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心外麻醉中甲状腺素、反T3、促甲状腺素变化及临床意义(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2001年第4期
页码:
299-302
栏目:
论著
出版日期:
2001-07-01

文章信息/Info

Title:
The changes of thyroid hormone, TSH, reverse triiodothyronine during cardio-anesthesia and its clinical implication
作者:
汪　晨;  陈　敏;  侯立朝;  曾　毅
第四军医大学西京医院麻醉科, 陕西西安710032
Author(s):
WANG Chen;  CHEN Min;  HOU Li-chao;  ZENG Yi
Department of Anesthesia, Xijing Hospital, Fourth Military Medical University, Xi’an Shaanxi 710032, China
关键词:
甲状腺素;  促甲状腺素;  麻醉;  体外循环;  心脏功能
Keywords:
thyroxine;  thyrotropin;  anesthesia;  extracorporeal circulation;  Cardiac function
分类号:
R614. 1
DOI:
-
文献标识码:
A
摘要:
目的 评估麻醉、手术应激、体外循环(CPB) 预充液(VInti) 及最低温度(Tmin ) 对甲状腺功能(FT3, FT4)、促甲状腺素(TSH) 分泌、反T3 (RT3) 的影响及拟解决途径。方法 31 例择期心外手术患者, 分别测定诱导前(Pre-Induc) ,CPB 前(Pre-CPB) 及CPB 后1 h (Post-CPB) 时FT3, FT4, RT3, TSH 值, 设Pre-Induc 为对照。结果 Pre-CPB, Post-CPB 时FT3, FT4 较Pre-Induc 大幅降低(P< 0. 05, P< 0. 01) ; Pre-CPB , Post-CPB 时RT3 亦较Pre-Induc 显著降低(P< 0101) , 该结果与已往相关报道相悖; Pre-CPB 时TSH 与诱导前相近, 而Post-CPB 时显著降低(P < 0.01) ; VInti , Tmin对FT3, FT4, RT3, TSH 无影响。在Pre-Induc→Pre-CPB→Post-CPB 过程中, FT3, FT4 对TSH 负反馈抑制持续存在, 且后者作用较强。结论 心外麻醉、手术应激可导致FT3, FT4 水平明显降低, 而CPB 对此无影响, 证实某些患者CPB 后存在“暂时性低甲综合征”, 建议对CPB 后低心排者适度补充甲状腺素有助改善心功。
Abstract:
AIM The core of this study was mainly to evaluate cardio-anesthesia, surgical stress,hypothermia (Tmin ) and initial volume (Vinti) of cardiopulmonary bypass (CPB) affecting upon thyroid function, TSH secretion and level of reverse triiodothyronine (RT3) and to find a way to solve the problem. METHOD FT3, FT4, RT3 and TSH were measured on thirty-one patients undergoing elected cardiac surgery at pre-induction (Pre-Induc) , before CPB (Pre-CPB ) & after CPB for 1h (Post-CPB) , Pre-Induc was control group. RESULTS It was shown that the values of FT3, FT4 were greatly reduced at Pre-CPB & Post-CPB compared with control (P<0. 05 & P<0. 01); There was a tendency for RT3 to decrease at Pre-CPB & Post-CPB (P < 0. 01) , The tendency is against to past related reports; The level of TSH at Pre-CPB was similar to Pre-Induc’s, however it was greatly fallen at Post-CPB (P < 0. 01) ; Tmin &Vinti didn’t affect upon the values of FT3, FT4, RT3 and TSH. In the procedure of Pre-Induc to Pre-CPB to Post-CPB, the negative feedback inhibition of FT3, FT4 upon TSH continually remained, and FT4 has the main depressed effect. CONCLUSION Cardio-anesthesia and surgical stress can significantly decrease the level of FT3, FT4, while CPB didn’t affect them. It was proved“the temporary euthyroid sick syndrome”appears after CPB in certain patients. We suggest triiodothyronine administration would be beneficial to improve the cardiac function when the patientis with lower cardiac output after CPB.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2001-03-15.
更新日期/Last Update: 2001-07-01