Jaimes Marisol Carreno, Torrado Luis Alberto Arciniegas, Reyes Néstor Fernando Sandoval, Mackenzie Jaime Camacho, Mallarino Juan Pablo Umana
Fundación Cardioinfantil - Instituto de Cardiología, Bogota, Colombia.
Braz J Cardiovasc Surg. 2017 Nov-Dec;32(6):475-480. doi: 10.21470/1678-9741-2017-0080.
Few reports in the world have shown a differential effect of hypothyroidism in relation to morbidity and mortality following cardiac surgery.
To determine the association between preoperative hypothyroidism, composite and disaggregated outcomes of mortality and complications in patients undergoing first-time isolated myocardial revascularization surgery.
Historical cohort of patients undergoing myocardial revascularization between January 2008 and December 2014, with 626 patients included for evaluation of the composite and disaggregated outcomes of in-hospital mortality and complications (atrial fibrillation, surgical site infection and reoperation due to bleeding). A logistic regression model was used to determine the association between hypothyroidism and the onset of those outcomes.
Cohort of 1696 eligible patients for the study, with 1.8 mortality. Median age, female gender and prevalence of arterial hypertension were all significantly higher among hypothyroid patients. No differences were found in other preoperative or intraoperative characteristics. Hypothyroidism was associated with the presence of the composite outcome, RR 1.6 (1.04-2.4) and atrial fibrillation 1.9 (1.05-3.8). No association with mortality, infections or reoperation due to bleeding was found.
Hypothyroidism is a disease that affects females predominantly and does not determine the presence of other comorbidities. Hypothyroidism is a risk factor for the onset of postoperative fibrillation in patients undergoing myocardial revascularization surgery. Postoperative care protocols focused on the prevention of these complications in this type of patients must be instituted.
世界上很少有报告显示甲状腺功能减退对心脏手术后的发病率和死亡率有不同影响。
确定首次进行单纯心肌血运重建手术患者术前甲状腺功能减退与死亡率及并发症的综合和分项结局之间的关联。
对2008年1月至2014年12月期间接受心肌血运重建的患者进行历史性队列研究，纳入626例患者评估住院死亡率和并发症（房颤、手术部位感染和出血导致的再次手术）的综合和分项结局。采用逻辑回归模型确定甲状腺功能减退与这些结局发生之间的关联。
该研究队列中有1696例符合条件的患者，死亡率为1.8%。甲状腺功能减退患者的年龄中位数、女性比例和动脉高血压患病率均显著更高。在其他术前或术中特征方面未发现差异。甲状腺功能减退与综合结局相关，相对危险度为1.6（1.04 - 2.4），与房颤相关，相对危险度为1.9（1.05 - 3.8）。未发现与死亡率、感染或出血导致的再次手术有关联。
甲状腺功能减退是一种主要影响女性的疾病，并不决定其他合并症的存在。甲状腺功能减退是接受心肌血运重建手术患者术后房颤发生的危险因素。必须制定针对这类患者预防这些并发症的术后护理方案。
