Vertrees R A, Engelman R M, Haag B L, Rousou J H, Auvil J, Rohrer C
Chest. 1981 Feb;79(2):167-71. doi: 10.1378/chest.79.2.167.
Cardiopulmonary bypass may, by necessity, have to be performed in patients who are frankly hypothyroid. In treating five such patients, all of whom required coronary revascularization, it was noted that fluid balance during perfusion was considerably different than that in the normal population. In order to attempt to evaluate this difference, ten consecutive euthyroid patients having revascularization and the five hypothyroid patients were compared to correlate all fluid absorbed and excreted with the duration of bypass, the serum sodium, and subsequent weight gain. Fluid intake, urine output, and retained fluid were significantly elevated in the hypothyroid as compared to the euthyroid group, while serum sodium following operation was not significantly different. While there are considerable data indicating that hypothyroidism is associated with abnormal salt and water excretion, there is no information concerning the alterations which occur during cardiopulmonary bypass. The present study indicates that hypothyroidism is associated with significant diuresis (without administration of exogenous diuretic agents during cardiopulmonary bypass). The proposed explanation for this diuresis rests with the assumption that with cardiopulmonary bypass and appropriate fluid administration, the contracted blood volume in hypothyroid patients expands acutely and a diuresis results.
对于明显甲状腺功能减退的患者，必要时可能需要进行体外循环。在治疗五名此类患者时，他们均需要进行冠状动脉血运重建，结果发现灌注期间的液体平衡与正常人群有很大差异。为了评估这种差异，将十名连续接受血运重建的甲状腺功能正常的患者与五名甲状腺功能减退的患者进行比较，以关联所有吸收和排出的液体与体外循环持续时间、血清钠以及随后的体重增加情况。与甲状腺功能正常组相比，甲状腺功能减退组的液体摄入量、尿量和潴留液体量显著升高，而术后血清钠并无显著差异。虽然有大量数据表明甲状腺功能减退与盐和水排泄异常有关，但关于体外循环期间发生的变化尚无相关信息。本研究表明，甲状腺功能减退与显著利尿有关（体外循环期间未使用外源性利尿剂）。对这种利尿现象的推测解释是，在体外循环和适当的液体输注情况下，甲状腺功能减退患者收缩的血容量会急性扩张，从而导致利尿。
