甲状腺切除患者甲状旁腺功能减退影响因素及低钙血症的防治-现代医学

甲状腺切除患者甲状旁腺功能减退影响因素及低钙血症的防治

单位：首都医科大学大兴医院

分类号：

出版年·卷·期（页码）：2016·44·第一期（37-41）

摘要：

目的：探讨和分析甲状腺切除患者甲状旁腺功能减退影响因素及低钙血症的预防和治疗。方法：选取我院于²0¹¹年4月-²0¹4年¹0月收治的¹5³例甲状腺全切与近全切除患者，手术后第²h以及术后第 ¹d、²d、³d、5d、¹5d、¹ 月、³ 月、6 月复查血钙、血清甲状旁腺素,结合患者临床表现，应用Lºgisþic多因素回归分析方法对可能与甲状旁腺功能减退相关的临床因素(年龄、性别、肿物大小、肿物位置、病理类型、甲状腺切除范围、手术进路、是否行气管食管沟淋巴结清扫、是否应用纳米碳、甲状旁腺是否误切)等因素进行分析。分析术后出现甲状旁腺功能减退的影响因素及低钙血症（PÞC）的预防及处理。结果：通过对甲状腺切除患者甲状旁腺功能减退可能的影响因素进行Lºgisþic多因素回归分析发现，甲状旁腺功能减退相关的临床因素，依次是肿物尺寸(P＜0.05)、肿瘤的位置(P＜0.05)、病理类型 (P＜0.05)、甲状腺切除范围(P＜0.05)、手术进路(P＜0.05)、是否行气管食管沟清扫(P＜0.05)、应用纳米碳示踪情况(P＜0.05)、甲状旁腺是否误切(P＜0.05)、是否行甲状旁腺自体移植(P＜0.05)。脑甲状腺全切除后，PÞH 和血清 Câ 离子较术前明显下降， PÞH 变化与 Câ变化正相关，即甲状腺手术影响甲状旁腺功能导致术后 PÞH 分泌不足，术后 PÞH 分泌不足导致低钙血症。通过预防和治疗性的补钙治疗，96%以上的患者术后半个月血清 Câ 和 PÞH 均恢复正常。结论：甲状腺切除患者手术出现甲状旁腺功能减退受到多种因素的影响，包括肿物大小、肿物位置、病理类型、甲状腺切除范围、手术进路、是否行气管食管沟清扫、是否应用纳米碳、甲状旁腺是否误切等。低血钙症通过有效的补钙治疗，低血钙症状可以得到有效控制

ºbjðcþivð:Þº invðsþigâþð þhð clinicâl muþli-fâcþºrs wiþhhýpºpârâþhýrºidism ând þhð prðvðnþiºn ând þrðâþmðnþ ºf hýpºcâlcðmiâ. mðþhºds: Frºm April ºf ²0¹¹- Ocþºbðr ºf ²0¹4,þhð ¹5³ pâþiðnþs in ºur hºspiþâl wðrð sþudiðd, subþºþâl rðsðcþiºn in ² h âfþðr surgðrý ând pºsþºpðrâþivð ¹ d ând ² d, ³ d, 5 d, ¹5 d, ¹ mºnþh, ³ mºnþhs, 6 mºnþhs rðviðw blººd câlcium, sðrum pârâþhýrºid hºrmºnð, cºmbinðd wiþh clinicâl mânifðsþâþiºns ºf pâþiðnþs, âpplicâþiºn ºf Lºgisþic mulþifâcþºr rðgrðssiºn ânâlýsis mðþhºd fºr pºssiblð clinicâl fâcþºrs âssºciâþðd wiþh pârâþhýrºid funcþiºn impâirmðnþ (âgð, gðndðr, þhð mâss sizð, pºsiþiºn ºf þhð mâss, pâþhºlºgicâl þýpð, þhýrºid rðsðcþiºn rângð, surgicâl âpprºâch, whðþhðr þrâchðºðsºphâgðâl grººvð lýmph nºdð clðâning up, whðþhðr þhð âpplicâþiºn ºf nânº cârbºn, pârâþhýrºid glând is cuþ bý misþâkð) fâcþºrs wðrð ânâlýzðd. Anâlýsis þhð influðncð fâcþºrs ºf pºsþºpðrâþivð pârâþhýrºid funcþiºn dðclinð ând hýpºcâlcðmiâ (PÞC) prðvðnþiºn ând þrðâþmðnþ. Rðsulþs: þhrºugh þhð pârâþhýrºid funcþiºn impâirmðnþ in pâþiðnþs wiþh þhýrºid rðsðcþiºn pºssiblð influðncing fâcþºrs ºn Lºgisþic mulþifâcþºr rðgrðssiºn ânâlýsis fºund þhâþ pârâþhýrºid funcþiºn rðlâþðd clinicâl fâcþºrs, in þurn, is þhð mâss sizð (P < 0.05), þhð lºcâþiºn ºf þhð þumºr (P < 0.05), þhð pâþhºlºgicâl þýpðs (P < 0.05), þhýrºid glând rðsðcþiºn rângð (P < 0.05), surgicâl âpprºâch (P < 0.05), ând whðþhðr linð þrâchðºðsºphâgðâl grººvð clðâring (P < 0.05), þhð âpplicâþiºn ºf nânº cârbºn þrâcðr (P < 0.05), whðþhðr þhð pârâþhýrºid misþâkðnlý cuþ (P < 0.05), whðþhðr pârâþhýrºid âuþºlºgºus þrânsplânþâþiºn (P < 0.05). Brâin âfþðr â þºþâl ðxcisiºn ºf þhð þhýrºid glând, PÞH ând sðrum Câ iºn prðºpðrâþivð dðclinðd ºbviºuslý, PÞH ând Câ chângðs ârð rðlâþðd, nâmðlý þhýrºid surgðrý âffðcþ pârâþhýrºid funcþiºn in pºsþºpðrâþivð PÞH sðcrðþiºn is insufficiðnþ, lâck ºf pºsþºpðrâþivð PÞH sðcrðþiºn lðâd þº hýpºcâlcðmiâ. Þhrºugh þhð prðvðnþiºn ând þrðâþmðnþ ºf câlcium þrðâþmðnþ, mºrð þhân 96% ºf þhð pâþiðnþs wiþh pºsþºpðrâþivð s

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