摘要
目的:分析总结冠心病合并甲状腺功能减退症外科治疗围术期处理方法。方法:回顾性分析20例冠心病合并甲状腺功能减退患者外科治疗围术期临床资料。结果:全组患者手术效果良好,19例患者经治疗后痊愈出院,围术期死亡1例。术前甲减确诊者均服用左旋甲状腺素片,剂量为12.5～200μg/d,平均(85±11.9)μg/d,(1.15±0.14)μg/kg,术后3d内服用剂量为25～200μg/d,平均(113±11.3)μg/d,(1.56±0.13)μg/kg;术前漏诊6例,术后确诊后立即行激素替代治疗,左旋甲状腺素片最大剂量为250μg/d,最小剂量为75μg/d,平均179.17μg/d,(2.38±0.66)μg/kg;术后机械通气时间14～146 h,平均(38±21)h,ICU停留时间16～67 h,平均(35±14.5)h;术后使用2～5μg.kg-1.min-1多巴胺改善心功能,其中使用肾上腺素维持心功能者4例,剂量在0.02～0.08μg.kg-1.min-1,行IABP辅助治疗者1例,5 d后顺利撤除。结论:冠心病合并甲状腺功能减退症外科治疗增加患者术后机械通气时间、ICU停留时间,术后恢复较甲状腺功能正常者慢,积极有效的围术期处理,术后并发症的发生率、围术期病死率并无明显增高,可安全耐受手术。
Objective： To explore perioperation treatment of coronary artery disease combined with hypothyroidism. Method： Analyze the clinical materials of CAD combined with hypothyroidism （ n = 20） that were treated with surgical procedure. The extubation time, ICU Stay time, Hospital days, Inotrope use and LOCS incidence were studied.Result：The result of surgical treatment was excellent, 19 of those were well, and one died. Extubation time was from 14 to 146 hours,（38 ± 21）hours; the ICU stay time was from 16 to 67 hours, （35 ± 14.5）hours. To imporove the cardiac function, Dopamine was administered to each patient with dose 2-5μg.kg^-1.min^-1 . Epinephrine was used in four patients with dose 0.02-0.08 μg.kg^-1.min^-1. One was supported by IABP due to the poor left ventricular function, and the IABP was moved after 5 days; one was died from MODS. Conclusion： The surgical treatment of CAD combined with hypothyroidism was safety and the result was excellent, but the extubation time, ICU Stay time and Hospital days were longer than usual. To deal with effective perioperative treatment, surgical treatment do not raise the rate of complication and mortality.
出处
《心肺血管病杂志》
CAS
2009年第4期217-219,239,共4页
Journal of Cardiovascular and Pulmonary Diseases
