风心病二尖瓣置换术后房颤早期自动复律与甲状腺激素代谢的关系  

Relationship between early spontaneous cardioversion of atrial fibrillation and thyroid hormone metabolism after mitral replacement in patients with rheumatic heart disease

作　　者：陈群清[1] 童健[1] 闫玉生[1] 张福伟[1] 

机构地区：[1]南方医科大学珠江医院心胸外科,广东广州510282

出　　处：《南方医科大学学报》2010年第11期2548-2550,共3页Journal of Southern Medical University

摘　　要：目的通过分析风心病二尖瓣置换术后房颤早期自动复律与甲状腺激素代谢的关系,探索二尖瓣置换术后早期房颤复律的治疗策略。方法 138例患者接受二尖瓣置换术,按术后早期自动回复窦性心律情况分为复律组和非复律组。复律组中按窦律维持时间分为<3d组和>3d组。以放免法检测各组三碘甲腺原氨酸(T3)水平。结果全组患者术后早期T3代谢水平明显下降;术后2h后自动复律52例,占37.7%,其中维持时间大于3d的有28例,占20.3%。复律组与非复律组术后T3均有明显下降,术后2h、术后第1天、第3天分别下降44.5%vs58.7%、40.0%vs52.4%和28.6%vs37.7%,复律组T3水平明显高于非复律组,而维持窦律时间<3d组和>3d组间T3水平未见明显差异。结论心脏瓣膜置换术后T3水平的提高可增加二尖瓣置换术后房颤复律的几率,但窦律维持时间的长短与T3水平并无多大关系;本研究结果为心脏围手术期补充T3提供了理论基础。Objective To analyze the relationship between early spontaneous cardioversion of atrial fibrillation（AF） and thyroid hormone metabolism after mitral replacement in patients with rheumatic heart disease,and explore the treatment strategy of early spontaneous cardioversion after mitral valve replacement.Methods According to the occurrence of cardioversion,138 patients with mitral valve replacement were divided into conversion group and non-conversion group,and based on the duration of sinus rhythm,the patients in conversion group were divided into 〈3 days group and 〉3 days group.Triiodothyronine（T3） was detected by radioimmunoassay in all the patients.Results T3 metabolism decreased significantly after the operation in all the patients.Early spontaneous cardioversion of AF occurred 2 h after the operation in 52 cases（37.7%）,and 28（20.3%） of the cases had a duration of sinus rhythm longer than 3 days.T3 was significantly decreased in conversion group and non-conversion group by 44.5% and 58.7% at 2 h,by 40.0% and 52.4% at 24 h and by 28.6% and 37.7% at 72 h after the operation,respectively.The levels of T3 in conversion group was significantly higher than the levels in non-conversion group,and showed no significant variation with the duration of sinus rhythm.Conclusion Enhancement of T3 levels after mitral valve replacement may increase the probability of early spontaneous cardioversion of AF,but can not affect the duration of sinus rhythm.This finding supports the supplementation of T3 perioperatively in patients undergoing cardiac surgeries.

关 键 词：心房纤颤 甲状腺激素 复律 二尖瓣置换术 风湿性心脏病 低T3综合征 

分 类 号：R654.2[医药卫生—外科学]