心脏病患者剖宫产甲状腺激素与循环功能的关系

Monitoring of Plasma Thyroid Hormone Concentrations and Circulatory Functions in Patients with Organic Heart Diseases during Cesearean Section

目的观察心脏病患者剖宫产围术期血浆甲状腺激素水平改变与循环功能、心肌酶学指标的关系及其临床意义。方法 30例剖宫产孕妇分为对照组（Ⅰ组,n=14）和心脏病组（Ⅱ组,n=16）,连续监测围术期心排量、血压,测定肌酸磷酸激酶（CPK）、乳酸脱氢酶（LDH）、谷草转氨酶（GOT）及肌脑肌酸磷酸激酶（CK-MB）,采用放免法测定术前、取胎和术毕时血浆游离三碘甲腺原氨酸（FT3）、反三碘甲腺原氨酸（rFT2）、FT3/rFT3和促甲状腺激素（TSH）浓度。结果1.血流动力学指标:各组患者进腹时CI、MAP和SVR均明显下降,心脏病患者下降幅度大于对照组（P<0.05）。2.心肌酶学指标:心脏病患者CPK、LDH、GOT异常变化发生率明显增加。3对照组术中FT3、rFT3和TSH浓度变化无统计学意义;心脏病组和术前相比FT3、T3/rFT3于取胎儿和术毕5min时明显下降（P<0.05）,rFT3和 TSH明显增加（P<0.05）。4.CI与FT3/rFT3有较好相关性。结论 心脏病产妇术中血流动力学异常发生率明显增加;心脏病患者剖宫产术中甲状腺激素测定可作为反映病情严重程度和预后的参考指标。

To evaluate the relationship among circulatory function, myocardial zymetology and plasma thyroid hormone concentration in patients with heart diseases during cesearean section. Methods Thirty pregnant women undergoing cesearean section were divided into two groups: control group (group I , n = 14 ), and heart disease group (group Ⅱ , n = 16 ). Plasma thyroid hormone concentrations were measured by radioimmunoassay, while hemodynamic parameters were determined by noninvasive cardiac output monitoring, and CPK, LDH, GOT and CK- MB were measured simultaneously. Results 1. Hemodynamic parameters: the values of CI, MAP and SVR decreased obviously when entering into the abdomen in each group and the amplitude in heart disease groups was larger than in group I ( P < 0.05 ). 2. CPK, LDH and GOT increases in pregnant patients heart failure and were related to newborn cyanosis. 3. Changes of plasma thyroid hormone concentrations in group I during operation were not significant. FT3, T3/rFT3 were markedly decreased during newborn delivery and 5min after operation ( P < 0.05 ) while the levels of rFT3 and TSH were significantly increased in the heart disease group in comparision with pre - operation ( P < 0.05 ). 4. There was a positive correlation between CI and T3/rFT3 at the perioperative period. Conclusion Pregnant women with heart diseases are inclined to have hemodynamic abnormalities and are directly related to newborn cyanosis. Measurement of plasma thyroid hormone may be a useful method to predictseverityand prognosis of patients with heart diseases during cesearean section.