亚临床甲状腺功能减退与冠状动脉旁路移植术后患者院内治疗相关性研究

Correlation Analysis of Subclinical Hypothyroidism With its Treatment in Patients After Coronary Artery Bypass Grafting

目的 ：研究亚临床甲状腺功能减退（简称：亚临床甲减）与冠状动脉旁路移植术（CABG）患者术后治疗的相关性。方法 ：收集2010-07至2014-03我院同一手术团队1 500例单纯行CABG患者资料,其中亚临床甲减组107例,甲状腺功能正常组1 393例,经1：4比例倾向性评分匹配后,共104对行CABG患者最终纳入研究。观察项目包括：主动脉内球囊反搏（IABP）置入率、围术期的输血率、机械呼吸辅助时间、新发脑梗死、新发心肌梗死、新发心房颤动、恶性心律失常、急性肾功能不全、院内死亡等事件。本研究比较了经倾向性匹配后的两组术后事件,并对治疗结果进行单因素和多因素分析。结果：经倾向性匹配后,亚临床甲减组的机械辅助呼吸时间明显长于甲状腺功能正常组（23.3±47.9 vs 15.0±5.5,P〈0.05）,机械辅助呼吸时间〉12 h率高于甲状腺功能正常组（89.4%vs 78.8%,P〈0.05）,IABP置入高于甲状腺功能正常组（3.8%vs 0.72%,P〈0.05）,且与亚临床甲减存在相关性[比值比（OR）值分别为2.363及6.126,95%可信区间（95%CI）分别为1.183～4.516及1.190～31.537）。包括院内死亡等其他事件两组差异无统计学意义（P〉0.05）。结论：基于本研究两组资料,亚临床甲减组与机械辅助呼吸时间及IABP置入比率存在相关性。

Objective： To study subclinical hypothyroidism （SCH） with its treatment in patients after coronary artery bypass grafting （CABG）. Methods： A total of 1500 patients received CABG by the same surgical team in our hospital from 2010-06 to 2014-03 were retrospectively studied. According to thyroid function, the patients were divided into 2 groups： SCH group,n=107 and Normal group, n=1393. With 1：4 propensity score matching, there were 104 patients in SCH group and 416 patients in Normal group enrolled in our research. The rates of intra-aortic balloom pumping （IABP） implantation and peri-operational blood transfusion, mechanical ventilation time, new onsets of stroke, myocardial infarction and atrial ifbrillation, malignant arrhythmia, acute kidney injury and in-hospital mortality were observed. The outcome of treatment was assessed by single- and multi-factor analysis. Results： Compared with Normal group, SCH group showed increased mechanical ventilation time （23.3±47.9） h vs （15.0±5.5） h, P〈0.05; more patients had mechanical ventilation time〉12 h （89.4% vs 78.8%）,P〈0.05 and more patients had IABP implantation （3.8% vs 0.72%）,P〈0.05. SCH was related to mechanical ventilation time〉12 h （OR=2.363, 95% CI 1.183-4.516） and IABP implantation （OR=6.126, 95% CI 1.190-31.537）. The in-hospital death and other events were similar between 2 groups,P〉0.05. Conclusion： Our research indicated that SCH was related to mechanical ventilation time and IABP implantation in patients after CABG.