心内直视手术后甲状腺功能减退患者的治疗策略

目的总结心内直视手术后甲状腺功能减退（甲减）患者的治疗方法。方法 2005年1月～2009年12月我院心内直视手术前后发生甲减的患者18例,术前确诊甲减者8例,术后确诊者10例。结果死亡3例,病死率16.7%。术前确诊者,术前均服用左旋甲状腺素片,术后并发广泛性肺渗出、低心排血量（低心排）各1例,其余6例顺利恢复,无死亡;术后确诊者,术后并发低心排6例,呼吸衰竭4例,死亡3例,死因分别为多器官功能衰竭2例,顽固性低氧血症1例。结论术前避免漏诊甲减,一旦确诊,尽早补充甲状腺素片,术后严防并发症是心内直视手术后甲减患者顺利恢复的关键。

The experience for patients with hypothyroidism after cardiopulmonary bypass

Objective To summarize the experience for patients with hypothyroidism after cardiopulmonary bypass.Methods Between January 2005 and December 2009,18 patients（11 male,7 female）with hypothyroidism after cardiopulmonary bypass.The age was from 5 to 68 yearsmean（56.2±6.4）years],the body weight was from 18 to 62kgmean（45.2±7.5）kg].Results The hospital mortality rate was 16.7%（n=3）.8 patients treated with exogenous thyroid hormone when they were diagnosed as hypothyroidism before corrective surgery,no patient died.Complication included extensive pulmonary infiltration in 1 patient and low cardiac output syndrome（LCOS） in another patient.The another 6 patients recovered smoothly;10 patients were diagnosed as hypothyroidism after corrective surgery.The causes of early death in 3 patients were multiple organs failure in 2 patients and refractory postoperative hypoxemia in 1 patient.Complication included LCOS 6 patients and postoperative respiratory failure 4 patients.Conclusion Avoiding preoperative misdiagnosis,Treating as early as possible when diagnosis was made,Prevention and cure the complication are all of great importance for recovery of the patients.