论文部分内容阅读
目的观察机械通气患者撤机前的甲状腺激素水平,探讨其与撤机是否成功的关系。方法将155例机械通气患者按原发病因不同分慢性阻塞性肺疾病(COPD)组(44例)、脑血管意外组(43例)、中毒组(33例)和创伤组(35例),再按照撤机是否成功分为撤机成功和撤机失败2个亚组。各组在年龄、性别、住院时间、营养状况和疾病严重程度(急性生理与慢性疾病评分、ApacheⅡ评分)等方面的差异均无统计学意义(均P>0.05)。比较各组撤机前1 d测定的甲状腺激素T3、T4、FT3、FT4和促甲状腺激素(TSH)水平。结果撤机失败的COPD和脑血管意外患者的T3和FT3水平明显低于撤机成功者(P<0.05),而在创伤和中毒患者中,撤机成功组和失败组的T3和FT3水平差异无统计学意义(P>0.05);各组间T4、FT4和TSH水平比较,差异均无统计学意义(均P>0.05)。结论在COPD和脑血管意外的机械通气患者中,T3和FT3水平低可预测撤机成功性较小;而在创伤和中毒机械通气患者的撤机中,T3和FT3水平尚无明显的预测作用。
Objective To observe the level of thyroid hormones in patients with mechanical ventilation before weaning and discuss the relationship between them and the success of weaning. Methods A total of 155 patients with mechanical ventilation were divided into two groups according to the primary cause of chronic obstructive pulmonary disease (COPD) group (44 cases), cerebrovascular accident group (43 cases), poisoning group (33 cases) and trauma group (35 cases) Then according to whether the successful weaning is divided into two groups of weaning success and weaning failure. There were no significant differences in age, sex, length of hospital stay, nutritional status and disease severity (Acute Physiology and Chronic Disease Score, ApacheⅡscore) among all groups (all P> 0.05). Thyroid hormones T3, T4, FT3, FT4 and thyrotropin (TSH) levels were measured at 1 d before weaning. Results The levels of T3 and FT3 in patients with weaning failure and in patients with cerebrovascular accident were significantly lower than those in patients with weaning success (P <0.05). However, the differences of T3 and FT3 levels in patients with trauma and poisoning between the successful and the failed patients There was no statistical significance (P> 0.05). There was no significant difference in the levels of T4, FT4 and TSH among the three groups (all P> 0.05). Conclusions In patients with COPD and cerebrovascular accident who have mechanical ventilation, low T3 and FT3 levels may predict less successful weaning, while T3 and FT3 levels are not significantly predictive of weaning in patients with traumatic and toxic mechanical ventilation .