先天性心脏病体外循环手术患儿正常甲状腺病态综合征研究进展  

Advances in cardiopulmonary bypass and euthyroid sick syndrome in children with congenital heart disease

作　　者：张明翔(综述) 尤国宙 罗忠明 洪伟(审校) Zhang Mingxiang;You Guozhou;Luo Zhongming;Hong Wei(Department of Cardiothoracic Surgery,Children′s Hospital of Kunming Medical University/Kunming Children′s Hospital,Kunming 650100,China)

机构地区：[1]昆明医科大学附属儿童医院,昆明市儿童医院心胸外科,650100

出　　处：《国际儿科学杂志》2022年第10期672-675,共4页International Journal of Pediatrics

基　　金：昆明市卫生科技人才培养项目暨"十百千"工程(2019-SW(省)-17)。

摘　　要：甲状腺激素(thyroid hormone,TH)是人体重要的激素之一,对心血管系统有着重要作用。研究发现体外循环过程中低体温、血液稀释、血管内皮损伤、缺血再灌注、炎性因子释放等因素会造成甲状腺功能障碍,导致正常甲状腺病态综合征(euthyroid sick syndrome,ESS)。ESS与术后心输出量降低、外周血管阻力增高密切相关,严重影响患儿预后。术后补充TH能够降低ESS的程度,特别是在低龄和复杂先心病儿童群体中有明显临床优势。但不同的临床研究存在差异,TH替代治疗目前还存在争议。该文对TH对心血管系统的影响及ESS和体外循环手术的关系进行综述,汇总分析目前ESS治疗的临床资料,以助于确立新的研究方向。Thyroid hormones(TH),one of the human′s essential hormones,play a crucial role in the cardiovascular system.Studies have shown that hypothermia,blood dilution,vascular endothelial injury,ischemia-reperfusion,and inflammatory factor release during cardiopulmonary bypass may cause thyroid dysfunction,leading to the euthyroid sick syndrome(ESS).There is a close correlation between ESS and postoperative low cardiac output and elevated systemic vascular resistance,which seriously affects the prognosis of pediatric patients.Studies have shown that perioperative supplementation of thyroid hormones can reduce ESS levels,especially among pediatric patients and those children with complex congenital heart disease have apparent clinical advantages.However,the results from different clinical studies varied,and currently,thyroid hormone replacement therapy is under debate.This review examines the available literature on the clinical effects of thyroid hormone on the cardiovascular system and the relationship between ESS and cardiopulmonary bypass.The clinical evidence of the treatment of ESS is gathered and discussed with an intent to find a gap for further research.

关 键 词：儿童 正常甲状腺病态综合征 甲状腺激素 体外循环 先天性心脏病 

分 类 号：R726.5[医药卫生—儿科]