摘要
目的研究口服甲状腺素对成人瓣膜置换围术期甲状腺激素和血流动力学的影响。方法拟行瓣膜置换手术的患者40例,采用随机、双盲的方法分为试验组(T组)和对照组组(NT组),每组20例。T组患者手术前48 h至体外循环(CPB)后48 h按50μg/8 h口服甲状腺素片,NT组给予安慰剂。分别于给药前(T1)、术前2 h(T2)、主动脉开放(T3)、CPB后6 h(T4)、12 h(T5)、24 h(T6)、48 h(T7)抽取血样测定血浆FT3,FT4,T3,T4,TSH浓度。分别于T1、T2、T4、T5、T6、T7测量BMR、PCWP、SVRI、PVRI、LVSWI。结果 NT组在T3～T6血浆FT3、FT4、T3浓度持续降低,在T6分别较T1下降了约50%、40%、55%(P<0.05)。T组在T3～T6血浆FT3、FT4、T3浓度也持续降低,但均高于NT组(P<0.05)。两组各时间点血浆T4、TSH浓度无显著性差别(P>0.05)。两组各时间点基础代谢率无显著性差别(P>0.05)。T组SVRI、PVRI值在T3～T6均低于NT组(P<0.05),LVSWI值在T3～T6均高于NT组(P<0.05)。结论口服甲状腺素能安全、有效防治CPB围术期甲状腺病态综合征,能有效改善CPB后血流动力学紊乱。
Objective To investigate the impact of oral thyroxine on serum thyroid hormone concentration and hemodynamics at peri-operation of valvular cardiac surgery in adults. Methods Forty patients to be underwent cardiac surgery for valvular disease with invasive hemodynamic monitoring were randomly divided into 2 groups： the T group（n=20） received oral triiodothyronine, 50μg/8 h, initiated 48 h before surgery and maintained for 48 h; the NT group （n=20） received placebo. Serum FT3, FT4, T3, T4, TSH were determined at baseline （T1）, 2 h before surgery（T2）, removal of the aortic cross-clamp（T3）, and 6 h（T4）, 12 h（Ts）, 24 h（T6）, and 48 h（TT） after cessation of CPB. BMR, PCWP, SVRI, PVRI, LVSWI were measured at T1, T2, T4, Ts, T6, T7. Result The two groups were compared with respects of age, sex, stature, body weight, ejection fraction, accompanying diseases, duration of CPB and aortic cross-clamping time. In the NT group, serum FT3, FT4, T3 levels were progressively decreased from T3 to T6, and there were significant reduction of 50%, 40%, 55% when comparing T6 with baseline level （P〈0.05）. The concentrations of serum FT3, FT4, T3 in the T group were significantly higher than those in the NT group （P〈0.05）. Serum T4, TSH levels were no significantly difference in both groups （P〉0.05）. BMR levels were no significantly difference in both groups （P〉0.05）. The SVRI, PVRI in the T group were significantly lower than those in the NT group from T4 to T6 （P〈0.05）, and the LVSWI in the T group were significantly higher than those in the NT group from T4 to T6 （P〈0.05）. Conclusion Triiodothyronine replacement therapy at perioperation of valvular cardiac surgery in adults could prevent ESS safely and effectively, and could improve postoperative hemodynamic dysfunction.
出处
《实用医药杂志》
2012年第1期1-4,共4页
Practical Journal of Medicine & Pharmacy
