口服甲状腺素对低体重先心病患儿围术期甲状腺激素和血流动力学的影响  

The impact of oral triiodothyronine replacement therapy on serum thyroid hormones concentrations and hemodynamics during the peri-operative period in low weight infants undergoing surgery for congenital heart disease

作　　者：王少强[1] 魏松洋[1] 马志强[1] 杨瑞丽[1] 刘鹏[1] 郑庆杰[1] 徐泽红[1] 

机构地区：[1]中国人民解放军第一五五中心医院胸心外科,河南省开封市475003

出　　处：《中国心血管病研究》2012年第5期333-336,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的研究口服甲状腺素对低体重先心病患儿围术期甲状腺激素（TH）和血流动力学的影响。方法选择10k以下需在CPB下行心脏手术的先心病患儿40例，采用随机、对照的方法分为用药组（T组）和对照组（NT组），每组20例。T组患儿术前48h至CPB后72h按1．5μg·kg·8h^-1口服甲状腺素片，NT组给予安慰剂。分别于用药前（T1），术前20min（T2），CPB后4h（T3）、12h（T4）、24h（T5）、48h（T6）、72h（B）抽血，采用化学发光免疫分析法测定血浆T3、FT3、T4、FT4、TSH浓度，并利用监护仪读数测算心率（HR）、肺毛细血管楔压（PCWP）、体循环阻力指数（SVRI）、肺循环阻力指数（PVRI）和左心室每搏做功指数（LVSwI）。结果两组患儿一般资料差异无统计学意义。NT组血浆T3、FT3、T4、FT4浓度在T3-T6时持续降低，R分别比Tl时下降约67％、53％、58％和47％（P〈0．05）；血浆TSH浓度在T2-T5时持续降低，T5较T1时下降约390k（P〈0．05）。T组血浆T3、FT3、FT4浓度在T33-T7时均高于NT组（P〈0．05）；T组血浆T4、TSH浓度均在正常范围内波动（P〉0．05）。两组各时间点HR相比差异无统计学意义（P均〉O．05）。T组T3-T6时的SVRI、PVRI值均低于NT组（P均〈0．05），但LVSWI高于NT组（P均〈0．05）。结论口服甲状腺素能安全、有效地防治低体重先心病患儿CPB围术期正常甲状腺病态综合征（ESS），能有效地改善CPB后血流动力学紊乱。Objective To investigated the impact of oral triiodothyronine replacement therapy on serum thyroid hormones concentrations and hemodynamics during the peri-operative period in low weight infants undergo- ing surgery for congenital heart disease. Methods Forty infants weighting less than 10 kg who underwent cardiac surgery for congenital heart disease were randomly assigned to 2 groups： the T group （n=20） received oral tri- iodothyronine, 1.5 μg·kg·8h^-1, initiated 48 h before surgery and maintained [or 72 h after CPB and the NT group （n=20） received placebo. Serum T3, FT3, T4, FT4, TSH were determined at baseline（T1）, 20 min before surzery（T2）, and 4 h（T3）, 12 h（T4）, 24 h（T5）, 48 h（T6）, 72 h（TT） after cessation of CPB. HR, PCWP,SVRI, PVRI, LVSWI were measured at T2, T3, W4, Ts, T6, TT. Results The two groups were comparable with respect to age, sex, body weight, ejection fraction, duration of CPB and aortic cross-clamping time. In the NT group, serum T3, FT3, T4, FT4 levels were progressively decreased from T3 to T6, and there were significant re- duction of 67%, 53%, 58%,47% when comparing T6 with T1 （P〈0.05）, and serum TSH levels were progressively decreased from T3 to Ts, and there were significant reduction of 39% when comparing T5 with T1 （P〈O.05）. Serum T3, FT3, FT4 levels in the T group were significantly higher than those in the NT group from T3 to T7 （P〈O.05）. Serum T4, TSH levels were no significantly difference in the T group （P〉O.05）. HR levels were no significantlydifference in 2 groups （P〉0.05）. The SVRI, PVRI in the T group wereu significantly lower than those in the NT group from T3 to T4（P〈0.05）, and the LVSWI in the T group were significantly higher than those in the NT group from T3 to T6（P〈0.05）. Conclusion Oral triiodothyronine replacement therapy during the peri-operative period in low weight infants undergoing surgery for congenital heart disease could prevent ESS safely and effectively, and could improve pos

关 键 词：体外循环 正常甲状腺病态综合征 甲状腺激素 血流动力学 

分 类 号：R654.2[医药卫生—外科学]