常温不停跳及低温停跳心内直视手术围术期甲状腺激素代谢比较

Comparison of Peri Operative Thyroid Hormone Metabolism in Warm Beating and Cold Cardioplegic Open Heart Surgery

目的 :探讨常温心脏不停跳 (非停跳组 )与低温停跳 (停跳组 )心内直视手术两组病历围术期低三碘甲状腺原氨酸 (T3)综合征发生程度比较及临床意义。方法 :用放射免疫分析法测定非停跳组 2 1例及停跳组 2 3例术前、体外循环 (ECC)转流 10 m in、停 ECC10 m in、术后 2 ,2 4,48h血清 T3、四碘甲状腺原氨酸 (T4)、逆三碘甲状腺原氨酸 (r T3)及促甲状腺素 (TSH)的浓度变化 ,分别与术前以及两组之间各时点进行比较。结果 :围术期两组均发生低T3综合征 ,但非停跳组发生程度比停跳组减轻。结论 :ECC心内直视手术围术期呈现低 T3综合征 ,常温心脏不停跳心内直视手术围术期低 T3综合征发生程度较低温停跳心内直视手术减轻。

Objective:Our purpose was to compare the occurrence and evaluate the significance of low triiodothyronine(T3) syndrome in warm beating and cold cardioplegic open heart surgery. Methods: Forty four patients were included in the study, 21 of them were in the warm beating surgery group and 23 were in the cold cardioplegic group. Blood were sampled before the operation, 10 min after the beginning of the operation, and weaning of extracorporeal circulation (ECC) respectively. Blood were also sampled at 2 hours, 24 hours, 48 hours after operation. The serum concentration of T 3, thyroxin (T 4), reverse T 3 (rT 3), and thyroid stimulating hormone (TSH) were measured with radioimmunoassay. Results: Low T3 syndrome occurred in both groups, but in the warm beating surgery group, the syndrome was not so severe.Conclusion:Low T 3 syndrome is ameliorated in warm beating heart surgery ,when compared with cold cardioplegic heart surgery .This indicates that warm beating heart surgery is less traumatic to body function.