Department of Medicine, University of Southern California, Los Angeles, California 90033, USA.
J Clin Endocrinol Metab. 2010 Oct;95(10):4526-34. doi: 10.1210/jc.2010-1052. Epub 2010 Jul 28.
Effects of thyroid hormone therapy on postoperative morbidity and mortality in adults remain controversial.
The aim was to conduct a systematic review evaluating effects and risks of postoperative T(3) therapy in adults.
Electronic databases and reference lists through March 2010 were searched.
Studies with comparable control groups comparing T(3) to placebo therapy in randomized controlled trials were selected.
Two reviewers independently screened and reviewed titles, abstracts, and articles. Data were abstracted from 14 randomized controlled trials (13 cardiac surgery and one renal transplantation). In seven studies, iv T(3) was given in high doses (0.175-0.333 μg/kg · h) for 6 to 9 h, in four studies iv T(3) was given in low doses (0.0275-0.0333 μg/kg · h for 14 to 24 h), and in three studies T(3) was given orally in variable doses and durations.
Both high- and low-dose iv T(3) therapy increased cardiac index after coronary artery bypass surgery. Mortality was not significantly altered by high-dose iv T(3) therapy and could not be assessed for low-dose iv or oral T(3). Effects on systemic vascular resistance, heart rate, pulmonary capillary wedge pressure, new onset atrial fibrillation, inotrope use, serum TSH and T(4) were inconclusive.
Numbers of usable unique studies and group sizes were small. Duration of T(3) therapy was short, and dosages and routes of administration varied.
Short duration postoperative iv T(3) therapy increases cardiac index and does not alter mortality. Effects on other parameters are inconclusive.
甲状腺激素治疗对成年人术后发病率和死亡率的影响仍存在争议。
系统评价评估成年人术后 T3 治疗的效果和风险。
通过 2010 年 3 月的电子数据库和参考文献列表进行搜索。
选择了与安慰剂治疗相比，在随机对照试验中比较 T3 治疗的可比对照组的研究。
两名评审员独立筛选和审查标题、摘要和文章。从 14 项随机对照试验中提取数据（13 项心脏手术和 1 项肾移植）。在 7 项研究中，静脉内 T3 以高剂量（0.175-0.333μg/kg·h）给予 6-9 小时，在 4 项研究中静脉内 T3 以低剂量（0.0275-0.0333μg/kg·h 给予 14-24 小时），在 3 项研究中 T3 以不同剂量和持续时间口服给予。
高剂量和低剂量静脉内 T3 治疗均增加冠状动脉旁路手术后的心指数。高剂量静脉内 T3 治疗并未显著改变死亡率，并且无法评估低剂量静脉内或口服 T3。对全身血管阻力、心率、肺毛细血管楔压、新发心房颤动、正性肌力药使用、血清 TSH 和 T4 的影响尚无定论。
可用的独特研究数量和组大小较小。T3 治疗的持续时间短，剂量和给药途径不同。
术后短时间静脉内 T3 治疗增加心指数，不改变死亡率。对其他参数的影响尚无定论。
