外源性甲状腺素对体外循环围术期作用观察.docVIP

外源性甲状腺素对体外循环围术期作用观察 　 作者：喻东亮，徐建军，李志民，彭金华，江涵，董啸 【关键词】 甲状腺激素 摘要：目的 探讨体外循环（CPB）围术期甲状腺激素（thyroid hormone，TH）变化规律和对术后甲状腺功能正常的病态综合症（euthyroid sick syndrome，ESS）的恰当的治疗方法。方法 将36例心脏手术患者分为对照组：非CPB心脏手术患者；观察组：常规CPB手术患者；实验组：为CPB围术期口服甲状腺素片0.4mg/(kg#12539;d)患者。三组患者于术前，术中，术后监测血浆TH浓度。观察组、实验组术前及术后测肌酸激酶同工酶MB(CK-MB)值及左室射血分数（EF）左室缩短分数（FS）值等。结果 三组病人术前TH无显著差异，三组患者术后均存在ESS，CPB手术患者的ESS更严重，实验组ESS恢复更快。实验组CK－MB术后与术前的差值与观察组的该值比较显著降低。实验组术后EF、FS值显著升高,循环稳定，血管活性药用量少。结论 围术期小剂量甲状腺激素治疗有利于改善CPB手术导致的ESS，能改善术后心功能，促进循环稳定。 　　关键词：体外循环；甲状腺激素；肌酸激酶同工酶； 　　Perioperative use of Exogenous Thyroid Hormone in Cardiopulmonary Bypass Surgery 　　Abstract: OBJECTIVE To detect the changes of serum thyroid hormone (TH) during CPB surgery and the reasonable therapy of ESS due to CPB surgery.METHODS 36 patients were divided into three groups,8 non-CPB operation cases as groupⅠ. 8 routine CPB operation cases as groupⅡand 20 cases treated with exogenous TH(an oral tablet of 0.4/(kg#12539;d) for 5 days preoperatively and 3 days postoperatively) as groupⅢ.Serum TH and thyroid-stimulating hormone(TSH) were measured perioperatively in all patients. Ejection fraction(EF),Fraction short(FS)，Creatine kinase-MB(CK-MB) were measured pre-and postoperatively in groupⅡ and group Ⅲ . RESULTS　Before operation,the levels of TH in all patients were in normal range.ESS in CPB cases was severer than that in non-CPB cases.In groupⅢ,ESS was alleviated,EF and FS’s　data were higher than that of preoperation,CK-MB’s datae were lower than groupⅡ. Hemodynamics were stable and vasoactive drug dosages were reduced.CONCLUSION Administration of mini-dose thyroid hormone in perioperation could ameliorate the ESS, boost the cardiovascular system stability after CPB surgery. 　　Key words：cardiopulmonary bypass; thyroid hormones；Creatine kinase -MB； 　 　　体外循环（CPB）等重大手术及危重疾病均可引起病态综合征（ESS）。CPB过程中存在低温、非搏动灌注、血流重新分布、代谢功能变化及心肌和各重要脏器缺血损害等，均可能导致严重的ESS［1,2］ 。而一定的甲状腺激素水平对于维持心功能，心肌正常的能量代谢有重要作用。但过高的甲状腺激素又增加心肌耗氧，诱发心衰。过低则会引起细胞水平的甲亢，增加心肌耗氧，加重心衰。有研究［3、4］认为在CPB围术期应用甲状腺激素有利于心肌