术前给予甲状腺素对体外循环心脏直视术后患儿血流动力学和甲状腺激素水平的影响  

Effect of preoperative thyroxine administration on hemodynamics and thyroid hormone levels in children after open heart surgery with extracorporeal circulation

作　　者：刘大为 崔琳 刘宇航 卢绪宁 朱全伟 LIU Da-wei;CUI Lin;LIU Yu-hang(Intensive Care Department,Dalian Women's and Children's Medical Center(Group)Hope Square Hospital,Dalian 116000,China)

机构地区：[1]大连市妇女儿童医疗中心(集团)希望广场院区重症医学科,116000 [2]大连市妇女儿童医疗中心(集团)希望广场院区心胸外科,116000

出　　处：《中国实用医药》2023年第10期104-107,共4页China Practical Medicine

基　　金：大连市医学科学研究计划项目;幼儿先心病围术期甲状腺激素变化及不同替代治疗研究。

摘　　要：目的分析术前给予甲状腺素对体外循环心脏直视术后患儿血流动力学和甲状腺激素水平的影响。方法50例行体外循环心脏直视术的患儿,采用随机数字表法分为对照组和观察组,每组25例。两组均在手术前2 d进行治疗。对照组给予安慰剂,观察组给予甲状腺片治疗。比较两组患儿手术前后的血流动力学指标[舒张压(DBP)、收缩压(SBP)、心率(HR)]水平、甲状腺激素[三碘甲状腺原氨酸(T_(3))、四碘甲状腺原氨酸(T_(4))、促甲状腺激素(TSH)]水平、重症加强护理病房(ICU)情况(ICU停留时间、气管导管保留时间、正性肌力药物使用率)。结果术前2 d,对照组SBP(104.37±11.74)mm Hg(1 mm Hg=0.133 kPa)、DBP(59.98±6.84)mm Hg、HR(97.73±18.47)次/min,观察组SBP(103.82±11.94)mm Hg、DBP(58.99±7.83)mm Hg、HR(98.96±19.04)次/min;术后3 d,对照组SBP(106.48±12.06)mm Hg、DBP(60.74±7.73)mm Hg、HR(100.78±13.05)次/min,观察组SBP(104.86±11.26)mm Hg、DBP(59.79±6.94)mm Hg、HR(102.83±14.96)次/min。两组患儿术后3 d的SBP、DBP、HR水平与术前2 d比较,术前2 d及术后3 d组间SBP、DBP、HR水平比较,差异均无统计学意义(P>0.05)。术后3 d,两组患儿T_(3)、T_(4)、TSH水平较术前2 d均降低,但观察组T_(3)(0.69±0.18)ng/ml、T_(4)(114.85±15.96)ng/ml、TSH(1.66±0.51)μIU/ml高于对照组的(0.51±0.12)ng/ml、(83.95±13.74)ng/ml、(1.20±0.47)μIU/ml,差异均具有统计学意义(P<0.05)。观察组ICU停留时间(46.39±7.04)h、气管导管保留时间(6.93±4.00)h与对照组的(47.95±8.10)、(6.74±4.03)h比较,差异均无统计学意义(P>0.05)。观察组正性肌力药物使用率4.00%低于对照组的32.00%,差异均具有统计学意义(P<0.05)。结论术前给予甲状腺素不会对体外循环心脏直视术后患儿血流动力学产生较大影响,同时可有效改善患儿术后甲状腺功能,降低正性肌力药物使用率。Objective To analyze the effect of preoperative thyroxine administration on hemodynamics and thyroid hormone levels in children after open heart surgery with extracorporeal circulation.Methods A total of 50 children undergoing open heart surgery with extracorporeal circulation were randomly divided into a control group and an observation group,with 25 cases in each group.Both groups received treatment 2 d before surgery.The control group was treated with placebo,while the observation group was treated with thyroid tablets.Both groups were compared in terms of hemodynamic indexes[diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR)],thyroid hormone[triiodothyronine(T_(3)),tetraiodothyronine(T_(4)),thyroid stimulating hormone(TSH)],ICU situation(ICU stay time,retention time of tracheal tube,utilization rate of positive inotropic agents)before and after surgery.Results 2 d before surgery,the control group had SBP of(104.37±11.74)mm Hg(1 mm Hg=0.133 kPa),DBP of(59.98±6.84)mm Hg,and HR of(97.73±18.47)beats/min;the observation group had SBP of(103.82±11.94)mm Hg,DBP of(58.99±7.83)mm Hg,and HR of(98.96±19.04)beats/min.At 3 d after surgery,the control group had SBP of(106.48±12.06)mm Hg,DBP of(60.74±7.73)mm Hg,and HR of(100.78±13.05)times/min;the observation group had SBP of(104.86±11.26)mm Hg,DBP of(59.79±6.94)mm Hg,and HR of(102.83±14.96)times/min.There were no statistically significant differences in SBP,DBP and HR levels 3 d after surgery in the two groups compared with those 2 d before surgery(P>0.05).There were no statistically significant differences in SBP,DBP and HR levels between the two groups 2 d before surgery and 3 d after surgery(P>0.05).At 3 d after surgery,the T_(3),T_(4),and TSH levels in both groups were lower than those 2 d before surgery in this group;the observation group had T_(3) of(0.69±0.18)ng/ml,T_(4) of(114.85±15.96)ng/ml,and TSH of(1.66±0.51)μIU/ml,which were higher than those of(0.51±0.12)ng/ml,(83.95±13.74)ng/ml,and(1.20±0.47)μIU/ml in the control gr

关 键 词：体外循环心脏直视 患儿 血流动力学 甲状腺激素 

分 类 号：R726.5[医药卫生—儿科]