目的 探討髖或膝關節置換術（THR/TKR）并存甲狀腺功能減退癥（甲減）患者圍手術期的處理策略。方法 2009年1月－2011年12月收治30例行THR/TKR并存甲減患者，其中男8例，女22例，平均年齡62.4歲。處理要點包括術前糾正甲狀腺激素水平；術中縮短手術時間，減少出血量，選擇性應用糖皮質激素；術后補充甲狀腺激素，預防感染及深靜脈血栓形成，改善胃腸功能。評價指標包括圍手術期血壓、心率變化，胃腸功能狀況，切口愈合時間，甲狀腺功能水平，黏液性水腫昏迷等并發癥發生率；術前及術后Harris及特種外科醫院評分系統（HSS）評分等。 結果 術后心率變化大，非致命性心律失常者20例；血壓控制平穩；術后甲狀腺功能變化不明顯，無黏液性水腫昏迷、心包積液及呼吸窘迫等嚴重并發癥發生。隨訪1個月，術前HSS評分平均28分，術后86分；術前Harris評分平均32分，術后87分。 結論 術前控制血清促甲狀腺素在0.5～3.0 mU/L以內，總甲狀腺素、游離甲狀腺素至正常水平，是有效預防甲減患者THR/TKR圍手術期并發癥的關鍵；綜合應用左甲狀腺素片、糖皮質激素和抗凝治療是安全渡過圍手術期的重要保證。
Objective To investigate the prevalence and risk factors of degenerative disc disease (DDD) in pilots. Methods From January 2021 to May 2022, pilots were surveyed using a whole group sampling method and relevant imaging data were collected. The contents of the survey included basic information, DDD-related information, flight-related information, and personal habits. The prevalence of DDD was calculated, and univariate χ2 test, t-test, and multivariate logistic regression analysis were performed for the diseased and healthy groups to screen the risk factors of DDD. Results A total of 170 copies of questionnaire were sent out and 162 valid copies were returned. The prevalence of DDD was 47.5% (77/162), including 27.8% (45/162) for cervical spondylosis, 29.6% (48/162) for lumbar disc herniation, and 3.1% (5/162) for degenerative lumbar spondylolisthesis. The results of univariate analysis showed that body mass index (t=2.594, P=0.010), driving age (t=2.160, P=0.032), maximum load in flight (t=2.953, P=0.004), mean load in flight (t=2.575, P=0.011), insomnia (χ2=4.756, P=0.029) and smoking (χ2=7.977, P=0.005) were significantly different between the diseased group and the healthy group. Multivariate logistic regression showed that driving age [odds ratio (OR)=1.077, 95% confidence interval (CI) (1.025, 1.132), P=0.004], maximum load in flight [OR=1.279, 95%CI (1.109, 1.475), P=0.001], helmet weight [OR=1.516, 95%CI (1.056, 2.175), P=0.024], insomnia [OR=2.235, 95%CI (1.114, 4.483), P=0.024], and smoking [OR=2.527, 95%CI (1.255, 5.087), P=0.009] were risk factors for DDD. Conclusions The prevalence of DDD is high in pilots. High driving age, high maximum load in flight, high helmet weight, insomnia, and smoking may be independent risk factors for DDD.