Kovacikova Lubica, Kunovsky Pavol, Lakomy Miroslav, Skrak Peter, Hraska Viktor, Kostalova Ludmila, Tomeckova Eva
Pediatric Cardiac Intensive Care Unit, Pediatric Cardiac Center, Bratislava, Slovak Republic.
Pediatr Crit Care Med. 2005 Mar;6(2):154-9. doi: 10.1097/01.PCC.0000154960.59452.06.
Thyroid hormone alterations after cardiac surgery may be aggravated by the use of iodine antiseptics. We evaluated thyroid function and ioduria in infants with delayed sternal closure (DSC) who are exposed to povidone-iodine for sternal wound protection and compared them with findings in infants after primary sternal closure.
Prospective clinical study.
Pediatric cardiac intensive care unit.
Ninety-three infants after cardiac surgery using cardiopulmonary bypass, 60 of them with primary sternal closure and 33 of them with delayed sternal closure.
Thyroid hormones were studied in patients with primary sternal closure immediately after surgery, 5 days and 19 days after surgery, in patients with DSC immediately after surgery, immediately after sternal closure, and 2 wks after sternal closure. Ioduria was evaluated on the first, third, and fifth postoperative days after cardiac surgery with primary sternal closure and immediately after DSC. In both groups of patients, low total triiodothyronine, total thyroxine, thyroxine-binding globulin levels, high reverse triiodothyronine levels, and normal free triiodothyronine, free thyroxine, and thyroid-stimulating hormone levels were recorded immediately after surgery. Concentrations of total triiodothyronine and thyroid-stimulating hormone were lower in the patients with DSC. Five days after primary sternal closure and 2 wks after DSC, all thyroid hormone levels were normal for age. Ioduria after DSC was higher than ioduria after primary sternal closure.
Patients with DSC compared with patients with primary sternal closure display more profound thyroid suppression in the immediate postoperative period. The use of povidone-iodine adhesive drapes with single povidone-iodine mediastinal irrigation in patients with DSC is associated with significant iodine absorption but no significant thyroid dysfunction.
心脏手术后甲状腺激素的改变可能因使用碘消毒剂而加重。我们评估了因胸骨伤口保护而接触聚维酮碘的延迟胸骨闭合（DSC）婴儿的甲状腺功能和尿碘情况，并将其与一期胸骨闭合婴儿的结果进行比较。
前瞻性临床研究。
儿科心脏重症监护病房。
93例接受体外循环心脏手术的婴儿，其中60例一期胸骨闭合，33例延迟胸骨闭合。
对一期胸骨闭合患者术后即刻、术后5天和19天，对DSC患者术后即刻、胸骨闭合后即刻和胸骨闭合后2周的甲状腺激素进行研究。对一期胸骨闭合心脏手术后第1、3和5天以及DSC后即刻的尿碘进行评估。两组患者术后即刻均记录到总三碘甲状腺原氨酸、总甲状腺素、甲状腺素结合球蛋白水平降低，反三碘甲状腺原氨酸水平升高，游离三碘甲状腺原氨酸、游离甲状腺素和促甲状腺激素水平正常。DSC患者的总三碘甲状腺原氨酸和促甲状腺激素浓度较低。一期胸骨闭合术后5天和DSC后2周，所有甲状腺激素水平均符合年龄正常范围。DSC后的尿碘高于一期胸骨闭合后的尿碘。
与一期胸骨闭合患者相比，DSC患者术后即刻甲状腺抑制更明显。DSC患者使用含单一聚维酮碘纵隔冲洗的聚维酮碘粘贴巾与显著的碘吸收相关，但无明显甲状腺功能障碍。
