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1、中华临床医师杂志(电子版)2013年12月第7卷第24期ChinJClinicians(ElectronicEdition),December15,2013,Vol.7,No.24·11153··临床论著·甲状腺激素的应用对风湿性心脏病二尖瓣置换术后早期房颤复律作用的随机研究陈群清莫文魁陈丽萍李少彬闫玉生吴源周【摘要】目的观察伴有房颤的风湿性心脏病患者术前应用甲状腺激素(优甲乐)对二尖瓣置换术后早期房颤复律的作用,探索二尖瓣置换术后早期房颤复律的治疗策略。方法172例伴有房颤的风湿性心脏病患者均在体外循环下行二尖瓣置换术,采用随机分组的方法将其分成治疗组(n
2、=86)和对照组(n=86),治疗组术前一周开始每日口服50µg左甲状腺素钠片(优甲乐)至术晨;检测术前、术晨、术后2h、术后第1天、第3天血甲状腺激素T3水平,并观察术后2h至3d的心律变化情况。结果术后3d内两组患者均处于低T3综合征状态,但术后3天内治疗组的T3水平却明显高于对照组(P<0.05);治疗组和对照组的术后2h,3d的复律率分别是64.0%vs.44.2%(P=0.009),37.2%vs.20.9%(P=0.019)。结论风心病房颤患者二尖瓣置换术前短期服用优甲乐可有效提高血T3水平,并可明显提高术后早期房颤的复律水平,为心脏术后早期心脏
3、功能的恢复创造了良好的条件。【关键词】甲状腺激素类;风湿性心脏病;心房颤动;电抗休克;心脏瓣膜,人工TherandomizedstudyofthyroidhormoneforearlycardioversionofatrialfibrillationaftermitralreplacementinpatientswithrheumaticheartdiseaseCHENQun-qing,MOWen-kui,CHENLi-ping,LIShao-bin,YANYu-sheng,WUYuan-zhou.DepartmentofCardiothoracicSurg
4、ery,ZhujiangHospital,SouthernMedicalUniversity,Guangzhou510282,ChinaCorrespondingauthor:WUYuan-zhou,Email:99706367@qq.com【Abstract】ObjectiveToobservetheroleoforalEuthyrox(Levo-thyroxineSodium)preoperativeinearlycardioversionofatrialfibrillation(AF)aftermitralreplacementinpatientswi
5、thAFassociatedwithrheumaticheartdisease,andexplorethetreatmentstrategyofearlycardioversionaftermitralvalvereplacement.Methods172patientswithAFassociatedwithrheumaticheartdiseasereceivedmitralreplacementduringcardiopulmonarybypass(CPB),theywererandomlydividedintotreatmentgroup(n=86)
6、andcontrolgroup(n=86).Intreatmentgroup,50µgEuthyroxwastakeneverydayfromaweekbeforesurgerytothemorningofsurgery.Triiodothyronine(T3)wasdetectedatpreoperative,at2h,1d,3dafteroperation,andthechangeofrhythmwasobservedfrom2hto3dafteroperation.ResultsAllthepatientswereLowT3Syndromein3day
7、safteroperation,butT3levelintreatmentgroupsignificantlyhigherthancontrolgroupduring3dafteroperation(P<0.05).Therateofcardioversionintreatmentgroupandcontrolgroupwere64.0%and44.2%at2h(P=0.009),37.2%and20.9%on3dpostoperatively(P=0.019).ConclusionT3levelinbloodcanbeeffectivelyimproved
8、bytakingEuthyroxinshortter