Bartkowski R, Wojtalik M, Korman E, Sharma G, Henschke J, Mrówczyński W
Department of Pediatric Cardiac Surgery, K. Marcinkowski University School of Medicine, ul. Fredry 10, 61-701 Poznan, Poland.
Eur J Cardiothorac Surg. 2002 Dec;22(6):879-84. doi: 10.1016/s1010-7940(02)00588-2.
The aim of this study was to find out if infants after cardiopulmonary bypass develop non-thyroidal illness and if illness severity after cardiopulmonary bypass depends on hormone concentration in ultrafiltrate.
Thyroid hormone status was assessed in 20 infants with congenital heart defects undergoing cardiac surgery (age range 7 days-11 months). Blood samples were collected preoperatively, during cardiopulmonary bypass, after cardiopulmonary bypass, and also postoperatively in 1, 2, 3, and 8 day after cardiac surgery. Plasma thyrotropin, thyroxine, free thyroxine, triiodothyronine, free triiodothyronine and reverse triiodothyronine were measured in blood samples and also in ultrafiltrate.
All patients had reduction in serum thyrotropin, thyroxine, free thyroxine, triiodothyronine, free triiodothyronine, and elevation of reverse triiodothyronine after cardiac surgery. In all patients we performed ultrafiltration. Patients were divided in to two groups. (with and without prolonged recovery). In the group of patients with prolonged recovery we noticed significantly higher amount of triiodothyronine per kilogram body weight. One of these patients died. The average level of total thyroxine decreased from the level 126 nmol/l before bypass to the minimal level 73 nmol/l after bypass, free thyroxine from the level 18 pmol/l before bypass to the minimal level 12 pmol/l after bypass. The average level of total triiodothyronine decreased from the level 1.54 nmol/l before bypass to the minimal level 0.42 nmol/l after bypass, free triiodothyronine from the level 6.12 pmol/l before bypass to the minimal level 3.21 pmol/l after bypass. The average level of TSH decreased from the level 4.31 mU/l before bypass to the level 0.64 mU/l after bypass. The average level of reverse-triiodothyronine increase from the level 0.83 nmol/l before bypass to the maximal level 1.94 nmol/l after bypass.
We conclude that non-thyroidal illness occurs in all infants after cardiopulmonary bypass. The amount of free triiodothyronine that is filtrated during cardiopulmonary bypass may influence postoperative recovery.
本研究旨在探究体外循环后的婴儿是否会发生非甲状腺疾病，以及体外循环后的疾病严重程度是否取决于超滤液中的激素浓度。
对20例接受心脏手术的先天性心脏病婴儿（年龄范围7天至11个月）的甲状腺激素状态进行评估。在术前、体外循环期间、体外循环后以及心脏手术后第1、2、3和8天采集血样。测定血样和超滤液中的血浆促甲状腺激素、甲状腺素、游离甲状腺素、三碘甲状腺原氨酸、游离三碘甲状腺原氨酸和反三碘甲状腺原氨酸。
所有患者心脏手术后血清促甲状腺激素、甲状腺素、游离甲状腺素、三碘甲状腺原氨酸、游离三碘甲状腺原氨酸均降低，反三碘甲状腺原氨酸升高。所有患者均进行了超滤。患者分为两组（恢复时间延长组和未延长组）。在恢复时间延长的患者组中，我们注意到每公斤体重的三碘甲状腺原氨酸含量显著更高。其中一名患者死亡。总甲状腺素的平均水平从体外循环前的126 nmol/l降至体外循环后的最低水平73 nmol/l，游离甲状腺素从体外循环前的18 pmol/l降至体外循环后的最低水平12 pmol/l。总三碘甲状腺原氨酸的平均水平从体外循环前的1.54 nmol/l降至体外循环后的最低水平0.42 nmol/l，游离三碘甲状腺原氨酸从体外循环前的6.12 pmol/l降至体外循环后的最低水平3.21 pmol/l。促甲状腺激素的平均水平从体外循环前的4.31 mU/l降至体外循环后的0.64 mU/l。反三碘甲状腺原氨酸的平均水平从体外循环前的0.83 nmol/l升至体外循环后的最高水平1.94 nmol/l。
我们得出结论，体外循环后的所有婴儿都会发生非甲状腺疾病。体外循环期间滤过的游离三碘甲状腺原氨酸量可能会影响术后恢复。
