甲状腺激素水平对冠状动脉旁路移植患者早期结果的影响

Impact of thyroid hormone levels on the early results after coronary artery bypass grafting in euthyroid subjects

目的 通过回顾性分析正常甲状腺功能的冠状动脉旁路移植术（CABG）术后相关并发症,探讨不同甲状腺激素水平是否影响CABG患者的早期结果。方法 收集2010年7月—2014年3月由阜外医院同一手术团队治疗的男性正常甲状腺功能CABG患者资料,其中311例低甲状腺激素水平[血清游离三碘甲状腺原氨酸（FT3）浓度1.79～2.93 pg/ml]为试验组（L组）,经左室射血分数、年龄进行1∶1匹配,311例高甲状腺激素水平（FT3浓度2.94～4.09 pg/ml）患者为对照组（H组）。观察早期结果项目包括：机械辅助呼吸时间、ICU滞留时间、术后住院天数,新发脑梗死、心肌梗死、新发房颤、急性肾功能不全（AKI）、恶性心律失常、气管切开、主动脉内球囊反搏（IABP）植入、院内死亡等事件。结果 L组的术后住院天数6（6,9）（四分位数表示）明显长于H组的术后住院天数6（6,9）（Z=4.159,P〈0.05）,IABP植入率为2.6%及AKI发生率为17.7%,高于H组的0.3%及9.0%（χ^2=5.524、10.136,P〈0.05）。而院内死亡、气管切开、血液透析、恶性心律失常、新发脑梗死、新发房颤、心肌梗死等早期事件发生率差异无统计学意义（P〉0.05）。结论 甲状腺激素水平显著影响CABG的早期结果。

Objective To study the impact of different thyroid hormone levels on the early results after coronary artery by- pass grafting（CABG） in euthyroid subjects by reviewing retrospectively the postoperative complications. Methods The data of 622 male patients undergoing CABG in our hospital between July,2010 and March,2014 were reciewed. The 311 patients with lower-Thyroid hormone level（ NF3 ： 1.79 - 2.93 pg/ml） were assigned into in the L group, while another 311 male cases with higher-Thyroid hormone level male （FT3：2.94 -4.09 pg/ml） matched with age and left ventricular ejec- tion fraction were assigned into H （control） group. The mechanical venitation time,length of ICU stay,length of stay after operation, new happened stroke, myocardical infartion, mortality, atrial fibrillation, hemodialysis, acute kidney injury, trach- eotomy, aligent arrhythmia, intra-aortic balloon pumping（IABP） implant were comparative analyzed. Results The length of stay after operation longer in group L[6 days（6,9） ] was more than that in the control[ 6 days（6,9） ] （Z=4. 159,P 〈 0.05 ）. The IABP implant（2.6% ） and incidences of acute kidney injury（ 17.7% ） in group L were higher those（0.3% and 9.00% ） in Group H（x^2 = 5. 524,10. 136 ,P 〈 0.05 ）. The incidences of new happened stroke, myocardical infarc- tion, mortality, atrial fibrillation, hemodialysis, maligent arrhythmia, tracheotomy were not statistically significant between the two groups（P 〉 0.05）. Conclusion The lower-thyroid hormone level can significantly impact the early results after CABG.