慢性肺原性心脏病合并甲状腺机能亢进伴左心功能不全的临床分析

Clinical study on the left cardiac insufficiency of chronic cor pulmonale complicated hyperthyroidism

目的：探讨慢性肺原性心脏病（肺心病）合并甲状腺机能亢进（甲亢）患者左心功能不全的临床特点和治疗措施。方法：总结和分析了９例肺心病合并甲亢出现左心功能不全患者的临床资料。结果：患者左心功能不全发生于肺心病的各病情分期及甲亢治疗中断后，临床特征除肺心病表现外，均出现心率加速、心律不齐、不同程度的左心扩大、顽固性心力衰竭、游离三碘甲状腺原氨酸和甲状腺素明显增高等突出的甲亢性心脏病表现。９例中８例经按肺心病治疗和抗甲亢治疗后，左心功能不全纠正，心律失常消失；１例未抗甲亢治疗患者死于左心衰竭。存活患者中４例随访０．５～２．０年，甲亢控制，心功能不全无复发。结论：肺心病合并甲亢患者，甲亢未控制可能是诱发左心功能不全的主要因素，左心功能不全心脏病的基础病因主要为甲亢性心脏病，其左心功能不全的治疗除对肺心病治疗外，还应积极抗甲亢治疗。

Objective:To investigate the clinical characteristics and therapeutic measures on the left cardiac insufficiency due to chronic cor pulmonale complicated hyperthyroidism.Methods:Nine cases with left cardiac insufficiency of chronic cor pulmonale comp licated hyperthyroidism were analyzed.Results:The left cardiac insufficiency occurred after interrupting the treatment on hyperthyroidism and every clinical stage of chronic cor pulmonale.All cases had some striking clinical manifestation of hyperthyroidism heart disease,such as heart rate acceleration,arrhythmia,left ventricular enlargement,refractory heart failure,free triiodothyronine and thyroxine significantly rised etc.and else manifestation of chronic cor pulmonale.There were 8 cases among 9 cases were treated according to therapeutic rules of chronic cor pulmonale and hyperthyroidism,and left cardiac insufficiency was corrected,arrhythmia disappearanced.But another one among 9 cases died from left heart failure for not antithyroidism treatment.There were 4 patients were followup survival for 6 months to 2 years.Their hyperthyroidism were controlled,and heart failure were not recurrence.Conclusions:For the patients with chronic cor pulmonale complicated hyperthyroidism,hyperthyroidism isn′t controlled may be an important factor for inducing the left cardiac insufficiency.Hyperthyroidism cardiac disease is the cardiac basic cause of left cardiac insufficiency.So it′s important to treat hyperthyroidism vigorously as well as cor pulmonale to improve the left cardiac insufficiency.