术前抗甲亢治疗对心脏病合并甲亢患者心内直视术后并发症及血流动力学的影响

发布时间：2018-03-23 18:25

本文选题：心脏病　切入点：甲状腺功能亢进　出处：《山东医药》2017年05期

【摘要】：目的探讨术前行抗甲状腺功能亢进(甲亢)治疗对心脏病合并甲亢患者心内直视术后并发症及血流动力学的影响。方法选择心脏病合并甲亢患者13例(甲亢组)、甲状腺功能正常心脏病患者13例(对照组)。两组均行心内直视术治疗。甲亢组术前给予甲巯咪唑、心得安及对症治疗,甲亢症状控制治疗,控制基础代谢率(BMR)20%行手术治疗。术中记录两组体外循环时间、主动脉阻断时间。分别于麻醉诱导前(T_1)及体外循环后4 h(T_2)、12 h(T_3)、1 d(T_4)、3 d(T_5)、5 d(T_6)测定甲状腺激素(T_H)、促甲状腺激素(T_SH);用多功能监护仪检测肺毛细血管楔压、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)。结果患者均痊愈出院,未发生围术期严重并发症。两组体外循环时间、主动脉阻断时间比较差异无统计学意义(P均0.05)。两组血清T_H水平均在T_5降至最低(P均0.05),在T_6仍未恢复至术前水平;而血清T_SH水平均在正常范围内波动。两组SVRI、PVRI均在T_2达最高(P均0.05),T_4恢复至术前水平;对照组LVSWI在T_3降至最低(P均0.05),T_5恢复至术前水平,甲亢组在T_4降至最低(P均0.05),T_6仍未恢复术前水平。T_2~T_6甲亢组SVRI、PVRI、LVSWI均低于对照组(P均0.05)。结论合并甲亢的心脏病患者心内直视术术前有效抗甲亢治疗可预防甲状腺危象等严重并发症的发生,但对术后血流动力学影响不大。
[Abstract]:Objective to investigate the effect of anti-hyperthyroidism (anti-hyperthyroidism) on postoperative complications and hemodynamics in patients with heart disease and hyperthyroidism before operation. Methods Thirteen patients with heart disease complicated with hyperthyroidism (hyperthyroidism group) were selected. 13 patients with normal thyroid function heart disease (control group, n = 13) were treated with open heart surgery. The hyperthyroidism group was treated with methimazole before operation. Propranolol and symptomatic treatment, symptomatic control of hyperthyroidism, control of basal metabolic rate and BMR-20% were operated on. The time of cardiopulmonary bypass was recorded in both groups. Duration of aortic clamping. Before induction of anesthesia (T _ 1) and 4 hours after cardiopulmonary bypass (CPB) and 4 h after cardiopulmonary bypass (CPB), respectively. The cardiac output was measured by thermal dilution method, and the systemic resistance index (SVRI), pulmonary vascular resistance index (PVRI) and left ventricular work index (LVSWI) were calculated. Results all the patients were discharged from hospital and no serious perioperative complications occurred. The time of cardiopulmonary bypass (CPB) was observed in both groups. There was no significant difference in aortic clamping time between the two groups (P < 0.05). The levels of serum th in the two groups decreased to the lowest level in Tap5, and still did not return to the preoperative level in T6. However, the serum T_SH levels fluctuated in the normal range. The highest T_SH levels in the two groups were found in T _ 2, P 0.05 and T _ 4 were restored to the preoperative level, while the LVSWI in the control group was reduced to the lowest level (P < 0.05) and T5 was restored to the preoperative level, respectively, in the control group, and in the control group, the serum T_SH level was lower than that in the control group (P < 0.05). In the hyperthyroidism group, the level of SVRIPVRIV LVSWI was lower than that in the control group (P < 0.05). Conclusion the effective anti-hyperthyroidism treatment before operation can prevent thyroid crisis in patients with hyperthyroidism. [WT5HZ] the preoperative level of T _ 2C _ 2 / T _ 6 hyperthyroidism group is lower than that of the control group (P = 0.05). Conclusion the effective anti-hyperthyroidism treatment before operation can prevent thyroid crisis in patients with hyperthyroidism. The occurrence of serious complications, But it has little effect on hemodynamics 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;R581.1

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