Graves病患者甲状腺激素水平对术中出血量及预后的评估价值  

The correlation between thyroid hormone levels and blood loss of thyroid surgery and clinical prognosis in patients with Graves disease

作　　者：张忠林[1] 陈锐[1] 吴阳[1] 李太军[1] 

机构地区：[1]四川省内江市第一人民医院普外二科,四川内江641000

出　　处：《现代预防医学》2016年第8期1519-1522,1536,共5页Modern Preventive Medicine

摘　　要：目的探讨Graves病患者甲状腺激素水平与甲状腺手术出血量的关系及其对临床预后的评估价值。方法选择2012年1月至2015年1月在某院确诊并且行甲状腺次全切除术的Graves病患者140例。根据Graves病患者术后预后情况分为:痊愈组、好转组、甲减组及无效组。术前采用放射免疫法测定甲状腺激素水平包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺素(TSH);术前超声检测甲状腺体积以及甲状腺上动脉峰值流速(STAPSV),记录术中的出血量及术后并发症情况。观察术前甲状腺激素水平与术中出血量、术后并发症及预后的关系。结果随着Graves病患者FT3、FT4和TSH水平越高,术中出血量越多,术后并发症发生率越高,同时临床预后也越差,即甲减组和无效组最高、好转组次之,痊愈组最低,甲减组与无效组比较差异无统计学意义(P>0.05),但甲减组和无效组与好转组、痊愈组间比较差异差异具有统计学意义(P<0.05)。相关性分析显示,Graves病患者术前FT3、FT4和TSH水平与术中出血量呈正相关(r=0.053、0.062、0.076,P<0.001);甲状腺体积与STA-PSV水平呈正相关(r=0.043,P=0.009);STA-PSV水平与术中出血量呈正相关(r=0.058,P<0.001);术前FT3、FT4和TSH水平与术后并发症的发生率呈正相关(r=0.038,P=0.013;r=0.048,P=0.007;r=0.056,P<0.001)。结论术前甲状腺激素水平可作为评估Graves病患者术中出血量及临床预后的有效指标,对于提高手术成功率及预后,具有重要的临床价值。Objective The aim of this article was to study the relationship between thyroid hormone levels and thyroid surgery bleeding,in order to assess the value of the clinical prognosis. Methods A total of 140 patients subjected to subtotal thyroidectomy in our hospital from January 2012 to January 2015 were enrolled in the study. According to the prognosis of Graves disease after surgery,these patients were divided into four groups： cured group,improved group,ineffective group and hypothyroidism group. The thyroid hormone levels including free triiodothyonine three（ FT3）,free thyroxine four（ FT4） and thyroid stimulating hormone（ TSH） were determined by rapid radioimmunoassay. The thyroid volume and thyroid artery peak velocity（ STA- PSV） were recorded preoperative by ultrasonography,and the blood loss and postoperative complications were observed. The relationship between preoperative thyroid hormone and intraoperative blood loss,postoperative complications and prognosis were analyzed. Results While FT3,FT4 and TSH levels were higher in Graves disease,blood loss was more and the incidence of postoperative complications was higher,but the prognosis was worse. The hypothyroidism group and ineffective group were the highest,followed by improved group,and the cured group was the lowest. The difference between the hypothyroidism group and ineffective group was not statistically significant（ P 0. 05）. But the difference between hypothyroidism group,ineffective group and improved group,and cured group was statistically significant（ P 0. 05）. The correlation analysis showed that the preoperative FT3,FT4 and TSH levels in Grave disease were positively correlated with blood loss（ r = 0. 053,0. 062,0. 076,P 0. 001）. The thyroid volume was positively correlated with STA- PSV（ r = 0. 043,P = 0. 009）. The STA- PSV level was positively correlated with blood loss（ r = 0. 058,P 0. 001）. The preoperative FT3,FT4 and TSH levels were positively correlated with the incidence of postoperative complicati

关 键 词：GRAVES病 甲状腺激素 预后 出血量 

分 类 号：R322.51[医药卫生—人体解剖和组织胚胎学]