探讨SHPT围手术期血钙变化的临床意义

发布时间：2018-06-25 08:54

本文选题：继发性甲旁亢 + 血钙　；参考：《皖南医学院》2015年硕士论文

【摘要】：目的:通过分析继发性甲旁亢患者围手术期血钙变化的曲线,从中寻找规律,并进一步分析患者术前与术后一月血钙磷乘积及i PTH水平变化趋势,回访患者术后服用钙剂量,以此评估手术效果。方法:回顾性分析皖南医学院第一附属医院血透中心自2012年6月至2015年1月的31例因内科治疗失效而选择外科手术治疗的继发性甲状旁腺功能亢进患者的资料,患者年龄在18-56岁(平均43.2岁),主要统计患者术前血钙值、术中血钙值、术后第1天的血钙值、术后第3天的血钙值、术后第7天的血钙值及术后1月的血钙值,患者术前术后的血钙磷乘积,并统计患者术前外周血i PTH值及术后1月外周血i PTH值,通过比较术前术后外周血i PTH值评估手术效果,并绘制血钙变化的曲线,结合术后随访,为患者制定合适的补钙方案,进一步改善患者的生活质量。结果:31例患者均顺利完成手术,其中1例患者行甲状旁腺全切术+自体移植术(total PTX with autotransplantation,TPTX+AT)、14例患者行甲状旁腺全切除不移植术(total PTX without autotransplantation,TPTX)、16例患者行甲状旁腺次全切除术(subtotal parathyroidectomy,SPTX),术前31例患者血钙平均(2.57±0.23)mmol/L,术中血钙平均(2.28±0.19)mmol/L,术后第1天血钙平均(1.94±0.26)mmol/L,术后第3天血钙平均(1.75±0.21)mmol/L,术后第7天血钙平均(1.93±0.20)mmol/L,术后1月血钙平均(2.30±0.31)mmol/L,术前血钙磷乘积平均(66.34±15.74)mmol2/L2,术后血钙磷乘积平均(34.79±13.08)mmol2/L2,术前i PTH平均(1795.40±512.61)pg/ml,术后1月的i PTH平均(37.27±86.67)pg/ml。通过统计学分析比较得出31例患者术后血钙、钙磷乘积均较术前降低,29例患者术后i PTH较术前降低明显,2例患者术后i PTH100pg/ml,其中1例钙磷尚正常,1例钙稍偏高,但较术前有所降低;手术共切除旁腺116枚,其中有23例患者有4枚旁腺(占74%),有8例患者有3枚旁腺(占26%),术后病理示:7枚呈弥漫性增生(6.03%),96枚呈结节状增生(82.76%),13枚呈增生伴腺瘤形成(11.21%),其中有3枚旁腺增生伴钙化,还有2例伴有甲状腺乳头状癌,术后均未出现声音嘶哑、饮水呛咳等并发症,术后有7例患者出现明显低血钙的临床表现,4例患者出现明显低血压,术后皮肤瘙痒、骨痛等症状消失。结论:1、患者术后有一血钙降低期,血液中钙转移入骨,有效改善了骨骼缺钙状态,延缓了相关并发症的发生;2、患者钙磷乘积较术前明显减少,降低了钙化防御的风险;3、骨骼缺钙状态改善后血钙升高,患者服钙量较术前减少,停用冲击治疗;4、患者术后PTH较术前明显减少,手术是治疗SHPT的有效手段。
[Abstract]:Objective: to analyze the changes of serum calcium in patients with secondary hyperparathyroidism during perioperative period, to find out the regularity, and to further analyze the change trend of serum calcium and phosphorus product and the level of I PTH in patients with secondary hyperparathyroidism before and after operation. To evaluate the effect of the operation. Methods: the data of 31 patients with secondary hyperparathyroidism who were selected for surgical treatment due to the failure of medical treatment from June 2012 to January 2015 in the Hemodialysis Center of the first affiliated Hospital of Southern Anhui Medical College were retrospectively analyzed. The patients were aged 18-56 years (mean 43.2 years). The preoperative calcium values, intraoperative calcium values, blood calcium values on the first day after operation, blood calcium values on the third day, blood calcium values on the 7th day and the serum calcium values at 1 month after operation were calculated. The preoperative and postoperative calcium and phosphorus products were calculated, and the values of I PTH in peripheral blood and I PTH in peripheral blood 1 month after operation were counted. The results of operation were evaluated by comparing the preoperative and postoperative I PTH values of peripheral blood, and the curves of changes of serum calcium were plotted, combined with postoperative follow-up. Develop appropriate calcium supplementation programs for patients to further improve their quality of life. Results all 31 patients successfully completed the operation. One patient underwent total with autotransplantation (TPTX AT) and 14 patients underwent total PTX without autotransplantation (TPTX) and 16 patients underwent subtotal parathyroid subtotal resection (subtotal parathyroid subtotal resection). The mean serum calcium was (2.57 卤0.23) mmol / L in 31 patients before operation. The mean blood calcium was (2.28 卤0.19) mmol / L during the operation, (1.94 卤0.26) mmol / L on the first day after operation, (1.75 卤0.21) mmol / L on the third day after operation, (1.93 卤0.20) mmol / L on the 7th day after operation, (2.30 卤0.31) mmol / L on the first month after operation, (66.34 卤15.74) mmol / r / L, (34.79 卤13.08) mmol / 2L / L on the third day after operation, and (3.79 卤13.08) mmol / L 路L ~ (2) on the seventh day after operation, and (2.30 卤0.31) mmol / L on the first month after operation. The mean value of I PTH was (1795.40 卤512.61) PG / ml and (37.27 卤86.67) PG / ml at 1 month postoperatively. The results of statistical analysis showed that the postoperative serum calcium, calcium and phosphorus product in 31 patients were significantly lower than those before operation in 29 patients, and the postoperative I PTH 100pg / ml in 2 patients was significantly lower than that in 2 patients. Among them, 1 patient had normal calcium and phosphorus, and 1 patient had a slightly higher calcium. The total number of paracentral glands was 116. Of the 23 patients, 4 were accessory glands (74%), 8 had 3 accessory glands (26%), 7 were diffuse hyperplasia (6.03%), 96 were nodular hyperplasia (82.76%), 13 were hyperplasia with adenoma (11.21%), 3 were paraspinal hyperplasia with calcification. There were also 2 patients with papillary thyroid carcinoma. There were no postoperative complications such as hoarseness, drinking water choking and coughing. There were 7 cases with obvious hypocalcemia, 4 cases with obvious hypotension and postoperative skin itching. Symptoms such as bone pain have disappeared. Conclusion: there is a period of decrease of blood calcium after operation, which can effectively improve the status of bone calcium deficiency, delay the occurrence of related complications, and decrease the product of calcium and phosphorus. The risk of calcification defense was reduced, the blood calcium level was increased after bone calcium deficiency was improved, the calcium consumption of patients was decreased compared with that before operation, and the PTH was significantly reduced after discontinuation of shock therapy. Surgery is an effective method in the treatment of SHPT.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R653

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