左甲状腺素钠对冠心病合并甲状腺功能减退患者外科手术治疗的影响  

Impact of levothyroxine on postoperative outcomes in hypothyroid patients with coronary artery disease

作　　者：赵栋 吕晓东[1] 宋民[1] 苏文君[1] ZHAO Dong;LV Xiaodong;SONG Min;SU Wenjun(Department of Cardiac Surgery,National Center for CardiovascularDisease,Fu Wai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管外科

出　　处：《心肺血管病杂志》2019年第7期752-755,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨左甲状腺素对合并甲状腺功能减退症(甲状腺功能减退)冠心病患者行冠状动脉旁路移植手术(CABG)效果的影响。方法:2014年1月至2018年5月,我院对96例合并甲状腺功能减退的冠心病患者行CABG术,其中术前服用左甲状腺素钠患者68例(用药组),术前未服用左甲状腺素钠患者28例(未用药组)。比较两组患者术前术中及术后各项指标变化及临床结果。结果:两组患者术前一般情况及术中情况,差异无统计学意义,术后均无死亡病例。但与未用药组相比,用药组术后WBC计数恢复至正常值的时间更长[(8.3±2.7)vs.(5.1±1.6)d,P=0.021]、术后正性肌力药物应用时间也更长(P=0.012)、术后住院时间延长[(10.5±3.2)vs.(7.3±0.8)d,P=0.011]、术中及术后血浆用量增多[(671.4±198.3)vs.(226.1±101.1)mL,P=0.033]。结论:甲状腺功能减退患者行CABG手术时,术前补充左甲状腺素钠与患者术后白细胞计数恢复至正常值的时间延长、术后正性肌力药物治疗时间延长、术中及术后血浆用量增加、术后住院时间延长相关。Objective: To evaluate the influence of preoperative use of levothyroxine on recovery of hypothyroid patients after coronary artery bypass grafting ( CABG). Methods: From January 2014 to May 2018, 96 consecutive adult patients with hypothyroidism and coronary artery disease underwent primary isolated CABG in our hospital. 68 patients with preoperative use of levothyroxine were termed as treatment group,and the remaining 28 patients were termed as control group. The baseline preoperative characteristics,intra-operative characteristics and postoperative outcomes were compared. Results: The baseline preoperative and intraoperative characteristics distributed between two groups were similar. No death occurred in either group. Compared with patients in Control Group,those in Treatment Group had longer time for restoring normality of leukocyte [( 8. 3± 2. 7) vs.( 5. 1± 1. 6) d,P = 0. 021],longer duration of postoperative inotropic support ( P = 0. 012),longer postoperative stay [( 10. 5±3. 2) vs.( 7. 3±0. 8) d,P= 0. 011]and more consumption of plasma [( 671. 4±198. 3) vs.( 226. 1±101. 1) mL,P= 0. 033]. Conclusions: Use of levothyroxine before CABG surgery in hypothyroid patients is associated with increased postoperative time for restoring normality of leukocyte, duration of postoperative inotropic support,postoperative stay and consumption of plasma.

关 键 词：冠心病 冠状动脉旁路移植术 甲状腺功能减退 左甲状腺素钠 

分 类 号：R54[医药卫生—心血管疾病]