心内直视手术后甲状腺功能减退患者的治疗策略

The experience for patients with hypothyroidism after cardiopulmonary bypass

目的总结心内直视手术后甲状腺功能减退(甲减)患者的治疗方法。方法 2005年1月～2009年12月我院心内直视手术前后发生甲减的患者18例,术前确诊甲减者8例,术后确诊者10例。结果死亡3例,病死率16.7%。术前确诊者,术前均服用左旋甲状腺素片,术后并发广泛性肺渗出、低心排血量(低心排)各1例,其余6例顺利恢复,无死亡;术后确诊者,术后并发低心排6例,呼吸衰竭4例,死亡3例,死因分别为多器官功能衰竭2例,顽固性低氧血症1例。结论术前避免漏诊甲减,一旦确诊,尽早补充甲状腺素片,术后严防并发症是心内直视手术后甲减患者顺利恢复的关键。

Objective To summarize the experience for patients with hypothyroidism after cardiopulmonary bypass.Methods Between January 2005 and December 2009,18 patients（11 male,7 female）with hypothyroidism after cardiopulmonary bypass.The age was from 5 to 68 years[mean（56.2±6.4）years],the body weight was from 18 to 62kg[mean（45.2±7.5）kg].Results The hospital mortality rate was 16.7%（n=3）.8 patients treated with exogenous thyroid hormone when they were diagnosed as hypothyroidism before corrective surgery,no patient died.Complication included extensive pulmonary infiltration in 1 patient and low cardiac output syndrome（LCOS） in another patient.The another 6 patients recovered smoothly;10 patients were diagnosed as hypothyroidism after corrective surgery.The causes of early death in 3 patients were multiple organs failure in 2 patients and refractory postoperative hypoxemia in 1 patient.Complication included LCOS 6 patients and postoperative respiratory failure 4 patients.Conclusion Avoiding preoperative misdiagnosis,Treating as early as possible when diagnosis was made,Prevention and cure the complication are all of great importance for recovery of the patients.