同期甲状腺手术对心内直视手术患者血清甲状腺激素水平及血流动力学的影响

发布时间：2018-01-16 22:27

本文关键词：同期甲状腺手术对心内直视手术患者血清甲状腺激素水平及血流动力学的影响　出处：《山东医药》2017年38期 　论文类型：期刊论文

【摘要】：目的观察同期甲状腺手术对心内直视手术患者血清甲状腺激素水平及血流动力学的影响。方法选择心脏病合并甲状腺肿瘤的患者9例作为观察组,同期选择无甲状腺疾病的心脏病患者9例作为对照组。观察组先行甲状腺手术,然后行心内直视手术,对照组仅行心内直视手术。术中记录两组体外循环(CPB)时间、主动脉阻断时间。分别于麻醉诱导前(T_1)及CPB后4 h(T_2)、12 h(T_3)、1 d(T_4)、3 d(T_6)、5 d(T_7)测定血清三碘甲状腺原氨酸(T_3)、四碘甲状腺原氨酸(T_4)、游离T_3(FT_3)、游离T_4(FT_4)、促甲状腺激素(TSH);用多功能监护仪检测肺毛细血管楔压(PCWP)、中心静脉压,用热稀释法测定心输出量,计算体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)、左心室每搏做功指数(LVSWI)。结果两组患者均痊愈出院,未发生围手术期严重并发症。两组CPB时间、主动脉阻断时间比较差异无统计学意义。对照组血清FT_3、FT_4、T_3、T_4水平在T_2~T_5持续降低(P均0.05),在T_6仍未恢复至术前水平。观察组血清FT_3、FT_4、T_3、T_4水平在T_2~T_6持续降低(P均0.05),且各时间点均低于对照组(P均0.05)。两组血清TSH水平均在正常范围内波动。对照组SVRI、PVRI在T_2达峰值(P均0.05),在T_4恢复至术前水平。观察组SVRI、PVRI在T_3达峰值(P均0.05),在T_5恢复至术前水平,且在T_2~T_4均高于对照组(P均0.05)。两组LVSWI均在T_3降至最低值(P均0.05),对照组在T_5恢复至术前水平,观察组在T_6恢复至术前水平;且观察组LVSWI在T_2~T_5均低于对照组(P均0.05)。两组PCWP均在正常范围内波动。结论同期行甲状腺手术使心内直视手术患者血清甲状腺激素水平显著降低,外周血管阻力升高的程度和心功能损害的程度增大,且持续时间较长,术后未发生严重并发症。
[Abstract]:Objective to observe the effect of thyroid surgery on serum thyroid hormone level and hemodynamics in patients undergoing open heart surgery. Methods Nine patients with heart disease and thyroid tumor were selected as observation group. Nine patients with heart disease without thyroid disease were selected as control group. In the control group, only open heart surgery was performed. The CPB time and aortic clamping time were recorded in the two groups respectively before anesthesia induction and 4 h after CPB. (12 h / T _ 3 / T _ 3 / T _ 4 / T _ 4 / T _ 6 / T _ 7) determination of serum triiodothyronine (T3) and tetraiodothyronine (T _ 4). Free T _ 3 / T _ 3 / T _ 4 / T _ 4 / T _ 4 / T _ 3 / T _ 3 / T _ 4 / T _ 3 / T _ 3 / T _ 3 / T _ 3. Pulmonary capillary wedge pressure (PCWP), central venous pressure (CPP), cardiac output were measured by thermal dilution method, and systemic circulation resistance index (SVRI) was calculated. Results Pulmonary vascular resistance index (PVR) and left ventricular stroke work index (LVSWI) were measured. Results the patients in both groups were cured and discharged without serious complications during perioperative period. There was no significant difference in aortic clamping time. In the control group, the level of FT3 / T _ 3 / T _ 4 / T _ 3 / T _ 4 in the serum of the control group was decreased continuously (P = 0.05) in T _ 2 / T _ (5) (P < 0.05). In the observation group, the level of serum FT3FT4T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T /. The levels of serum TSH in both groups fluctuated within normal range, and the control group had a peak value of PVRI in T2 (P 0.05). In the observation group, SVRI PVRI reached the peak value in T _ 3 (P = 0.05), and recovered to the preoperative level at T _ (5). The levels of LVSWI in both groups were lower than those in the control group (P < 0.05), and the levels of LVSWI in the control group were lower than those in the control group (P < 0.05). The patients in the observation group recovered to the preoperative level at T6; LVSWI in the observation group was lower than that in the control group (P < 0.05). Conclusion the serum thyroid hormone levels in patients undergoing open heart surgery were significantly decreased during the same period of thyroidectomy. [WT5HZ] [WT5 "BZ] [WT5" BZ] [WT5BZ]. The degree of the increase of peripheral vascular resistance and the degree of cardiac function damage were increased and lasted for a long time. No serious complications occurred after operation.
【作者单位】：中国人民解放军第一五五中心医院;
【分类号】：R654.2
【正文快照】： 近年来,甲状腺肿瘤的发病率逐年增高[1],因此心脏病合并甲状腺肿瘤的患者逐渐增多。对于如何处理心脏病合并甲状腺肿瘤压迫气管并产生胸闷症状的患者和心脏病合并甲状腺恶性肿瘤的患者,国内外的报道较少。本研究对这类患者同期行甲状腺手术和心内直视手术治疗,通过观察患者术

【相似文献】