脓毒症患者甲状腺功能和左心室功能改变相关性探究.docxVIP

脓毒症患者甲状腺功能和左心室功能改变相关性探究 【摘要】目的探讨脓毒症患者甲状腺功能紊乱的 发生情况及其与左心室结构、功能变化的关系。方法入选 63例脓毒症患者，入院次日测定血清甲状腺激素和C反应 蛋白（CRP）水平，记录患者入院时年龄、性别、疾病、APACHEII 评分和后期发生休克及多器官功能障碍综合征（MODS）等一 般资料，并在入院24h、第2周、第3周动态观察左心室结 构及功能的变化。另选择一般感染组患者（38例）作对照组, 比较脓毒症组与对照组甲状腺功能的差别以及早期血清甲 状腺激素水平在脓毒症患者不同严重程度的心脏结构及功 能改变间的差异性。结果脓毒症患者血清游离三碘甲状腺 原氨酸（FT3）、游离甲状腺（FT4）水平均明显低于一般 感染组（P0, 05）,其左心室变化表现为：左心室舒张功能 减低（I型）31例，左心室扩大和左心室舒张功能减低（II 型）18例，左心室扩大、左心室收缩和舒张功能减低（III型） 14例；与I、II型比较，III型患者血清FT3、FT4水平显著 降低，休克及MODS发生率显著升高而I、II型患者间上述 指标差异均无统计学意义。结论脓毒症患者普遍存在甲状 腺功能紊乱，早期血清甲状腺激素水平对疾病后期左心室结 构和功能病变具有一定预测作用。 【关键词】脓毒症；左心室；超声心动图；甲状腺激素; c-反应蛋白 Relationship between thyRoid hoRmone level and the change of left ventRiculaR function in septic patients Wang Bin, Guo Zhiguo, Ge Qinggang, Zheng Ya， an. EmeRgency DepaRtment , Peking UniveRsity ThiRd Hospital, Beijing 100191, China CoRResponding authoR： Zheng Ya an, Email： z, y, a@medmail, com, cn [AbstRact] Objective To investigate the occuRRence of thyRoid disoRdeRs in septic patients and the Relationship between thyRoid hoRmone level and the change of left ventRiculaR function. Methods A total of 63 septic patients, 43 male and 20 female, aged 50 to 88 yeaRs with mean 63, 3+ 18, 5, weRe included in the pResent study. The thyRoid hoRmone levels and C-Reactive pRotein (CRP) levels weRe detected in all patients on the next day of admission. Clinical infoRmation of each patient was RecoRded including demogRaphics and co-existed disease, APACHEII scoRe at admission and the incidenee of shock and subsequent multipie oRgan dysfunction syndRome (MODS) . At 24 houRs , the second week and the thiRd week afteR admission, a seRial tRans-thoRacic echocaRdiogRaphy weRe peRfoRmed in all patients to obseRve changes of left ventRiculaR end diastolie dimension , left ventRiculaR e jec t fRoc tion and E/A (the Ratio bet ween maximal velocity of blood flow at mitRal valve oRifice in the eaRly diastolie phase and maximal velocity of blood flow of atRium in systolic phase)? AnotheR 38 patients with oRdinaRy inf