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华西医学  2012 

甲状腺功能减退症患者髋或膝关节置换术围手术期的处理

, PP. 665-669

Keywords: 甲状腺功能减退症,全髋关节置换术,全膝关节置换术,围手术期

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Abstract:

目的 探讨髋或膝关节置换术(THR/TKR)并存甲状腺功能减退症(甲减)患者围手术期的处理策略。方法 2009年1月-2011年12月收治30例行THR/TKR并存甲减患者,其中男8例,女22例,平均年龄62.4岁。处理要点包括术前纠正甲状腺激素水平;术中缩短手术时间,减少出血量,选择性应用糖皮质激素;术后补充甲状腺激素,预防感染及深静脉血栓形成,改善胃肠功能。评价指标包括围手术期血压、心率变化,胃肠功能状况,切口愈合时间,甲状腺功能水平,黏液性水肿昏迷等并发症发生率;术前及术后Harris及特种外科医院评分系统(HSS)评分等。结果 术后心率变化大,非致命性心律失常者20例;血压控制平稳;术后甲状腺功能变化不明显,无黏液性水肿昏迷、心包积液及呼吸窘迫等严重并发症发生。随访1个月,术前HSS评分平均28分,术后86分;术前Harris评分平均32分,术后87分。结论 术前控制血清促甲状腺素在0.5~3.0mU/L以内,总甲状腺素、游离甲状腺素至正常水平,是有效预防甲减患者THR/TKR围手术期并发症的关键;综合应用左甲状腺素片、糖皮质激素和抗凝治疗是安全渡过围手术期的重要保证。

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