髋关节置换术中碘伏冲洗对患者甲状腺功能的影响  

Effect of iodophor irrigation and disinfection on thyroid function in patients undergoing total hip arthroplasty

作　　者：步子恒 黄轩 胡宏悻 刘洋 徐卫东 战策 傅利勤 朱善邦 刘忠堂 Bu Ziheng;Huang Xuan;Hu Hongxing;Liu Yang;Xu Weidong;Zhan Ce;Fu Liqin;Zhu Shanbang;Liu Zhongtang(Changhai Hospital of Shanghai,Shanghai 200082,China;Wenzhou Medical College,Wenzhou 325000,China)

机构地区：[1]上海长海医院,200082 [2]温州医科大学,325000

出　　处：《中华关节外科杂志（电子版）》2019年第2期151-156,共6页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：国家自然科学基金(51673212)

摘　　要：目的探讨髋关节置换术术中使用碘伏冲洗消毒对患者术后甲状腺功能的影响。方法2017年1月至2017年9月将诊于上海长海医院关节外科拟行髋关节置换术的50名患者(无甲状腺疾病及髋关节感染患者),随机分为两组:实验组(术中于假体置入后应用碘伏冲洗、浸泡消毒5 min)25例,对照组(使用生理盐水冲洗、浸泡5 min)25例。两组术后采用相同的康复训练方案。采集所有患者术前、术后第1天,第1周以及第1个月促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)以及尿碘的结果,评估术后以及术后1 d、1周及1个月与术前相比变化的程度。各时间点的组间差异采用配对样本t检验。结果50名患者均顺利完成手术,且术后至少随访1个月。实验组FT3术前为(4.4±0.8)pmol/L,术后第1天、1周、1个月分别为(1.7±0.3)、(4.7±0.7)、(4.3±1.0)pmol/L,对照组术前为(4.2±0.7)pmol/L,术后1 d,1周、1个月分别为(2.9±0.5)、(3.8±0.8)、(4.5±0.9)pmol/L;实验组FT4术前为(15.4±3.6)pmol/L,术后第1天、1周、1个月分别为(10.7±2.5)、(12.1±2.7)、(15.3±3.5)pmol/L,对照组术前为(15.1±3.8)pmol/L,术后1 d,1周、1个月分别为(13.9±2.7)、(14.6±2.3)、(15.7±3.1)pmol/L;实验组TSH术前为(2.6±1.3)m IU/L,术后1 d、1周、1个月分别为(1.3±0.3)、(3.1±1.0)、(2.36±1.9)m IU/L,对照组术前为(2.6±1.0)m IU/L,术后1 d,1周、1个月分别为(1.3±0.3)、(2.0±1.1)、(2.5±1.5)m IU/L;实验组术前尿碘(251±97)μg/L,术后1 d、1周、1个月为(919±224)、(453±106)、(253±112)μg/L,对照组术前为(254±98)μg/L,术后1 d,1周、1个月分别为(262±215)、(255±107)、(244±94)μg/L。两组组间相比术后1 d及1周TSH、FT3、FT4以及尿碘值比较差异有统计学意义(术后1 d TSH:t=0.892,术后1 d FT3:t=7.165,术后1 d FT4:t=3.296,术后1 d尿碘值:t=8.184,均为P<0.05;术后1周TSH:t=2.691,术后1周FT3:t=3.339,术后1周FT4:t=2.754,术后1周尿碘值:t=5.092;均为P<0Objective To explore the effect of rinsing and disinfecting with iodophor on the thyroid function of patients who recievestotal total hip arthroplasty(THA).Methods From January 2017 to September 2017,50 patients(without thyroid disease and infection)who were scheduled to undergo THA in joint surgery department of Shanghai Changhai Hospital were randomly divided into two groups:experimental group(25 patients were treated with iodophor irrigation and immersion disinfection for five minutes after implantation of prosthesis)and control group(25 patients were treated with saline irrigation and immersion for five minutes).The same rehabilitation training program was used in both groups after operation.The results of thgroid stimulating hormone(TSH),tree tri-iodothyronine(FT3),tetra-iodothyronine(FT4)and urine iodine were collected before operation,at the postoperative one day,the one week and one month.The changes of TSH,FT3,FT4 and urine iodine were evaluated before the operation and postoperative one day,one week and one month.The differences among groups at different time points were tested by paired sample t test.Results All the 50 patients completed the operation successfully and were followed up for at least one month after the operation.The preoperative FT3 of the experimental group was(4.4±0.8)pmol/L,and at postoperative one day,one week,one month were(1.7±0.3),(4.7±0.7)and(4.3±1.0)pmol/L respectively;the preoperative FT3 of the control group was(4.2±0.7)pmol/L,and were(2.9±0.5),(3.8±0.8),(4.5±0.9)pmol/L respectively at postoperative one day,one week and one month.The experimental group preoperative FT4 was(15.4±3.6)pmol/L,and were(10.7±2.5),(12.1±2.7),(15.3±3.5)pmol/L respectively at postoperative one day,one weeks and one months;the control group preoperative FT4 was(15.1±3.8),and were(13.9±2.7),(14.6±2.3),(15.3±3.1)pmol/L respectively at postoperative one day,one week,one month.The experimental group preoperative TSH was(2.6±1.3)m IU/L,and at postoperative one day,one week and one month were

关 键 词：关节成形术 置换 髋 感染 聚维酮碘 甲状腺疾病 

分 类 号：R687.4[医药卫生—骨科学]