甲亢病人围手术期应用心得安的临床研究  

Chinical research on the perioperative application of propranolol in patients with hyperthyroidism

作　　者：郭跃先[1] 王秀丽[1] 吴增安[2] 陆萍[1] 张金华[1] 孟庆云[1] 

机构地区：[1]河北医科大学第三医院外科,河北石家庄050051 [2]北京酒仙桥医院普外科,北京100034

出　　处：《中国普通外科杂志》2000年第6期524-526,共3页China Journal of General Surgery

摘　　要：目的　探讨围手术期服用心得安对甲亢病人术后甲状腺激素的影响。方法　对40例中、重度甲亢病人按麻醉方法和手术前后是否服用心得安等随机分为 4组 :心得安加全麻 (A组 ) ;全麻 (B组 ) ;心得安加颈丛神经阻滞 (C组 ) ;颈丛神经阻滞 (D组 )。用放免法测定手术前后各组病人不同时间的T3,T4 ,rT3,TSH的变化。结果　术后 1～ 7d各组T3 值均下降 ,A ,C组于术后 3～ 7d ,B ,D组于术后 1～ 3d下降明显 (P <0 .0 5 ) ;B ,D组rT3 值术后 1～ 3d明显上升 (P <0 .0 5 )。组间相比 ,T3 于术后 1～ 7d ,rT3 于术后 1～ 3d ,A与B组 ,C与D组间均存在明显差异 (P <0 .0 5 )。结论　心得安可影响术后T3,rT3 的合成和分泌。Objective To investigate the effects of propranolol on thyroid hormone in patients with hyperthyroidism after operation. Methods Forty patients with mediate or severe degree hyperthyroidism undergoing operation were randomly divided into four groups according to anesthesia and whether to take propranolol in perioperative period: Group A:propranolol plus general anesthesia; Group B: general anesthesia; Group C:propranolol plus cervical plexus blocking; Group D: cervical plexus blocking. The consecutive changes of T 3, T 4,rT 3 and TSH were measured with radioimmunological assay pre and post operatively. Results The level of serum T 3 in all groups decreased 1～7 days after operation. The decrease in serum T 3 leves was most significant 3～7 days after operation in group A and C, 1～3 days after operation in proup B and D(P<0.05); While significant increase of serum T 3 was also observed on 1～3 days after operation in group B and D(P<0.05).The levels of serum T 3 and rT 3 on 1～3 days after operation showed significant difference between group A and B, and between group C and D(P<0.05). Conclusions Propranolol can influence synthesis and secretion of T 3 and rT 3. Application of propranolol in periopertive period can reduce the incidence of chyroid crisis.

关 键 词：甲状腺机能亢进症/外科学 普萘洛尔/治疗应用 围手术期 

分 类 号：R581.1[医药卫生—内分泌] R971.94[医药卫生—内科学]