【作者】 罗俊；

【导师】 薛玉良； 王洪武； 王中；

【作者基本信息】 天津医科大学 ， 麻醉学， 2008， 硕士

【摘要】 目的观察低体重婴幼儿体外循环心脏手术围手术期甲状腺激素的变化及其规律,探讨体外循环心脏手术对婴幼儿甲状腺激素代谢的影响。方法选择21例10kg以下行体外循环心室间隔缺损修补术的患儿。分别采取其体外循环前、体外循环结束后、术后第一天、术后第二天和术后第四天的静脉血样,应用微粒子酶联免疫法检测血清中的三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺激素(TSH)浓度。结果T3浓度在体外循环后明显下降,由1.05±0.35ng/ml降至0.83±0.19ng/ml,与体外循环前比较下降了21%,随后继续下降,术后第一天下降49%,术后第二天降至最低点0.41±0.13ng/ml,下降了61%,随后开始恢复,直至术后第四天仍未能恢复至体外循环前水平,较体外循环前下降21%;T4浓度在体外循环结束后及术后第一天未见明显下降,第二天出现明显下降,由7.65±1.73ug/dl降至5.81±1.30ug/dl,第四天恢复至体外循环前水平;TSH浓度体外循环后未发生下降,反而稍有上升,术后第一和第二天出现明显下降,由1.71±1.34uIU/L降至0.38±0.24uIU/L和0.57±0.54uIU/L,分别下降了78%和66%,第四天恢复至体外循环前水平。结论小儿体外循环心脏手术是发生正常甲状腺病态综合征的明确风险因素,特别是低体重婴幼儿。10kg以下婴幼儿在体外循环心脏手术围手术期会发生2型正常甲状腺病态综合征,表现为不同时刻出现T3、T4和TSH浓度的下降。体外循环心脏手术对小儿,特别是低体重婴幼儿的甲状腺激素水平和功能有重要影响,围手术期加强对患儿甲状腺激素浓度的监测及术后早期补充甲状腺激素有重要意义。更多还原

【Abstract】 Objective: To observe the tendency and law of thyroid hormone perioperatively, and explore the effects of ECC on thyroid hormone metabolism in low weight infants undergoing ECC surgeries.Methods: 21 infants weighting less than 10kg undergoing ventricular septal defect(VSD) repair surgeries on ECC was investigated. The venous blood samples were collected at five time points: before ECC, after ECC, 1 day, 2 day, and 4 day post-operatively. The concentration of serum thyroid hormone triiodothyronine(T3), tetraiodothyronine(T4) and thyroid stimulating hormone(TSH) ware assayed by Microparticle Enzyme Immunoassay (MEIA).Results: The concentration of T3 decreased significantly after ECC, from 1.05±0.35ng/ml to 0.83±0.19ng/ml, which was 21% less than that before ECC, and went on decreasing by 49% on the first day post-operatively and 61% on the second day post-operatively to 0.83±0.19ng/ml, which reached the lowest point. Then it began to recovery, but didn’t reach the level before ECC yet, 21% lower than that before ECC; The concentration of T4 didn’t decrease obviously after ECC and the first day post-operatively, but decreased from 7.65±1.73ug/dl to 5.81±1.30ug/dl on the second day after ECC, and recovered to the level before ECC on the fourth day. The concentration of TSH increased rather than decreased after ECC, but decreased obviously on the first and second day after operation, from 1.71±1.34uIU/L to 0.38±0.24uIU/L and 0.57±0.54uIU/L, which was 78% and 66% lower. Then it recovered to the level before ECC on the fourth day.Conclusion: ECC surgery in infants is a definite risk factor related to Euthyroid Sick Syndrome, especially for low birth weight infants. Infants weighting less than 10kg undergoing ECC surgeories could develop type II Euthyroid Sick Syndrome perioperatively and the concentrations of T3, T4 and TSH decreases at different time points. ECC surgery has great effects on the level and function of thyroid hormone of infants, especially for low birth weight infants, so it makes great sense to monitor the thyroid hormone level of the infants perioperatively and supplement thyroid hormone early after surgery.更多还原