甲状腺切除术后甲状旁腺功能与血钙、血磷变化分析  

Changes of serum calcium, phosphates and parathyroid function after thyroidectomy

作　　者：张骞[1] 李小伟[1] 康春博[1] 陈秀峰[1] 王德仲[1] 李文强[1] 李旭斌[1] 刘金洪[1] 郑建伟[1] 马瑜[1] 曲军[1] 

机构地区：[1]航天中心医院普外科,北京100049

出　　处：《中华普通外科杂志》2016年第3期204-207,共4页Chinese Journal of General Surgery

摘　　要：目的 观察双侧甲状腺切除术后血清甲状旁腺素（PTH）、血钙、血磷水平变化,并探讨其预测低钙血症的价值.方法 回顾性分析航天中心医院普外科2014年5月至2015年4月收治的有完整临床资料的32例双侧甲状腺切除术患者围手术期血PTH、血钙和血磷情况,观察术后血PTH、血钙、血磷变化及相互关系.结果 本研究32例患者中,术后1h血PTH值≥4 pg/ml患者组术后血PTH值都能恢复至正常范围（＞15 pg/ml）;而术后1h血PTH值＜4 pg/ml患者组术后血PTH值在72 h内不能恢复至正常范围（＞15 pg/ml）,虽经口服补钙血钙仍难以维持在正常水平,且血磷升高,提示患者持续处于甲状旁腺激素不足状态.结论 双侧甲状腺切除术后1h血PTH值4 pg/ml可能是判断甲状旁腺功能恢复情况的临界点.1h血PTH＜4 pg/ml提示甲状旁腺功能低下,术后应尽早（12h内）给予钙剂的补充,以防止低钙血症的发生.血磷值能间接反映甲状旁腺功能的恢复情况.Objective To observe the change of serum parathyroid hormone （PTH）,serum calcium and serum phosphate level after total thyroidectomy,and to explore their value in predicting hypocalcemia.Methods Perioperative serum PTH,calcium and phosphates in 32 total thyroidectomy patients from May 2014 to April 2015 were retrospectively analyzed.Results Postoperative PTH values recovered to normal range （〉 15 pg/ml）only in those with postoperative 1 hour blood PTH values ≥4 pg/ml,while postoperative 1 hour serum PTH values 〈 4 pg/ml,predicts a failure for PTH values back to normal range （〉 15 pg/ml） within 72 hours postoperatively,with a low serum calcium and abnormally high serum phosphates despite oral calcium supplement indicating a parathyroid hormone deficiency status.Conclusions Postoperative 1 hour serum PTH value of 4 pg/ml serves as a cut point for postoperative parathyroid function recovery after total thyroidectomy.Postoperative 1 hour serum PTH 〈 4 pg/ml prompts calcium supplement to prevent hypocalcemia.

关 键 词：甲状腺切除术 甲状旁腺素 血钙 血磷 

分 类 号：R653[医药卫生—外科学]