体外循环围手术期患者甲状腺功能改变的临床研究

Changes in thyroid gland function during perioperative period of extracorporeal circulation

目的 :探讨体外循环围手术期甲状腺功能的改变。方法 :采用放射免疫分析法 ,连续测定 45例低温体外循环心内直视手术患者围手术期甲状腺激素的动态变化。结果 :2组患者三碘甲状腺原氨酸 (T3)、游离 T3(FT3)从转流前〔T3: 组 (1.32± 0 .77) nmol/ L , 组 (1.0 4± 0 .72 ) nm ol/ L ;FT3: 组 (2 .92± 0 .94) pmol/ L , 组 (2 .6 1± 0 .80 ) pmol/ L〕至术后 48小时〔T3: 组 (1.2 6± 0 .34 ) nmol/ L , 组 (1.2 3± 0 .0 3) nm ol/ L ;FT3: 组 (2 .81± 0 .86 ) pm ol/ L , 组 (1.83± 0 .31) pm ol/ L〕,各时相值明显低于术前〔T3: 组 (1.77± 0 .6 3) nmol/ L , 组 (1.5 7± 0 .32 ) nm ol/ L;FT3: 组 (3.2 9± 1.36 ) pmol/ L, 组 (4.75± 1.15 ) pmol/ L〕,P<0 .0 5或 P<0 .0 1。T4在整个手术期无明显改变 ,与术前比较 P均 >0 .0 5。FT4各时相值较术前略有上升 ,但 P均 >0 .0 5。TSH各时相无明显改变。结论 :体外循环围手术期对患者甲状腺功能有一定的抑制作用 ,可发生 T3降低 ,对心脏直视手术后的功能恢复产生一定影响 ,故围手术期间适当给予患者 T3治疗 ,有利于促进机体功能的恢复。

Objective:To observe changes in thyroid gland function during perioperative period of extracorporeal circulation.Methods:By use of radioimmunoassay,thyroid hormone levels were detected in 45 patients during perioperative period,who underwent hypothermia extracorporeal circulation in intracardiac surgical repair under direct vision.Results:Our findings indicated that triiodothyronine (T 3) and free triiodothyronine (FT 3) in both groups decreased from the passing of circulation 〔T 3:group Ⅰ(1 32 ±0 77)mmol/L,groupⅡ(1 04±0 72)nmol/L;FT 3:groupⅠ(2 92±0 94)pmol/L,groupⅡ(2 61±0 80)pmol/L〕 to 48 hours after operations 〔T 3:group Ⅰ(1 26±0 34)mmol/L,groupⅡ(1 23±0 03)nmol/L;FT 3:groupⅠ(2 81± 0 86)pmol/L ,groupⅡ(1 83±0 31)pmol/L〕.All these values were obviously lower than those before operation〔T 3:group Ⅰ(1 77±0 63)nmol/L,groupⅡ(1 57±0 32)nmol/L;FT 3:groupⅠ(3 29±1 36)pmol/L,groupⅡ(4 75±1 15)pmol/L; P <0 05 or P <0 01〕.However,no marked changes in tetraiodothyronine (T 4) as well as thyroid stimulating hormone (TSH) levels were found during the whole operative period (all P >0 05),while free tetraiodothyronine (FT 4) slightly increased (all P >0 05).Conclusions:The results suggest that thyroid gland function could be inhibited during the perioperative period of extracorporeal circulation.A decrease of T 3 has effect on functional recovery of intracardiac surgical repair under direct vision.Therefore,treatment with T 3 during the perioperative period appears to be beneficial for patients after extracorporeal circulation.