甲状腺术后甲状旁腺功能变化及预防性补钙策略分析

发布时间：2018-05-04 11:58

本文选题：甲状腺手术 + 甲状旁腺功能减退　；参考：《山东大学》2017年硕士论文

【摘要】：[目的]观察甲状腺术后血清中甲状旁腺激素及血钙、血磷水平变化,明确低钙血症与甲状旁腺功能减退的关系,分析甲状腺术后甲状旁腺功能减退的相关因素,讨论甲状腺术后甲状旁腺功能变化规律,并据此总结合理的预防性补钙策略。[方法]收集2016年10月-11月于山东大学齐鲁医院(青岛)耳鼻咽喉科行手术治疗的甲状腺患者93例,分别测定患者术前,术后30min,术后第1、2、3、7天的甲状旁腺激素(PTH)及血钙、血磷水平,并随访患者术后1月和3月的复查情况。根据术后30min血PTH水平高低将所有患者分为4组:A组(PTH≥15pg/ml且PTH较术前变化≤20%)、B组(PTH≤15pg/ml且PTH较前下降20%)、C组(8pg/ml≤PTH15pg/ml)、D组(PTH8pg/ml)。单因素和多因素分析甲状旁腺功能减退与性别、年龄、病理性质、肿物大小、是否行甲状腺全切、是否行颈淋巴结清扫、是否伴有桥本病的关系。比较术后低血钙症和症状性低血钙与甲状旁腺功能减退的关系。分析甲状腺术后甲状旁腺功能变化规律,并总结有针对性的预防性补钙策略。[结果](1)93例甲状腺手术患者中,13例(14.0%)患者出现术后甲状旁腺功能减退,其中12例患者术后30minPTH水平低于正常,随访3月,无永久性甲状旁腺功能减退;11例(11.8%)患者出现低钙血症,其中3例(3.2%)患者出现症状性低血钙。(2)术后PTH水平越低,患者术后发生低血钙症和症状性低血钙的比例越大,差异具有统计学意义(P0.01)。(3)单因素分析结果提示:甲状腺肿物的病理类型(P=0.031)、甲状腺是否全切(P0.001)、是否行中央区颈淋巴结清扫(P=0.02)、是否行颈侧区颈淋巴结清扫(P=0.012)与术后甲状旁腺功能减退相关,差异均具有统计学意义。患者的性别(P=0.503)、年龄(P=0.871)、肿瘤的大小(P=0.214)、是否伴有桥本病(P-0.481)等因素,对术后甲状旁腺功能减退无明显影响。(4)多因素Logistic分析结果显示,是否进行甲状腺全切(P=0.047)是甲状腺术后甲状旁腺功能减退的独立危险因素。(5)手术范围不同,术后甲状旁腺功能减退和低钙血症的发生率不同,手术范围越大,术后发生甲旁减和低钙血症的比率越高,且PTH和血钙下降越多,差异具有统计学意义(P0.01)。(6)甲状腺切除术后30min,PTH水平越低,PTH恢复越慢,恢复到正常水平所需要的时间越长。当术后30minPTH8pg/ml时,术后7天,患者仍处于甲状旁腺功能减退状态。(7)甲状旁腺功能减退的患者,术后可出现血钙下降和血磷升高,其下降地程度和恢复到正常所需要地时间与术后30minPTH值相关。当术后30minPTH8pg/ml时,血钙与血磷波动较大且恢复较慢。[结论](1)甲状腺术后低钙血症与甲状旁腺功能减退密切相关。甲状旁腺功能减退与手术范围、肿瘤病理性质等因素有关,甲状腺是否全切是术后发生甲状旁腺功能减退的独立危险因素。手术范围越大,术后发生甲状旁腺功能减退的比率越高,发生低钙血症的可能性越大。(2)甲状腺切除术后30min血PTH水平可以反映甲状旁腺功能损伤情况,能够预测低钙血症及低钙症状的发生。对于甲状腺全切的患者,术后30min常规行PTH快速测定将有助于制定合理的预防性补钙策略。当术后30min血PTH≥15pg/ml时,无需预防性补钙;当8pg/ml≤PTH15时,术后7天内需要预防性补钙;当PTH8pg/ml时,术后需尽快给予足量的钙剂补充,且7天后仍需要补钙。
[Abstract]:[Objective] to observe the changes of parathyroid hormone and calcium in serum, the level of blood phosphorus, the relationship between hypocalcemia and parathyroid hypogonadism, analyze the related factors of hypothyroidism after thyroidectomy, and discuss the changes of parathyroid function after thyroidectomy, and summarize the rational preventive calcium supplement strategy. [Methods] to collect 93 cases of thyroid patients in the Department of Otolaryngology, Qilu Hospital (Qingdao), Shandong University (Qingdao), October 2016, to determine the level of parathyroid hormone (PTH), blood calcium and blood phosphorus in the patients before operation, 30min after operation, 1,2,3,7 day after operation, and the reexamination of the patients after the operation in January and March, and the 30min blood PTH after operation. The level of all patients was divided into 4 groups: group A (PTH > 15pg/ml and PTH compared with preoperative changes less than 20%), group B (PTH < 15pg/ml and PTH lower 20%), C group (8pg/ml < < PTH15pg/ml), D group. The relationship between lymph node dissection and bridging disease. Compare the relationship between postoperative hypocalcemia and symptomatic hypocalcemia and hypoparathyroidism. Analysis of the changes in parathyroid function after thyroidectomy, and summarize the targeted preventive calcium supplement. [results] (1) in 93 cases of thyroid gland surgery, 13 cases (14%) were treated after operation. Hypoparathyroidism, of which 12 patients had lower 30minPTH levels than normal after operation, no permanent parathyroid hypogonadism, 11 cases (11.8%) had hypocalcemia, of which 3 (3.2%) had symptomatic hypocalcemia. (2) the lower the level of PTH after operation, the greater the incidence of hypocalcemia and symptomatic hypocalcemia after operation. The difference was statistically significant (P0.01). (3) the results of single factor analysis showed that the pathological type of thyroid gland (P=0.031), total thyroidectomy (P0.001), cervical lymph node dissection (P=0.02) in the central region, cervical lymph node dissection (P=0.012) in the neck region were related to postoperative hypoparathyroidism, and the difference was statistically significant. Patients' sex (P=0.503), age (P=0.871), tumor size (P=0.214), and whether accompanied by bridging disease (P-0.481) and other factors have no significant effect on postoperative parathyroid hypogonadism. (4) multifactor Logistic analysis shows that thyroid total resection (P =0.047) is an independent risk factor for hypothyroidism after thyroid surgery. (5) The range of operation was different, the incidence of hypoparathyroidism and hypocalcemia after operation was different, the larger the operation range, the higher the ratio of parathyroid and hypocalcemia after operation, and the more decrease of PTH and blood calcium, the difference was statistically significant (P0.01). (6) the lower the level of 30min after thyroidectomy, the lower the level of PTH, the slower the recovery of PTH, the recovery to normal water The longer the time needed, the patient was still in parathyroid dysfunction 7 days after the operation. (7) the patients with parathyroid hypogonadism had the decrease of blood calcium and the increase of blood phosphorus after operation. The degree of descent and the recovery to the normal required time were related to the postoperative 30minPTH value. When the postoperative 30minPTH8pg/ml was 30minPTH8pg/ml. The fluctuation of blood calcium and blood phosphorus is relatively slow. [Conclusion] (1) hypocalcemia after thyroidectomy is closely related to hypoparathyroidism. Hypoparathyroidism is related to the scope of operation, the pathological nature of tumor and other factors. Whether the thyroid is completely cut is an independent risk factor for parathyroid dysfunction after operation. The larger the operation range, The higher the rate of parathyroid dysfunction after operation, the greater the possibility of hypocalcemia. (2) the level of 30min blood PTH after thyroidectomy can reflect parathyroid function damage and can predict the occurrence of hypocalcemia and hypocalcemia. For patients with total thyroidectomy, PTH rapid determination of 30min after operation will be helpful. A reasonable preventive calcium supplement should be made. When 30min blood PTH is more than 15pg/ml after operation, no preventive calcium is needed; when 8pg/ml is less than PTH15, preventive calcium needs to be prevented within 7 days after operation; when PTH8pg/ml, sufficient calcium is needed as soon as possible, and calcium is still needed after 7 days.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R653

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