体外循环下心内直视手术患儿血清 TSH、FT3、FT4 水平的变化。
Changes of serum TSH, FT3, and FT4 levels in infants received surgical correction of congenital heart disease under cardiopulmonary bypass.
机构信息
Department of Cardiac Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
出版信息
BMC Cardiovasc Disord. 2023 Nov 16;23(1):562. doi: 10.1186/s12872-023-03590-4.
OBJECTIVE
This study aimed to explore the fluctuations and clinical relevance of serum thyrotropin (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels in infants undergoing surgical correction for congenital heart disease (CHD) using cardiopulmonary bypass (CPB).
METHODS
In a retrospective design, 58 infants who underwent CHD surgical correction under CPB between January 2021 and January 2022 at our institution were incorporated. These infants were categorized into two groups: simple CHD (n = 34) and complex CHD (n = 24). TSH, FT3, and FT4 serum concentrations were assessed at four intervals: 24 h pre-surgery (T0) and 24 h (T1), 48 h (T2), and 72 h (T3) post-surgery.
RESULTS
The simple CHD group displayed a significantly reduced CPB duration compared to the complex CHD group (P < 0.001). Both groups exhibited a notable decline in serum thyroid hormone concentrations at T1 compared to T0. However, from T1 to T3, an upward trend in hormone levels was observed. By T3, though the levels in both groups had risen notably from T1, they remained significantly diminished from T0 (P < 0.01). In both the simple and complex CHD cohorts, significant fluctuations in thyroid hormone levels (TSH, FT3, FT4) were noted across the different timepoints (T0, T1, T3) (P < 0.01). While no significant disparities were found between the two groups' hormone concentrations at T0 and T1 (P > 0.05), at T2 and T3, the simple CHD group manifested higher TSH, FT3, and FT4 levels compared to the complex CHD group (P < 0.05).
CONCLUSIONS
Infants undergoing CHD surgical correction under CPB experience significant declines in TSH, FT3, and FT4 serum levels. The post-surgery thyroid hormone recovery was more pronounced in infants with simple CHD compared to those with complex CHD. As such, vigilant monitoring of thyroid hormone levels during the perioperative phase is imperative, and timely intervention measures should be employed when necessary.
目的
本研究旨在探讨体外循环（CPB）下心内直视手术治疗先天性心脏病（CHD）婴儿血清促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和游离甲状腺素（FT4）水平的波动及其临床意义。
方法
采用回顾性设计，纳入 2021 年 1 月至 2022 年 1 月在我院接受 CPB 下心内直视手术治疗的 58 例 CHD 婴儿。根据疾病的复杂程度，将这些患儿分为单纯 CHD 组（n=34）和复杂 CHD 组（n=24）。分别于术前 24 h（T0）、术后 24 h（T1）、48 h（T2）和 72 h（T3）检测 TSH、FT3 和 FT4 血清浓度。
结果
与复杂 CHD 组相比，单纯 CHD 组的 CPB 时间明显缩短（P<0.001）。两组患儿 T1 时血清甲状腺激素浓度均明显低于 T0 时，但从 T1 到 T3，激素水平呈上升趋势。到 T3 时，两组 T1 时的水平虽明显高于 T1，但仍明显低于 T0（P<0.01）。两组 TSH、FT3、FT4 水平在不同时间点（T0、T1、T3）均有显著波动（P<0.01）。两组患儿 T0 和 T1 时的激素浓度无显著差异（P>0.05），但在 T2 和 T3 时，单纯 CHD 组的 TSH、FT3 和 FT4 水平均高于复杂 CHD 组（P<0.05）。
结论
CPB 下心内直视手术治疗 CHD 的婴儿，血清 TSH、FT3 和 FT4 水平显著下降。与复杂 CHD 相比，单纯 CHD 婴儿术后甲状腺激素恢复更为明显。因此，围手术期应密切监测甲状腺激素水平，并在必要时采取及时的干预措施。
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