正常甲状腺功能病变综合征激素替代治疗的探讨.docVIP

有关急性颈髓损伤伴发正常甲状腺功能病变综合征激素替代治疗的探讨 A Investigation: Thyroid Hormone Replancement Therapy in Acute Cerbical Cord Injury Patients with Euthyroid Sick Syndrome 刘 奕 胡佩群 张仲汇 王 翦 颜柳子 LIU Yi HU Peiqun ZHANG Zhonghui WANG Jian YAN Liuzi 天津医院 ICU（中国300211） Tianjin Hospital ICU（China 300211） 中图分类号：R681.5＋4－581－459.1 文献标识码：A 文章编号：1818－0086（2010） 摘 要：目的 探讨急性颈髓损伤伴发正常甲状腺功能病变综合征（euthyroid sick syndrome，ESS）患者甲状腺激素替代治疗的可行性。 前瞻性地观察了自2006年所收治的急性颈髓损伤伴发ESS发生粘液性水肿的41例患者激素替代治疗前后的临床症状、甲状腺激素水平等的变化，以及与APACHEⅡ评分的相关性。 口服甲状腺片后，所有患者的粘液性水肿消失，临床症状明显改善，即使部分患者的甲状腺激素水平仍低于正常。甲状腺激素水平的变化与APACHEⅡ评分的相关性不甚明显。 急性颈髓损伤伴发ESS出现粘液性水肿是疾病发展过程中的一种不良适应，不给予干预会加重急性颈髓损伤的临床症状。本组所有使用甲状腺激素治疗的患者均未发生任何不良反应。 正常甲状腺功能病变综合征（ESS）；急性颈髓损伤 To investigate a treatment of thyroid hormone replacement therapy were used in euthyroid sick syndrome（ESS）patients with acute cervical cord injury found myxedema. The changes of clinical appearances and thyroid hormones level before and after thyroid hormone supplementation were observed in the 41 patients, and a correlation between thyroid hormones level and APACHEⅡscore was investigated since 2006, prospectvely. Result All of the patients in this study were found to get a continued improvements clinically and myxedema disappeared after oral Thyroid Tablets, though a part of them got still lower thyroid hormones level than normal range. There was no substantial evidence to show that thyroid hormone level was associated with APACHEⅡ score. Conclusion The acute cervical cord injury patients with ESS were found myxedema to be a maladaptive response, which could deteriorate symptoms of acute cervical cord injury clinically if was not administrated thyroid hormone supplementation. No adverse responses were found in the all of the patients treated with thyroid hormone therapy in this study. Key words: euthyroid sick syndrome（ESS）, acute cervical cord injury “正常甲状腺功能病变综合征（euthyroid sick syndrome，ESS）”以往也称为非甲状腺功能性疾病（Non-thyroidal illness），在临床上其实并不少见，诸如脓毒症、〔1、2〕心脏骤