The Changing Rule Of Thyroid Hormone Level Of Pediatric Patients With Congenital Heart Disease And The Relationship Between Thyroid Hormone Level And The Prognosis In Intensive Care Unit

The first part:Exploring the changing rule of thyroid hormone level in pediatric patients of complex congenital heart disease after cardiac surgery with cardiopulmonary bypass.Background and Objective:Caridiac surgery undergoing cardiopulmonary bypass have become the main way to treat Complex congenital heart disease,but the tissue and orgen of pediatric patients is immature and susceptible to cardiopulmonary bypass and cardiac surgery, the thyroid hormone level would decrease postoperatively. The plasma thyroid hormone level were measured in pediatric patients aged less than 1-year old with Complex congenital heart disease, exploring the changing rule of thyroid hormone postoperatively.Methods:26 pediatric patients were taken in this study, all were diagnosed and accepted cardiac surgery undergoing cardiopulmonary bypass. The blood samples were taken preoperatively and in 24 hours postoperatively,48 hours postoperatively,72 hours postoperatively,120 hours postoperatively in order to measure the thyroid hormone level of free triiodothyronine(FT3), total triiodothyronine(TT3), free thyroxine(FT4), total thyroxine(TT4) and thyroid Stimulating Hormone (TSH).Results:After the cardiac surgery with cardiopulmonary bypass, the thyroid hormone level decreased less than the normal lower limit. And the FT3 level was reduced within 48 hours after surgery continuously:the FT3 level at 48 hours postoperatively was lower than that at 24 hours postoperatively(P<0.05); the TSH level was increased within 72 hours postoperatively, the level of TSH at 48 hours postoperatively was higher than that at 24 hours postoperatively (P<0.05), the level of TSH at 72 hours postoperatively was higher than that at 48 hours postoperativel (P<0.05). FT3、FT4、TT3、TT4、TSH recover to the preoperative level in 120 hours operatively(P>0.05).Conclusion:The thyroid hormone level of pediatric patients undergoing cardiac surgery with CPB reduced, and reach the bottom in 24~48 hours postoperatively, the thyroid hormone level increase to the normal with the rehabilitation; and the FT3 level shown the biggest decline, the TSH level recover firstly.The second part: Exploring the relationship between thyroid hormones level after cardiac surgery with cardiopulmonary bypass of children aged less than lyear and prolonged recovery.Objective:To explore the relationship between thyroid hormones level of children aged less than 1 year undergoing cardiopulmonary bypass (CPB) and prolonged recovery.Method:186 children less than lyear undergoing cardiac surgery with CPB in Fu Wai Hospital from January 2014 to July 2015 were retrospectively analyzed. The pediatric intensive care unit(PICU) stay longer than 5days were defined as prolonged recovery. The relationship between thyroid hormones with 24hours postoperatively were analyzed.Result:The prolonged recovery group had lower free triiodothyronine (FT3) (P=0.003)、total triiodothyronine (TT3) (P<0.001)、total thyroxine (TT4) (P=0.009). According to multivariable logistical regression model, low level FT3 was the independent predictor for prolonged recovery (OR= 0.27; 95%CI=0.11~0.68; P=0.005). the reduction of thyroid hormone were associated with low weight (r=0.11, P<0.001). Among all the patients with SES, SES-2 occupied 61.54%, the incidence of prolonged recovery was higher in SES-2 group (P<0.05), and no independent predicting factor for SES-2 was found.Conclusion:Children less than lyear with low weight were likely to have a decreasing level of FT3 within 24hours postoperatively; and the level of FT3 was the independent predictor for prolonged recovery. SES-2 would likely to occur prolonged recovery.