSH,rT3) were measured by chemical-luminal and RIA in 62 patients at certain time in perioperation period,as well as 30 normal volunteers on a fasting basis.SPSS 10.0 was used for statistic analysis.Results The levels of serum thyroid hormones had no significant difference between controls and patients before CABG.At 10 min and 60 rain after giving heparin,serum TT4,FT4 levels in patients during operation elevated significantly than before (P ＜ 0.01),however,at 2 h after operation,serum TT3,TT4,FT3,FT4,rT3,TSH levels had no significam changes.Serum TT3,TT4,FT3,FT4,TSH levels at 24 h and 72 h after operation were significantly lower in patients than before CABG (P ＜ 0.01).Especially at 24 h,serum TT3,FT3 levels decreased by 52.7% and 46.6% than before respectively,while serum rT3 levels increased significantly(P ＜ 0.01) and serum TT3,rT3 levels decreased significantly (P ＜ 0.01).The serum TT4,FT3,FT4,TSH levels didn't return to normal at 7 d after operation.Conclusion Elevated serum TT4,FT4 levels are present in acute period in patients accepted CABG.Decreased serum T3 and FT3 levels after CABG may indicate a bad prediction.