外源性甲状腺素对婴幼儿心脏手术围术期血流动力的影响

Effects of thyroid hormone on cardiac function during open heart surgery in infants

目的研究外源性甲状腺素对婴幼儿心内直视术围术期血流动力的影响。方法将20例婴幼儿室间隔缺损(VSD)患者,随机分为A组(用药组)和B组(对照组),A组除常规围术期处理外,于术前2d至术后第3d口服甲状腺素片,0.4mg/kg/d。B组只作常规围术期处理,未用药。两组均于术前、术中、术后第1d、术后第3d测定血浆T3、T4及FT3浓度以及心率、血压,并记录,比较两组T3、T4、FT3、心率及血压的变化。结果两组患儿术前甲状腺素无显著差异,术后均存在甲状腺素水平下降,A组甲状腺素水平术后恢复正常较快,动脉血压较稳定,术后血管活性药物用量少,循环系统功能稳定。结论围术期口服小剂量甲状腺素,有利于改善婴幼儿心内直视术后的低甲状腺素状态,能改善术后心功能,维持循环系统功能的稳定。

Objective To study effects of the exogenous thyroxine on the cardiac function of perioperation of open heart operation in infants. Methods 20 infants with congenital hear disease were divided at random into two groups. Group A routine perioperative management plus oral thyroxine： a table of 0.4mg/kg/d for 2 days perioperation and 3 days postoperation. Group B： only received routine management after open heart operation. Serum T3, T4, FT3, HR and BP were measured respectively in the preoperation, perioperation and postoperation in all patients. Results Before the operation, serum levels of T3, T4 and FT3 in two groups were no obviously different, but serum thyroxine levels were decreased post-operation. All patients occurred serious euthyroid sick syndrome （ESS）. Post-operation, serum thyroxine level recovered rapidly, the ESS was alleviated, BP stable vasoactive agent dosage was reduced in group A. Conclusion Administration of low dose thyroxine in perioperation could improve ESS, cardiovascular function after open heart operation in infants.