非体外循环冠状动脉搭桥手术对老年患者甲状腺功能的影响  

Effect of Off-Pump Coronary Artery Bypass Surgery on Thyroid Function in Elderly Patients

作　　者：孙德权[1] 孟冬梅[1] 李培军[1] 王联群[1] 刘建实[1] 

机构地区：[1]天津市胸科医院心脏外科,300051

出　　处：《天津医药》2011年第7期601-603,共3页Tianjin Medical Journal

摘　　要：目的:探讨80岁以上非体外循环冠状动脉搭桥手术患者甲状腺功能的变化。方法:50例患者分别于术前1d,返回监护室即刻和术后第1、2、5天检测甲状腺功能。根据欧洲心脏手术风险评估系统将患者分为高风险组和中低风险组,分析2组患者甲状腺激素水平及围术期临床资料的差异。结果:2组主动脉内气囊反搏(IABP)使用、术后24h正性肌力药物评分、呼吸机辅助时间和ICU监护时间差异有统计学意义(P<0.01)。高风险组术后总三碘甲状腺原氨酸、游离三碘甲状腺原氨酸和促甲状腺激素明显低于中低风险组(P<0.05或P<0.01)。其甲状腺功能低谷时段恰好是该组患者术后血流动力学不稳定期。结论:非体外循环冠状动脉搭桥手术不能防止正常甲状腺功能病态综合征的发生,甲状腺激素是评估心功能障碍患者转归的重要指标。Objective：To evaluate the altered thyroid function after off-pump coronary artery bypass surgery in patients over 80 years old.Methods：The values of thyroid function were analyzed in 50 patients 1 d before operation,in ICU just after operation,and 1 d,2 d and 5 d after operation.According to European System for Cardiac Operative Risk Evaluation,the patients were divided into high risk group or median and low risk groups.The thyroid function and perioperative parameters were compared between two groups.Results：There were statistical differences in intra-aortic balloon pump（IABP） assist,inotropic score,mean duration of ventilatory support and mean length of ICU stay between two groups（P 〈 0.01）.Additionally,there were significantly lower levels of liothyronine,free triiodothyronine and thyroid stimulating hormone in high risk group than those of median and low risk group.No significant differences in levels of total and free thyroxine were observed between two groups（P 〈 0.01）.It was found that the lower stage of thyroid function was exactly the time of？postoperative hemodynamic instability.Conclusion：The findings indicated that off-pump surgery could not prevent the onset of euthyroid sick syndrome.Thyroid hormone is an important indicator to assess the prognosis in patients with cardiac dysfunction.

关 键 词：甲状腺激素类 冠状动脉旁路移植术 非体外循环 甲状腺功能试验 功能正常甲状腺病综合征 老年人 80以上 

分 类 号：R541.61[医药卫生—心血管疾病]