影响甲状旁腺全切除术后血钙和血磷变化的相关因素分析  

Factors affecting the change of serum calcium and phosphorus after total parathyroidectomy

作　　者：杨艳 吴佳龙 张伯阳 马忠锋[1] 秦鹏 金德斌[1] 刘美琨 杨长东[1] Yang Yan;Wu Jialong;Zhang Boyang;Ma Zhongfeng;Qin Peng;Jin Debin;Liu Meikun;Yang Changdong(Department of Head and Neck Surgery,the First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院头颈外科,秦皇岛066000

出　　处：《中华普通外科杂志》2024年第8期604-608,共5页Chinese Journal of General Surgery

摘　　要：目的探讨继发性甲状旁腺功能亢进症行甲状旁腺全切除术后影响血钙和血磷变化的相关因素。方法选取2019年4月至2022年5月秦皇岛市第一医院收治的60例行甲状旁腺全切除术的继发性甲状旁腺功能亢进症患者为研究对象,记录患者性别、年龄、血液透析时间、骨痛时间、静脉补钙时间、入院时血清甲状旁腺激素(PTH)、甲状旁腺质量、血钙、血磷及血清碱性磷酸酶(ALP)水平,比较各观察指标之间的相关性及术后血钙和血磷的变化。结果入院时与术后6 h、术后第1、2、3天、出院时血钙分别为(2.50±0.02)、(2.27±0.03)、(1.97±0.03)、(1.95±0.03)、(1.95±0.03)、(2.03±0.02)mmol/L,血磷分别为(2.32±0.07)、(1.95±0.05)、(1.65±0.06)、(1.44±0.05)、(1.35±0.36)、(1.14±0.04)mmol/L,两两之间比较差异均有统计学意义(F=100.979,P<0.05;F=118.910,P<0.05);入院时血清PTH为(1791±760)pg/ml,术后静脉补钙时间为(7.13±2.34)d,入院时血清PTH与骨痛时间、血磷、甲状旁腺质量呈正相关(t=-2.199,P<0.05;t=4.718,P<0.05;t=2.507,P<0.05)。静脉补钙时间与入院时血清ALP呈正相关(t=3.098,P<0.05)。术前血清PTH>1430 pg/ml或ALP>191 mmol/L的患者在术后第1天可能出现低钙血症。结论骨痛时间越长、血磷越高、甲状旁腺增生越明显时血清PTH越高;血清ALP越高术后静脉补钙时间越长;术前血清PTH和ALP值可作为术后第1天即出现低钙血症的预测指标。ObjectiveTo investigate the factors affecting the change of serum calcium and phosphorus after total parathyroidectomy for secondary hyperparathyroidism(SHPT).MethodSixty patients with secondary hyperparathyroidism undergoing total parathyroidectomy were selected.Gender,age,hemodialysis time,bone pain time,intravenous calcium supplementation time,blood parathyroid hormone(PTH),parathyroid mass,blood calcium,phosphorus and alkaline phosphatase at admission were tested to compare the correlation between postoperative calcium and phosphorus changes.ResultBlood calcium was:(2.50±0.02),(2.27±0.03),(1.97±0.03),(1.95±0.03),(1.95±0.03),(2.03±0.02)mmol/L at admission,6 hours after surgery,1,2,3 days after surgery,and when discharged.Blood phosphorus was:(2.32±0.07),(1.95±0.05),(1.65±0.06),(1.44±0.05),(1.35±0.36),(1.14±0.04)mmol/L and when discharged.There are differences between pairwise comparisons(F=100.979,P<0.05;F=118.910,P<0.05).The blood PTH was(1791±760)pg/ml,and the postoperative intravenous calcium supplementation time was(7.13±2.34)days.Blood PTH was positively correlated with bone pain time,blood phosphorus and parathyroid mass at admission(t=-2.199,P<0.05;t=4.718,P<0.05;t=2.507,P<0.05).The time of intravenous calcium supplementation was positively correlated with ALP at admission(t=3.098,P<0.05).Preoperative serum PTH>1430 pg/ml or ALP>191 mmol/L were prone to hypocalcemia on the first day after surgery.ConclusionsThe longer bone pain time,the higher blood phosphorus and the more obvious parathyroid hyperplasia were,the higher PTH was.The higher the ALP,the longer the time of intravenous calcium supplementation.Preoperative serum PTH and ALP values can be used as predictors of hypocalcemia on the first day after surgery.

关 键 词：甲状旁腺功能亢进症 继发性 低钙血症 甲状旁腺素 甲状旁腺切除术 

分 类 号：R653[医药卫生—外科学]