心内直视手术前后甲状腺激素监测  

Plasma thyroid hormones during cardiopulmonary bypass

作　　者：周建峰[1,2] 景华 李忠东[1,2] 董国华 申翼[1,2] 钱建军 张憬[1,2] 

机构地区：[1]南京军区南京总医院心胸外科 [2]南京海军第四一四医院胸外科

出　　处：《中华外科杂志》1999年第1期50-52,共3页Chinese Journal of Surgery

摘　　要：目的为了了解体外循环（ＣＰＢ）手术前后甲状腺激素代谢的变化规律，及其与心功能变化的相关性。方法对３６例患者ＣＰＢ术前２小时、术后１～５天血浆甲状腺激素进行监测，另对其中１６例手术前后心功能变化进行动态监测，并观察它们之间的相互关系。结果术前血浆甲状腺激素水平正常。ＦＴ３、ＦＴ４、ＴＴ３、ＴＴ４术后均呈现先下降后逐渐回升的变化趋势。ＴＳＨ术后第１天升至最高水平（Ｐ＜００５），此后缓慢下降至术前水平（Ｐ＞００５）。ｒＴ３术后第１天升至最高水平，此后缓慢下降，但仍高于术前水平。结论ＣＰＢ术后存在低Ｔ３、低Ｔ３和Ｔ４综合征，并且与术后一定时间内心脏功能抑制呈明显正相关性。Objective To study the changes and clinical significance of plasma thyroid hormones were during cardiopulmonary bypass (CPB). Methods Plasma thyroid hormones was studied in 36 patients during open heart surgery under CPB.Blood samples were taken preoperatively, and 1,2,3,4,5 days postoperatively.Doppler echocardiogragpy was performed in 16 patients before and after surgery for evaluating heart function. Results Before CPB,the levels of thyroid hormones were within normal range.At early stage after CPB,the levels of FT 3,FT 4,TT 3 and TT 4 were significantly decreased and increased.Both TSH and rT 3 were increased significantly after CPB ( P <0 05) and reached their highest levels at the first postoperative day.TSH and rT 3 were gradually dropped subsequently,but TSH returned to the basic level and the level of rT 3 was still high. A positive relation was seen between plasma thyroid hormones and cardiac function. Conclusions The changes of plasma thyroid hormones are closely related to cardiopulmonary bypass and could result in postoperative cardiac disfunction.

关 键 词：体外循环 甲状腺素 心功能 心内直视术 监测 

分 类 号：R654.2[医药卫生—外科学] R654.1[医药卫生—临床医学]