Jones T H, Hunter S M, Price A, Angelini G D
Department of Medicine, Northern General Hospital, Sheffield, United Kingdom.
Ann Thorac Surg. 1994 Aug;58(2):434-6. doi: 10.1016/0003-4975(94)92223-3.
Thyroid function is depressed during and after cardiopulmonary bypass surgical procedures, and this may adversely affect myocardial performance. There is known to be a high prevalence of thyroid abnormalities in the elderly population, and many patients undergoing cardiac operations fall into this category. We have assessed thyroid function in 116 patients admitted for elective open heart procedures to determine the value of preoperative testing. Abnormalities in thyroid function were present in 13 (11.2%) of the patients studied, 3 of whom were receiving thyroxine therapy. One patient who had overt hypothyroidism died postoperatively of a large cerebral infarct; 11 had elevated thyrotropin levels with normal serum thyroxine levels; and 1 who had overtreated hypothyroidism suffered fast atrial fibrillation postoperatively. No other complications were observed. These findings indicate that thyroid function should be assessed preoperatively in patients already on thyroxine therapy. Whether thyroid function should be evaluated routinely in all patients before operations involving cardiopulmonary bypass is not clear. Although there is a high incidence of abnormal laboratory results, there were no apparent adverse effects on the surgical outcome.
在心肺转流手术期间及术后，甲状腺功能会受到抑制，这可能会对心肌功能产生不利影响。已知老年人群中甲状腺异常的患病率较高，许多接受心脏手术的患者属于这一类别。我们评估了116例因择期心脏直视手术入院患者的甲状腺功能，以确定术前检查的价值。在所研究的患者中，13例（11.2%）存在甲状腺功能异常，其中3例正在接受甲状腺素治疗。1例明显甲状腺功能减退的患者术后死于大面积脑梗死；11例促甲状腺素水平升高但血清甲状腺素水平正常；1例甲状腺功能减退治疗过度的患者术后发生快速心房颤动。未观察到其他并发症。这些发现表明，对于已经接受甲状腺素治疗的患者，应在术前评估甲状腺功能。对于所有接受心肺转流手术的患者是否应常规评估甲状腺功能尚不清楚。虽然实验室检查结果异常的发生率较高，但对手术结果没有明显的不良影响。
