本文關(guān)鍵詞：同期甲狀腺手術(shù)對(duì)心內(nèi)直視手術(shù)患者血清甲狀腺激素水平及血流動(dòng)力學(xué)的影響　出處：《山東醫(yī)藥》2017年38期 　論文類型：期刊論文

  更多相關(guān)文章： 心臟病 甲狀腺腫瘤 心內(nèi)直視手術(shù) 甲狀腺激素 血流動(dòng)力學(xué)

【摘要】：目的觀察同期甲狀腺手術(shù)對(duì)心內(nèi)直視手術(shù)患者血清甲狀腺激素水平及血流動(dòng)力學(xué)的影響。方法選擇心臟病合并甲狀腺腫瘤的患者9例作為觀察組,同期選擇無(wú)甲狀腺疾病的心臟病患者9例作為對(duì)照組。觀察組先行甲狀腺手術(shù),然后行心內(nèi)直視手術(shù),對(duì)照組僅行心內(nèi)直視手術(shù)。術(shù)中記錄兩組體外循環(huán)(CPB)時(shí)間、主動(dòng)脈阻斷時(shí)間。分別于麻醉誘導(dǎo)前(T_1)及CPB后4 h(T_2)、12 h(T_3)、1 d(T_4)、3 d(T_6)、5 d(T_7)測(cè)定血清三碘甲狀腺原氨酸(T_3)、四碘甲狀腺原氨酸(T_4)、游離T_3(FT_3)、游離T_4(FT_4)、促甲狀腺激素(TSH);用多功能監(jiān)護(hù)儀檢測(cè)肺毛細(xì)血管楔壓(PCWP)、中心靜脈壓,用熱稀釋法測(cè)定心輸出量,計(jì)算體循環(huán)阻力指數(shù)(SVRI)、肺循環(huán)阻力指數(shù)(PVRI)、左心室每搏做功指數(shù)(LVSWI)。結(jié)果兩組患者均痊愈出院,未發(fā)生圍手術(shù)期嚴(yán)重并發(fā)癥。兩組CPB時(shí)間、主動(dòng)脈阻斷時(shí)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義。對(duì)照組血清FT_3、FT_4、T_3、T_4水平在T_2~T_5持續(xù)降低(P均0.05),在T_6仍未恢復(fù)至術(shù)前水平。觀察組血清FT_3、FT_4、T_3、T_4水平在T_2~T_6持續(xù)降低(P均0.05),且各時(shí)間點(diǎn)均低于對(duì)照組(P均0.05)。兩組血清TSH水平均在正常范圍內(nèi)波動(dòng)。對(duì)照組SVRI、PVRI在T_2達(dá)峰值(P均0.05),在T_4恢復(fù)至術(shù)前水平。觀察組SVRI、PVRI在T_3達(dá)峰值(P均0.05),在T_5恢復(fù)至術(shù)前水平,且在T_2~T_4均高于對(duì)照組(P均0.05)。兩組LVSWI均在T_3降至最低值(P均0.05),對(duì)照組在T_5恢復(fù)至術(shù)前水平,觀察組在T_6恢復(fù)至術(shù)前水平;且觀察組LVSWI在T_2~T_5均低于對(duì)照組(P均0.05)。兩組PCWP均在正常范圍內(nèi)波動(dòng)。結(jié)論同期行甲狀腺手術(shù)使心內(nèi)直視手術(shù)患者血清甲狀腺激素水平顯著降低,外周血管阻力升高的程度和心功能損害的程度增大,且持續(xù)時(shí)間較長(zhǎng),術(shù)后未發(fā)生嚴(yán)重并發(fā)癥。
[Abstract]:Objective to observe the effect of thyroid surgery on serum thyroid hormone level and hemodynamics in patients undergoing open heart surgery. Methods Nine patients with heart disease and thyroid tumor were selected as observation group. Nine patients with heart disease without thyroid disease were selected as control group. In the control group, only open heart surgery was performed. The CPB time and aortic clamping time were recorded in the two groups respectively before anesthesia induction and 4 h after CPB. (12 h / T _ 3 / T _ 3 / T _ 4 / T _ 4 / T _ 6 / T _ 7) determination of serum triiodothyronine (T3) and tetraiodothyronine (T _ 4). Free T _ 3 / T _ 3 / T _ 4 / T _ 4 / T _ 4 / T _ 3 / T _ 3 / T _ 4 / T _ 3 / T _ 3 / T _ 3 / T _ 3. Pulmonary capillary wedge pressure (PCWP), central venous pressure (CPP), cardiac output were measured by thermal dilution method, and systemic circulation resistance index (SVRI) was calculated. Results Pulmonary vascular resistance index (PVR) and left ventricular stroke work index (LVSWI) were measured. Results the patients in both groups were cured and discharged without serious complications during perioperative period. There was no significant difference in aortic clamping time. In the control group, the level of FT3 / T _ 3 / T _ 4 / T _ 3 / T _ 4 in the serum of the control group was decreased continuously (P = 0.05) in T _ 2 / T _ (5) (P < 0.05). In the observation group, the level of serum FT3FT4T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T / T /. The levels of serum TSH in both groups fluctuated within normal range, and the control group had a peak value of PVRI in T2 (P 0.05). In the observation group, SVRI PVRI reached the peak value in T _ 3 (P = 0.05), and recovered to the preoperative level at T _ (5). The levels of LVSWI in both groups were lower than those in the control group (P < 0.05), and the levels of LVSWI in the control group were lower than those in the control group (P < 0.05). The patients in the observation group recovered to the preoperative level at T6; LVSWI in the observation group was lower than that in the control group (P < 0.05). Conclusion the serum thyroid hormone levels in patients undergoing open heart surgery were significantly decreased during the same period of thyroidectomy. [WT5HZ] [WT5 "BZ] [WT5" BZ] [WT5BZ]. The degree of the increase of peripheral vascular resistance and the degree of cardiac function damage were increased and lasted for a long time. No serious complications occurred after operation.
【作者單位】： 中國(guó)人民解放軍第一五五中心醫(yī)院;
【分類號(hào)】：R654.2
【正文快照】： 近年來(lái),甲狀腺腫瘤的發(fā)病率逐年增高[1],因此心臟病合并甲狀腺腫瘤的患者逐漸增多。對(duì)于如何處理心臟病合并甲狀腺腫瘤壓迫氣管并產(chǎn)生胸悶癥狀的患者和心臟病合并甲狀腺惡性腫瘤的患者,國(guó)內(nèi)外的報(bào)道較少。本研究對(duì)這類患者同期行甲狀腺手術(shù)和心內(nèi)直視手術(shù)治療,通過(guò)觀察患者術(shù)

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉劍萍,黎新建,俄比澤仁;心內(nèi)直視手術(shù)后循環(huán)復(fù)蘇成功1例報(bào)道[J];四川省衛(wèi)生管理干部學(xué)院學(xué)報(bào);2000年03期

2 李慶新,張?zhí)m萍,呂國(guó)禎,徐克勁,董逸飛;微創(chuàng)和不停跳心內(nèi)直視手術(shù)[J];心肺血管病雜志;2001年03期

3 蔡秋 ,俞詩(shī)娃;時(shí)控制冰在心內(nèi)直視手術(shù)中的應(yīng)用[J];海南醫(yī)學(xué);2002年02期

4 劉建華,耿琳;微創(chuàng)和不停跳在心內(nèi)直視手術(shù)中的應(yīng)用[J];中國(guó)煤炭工業(yè)醫(yī)學(xué)雜志;2002年08期

5 張寶山,王大蘭;10公斤以下小兒心內(nèi)直視手術(shù)的麻醉處理[J];青島醫(yī)藥衛(wèi)生;2004年02期

6 周黔華;心內(nèi)直視手術(shù)后早期活動(dòng)的效果觀察[J];青海醫(yī)藥雜志;2004年12期

7 陳柏成;肖穎彬;錢桂生;陳林;鐘前進(jìn);王學(xué)鋒;;心內(nèi)直視手術(shù)后急性呼吸窘迫綜合征發(fā)生的危險(xiǎn)因素[J];中華急診醫(yī)學(xué)雜志;2006年05期

8 孫江泰;張仁福;陳陽(yáng);馬瑞;黃銀屏;;心內(nèi)直視手術(shù)后并發(fā)急性呼吸窘迫綜合征搶救成功3例[J];沈陽(yáng)部隊(duì)醫(yī)藥;2006年05期

9 楊斌;李凱;梁巧茹;李少珂;;經(jīng)右腋下豎直切口心內(nèi)直視手術(shù)臨床研究[J];醫(yī)藥論壇雜志;2008年16期

10 傅律明;馬詒縉;閔梅先;張巖\，

本文編號(hào)：1435128