继发性甲状旁腺功能亢进行甲状旁腺全切除术后低钙血症的防治  

Prevention and management of hypocalcaemia after total parathyroidectomy for secondary hyperparathyroidism

作　　者：郝国强[1] 邢壮杰[1] 邓芝徽[1] 李润生[1] 赵晖[1] 郑新[1] HAO Guoqiang;XING Zhuangjie;DENG Zhihui;LI Yunsheng;ZHAO Hui;ZHENG Xin(Department of General Surgery,Affiliated Zhongshan Hospital of Dalian University,Dalian,Liaoning 116001,China)

机构地区：[1]大连大学附属中山医院普外一科

出　　处：《安徽医药》2019年第10期1998-2000,共3页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨全甲状旁腺切除治疗继发性甲状旁腺功能亢进术后低钙血症的有效防治方法。方法回顾总结2015年1月至2018年1月大连大学附属中山医院38例继发性甲状旁腺功能亢进的慢性肾功能衰竭尿毒症期病人接受甲状旁腺全切除术,男性26例,女性12例;年龄范围为28~76岁;透析时间平均为7.8年。38例中29例病人血甲状旁腺素(parathyroid hormone,PTH)值>2 300 pg/mL,另外7例病人血PTH值为1 200~2 200 pg/mL,其余2例病人血PTH值为800~1 200 pg/mL;增强CT检查结果提示:甲状旁腺增生(2~4枚)。均行甲状旁腺(4枚)全部切除术,其中1例同时行甲状腺癌根治术,术程顺利,术后甲状旁腺素降至正常或低于正常值(15~72 pg/mL)。术后立即补钙,根据每6小时检测血钙检测值的情况及时调整微量泵注入速度(10%葡萄糖酸钙30 mL+10%葡萄糖20 mL,微量泵25 mL/h持续泵入,每天5~12次),维持血钙在2.4~2.6 mmol/L。结果38例病人每日葡萄糖酸钙(口服及静脉泵入)补充量10~40 g,静脉补钙时间6~15 d,5例病人术后第1天出现轻度低钙血症症状,其余病人均无临床低钙血症症状。结论术后应及时并足剂量的补充钙剂,维持血钙于正常上限水平,可缩短静脉补钙时间,减少住院时间,避免低钙血症引起的症状。Objective To explore the effective prevention and management of hypocalcaemia after total parathyroidectomy for sec?ondary hyperparathyroidism.Methods Thirty?eight patients with secondary hyperparathyroidism in the uremia stage of chronic re?nal failure who undergone total parathyroidectomy in Affiliated Zhongshan Hospital of Dalian University from January 2015 to Janu?ary 2018 were retrospectively analyzed,of whom there are 26 males and 12 females.The age range is 28 to 76 years,the average di?alysis time is 7.8 years.29 cases in 38 patients had a parathyroid hormone(PTH)value>2 300 pg/mL,and 7 patients had a blood PTH value of 1 200?2 200 pg/mL,2 patients had a blood PTH value of 800?1 200 pg/mL.The enhanced CT results showed that parathyroid hyperplasia(2?4).All patients underwent total resection of the parathyroid glands(4).The procedure was successful.Postoperative parathyroid hormone decreased to normal or below normal(15?72 pg/mL).One of them underwent radical thyroidecto?my.Calcium supplementation immediately after surgery,according to the detection of blood calcium detection value every 6 hours,timely adjust the micro pump injection speed(10%calcium gluconate 30 mL+10%glucose 20 mL,micro pump 25 mL/h with continuous pumping,5?12 times a day),blood calcium was maintained at the 2.4 to 2.6 mmol/L.Results 38 patients was given cal?cium gluconate(oral and intravenous pumping),with 10?40 g every day,the time of the calcium supplement is 6?15 days.On the 1st day after surgery,5 patients undergone mild temporary clinic symptoms of hypocalcemia,the others had no hypocalcemia.Conclusion Calcium supplement should be given in a time and sufficient dose after surgery to keep the level blood calcium at up?per limits of normal,maybe that can shorten the time of calcium supplement,reduce the hospital stays,and avoid the clinic symp?toms of hypocalcemia.

关 键 词：尿毒症 甲状旁腺切除术/副作用 甲状旁腺功能亢进 继发性 低钙血症 

分 类 号：R73[医药卫生—肿瘤]