先天性心脏病患儿的体外循环与血清甲状腺激素水平

Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease.

作者信息

Talwar Sachin, Khadgawat Rajesh, Sandeep Jandardhan Alamanda, Sreenivas Vishnubhatla, Choudhary Shiv Kumar, Gupta Nandita, Airan Balram

机构信息

Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Congenit Heart Dis. 2012 Sep-Oct;7(5):433-40. doi: 10.1111/j.1747-0803.2012.00667.x. Epub 2012 May 22.

DOI:10.1111/j.1747-0803.2012.00667.x

PMID:22613232

Abstract

OBJECTIVE

To study the effect of cardiopulmonary bypass (CPB) on serum thyroid hormone profile in children undergoing open-heart surgery.

DESIGN

Prospective cross-sectional study.

SETTING

Multispecialty tertiary level referral center.

PATIENTS

One hundred consecutive patients (age 15.9 ± 14.6 months, weight 6.7 ± 2.5 kg) undergoing open-heart surgery under CPB.

INTERVENTIONS

None.

OUTCOME MEASURES

Levels and trends of serum total thyroxine (TT4), free thyroxine (FT4), total tri-iodothyronine (TT3), free tri-iodothyronine (FT3) and thyroid stimulating hormone (TSH), survival, inotropic score, duration of mechanical ventilation, postoperative complications.

RESULTS

TT4 levels were 9.08 ± 3.6, 6.4 ± 2.5, 6.24 ± 2.1, 6.43 ± 2.4, 7.20 ± 3.0 µg/dL at baseline and at 1, 24, 48 and 72 hours; FT4 levels were 1.82 ± 0.5, 1.49 ± 0.3, 1.29 ± 0.3, 1.32 ± 0.4, and 1.43 ± 0.5 ng/dL; TT3 levels were 1.81 ± 0.4, 1.31 ± 0.3, 0.99 ± 0.2, 1.0 ± 0.37, and 1.17 ± 0.48 ng/ml; FT3 levels were 4.09 ± 1.0, 3.02 ± 0.8, 2.21 ± 0.6, 2.22 ± 0.7, and 2.66 ± 1.05 pg/ml; TSH levels were 5.40 ± 3.8, 2.0 ± 3.1, 1.24 ± 1.1, 2.90 ± 3.3, and 4.03 ± 3.4 mIU/L. There was significant fall (29.1% for FT4, 32.1% for TT4, 77% for TSH, 46% for FT3 and 45% for TT3, p < 0.0001). When area under curve (AUC) TT4 was compared between survivors (n = 87) and nonsurvivors (n = 12), significantly larger AUC was seen in survivors (492.81 ± 158.6) than nonsurvivors (360.75 ± 179.6 p = 0.0125). In survivors >72 hours, AUC TT4 was larger in patients with uneventful postoperative course versus those with postoperative complications (516.48 ± 18.6 vs. 394.78 ± 29.9, p = 0.001). AUC TT4 showed significant inverse correlation with inotropic score and borderline inverse correlation with duration of mechanical ventilation.

CONCLUSION

Children undergoing surgery under CPB showed significant fall in thyroid hormones. Because TT4 level is modifiable, prophylactic administration of TT4 for improving outcomes needs to be studied further.

摘要

目的

研究体外循环（CPB）对接受心脏直视手术患儿血清甲状腺激素水平的影响。

设计

前瞻性横断面研究。

地点

多专科三级转诊中心。

患者

100例连续接受CPB下心脏直视手术的患儿（年龄15.9±14.6个月，体重6.7±2.5 kg）。

干预措施

无。

观察指标

血清总甲状腺素（TT4）、游离甲状腺素（FT4）、总三碘甲状腺原氨酸（TT3）、游离三碘甲状腺原氨酸（FT3）和促甲状腺激素（TSH）的水平及变化趋势、生存率、肌力评分、机械通气时间、术后并发症。

结果

基线时及术后1、24、48和72小时TT4水平分别为9.08±3.6、6.4±2.5、6.24±2.1、6.43±2.4、7.20±3.0μg/dL；FT4水平分别为1.82±0.5、1.49±0.3、1.29±0.3、1.32±0.4、1.43±0.5 ng/dL；TT3水平分别为1.81±0.4、1.31±0.3、0.99±0.2、1.0±0.37、1.17±0.48 ng/ml；FT3水平分别为4.09±1.0、3.02±0.8、2.21±0.6、2.22±0.7、2.66±1.05 pg/ml；TSH水平分别为5.40±3.8、2.0±3.1、1.24±1.1、2.90±3.3、4.03±3.4 mIU/L。甲状腺激素水平显著下降（FT4下降29.1%，TT4下降32.1%，TSH下降77%，FT3下降46%，TT3下降45%，p<0.0001）。比较存活者（n = 87）和非存活者（n = 12）的曲线下面积（AUC）TT4，存活者的AUC（492.81±158.6）显著大于非存活者（360.75±179.6，p = 0.0125）。在术后>72小时的存活者中，术后过程平稳的患者AUC TT4大于有术后并发症的患者（516.48±18.6 vs. 394.78±29.9，p = 0.001）。AUC TT4与肌力评分呈显著负相关，与机械通气时间呈临界负相关。