瓣膜置换围术期甲状腺功能变化及干预治疗的意义

The significance of altered thyroid function and intervention on Perioperative period after heart valve replacement surgery

目的探讨瓣膜置换患者围术期甲状腺功能变化及干预治疗的意义。方法选取心脏瓣膜置换患者80例,用随机、双盲法分为实验组和对照组,每组40例。实验组患者从术前24 h至术后第5天给予左甲状腺素片(优甲乐) 50μg/qd口服,对照组不予口服。测定2组患者术前、术后第1、3、5天血清T3、T4、TSH浓度,计算BMR,统计2组患者术后多巴胺、肾上腺素总用量,并比较术后第5天心脏EF及FS值。结果 2组患者术后第1、3、5天血清T3浓度均较术前降低(P<0.05),但实验组均高于对照组(P<0.05),实验组血清T3水平恢复快。2组患者各时间点血清T4、TSH及BMR比较差异无统计学意义(P>0.05)。实验组患者术后第5天心脏EF及FS值比对照组高(P<0.05),术后多巴胺、肾上腺素总用量比对照组少(P<0.05)。结论瓣膜置换手术可引起术后T3下降,围术期补充甲状腺激素有利于心功能的恢复。

Objective To evaluate the significance of altered thyroid function and the intervention after heart valve replacement surgery.Methods 80 patients accepting heart valve replacement surgery were randomly divided into two groups:the test group(n=40)received oral triiodothyronine,50μg/qd,initiated 24 h before surgery and maintained for five days after operation,the control group(n=40)received nothing.Serum T3,T4,TSH were determined at pre-operation and at 1,3,5 d after operation.BMR were calculated.The total dosage of dopamine and epinephrine after operation was calculated and compared the heart EF,FS at 5 days after operation.Results In the two groups,serum T3 levels were progressively decreased at 1,3,5 d after operation,but the test group were significantly higher than those in the control group(P<0.05).The serum T3 levels in the test group were quick recovery.Serum T4,TSH and BMR levels were no significantly difference in both groups(P>0.05).The heart EF,FS at 5 d after operation in the test group were significantly higher than those in the control group(P<0.05).The total dosage of dopamine and epinephrine after operation in the test group were less than those in the control group(P<0.05).Conclusion Heart valve replacement surgery can decrease serum T3 level.It may be beneficial for heart function to supply triiodothyronine at peri-operation.