尿毒症合并继发性甲状旁腺功能亢进患者甲状旁腺全切术术后HD、CRRT治疗效果对比观察  

Comparison of curative effects of HD and CRRT on patients with uremia complicated with secondary hyperparathyroidism after total parathyroidectomy

作　　者：王彦江[1] 王海琳 袁心柱 费微 杨晓英 谢席胜[1] 冯胜刚[1] WANG Yanjiang;WANG Hailin;YUAN Xinzhu;FEI Wei;YANG Xiaoying;XIE Xisheng;FENG Shenggang(Department of Nephrology,Nanchong Central Hospital,Nanchong 637001,China;不详)

机构地区：[1]川北医学院第二临床医学院南充市中心医院肾内科,四川南充637001 [2]潆溪街道社区卫生服务中心公卫科 [3]川北医学院第二临床医学院南充市中心医院医院感染管理科

出　　处：《山东医药》2023年第24期25-29,共5页Shandong Medical Journal

基　　金：南充市2022年第二批市级科技计划项目(22JCYJPT0014)。

摘　　要：目的对比观察尿毒症合并继发性甲状旁腺功能亢进(SHPT)患者甲状旁腺全切(TP)+甲状旁腺自体移植术(AT)后血液透析(HD)、连续性肾脏替代治疗(CRRT)的效果。方法60例行TP+AT治疗的尿毒症合并SHPT患者按照术后血液净化方式不同分为血透组和肾替组各30例,血透组患者术后第1天给予HD治疗,采用无肝素抗凝模式;肾替组患者术后第1天给予CRRT治疗,采用枸橼酸抗凝模式。比较两组单室Kt/V(spKt/V)、尿素下降率(URR)、并发症及手术前后血钙、血磷、全段甲状旁腺激素(iPTH)。结果与肾替组比较,血透组spKt/V、URR升高(P均<0.05)。血透组和肾替组均无手术切口部位出血;与肾替组比较,血透组透析管路总凝血率高(P<0.05)。与同组术前比较,两组术后第1天血钙、血磷、iPTH水平降低(P均<0.05)。结论对于TP+AP术后的尿毒症合并SHPT患者,施行CRRT后管路凝血发生率低,但小分子量毒素清除方面较差;HD在清除小分子量毒素方面能力更强,但是有一定的管路凝血发生率,但很少出现因严重凝血而发生的HD中止现象。Objective To compare the effects of hemodialysis(HD)and continuous renal replacement therapy on patients with uremia complicated with secondary hyperparathyroidism(SHPT)after total parathyroidectomy(TP)+parathyroid autotransplantation(AT).Methods Sixty patients with uremia complicated with SHPT treated with TP+AT were divided into the hemodialysis group(n=30)and renal replacement group(n=30)according to the different ways of postoperative blood purification.HD treatment was given to the patients in the hemodialysis group on the first day after surgery,and heparin free anticoagulation mode was used;patients in the renal replacement group were treated with CRRT on the first day after surgery,and the citrate anticoagulation mode was used in the renal replacement group.The single chamber Kt/V(spKt/V),urea reduction rate(URR),complications,and preoperative and postoperative blood calcium,phosphorus and total parathyroid hormone(iPTH)were compared between two groups.Results Compared with the renal replacement group,the spKt/V and URR in the hemodialysis group increased(both P<0.05).There was no bleeding at the surgical incision in the hemodialysis group and renal replacement group.Compared with the renal replacement group,the total coagulation rate of the dialysis pipeline in the hemodialysis group was higher(P<0.05).Compared with the same group before surgery,the levels of blood calcium,phosphorus and iPTH in both groups decreased on the first day after surgery(all P<0.05).Conclusions For uremic SHPT patients after TP+AP,the incidence of blood coagulation in the pipeline after CRRT is low,but the clearance of small molecular weight toxins is poor.HD has a stronger ability to clear small molecular weight toxins;there is a certain incidence of pipeline clotting,but there is rarely HD discontinuation caused by severe clotting.

关 键 词：甲状旁腺功能亢进 尿毒症并发症 尿毒症 血液透析疗法 连续性肾脏替代疗法 甲状旁腺全切术 甲状旁腺自体移植术 

分 类 号：R459.5[医药卫生—治疗学]