Kovacikova L, Kunovsky P, Skrak P, Hraska V, Kostalova L, Tomeckova E
Cardiac Intensive Care Unit, Children's University Hospital, Limbova 1, 833 40, Bratislava, Slovak Republic.
Eur J Cardiothorac Surg. 2002 Jun;21(6):1037-41. doi: 10.1016/s1010-7940(02)00110-0.
The purpose of this study was to assess the influence of povidone-iodine mediastinal irrigation used for the treatment of deep sternal wound infection (DSWI) on thyroid function.
Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone-iodine irrigation for DSWI. The median age of patients was 8 months (18 days-5.3 years). Serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), reverse triiodothyronine (rT3) and thyroxine-binding globulin (TBG) were measured at three time points: (a) prior to mediastinal reexploration (before povidone-iodine exposure); (b) immediately after discontinuation of povidone-iodine irrigation; (c) 2 weeks after discontinuation of mediastinal irrigation. Urinary iodine excretion was examined on the last day of povidone-iodine exposure.
Prior to the mediastinal reexploration, the median TT3 and TT4 levels were below the normal range, then increased significantly to concentrations within the normal range. The median serum FT3 levels were within the normal range throughout the observation period, though a significant increase of FT3 levels was observed after discontinuation of irrigation. The median serum FT4 concentrations were within the normal range prior to irrigation and did not change significantly. The median rT3 levels were within the normal range, close to upper normal limit. The median TBG levels were within the normal range throughout the observation period, though a significant increase of TBG levels was observed during the period of mediastinal irrigation. The median TSH level was within the normal range prior to mediastinal irrigation and did not change significantly. Urinary iodine concentrations in infants with povidone-iodine irrigation were significantly higher 6700 microg/l (range, 1600-15000 microg/l) than in the group of 53 healthy infants 200 microg/l (range, 20-780 microg/l, P<0,001).
Our data showed that the use of povidone-iodine irrigation in the patients with DSWI has not lead to any significant alteration in thyroid function within the study period.
本研究旨在评估聚维酮碘纵隔冲洗用于治疗深部胸骨伤口感染（DSWI）对甲状腺功能的影响。
对18例接受聚维酮碘持续冲洗治疗DSWI的小儿心脏手术患者的甲状腺功能进行研究。患者的中位年龄为8个月（18天至5.3岁）。在三个时间点测量血清总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）、反三碘甲状腺原氨酸（rT3）和甲状腺素结合球蛋白（TBG）的浓度：（a）纵隔再次探查前（聚维酮碘暴露前）；（b）聚维酮碘冲洗停止后立即；（c）纵隔冲洗停止后2周。在聚维酮碘暴露的最后一天检测尿碘排泄情况。
纵隔再次探查前，TT3和TT4的中位水平低于正常范围，之后显著升高至正常范围内的浓度。整个观察期内血清FT3的中位水平在正常范围内，尽管冲洗停止后FT3水平显著升高。冲洗前血清FT4的中位浓度在正常范围内且无显著变化。rT3的中位水平在正常范围内，接近正常上限。整个观察期内TBG的中位水平在正常范围内，尽管在纵隔冲洗期间TBG水平显著升高。纵隔冲洗前TSH的中位水平在正常范围内且无显著变化。接受聚维酮碘冲洗的婴儿尿碘浓度为6700微克/升（范围为1600至15000微克/升），显著高于53例健康婴儿组的200微克/升（范围为20至780微克/升，P<0.001）。
我们的数据表明，在DSWI患者中使用聚维酮碘冲洗在研究期间未导致甲状腺功能发生任何显著改变。
