心脏外科术后并发低T3综合征的早期预后分析

Early prognostic analysis of patients with low T3 syndrome after cardiac surgery

目的探讨心脏外科术后出现低T3综合征,即正常甲状腺功能病态综合征(euthyroid sick syndrome,ESS)的早期预后分析。方法入选2022年4月至2022年8月于南京市第一医院接受体外循环(cardiopulmonary bypass,CPB)的354例心脏手术的成年心脏病患者作为研究对象,根据术后游离三碘甲状腺原氨酸(free triiodothyronine,FT3)水平分为ESS组及非ESS组。比较两组患者一般临床资料、甲状腺激素水平、最大血管活性药物评分(vasoactive-inotropic score max,VISmax)、住重症监护病房(intensive care unit,ICU)时间和机械通气时间等指标的差异,分析心脏外科术后患者出现低T3综合征的早期预后。结果ESS组患者的年龄(66.38±8.49)岁、手术时间(4.76±1.22)h、APACHEⅡ评分(14.16±3.41)、基础合并糖尿病的比例(31.25%)、基础合并冠心病的比例(70.31%)均高于非ESS组(62.75±11.19)岁、(4.44±1.07)h、(12.26±3.31)、(19.66%)、(48.28%)(P<0.05)。ESS组患者的VISmax 7.00(3.00,15.00)高于非ESS组5.00(1.00,10.00)(P<0.05)。两组间的住ICU时间[1.00(1.00,2.00)比1.00(1.00,2.00)]d和机械通气时间[8.83(7.50,12.83)比8.65(7.00,11.71)]h无显著差异。结论心脏术后并发低T3综合征患者的VISmax明显升高,术后需要更多的血管活性药物支持,但两组间住ICU时间及机械通气时间无显著差异,是否需补充甲状腺素需根据患者具体情况而定。

Objective To explore the early prognosis of low T3 syndrome(euthyroid sick syndrome,ESS)in patients after cardiac surgery.Methods A total of 354 patients after cardiac surgery undergoing cardiopulmonary bypass(CPB)in Nanjing First Hospital from April 2022 to August 2022 were enrolled as the study subjects.They were divided into the ESS group and the non-ESS group according to the level of thyroid hormone FT3.The differences between the two groups in general clinical data,thyroid hormone level,vasoactive-inotropic score max(VISmax),ICU length of stay and duration of mechanical ventilation were compared to explore the early prognosis of ESS after cardiac surgery.Results The age,operation time,APACHEⅡscore at ICU admission,proportion of history of diabetes and proportion of history of coronary heart disease in the ESS group were higher than those in the non ESS group[(66.38±8.49)years old vs.(62.75±11.19)years old],[(4.76±1.22)h vs.(4.44±1.07)h],[(14.16±3.41)vs.(12.26±3.31)],(31.25%vs.19.66%),(70.31%vs.48.28%)(P<0.05).The VISmax in the ESS group was higher than that in the non-ESS group[7.00(3.00,15.00)vs.5.00(1.00,10.00)](P<0.05).There were no significant differences in ICU length of stay and duration of mechanical ventilation between the two groups[1.00(1.00,2.00)d vs.1.00(1.00,2.00)d]、[8.83(7.50,12.83)h vs.8.65(7.00,11.71)h].Conclusion The VISmax of the patients with ESS after cardiac surgery are significantly higher,and more vasoactive drugs are needed after the surgery.Whether thyroxine supplementation is needed depends on the specific situation of the patient.