天津医药

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非体外循环冠状动脉搭桥手术对老年患者甲状腺功能的影响

孙德权1,孟冬梅2,李培军3,王联群3,姜楠4   

  1. 1. 天津胸科医院心脏外科
    2. 天津市胸科医院心外监护
    3. 天津市胸科医院心外科
    4. 天津市胸科医院
  • 收稿日期:2010-08-12 修回日期:2010-12-09 出版日期:2011-07-15 发布日期:2011-07-15
  • 通讯作者: 孙德权

Effect of Off-pump Coronary Artery Bypass Surgery on Thyroid Function and Clinical Implications Among Patients Aged Over 80-year-old

  • Received:2010-08-12 Revised:2010-12-09 Published:2011-07-15 Online:2011-07-15
  • Contact: De-Quan SUN

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摘要： 目的 探讨80岁以上非体外循环冠状动脉搭桥手术患者甲状腺功能的变化, 并分析其与术后心功能关系. 方法 50例病人分别于术前1天, 返回监护室即刻, 和术后第1, 2, 5天检测甲状腺功能. 根据欧洲心脏手术风险评估系统将病人分为高风险组和中低风险组, 分析两组病例甲状腺激素水平及围术期临床资料的差异. 结果 50例患者除外游离四碘甲腺原氨酸术后出现一过性上升, 其余甲状腺激素水平均下降. 高风险组和中低风险组主动脉内气囊反搏(IABP)使用, 术后24小时正性肌力药物评分, 呼吸机辅助时间和ICU监护时间存在显著差异(P<0.05或P<0.01). 高风险组术后总三碘甲腺原氨酸(P<0.01), 游离三碘甲腺原氨酸(P<0.01或P<0.05)和促甲状腺激素(P<0.01或P<0.05)明显低于中低风险组. 其甲状腺功能低谷时段恰好是该组病例术后血流动力学不稳定期 结论 非体外循环冠状动脉搭桥手术不能防止正常甲状腺功能病态综合征的发生. 甲状腺激素与心外科术后早期心功能的恢复关系密切, 是评估心功能障碍病人转归的重要指标.

关键词: 甲状腺激素, 正常甲状腺功能病态综合征, 心脏重症监护, 冠状动脉分流术

Abstract: Objective: The aim of this study is to evaluate altered thyroid function after off-pump coronary artery bypass surgery among patients aged over 80-year-old, and to investigate the potential association between thyroid alterations and postoperative parameters. Methods: From 2005-6 to 2009-12, alterations in thyroid function were analyzed in 50 patients. The blood samples were taken on 1 day prior to surgery, upon arrival to ICU, and on postoperative day 1, 2, 5. Meanwhile, according to European System for Cardiac Operative Risk Evaluation, the patients were divided into high risk group or median and low risk group. The altered thyroid function and perioperative parameters were compared between two groups. Results: Among 50 patients studied, except free thyroxine increased transiently, other thyroid hormone decreased significantly. There were statistical differences between the groups in clinical data, including inotropic score, IABP assist, mean duration of ventilatory support and mean length of ICU stay. Additionally, 12 patients of high risk group exhibited significantly lower levels of total and free triiodothyronine as compared with 38 patients of median and low risk group; No significant differences in levels of total and free thyroxine were observed between two groups; Thyroid-stimulating hormone differed significantly between two groups, and the recovery in thyroid-stimulating hormone was observed in median and low risk group, as was recognized the initiation of re-establishment of thyroid hormones homeostasis from suppression. Conclusion: Our findings indicated that off-pump surgery could not prevent the onset of nonthyroid illness syndrome, and the low triiodothyronine in critically cardiosurgical patients was observed to correspond to the period when hemodynamic dysfunction occurred, which had important implications for prognosis and therapy after cardiac surgery.

Key words: Thyroid hormone, Nonthyroid illness syndrome, Cardiac intensive care Coronary artery bypass surgery