Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study
Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study
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DOI：
10.1016/s0140-6736(00)02576-9
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发表时间：
2000-08-12
期刊：
影响因子：
168.9
通讯作者：
Heinrich, UE
中科院分区：
文献类型：
--
作者：
Bettendorf, M;Schmidt, KG;Heinrich, UE
背景：危重病期间和手术后，血清甲状腺激素浓度短暂下降。我们前瞻性研究了先天性心脏畸形患儿体外循环术后三碘甲状腺原氨酸治疗的内分泌和血液动力学效应。（中位年龄0.6岁;范围2天至10.4岁）随机分配安慰剂（生理盐水）或每日输注三碘甲状腺原氨酸（2 μ g/在术后第1天给予1 μ g/kg体重，在随后的术后天数直至术后12天给予1 μ g/kg体重。在首次输注前及输注后2 h、24 h、72 h，用放射免疫法测定血浆甲状腺激素浓度，用超声心动图评价心脏收缩功能。在术后过程中，重症监护措施进行了评估，通过使用的治疗干预评分系统，结果在所有患者中，术后血浆促甲状腺激素，甲状腺素，游离甲状腺素，三碘甲状腺原氨酸的浓度异常低，血浆浓度的反向三碘甲状腺原氨酸升高。治疗开始后，给予三碘甲状腺原氨酸的患者的三碘甲状腺原氨酸显著高于接受安慰剂的患者，而两组的促甲状腺激素、甲状腺素、游离甲状腺素和反向三碘甲状腺原氨酸保持相似。出院时，所有患者的甲状腺激素均在正常范围内，但促甲状腺激素分泌增加至血浆浓度高于治疗前。给予三碘甲状腺原氨酸的儿童心脏指数的平均变化显著更高（20.4%[SD 19.6] vs 10.0%[15.2]; p = 0.004）。在较长时间的体外循环手术后，给予三碘甲状腺原氨酸的患者的心功能改善最多。总体而言，给予三碘甲状腺原氨酸的患者有显着降低的平均治疗scores.Interpretation治疗的儿童与三碘甲状腺原氨酸体外循环手术后提高三碘甲状腺原氨酸血浆浓度，改善心肌功能，特别是在术后心输出量低的患者没有不良事件，并没有延迟术后恢复甲状腺功能，此外，三碘甲状腺原氨酸减少了术后重症监护的需要。
Background Serum thyroid hormone concentrations decline transiently during critical illness and after surgical procedures. We investigated prospectively the endocrine and haemodynamic effects of tri-iodothyronine treatment after cardiopulmonary bypass operations in children with congenital cardiac malformations.Methods We did a randomised, double-blind, placebo-controlled trial, in which 40 children (median age 0.6 years; range 2 days to 10.4 years) were randomly assigned placebo (saline) or one daily infusion of tri-iodothyronine (2 mu g/kg bodyweight on day 1 after surgery and 1 mu g/kg bodyweight on subsequent postoperative days up to 12 days after surgery. Before and 2 h, 24 h, and 72 h after the first infusion, plasma concentrations of thyroid hormones were measured by RIA, and systolic cardiac function was evaluated by echocardiography. During the postoperative course intensive-care measures were assessed by use of the therapeutic intervention scoring system,Findings In all patients, postoperative plasma concentrations of thyrotropin, thyroxine, free thyroxine, tri-iodothyronine were abnormally low and plasma concentrations of reverse tri-iodothyronine were raised. After start of treatment, tri-iodothyronine was significantly higher in patients given tri-iodothyronine than in those receiving placebo, whereas thyrotropin, thyroxine, free thyroxine, and reverse tri-iodothyronine remained similar in the two groups. At discharge, thyroid hormones of all patients were within the normal range, but thyrotropin secretion increased to plasma concentrations higher than those seen before treatment. The mean change of cardiac index was significantly higher in children given tri-iodothyronine (20.4% [SD 19.6] vs 10.0% [15.2]; p=0.004). Systolic cardiac function improved most in patients given tri-iodothyronine after longer cardiopulmonary bypass operations. Overall, patients given tri-iodothyronine had significantly lower mean treatment scores.Interpretation Treatment of children with tri-iodothyronine after cardiopulmonary bypass operations raises tri-iodothyronine plasma concentrations and improves myocardial function especially in patients with low postoperative cardiac output without adverse events, and without delaying postoperative recovery of thyroid function, Furthermore, tri-iodothyronine reduces the need for postoperative intensive care.