中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
24期
11153-11156
,共4页
陈群清%莫文魁%陈丽萍%李少彬%闫玉生%吴源周
陳群清%莫文魁%陳麗萍%李少彬%閆玉生%吳源週
진군청%막문괴%진려평%리소빈%염옥생%오원주
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
甲狀腺激素類%風濕性心髒病%心房顫動%電抗休剋%心髒瓣膜,人工
갑상선격소류%풍습성심장병%심방전동%전항휴극%심장판막,인공
Thyroid hormones%Rheumatic heart disease%Atrial fibrillation%Electric countershock%Heart valve prosthesis
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＝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2 h、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2 h，3 d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功能的恢复创造了良好的条件。
目的：觀察伴有房顫的風濕性心髒病患者術前應用甲狀腺激素（優甲樂）對二尖瓣置換術後早期房顫複律的作用，探索二尖瓣置換術後早期房顫複律的治療策略。方法172例伴有房顫的風濕性心髒病患者均在體外循環下行二尖瓣置換術，採用隨機分組的方法將其分成治療組（n＝86）和對照組（n＝86），治療組術前一週開始每日口服50μg左甲狀腺素鈉片（優甲樂）至術晨；檢測術前、術晨、術後2 h、術後第1天、第3天血甲狀腺激素T3水平，併觀察術後2h至3d的心律變化情況。結果術後3d內兩組患者均處于低T3綜閤徵狀態，但術後3天內治療組的T3水平卻明顯高于對照組（P＜0.05）；治療組和對照組的術後2 h，3 d的複律率分彆是64.0%vs.44.2%（P＝0.009），37.2%vs.20.9%（P＝0.019）。結論風心病房顫患者二尖瓣置換術前短期服用優甲樂可有效提高血T3水平，併可明顯提高術後早期房顫的複律水平，為心髒術後早期心髒功能的恢複創造瞭良好的條件。
목적：관찰반유방전적풍습성심장병환자술전응용갑상선격소（우갑악）대이첨판치환술후조기방전복률적작용，탐색이첨판치환술후조기방전복률적치료책략。방법172례반유방전적풍습성심장병환자균재체외순배하행이첨판치환술，채용수궤분조적방법장기분성치료조（n＝86）화대조조（n＝86），치료조술전일주개시매일구복50μg좌갑상선소납편（우갑악）지술신；검측술전、술신、술후2 h、술후제1천、제3천혈갑상선격소T3수평，병관찰술후2h지3d적심률변화정황。결과술후3d내량조환자균처우저T3종합정상태，단술후3천내치료조적T3수평각명현고우대조조（P＜0.05）；치료조화대조조적술후2 h，3 d적복률솔분별시64.0%vs.44.2%（P＝0.009），37.2%vs.20.9%（P＝0.019）。결론풍심병방전환자이첨판치환술전단기복용우갑악가유효제고혈T3수평，병가명현제고술후조기방전적복률수평，위심장술후조기심장공능적회복창조료량호적조건。
Objective To observe the role of oral Euthyrox(Levo-thyroxine Sodium)preoperative in early cardioversion of atrial fibrillation(AF) after mitral replacement in patients with AF associated with rheumatic heart disease, and explore the treatment strategy of early cardioversion after mitral valve replacement. Methods 172 patients with AF associated with rheumatic heart disease received mitral replacement during cardiopulmonary bypass(CPB), they were randomly divided into treatment group(n=86) and control group(n=86). In treatment group, 50 μg Euthyrox was taken everyday from a week before surgery to the morning of surgery. Triiodothyronine (T3) was detected at preoperative, at 2 h, 1 d, 3 d after operation,and the change of rhythm was observed from 2 h to 3 d after operation. Results All the patients were Low T3 Syndrome in 3 days after operation, but T3 level in treatment group significantly higher than control group during 3 d after operation (P<0.05). The rate of cardioversion in treatment group and control group were 64.0%and 44.2%at 2 h (P=0.009), 37.2%and 20.9% on 3 d postoperatively(P=0.019). Conclusion T3 level in blood can be effectively improved by taking Euthyrox in short term before operation. And the level of early cardioversion of atrial fibrillation is improved significantly after operation. It may be good at conditions for early cardiac function recovery after heart surgery.
