不同钙浓度透析液治疗甲状旁腺切除术后低钙血症的探讨  

Dialysate with different concentrations of calcium for hypocalcemia after parathyroidectomy

作　　者：孔新保[1] 何禾[1] 吕强[1] 王帅[1] 

机构地区：[1]皖南医学院第二附属医院肾内科

出　　处：《临床肾脏病杂志》2015年第4期230-233,共4页Journal Of Clinical Nephrology

摘　　要：目的观察血液透析患者行甲状旁腺切除术后，使用不同钙浓度透析液纠正术后低钙血症的效果。方法回顾性分析2011年10月至2014年5月我院血液透析中心行甲状旁腺切除术的13例患者，根据术后透析治疗时使用的不同钙浓度透析液，分为A组（使用钙浓度1．50mmol／L透析液）5例，B组（使用钙浓度1．75mmol／L透析液）8例。分别观察2组患者术后当日、术后第3．6个月透析前后的血压及透析问期的血钙、血磷、全段甲状旁腺素（intact parathyroid hormone，iPTH），比较数值之间的变化；同时统计2组患者口服钙剂的用量，并通过彩色多普勒超声心脏瓣膜评估及胸部多层螺旋电子计算机断层扫描成像（multi-slice computed tomogmphy，MSCT）所示心脏大血管的影像学表现，比较术前及术后第6个月患者冠状动脉钙化评分分值的变化。结果比较2组单次血液透析治疗时透析前与透析结束后4h的血钙，2组透析结束后4h的血钙较透析前均升高，差异有统计学意义（P〈0．05）。同时分别比较2组透析前与术后第3、6个月时血钙变化，差异有统计学意义（P〈0．05）。而2组之间透析前的血磷、iPTH无统计学差异（P〉0．05）。通过6个月调整治疗后，血钙较术后当日明显升高（P〈0．05），血磷明显下降（P〈0．05）。术后第6个月时，B组较A组口服钙片的剂量明显减少，血压明显上升（P〈0．05）。同时术前及术后第6个月心脏瓣膜评估及冠状动脉钙化评分分值无明显变化（P〈0．05）。结论高钙透析液能更好、更快的纠正术后出现的严重低钙血症，减少维持性钙片的服用剂量，但须注意异位钙化的风险及高血压的发生。Objective To observe the efficacy of dialysate with different concentrations of calcium for hypocalcemia after parathyroidectomy in maintenance hemodialysis （MHD） patients. Methods Thirteen patients who have received parathyroidectomy from 2011 to 2014 in Hemodialysis Center were divided into group A given 1.50 mmol/L low calcium concentration dialysate, and group B given 1.75 mmol/L high calcium concentration dialysate. The blood pressure, serum total calcium, blood phosphate and parathyroid hormone were determined on the operation day, and 3rd and 6th month after operation. The calcium usage was recorded. The changes of calcification scores in coronary artery were compared before and 6th month after operation color Doppler sonography and multi-slice computed tomography. Results The serum total calcium in group A and group B was significantly increased at 4 h after calcium administration as compared with that before operation （P〈0. 05）. There was significant difference in serum total calcium and blood phosphate in both two groups before and 3 and 6 months after operation （P〈0. 05）, but there was no significant difference in blood phosphate and iPTH between two groups before MHD （P〉0. 05）. The serum total calcium was higher, and blood phosphate was lower in group B than in group A. At 6th month after operation, the usage of calcium dose was significantly reduced, and the blood pressure was markedly elevated in group B as compared with group A （P〈0. 05）. There were no significant changes in the calcification scores in coronary artery before and 6th month after operation （P〉0. 05）. Conclusions High calcium concentration dialysate can correct hypocalcemia after operation and reduce the usage of caleium. But the risk of heterotopic calcification and hypertension should be noticed as well.

关 键 词：甲状旁腺切除术 低钙血症 透析液 

分 类 号：R653[医药卫生—外科学]