体外循环下心脏外科手术成人患者围术期甲状腺激素水平变化分析

Changes of perioperative thyroid hormone in adult patients undergoing cardiac surgery under cardiopulmonary bypass

目的分析体外循环(CPB)下心脏外科手术患者围术期甲状腺激素水平的变化,为心脏围术期管理提供一定的指导依据。方法收集2019年1~5月我院CPB下行心脏外科手术72例患者的临床资料,其中男35例、女37例,年龄19~72(52.35±10.40)岁。分析甲状腺激素在术前、术后2 h、术后24 h变化趋势。结果 CPB心脏术后2 h血清促甲状腺激素(TSH)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、游离四碘甲状腺原氨酸(FT4)与术前的差异有统计学意义(P<0.05);术后24 h TSH、T3、游离三碘甲状腺原氨酸(FT3)、T4、FT4与术前的差异有统计学意义(P<0.05);术后24 h TSH、T3、FT3、T4与术后2 h的差异有统计学意义(P<0.05);术后T3、FT3下降,TSH上升后下降,T4、FT4在正常范围内。重复测量方差分析结果显示TSH、T3、FT3、T4、FT4在时间效应上差异均有统计学意义。结论 CPB下心脏外科手术患者术后甲状腺激素较术前有差异,T3、FT3下降,TSH上升后下降,T4、FT4在正常范围内,今后尚需开展大样本、多中心、高质量的临床研究进一步验证。

Objective To analyze the changes of perioperative thyroid hormone in patients undergoing cardiac surgery under cardiopulmonary bypass,and to provide guidance for postoperative cardiac management.Methods The clinical data of 72 patients receiving cardiac surgery under cardiopulmonary bypass in our hospital from January to May2019 were collected,including 35 males and 37 females,aged 19-72(52.35±10.40) years.The changes of thyroid hormones before operation,2 hours and 24 hours after operation were analyzed.Results There was a statistical difference in thyroid stimulating hormone(TSH),triiodothyronine(T3),tetraiodothyronine(T4) and free tetraiodothyronine(FT4)between postoperative 2 hours and preoperation(P<0.05).There was a statistical difference in TSH,T3,free triiodothyronine(FT3),T4 and FT4 between postoperative 24 hours and preoperation(P<0.05).There was a statistical difference in TSH,T3,FT3 and T4 between postoperative 24 hours and 2 hours(P<0.05).Postoperatively T3 and FT3 decreased,TSH increased and then decreased while T4 and FT4 were within the normal range.Repeated measures analysis of variance showed a statistical difference of time effect in TSH,T3,FT3,T4 and FT4.Conclusion Patients with cardiac surgery under cardiopulmonary bypass have different thyroid hormones postoperatively compared with preoperatively.T3 and FT3 decrease,TSH increases and then decreases,while T4 and FT4 are in the normal range.The results require further large-scale,multi-center,high-quality clinical studies to be confirmed.