甲状腺功能减退伴ST段改变患者非心脏开胸术后并发症观察  

Study on complication after noncardiac thoracotomy in hypothyroidism with ST segment change patients

作　　者：张岩[1] 徐进志[2] 

机构地区：[1]哈尔滨医科大学附属第二医院动态心电室,150086 [2]哈尔滨医科大学附属第四医院胸心外科,150086

出　　处：《中国地方病学杂志》2009年第5期572-574,共3页Chinese Jouranl of Endemiology

基　　金：黑龙江省卫生厅课题（2007-371）

摘　　要：目的观察甲状腺功能减退伴ST段改变患者非心脏开胸术后并发症发生情况。方法选择61例甲状腺功能减退需行非心脏开胸手术患者，在术前7天内补充甲状腺激素至正常水平，并用动态心电图（Hoher）检测其ST段变化，按ST段压低〉10．05mV分为ST段改变组（28例）和ST段非改变组（33例）。在手术前、后检测血清甲状腺激素水平．术后48h Holter检测心肌缺血情况，并院内随访术后其他心血管并发症。结果手术前、后ST段改变组患者血清TT3[（1．30±0．41）、（2．09±0．45）nmol／L]、TT4[（80．56±30．28）、（84．55±33．57）nmol／L]，与ST段非改变组[TT2：（1．43±0．52）、（2．38±0．51）nmol／L；TT4（82．70±29．43）、（93．47±35．02）nmo]／L]比较，差异无统计学意义（P均〉0．05）。ST段改变组患者有24例术后发生心肌缺血．而发生其他心血管并发症者10例，ST段非改变组有8例术后发生心肌缺血，其他心血管并发症l例，两组比较差异有统计学意义（χ^2=22．95、10．95，P均〈0．05）。术前Holter检测ST段改变对术后其他心血管并发症发生的阳性预测值为36％（10／28），而未改变的阴性预测值为97％（32／33）。结论甲状腺功能减退伴ST段改变患者非心脏开胸术后易发生心肌缺血和其他心血管并发症，术前Hoher检测ST段改变对术后心血管并发症有一定的预测价值。Objective To investigate complications in patients after noncardiac thoracotomy in hypothyroidism with ST changes. Methods Sixty one patients with hypothyroidism undergoing noncardiae thoracotomy were divided into ST segment change group （28 patients having ST segment depression ≥0.05 mV） and controls（33 patients） according to the results of Hoher. All patients were added with thyroid hormone, until the function of thyroid gland was normal before thoracotomy. The myocardial ischemia was measured by Hoiter within 48 hours after thoracotomy. Serum thyroid hormones was examined by radioimmunoassay during, before and after thoracotomy. And cardiovascular events were followed-up to hospital. Results Before and after thoracotomy serum TT3 in ST segment change group was （ 1.30 ± 0.41 ）, （2.09 ± 0.45 ）nmol/L, TT4 was （80.56 ± 30.28 ）, （84.55 ± 33.57 ） nmol/L, respectively; compared with the control group[TT3： （1.43 ± 0.52）, （2.38 ± 0.51 ）nmol/L, TT4：（82.70 ±29.43）, （93.47 ± 35.02）nmol/L], no significant differences were found（all P 〉 0.05）. After thoracotomy, 24 patients occurred myocardial ischemia, 10 patients occurred cardiovascular events in ST segment change group; 8 patients occurred myocardial ischemia, a patient occurred cardiovascular events in control group, there were significant differences between two groups （χ^2 = 22.95,10.95, all P 〈 0.05）. The positive predictive value of ST segment change in Holier detection was 36% （10/28） recording in cardiovascular events of patients with cardiovascular disease undergoing noncardiac thoracotomy and hypothyroidism, negative predictive value was 97%（32/33）. Conclusions Myocardial ischemia and other cardiovascular events tend to occur in hypothyroidism patients with ST segment change after noncardiac thoracotomy. ST segment change of preoperative Hoher detection recording cardiovascular events of hypothyroidism patients undergoing noncardiac thoracotomy has certain predictive value.

关 键 词：甲状腺功能减退症 非心脏开胸手术 心肌缺血 心血管事件 动态心电图 

分 类 号：R686[医药卫生—骨科学]