心脏手术期间及术后血浆甲状腺激素的变化

Changes of thyroid hormones in plasma during and after heart surgery

目的观察心脏手术期间及术后血浆甲状腺激素的变化规律。方法在静脉复合麻醉下行心脏手术，分别在麻醉前、诱导插管后5min、转流开始后10min、停止转流后30min及术后1、3、5d等时间点从外周静脉取血5ml，进行血浆T3。FT3、T4、FT4、TSH的放射免疫测定。结果在转流期间血浆T3、FT3、T4、FT4均显著降低（P＜0．001）；停止转流后有所回升；术后1、3、sd血浆T3、FT3甚至低于转流停止后水平（P＜0.01），而血浆T4、FT4则回升并接近术前水平（P＞0．05）。结论本研究表明在心脏手术期间和术后，确实存在低T3或T4综合征，其对心脏复跳及术后低心排综合征的发生有何作用有待研究。

Objective To investigate the changes of plasma thyroid hormones during and aller heart surgery. Methods Open heartoperation were performed on 11 patients with combined intravenous anesthesia Plasma thyroid hormones were determinedpreanesthetically, 5 min after the induction of anesthesia, 10 min after starting cardiopulmonare bypass (CPB), 30 min after thetermination of CPB, and l, 3 and 5'days after operation. ResultS The levels of total (T,) and free (FT,) triiodothyronine, total (T4)and free (FT4) thyroxine, and thyroid-stimulating hormone (TSH) markedly decreased during CPB and slightly increased after thetermination of CPB, and the levels of T, and FT3 at l, 3 and 5 da}'s after operation were lower than those after the termination ofCPB, while the level of T. and FT4 rose again and approached their preoperative levels at l, 3 and 5 days after operation. ConclusionThe results suggest that there was indeed 'low T, or T. syndrome' during and aller open heart operation.