1岁以下先天性心脏病患儿体外循环下心脏术后甲状腺激素水平与延迟恢复的关系

Relationship Between Thyroid Hormone Levels and Prolonged Recovery After Cardiac Surgery With Cardiopulmonary Bypass in Congenital Heart Disease Children Younger Than 1 Year of Age

目的 ：探索1岁以下先天性心脏病患儿体外循环下心脏术后甲状腺激素水平与延迟恢复的关系。方法：回顾性分析2014-01至2015-01期间,在我院行体外循环心脏手术的186例1岁以下患儿资料,将术后小儿重症恢复室（PICU）停留时间≥5天定义为延迟恢复,据此将186例患儿分成两组,PICU停留时间≥5天的为延迟恢复组（n=39）,PICU停留时间〈5天的为非延迟恢复组（n=147）。对患儿术后的24 h甲状腺激素水平与延迟恢复情况进行统计分析。结果：与非延续恢复组比较,延迟恢复组术后24 h游离三碘甲状腺原氨酸[FT3,（2.02±0.48）pg/ml vs（2.27±0.46）pg/ml]、总三碘甲状腺原氨酸[TT3,（0.59±0.30）ng/dl vs（0.71±0.24）ng/dl]、总甲状腺素[TT4,（5.39±2.58）μg/ml vs（6.49±2.20）μg/ml]水平显著降低,差异均有统计学意义（P〈0.05）。但是两组间游离甲状腺素水平及促甲状腺激素水平差异无统计学意义（P〉0.05）。多因素Logistic回归分析结果显示,术后24 h内的低水平的FT3（比值比=0.32;95%可信区间：0.12~0.84;P〈0.05）是延迟恢复的独立危险因素。线性回归分析结果显示,术后低水平的FT3与患儿的体重线性相关（r=0.11,P〈0.001）。结论：1岁以下患儿体重越轻,术后24 h内的FT3水平越低;低水平FT3是患儿术后延迟恢复的独立危险因素。

Objective： To explore the relationship between thyroid hormone levels and prolonged recovery after cardiac surgery with cardiopulmonary bypass （CPB） in congenital heart disease （CHD） children younger than 1 year of age. Methods： A total of 186 CHD children younger than 1 year treated in our hospital from 2014-01 to 2015-01 were retrospectively summarized. According to the pediatric intensive care unit （PICU） stay time, the patients were divided into 2 groups： Prolonged recovery group, the patients stated in PICU≥5 days, n=39 and Non-prolonged recovery group, the patients stayed in PICU〈5 days, n=147. Thyroid hormone levels within 24 hours of operation with prolonged recovery conditions were studied. Results： Compared with Non-prolonged recovery group, the patients in Prolonged recovery group showed decreased levels of FT3 （2.02± 0.48） pg/ml vs （2.27 ± 0.46） pg/ml, TT3 （0.59 ±0.30） ng/dl vs （0.71 ± 0.24） ng/dl and TT4 （5.39 ± 2.58） μg/ml vs （6.49 ±2.20） μg/ml, all P〈0.05; while the levels of free thyroid hormone and thyrotropin were similar between 2 groups, P〉0.05. Multivariable logistical regression analysis presented that low level of FT3 within 24 hours of operation was the independent risk factor for prolonged recovery （OR= 0.32, 95% CI 0.12-0.84, P=0.02）; linear regression analysis indicated that post-operative reduction of thyroid hormone was related to low body weight of the patients （r=0.11, P〈0,001）. Conclusion： Lower body weight was usually having lower level of FT3 within 24 hours of operation, which was the independent predictor for prolonged recovery in CHD children younger than 1 year after cardiac surgery.