术前短期口服小剂量甲状腺素片对体外循环心脏直视术后患儿正常甲状腺病态综合征的预防效果  

Preventive efficacy of oral small-dose thyroid hormone tablet premedication for a short time on euthyroid sick syndrome in children undergoing open heart surgery under cardiopulmonary bypass

作　　者：杨泉涌[1] 薛富善[1] 薛玉良[2] 王亚欣[2] 许亚超[1] 廖旭[1] 熊军[1] 袁玉静[1] 王强[1] 李杉[1] 王卫利[1] 

机构地区：[1]中国医学科学院北京协和医学院整形外科医院麻醉科,100144 [2]天津泰达国际心血管病医院麻醉科

出　　处：《中华麻醉学杂志》2010年第9期1058-1061,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价术前短期口服小剂量甲状腺素片对体外循环心脏直视术后患儿正常甲状腺病态综合征（ESS）的预防效果.方法 择期体外循环下行先天性心脏病矫正术的患儿40例,年龄3～12岁,体重10～30 kg,ASA分级Ⅰ或Ⅱ级,心功能分级Ⅰ级,随机分为2组（n=20）：安慰剂组（P组）和甲状腺素片组（T组）.T组患儿术前4 d开始每天口服甲状腺素片0.4 mg/kg,连续4 d;P组给予安慰剂.常规建立体外循环,采用浅低温、中度血液稀释、高流量灌注.于入院时（基础状态）、术后第1、2、4天时采集桡静脉血样5 ml,采用酶联免疫法测定血清三碘甲状腺原氨酸（T3）、四碘甲状腺素（T4）、促甲状腺激素（TSH）浓度,于入院时、术毕即刻及术后第1、2天时记录患儿SP、DP和HR.记录患儿气管导管保留时间、ICU停留时间、正性肌力药物的使用情况及术后ESS的发生情况.结果 两组患儿血液动力学指标、ICU停留时间和气管导管保留时间比较差异无统计学意义（P＞0.05）.与基础值比较,P组和T组术后第1、2、4天时血清T3浓度降低,术后第1天时血清TSH浓度降低,P组术后第1天时血清T4浓度降低（P＜0.05）.与P组比较,T组血清T3和T4浓度升高,术后ESS严重程度和正性肌力药物使用率降低（P＜0.05）.结论 体外循环心脏直视手术患儿术前口服小剂量甲状腺素片4 d（0.4 mg·kg^-1·d^-1）虽可减轻术后正常甲状腺病态综合征的严重程度,但不能预防术后正常甲状腺病态综合征的发生.Objective To evaluate the preventive efficacy of oral small-dose thyroid hormone tablet premedication for a short time on euthyroid sick syndrome （ESS） in children undergoing open heart surgery under cardiopulmonary bypass （CPB） .Methods Forty ASA Ⅰ or Ⅱ children aged 3-12 yr, weighing 10-30 kg, scheduled for elective congenital heart disease surgery under CPB, were randomly allocated into 2 groups （ n = 20 each）：placebo group （group P） and thyroid hormone tablet group （group T）. Group T received oral thyroid hormone tablets 0.4 mg/kg every day for 4 consecutive days before surgery, while group C were given placebo. CPB was routinely established, and mild hypothermia, moderate hemodilution and high flow perfusion were adopted. Blood samples were taken from radial veins before administration （baseline） and on 1st, 2nd and 4th day after surgery to detect the serum concentrations of triiodothyronine （T3）, thyroxine （T4） and thyroid stimulating hormone （TSH）.SP, DP and HR were recorded before administration, immediately after surgery, and on 1st and 2nd day after surgery. The endotracheal extubation time, length of ICU stay, application of positive inotropic agents and occurrence of ESS were recorded. Results No significant difference was found in hemodynamic parameters, endotracheal extubation time and length of ICU stay between the two groups （ P 〉 0.05）. As compared with the baseline values,the serum T3 levels on 1st, 2nd and 4th day after surgery, and the serum TSH levels on 1 st day after surgery were significantly decreased in the two groups, and the serum T4 levels were significantly decreased on 1 st day after surgery in group P （ P 〈 0.05）. The serum levels of T3 and T4 were significantly higher, the severity of postoperative ESS and the number of positive inotropic agent administration were significantly lower in group T than in group P （P 〈 0.05 ）. Conclusion Although oral small-dose thyroid hormone tablet premedication for 4 days （0.4 mg/kg per

关 键 词：甲状腺激素类 功能正常甲状腺病综合征 体外循环 心脏外科手术 儿童 

分 类 号：R726.5[医药卫生—儿科]