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1、心肺血管病杂志2009年7月第28卷第4期JournalofCardiovascular&PulmonaryDiseases,July2009,Vol.28,No.4217DOI:10.3969Pj.issn.100725062.2009.04.001·临床论著·冠心病合并甲状腺功能减退症冠状动脉搭桥术围术期治疗3张富恩张健群孔晴宇甘辉立曹向戎毛斌李继勇〔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
2、前甲减确诊者均服用左旋甲状腺素片,剂量为1215～200μgPd,平均(85±1119)μgPd,(1115±0114)μgPkg,术后3d内服用剂量为25～200μgPd,平均(113±1113)μgPd,(1156±0113)μgPkg;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250μgPd,最小剂量为75μgPd,平均179117μgPd,(2138±0166)μgPkg;术后机械通气时间14～146h,平均-1-1(38±21)h,ICU停留时间16～67h,平均(35±1415)h;术后使用2～5μg·kg·min多巴胺改善心功能,
3、-1-1其中使用肾上腺素维持心功能者4例,剂量在0102～0108μg·kg·min,行IABP辅助治疗者1例,5d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。〔关键词〕冠状动脉疾病;心脏外科手术;甲状腺功能减退症〔中图分类号〕R543.3〔文献标识码〕A〔文章编号〕100725062(2009)042217204Thesurgicaltreatmentofcoronaryarterydiseasecombi
4、nedwithhypothyroidismZHANGFuen,ZHANGJianqun,KONGQingyu,GANHuili,CAOXiangrong,MAOBin,LIJiyongDepartmentofCardiovascularSurgery,CapitalMedicalUniversityaffiliatedAnzhenHospital,BeijingInstituteofHeart,LungandBloodVesselDiseases,Beijing100029,China[Abstract]Objective:Toexploreperioperationt
5、reatmentofcoronaryarterydiseasecombinedwithhypothyroidism.Method:AnalyzetheclinicalmaterialsofCADcombinedwithhypothyroidism(n=20)thatweretreatedwithsurgicalprocedure.Theextubationtime,ICUStaytime,Hospitaldays,InotropeuseandLOCSincidencewerestudied.Result:Theresultofsurgicaltreatmentwasex
6、cellent,19ofthosewerewell,andonedied.Extubationtimewasfrom14to146hours,(38±21)hours;theICUstaytimewasfrom16to67hours,(35±1415)hours.To-1-1improvethecardiacfunction,Dopaminewasadministeredtoeachpatientwithdose225μg·kg·min.Epinephrine-1-1wasusedinfourpatientswithdose010220108μg·kg·min.Onew
7、assupportedbyIABPduetothepoorleftventricularfunction,andtheIABPwasmovedafter5days;onewasdiedfromMODS.Conclusion:ThesurgicaltreatmentofCADcombinedwithhypothyroidismwassafetyandtheresultwasexcellent,buttheextubationtime、ICUStaytimeandHospitaldayswerelongerthanusual.Todealwi
