甲状腺功能亢进症患者围手术期甲状腺危象风险的系统评价
贵州医科大学 麻醉与心脏电生理课题组
翻译：牛振英 编辑：张中伟 审校：曹莹
甲状腺危象是接受手术的甲状腺机能亢进症患者的一种可怕的并发症。我们评估了接受手术的原发性甲状腺功能亢进症患者不同术前治疗方案的甲状腺危象风险。
系统地搜索PubMed、EMBASE和Cochrane图书馆，查找关于成年甲亢患者在全麻下接受择期手术的所有研究。选定的研究根据术前治疗进行分类：不治疗、抗甲状腺药物(硫代酰胺)治疗、碘剂治疗、β-受体阻滞剂治疗或联合治疗。如果文献中有报告治疗效果，也就是恢复正常甲状腺功能，则从相关文献中摘录出来。使用非随机化干预研究中的偏倚风险(Robins-I)或随机研究的Cochrane偏倚风险工具来评估偏倚风险。
共检索到7009篇文章，其中有26篇研究发表于1975年至2020年之间，并进行了评估。所有研究都有中度到严重的偏倚风险，主要归因于混淆风险、干预状态的分类和结果的定义。所有研究都报道了甲状腺切除术患者。我们发现没有随机研究比较治疗患者和未治疗患者患甲状腺危象的风险。所有治疗组都报告了甲状腺危象的病例（如果没有明确报告甲状腺危象的发生，但BurcheWartofsky评分中包括相关症状，则计算BurcheWartofsky评分(表1)。BurcheWartofsky评分>45被认为提示甲状腺危象。），描述的发生率从0%到14%不等。
评估围手术期甲状腺危象风险的证据不充分。考虑到这一并发症的严重性和不可能识别出风险增加的患者，这些患者的术前治疗仍然是有必要的。
De Mul N, et al. Risk of perioperative thyroid storm in hyperthyroid patients: a systematic review[J].Br J Anaesth. 2021 Dec;127(6):879-889. doi: 10.1016/j.bja.2021.06.043. Epub 2021 Aug 11.
Risk of perioperative thyroid storm in hyperthyroid patients: a
systematic review
Abstract：
Background: Thyroid storm is a feared complication in patients with hyperthyroidism undergoing surgery. We assessed the risk of thyroid storm for different preoperative treatment options for patients with primary hyperthyroidism undergoing surgery.
Methods: Pubmed, EMBASE, and The Cochrane Library were searched systematically for all studies reporting on adult hyperthyroid patients undergoing elective surgery under general anaesthesia. Selected studies were categorised based on preoperative treatment: no treatment, antithyroid medication (thionamides), iodine, b-blocking medication, or a combination thereof. Treatment effect, that is restoring euthyroidism, was extracted from the publications if available. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) or the Cochrane Risk of Bias tool for randomised studies.
Results: The search yielded 7009 articles, of which 26 studies published between 1975 and 2020 were selected for critical appraisal. All studies had moderate to critical risk of bias, mainly attributable to risk of confounding, classification of intervention status, and definition of the outcome. All studies reported on thyroidectomy patients. We found no randomised studies comparing the risk of thyroid storm between treated and untreated patients. Cases of thyroid storm were reported in all treatment groups with incidences described ranging from 0% to 14%.
Conclusion: Evidence assessing the risk of perioperative thyroid storm is of insufficient quality. Given the seriousness of this complication and the impossibility of identifying patients at increased risk, preoperative treatment of these patients remains warranted.
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