Novitzky D, Fontanet H, Snyder M, Coblio N, Smith D, Parsonnet V
Department of Surgery, University of South Florida, Tampa, Fla 33612, USA.
Cardiology. 1996 Nov-Dec;87(6):509-15. doi: 10.1159/000177147.
Experimental and clinical studies have shown the beneficial effects of triiodothyronine (T3) following myocardial revascularization on cardiopulmonary bypass (CPB). In this study, open-label T3 was administered to 68 high-risk patients undergoing open heart surgery. The New Jersey Risk Assessment was used to calculate the preoperative estimated surgical mortality. A loading dose of T3 was administered: (a) at release of the aortic cross-clamp, (b) whenever the patient became CPB dependent, (c) if the patient exhibited low cardiac output after discontinuing CPB and (d) as pretreatment before initiating CPB. All therapeutic modalities were followed by a continuous T3 infusion. Following T3 therapy, CPB was discontinued in all patients. Based upon discriminant analysis, a total of 26 deaths were expected from the entire group, but only 7 patients died, therefore, the observed mortality was reduced by 72% (p < 0.007). The use of T3 had a major impact on reducing surgical mortality, and may be advocated as a new therapeutic modality in patients with high estimated mortality undergoing open heart surgery.
实验和临床研究表明，心肌血运重建术后给予三碘甲状腺原氨酸（T3）对体外循环（CPB）有益。在本研究中，对68例接受心脏直视手术的高危患者给予开放标签的T3。采用新泽西风险评估法计算术前估计手术死亡率。给予T3负荷剂量：（a）在松开主动脉交叉钳时，（b）每当患者依赖CPB时，（c）如果患者在CPB停止后出现低心输出量，以及（d）在开始CPB之前作为预处理。所有治疗方式后均持续输注T3。T3治疗后，所有患者均停止CPB。基于判别分析，整个组预计共有26例死亡，但仅7例患者死亡，因此，观察到的死亡率降低了72%（p<0.007）。T3的使用对降低手术死亡率有重大影响，对于估计死亡率高的心脏直视手术患者，可提倡将其作为一种新的治疗方式。
