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检测31例小儿先天性心脏病手术前、后血清甲状腺激素及皮质醇水平。发现30例(96.8％)患儿术后1天呈低T_3、高rT_3;术后T_4和TSH仅有轻度变化。皮质醇于术后6小时达峰值;后者与术后1天T_3或rT_3分别呈明显负或正相关。术中接受体外循环患儿,主动脉阻断时间与术后1天T_3或rT_3值分别呈负或正相关。有并发症患儿术后1天T_3和FT_3I明显低于无并发症患儿;rT_3则高于无并发症者。本研究表明小儿先心病术后血清甲状腺变化特点主要是低T_3综合征,前述变化主要与内源性糖皮质激素分泌增多有关。
Serum thyroid hormone and cortisol levels were measured in 31 children with congenital heart disease before and after surgery. Thirty (96.8%) children were found to have low T_3 and high rT_3 one day after surgery. T_4 and TSH only slightly changed after operation. Cortisol peaked at 6 hours after surgery; the latter was negatively or positively correlated with T_3 or rT_3 on the 1st postoperative day respectively. In children undergoing cardiopulmonary bypass during surgery, the aorta occlusion time was negatively or positively correlated with T_3 or rT_3 values on the first postoperative day respectively. Children with complications on the 1st postoperative day T_3 and FT_3I was significantly lower than those without complications; rT_3 was higher than no complications. This study shows that thyroid changes in children with congenital heart disease is mainly characterized by low T 3 syndrome, the aforementioned changes mainly associated with increased endogenous glucocorticoid secretion.