Vavouranakis I, Sanoudos G, Manios A, Kalogeropoulou K, Sitaras K, Kokkinos C
Division of Cardiovascular Surgery, NIMTS Hospital, Athens, Greece.
J Cardiovasc Surg (Torino). 1994 Oct;35(5):383-9.
The purpose of this study was to investigate any potential hemodynamic effect of intravenously administered triiodothyronine in patients undergoing coronary artery bypass surgery.
Thirty patients were randomized in this single-blind, placebo-controlled trial. Hemodynamic parameters including heart rate, stroke volume index, cardiac index, pulmonary wedge pressure, pulmonary vascular resistances, systemic vascular resistances, and mean blood pressure, were compared between the two groups preoperatively, before the initiation of cardiopulmonary bypass (CPB), 5 minutes after the end of CPB, and 2, 4, 10, 16, and 22 hours thereafter.
Triiodothyronine was administered as a bolus infusion over a 1 min period after removal of the aortic cross-clamp, (0.15 microgram/kg), before the end of CPB (0.1 microgram/kg), 4 hours after the end of CPB (0.1 microgram/kg), 9 hours after CPB (0.1 microgram/kg), and 14 hours after CPB (0.1 microgram/kg). Patients received inotropes, vasodilators, and diuretics only if specifically indicated.
Plasma FT3 levels were higher in the T3 group, but within the normal range. No significant differences were noted in the pre and post CPB hemodynamics between the two groups for the most part of the study except that heart rate was increased in T3 group. A greater number of patients in the control group received vasodilators. No adverse reactions were noted with triiodothyronine administration.
Triiodothyronine administration in patients undergoing cardiopulmonary bypass surgery is safe, may lessen the need for pharmacological (vasodilator) therapy, but may increase heart rate.
本研究旨在调查静脉注射三碘甲状腺原氨酸对接受冠状动脉搭桥手术患者的任何潜在血流动力学影响。
在这项单盲、安慰剂对照试验中，30名患者被随机分组。比较两组患者术前、体外循环（CPB）开始前、CPB结束后5分钟以及此后2、4、10、16和22小时的血流动力学参数，包括心率、每搏量指数、心脏指数、肺楔压、肺血管阻力、体循环血管阻力和平均血压。
在主动脉阻断钳移除后1分钟内，以推注方式输注三碘甲状腺原氨酸（0.15微克/千克），在CPB结束前（0.1微克/千克）、CPB结束后4小时（0.1微克/千克）、CPB后9小时（0.1微克/千克）和CPB后14小时（0.1微克/千克）。仅在有明确指征时，患者才接受正性肌力药、血管扩张剂和利尿剂治疗。
T3组血浆FT3水平较高，但在正常范围内。在研究的大部分时间里，两组CPB前后的血流动力学无显著差异，只是T3组心率增加。对照组有更多患者接受血管扩张剂治疗。未观察到三碘甲状腺原氨酸给药的不良反应。
在接受体外循环手术的患者中，给予三碘甲状腺原氨酸是安全的，可能减少对药物（血管扩张剂）治疗 的需求，但可能会增加心率。
