摘要
目的总结继发性甲状旁腺功能亢进患者接受甲状旁腺全切除+自体移植术(TPTX+AT)的围手术期钙调节策略,指导临床诊治及评估预后。方法收集2020-01-01-2021-12-31就诊于锦州市中心医院的42例确诊为继发性甲状旁腺功能亢进症,接受TPTX+AT的患者的围手术期临床资料。按照术后调整泵钙的中位时间进行分组:观察组和对照组各21例,对2组患者术后泵钙剂量及持续时间进行记录,并对一般资料及围手术期相关资料进行单因素及多因素分析,评估影响术后泵钙调节时间的影响因素。结果术中调整泵钙的中位时间(7.67±2.82)d。观察组年龄均值为(55.33±11.06)岁,对照组为(40.62±10.34)岁,2组比较差异有统计学意义,t=4.452,P<0.001;观察组术前持续透析时间为(6.29±2.41)年,对照组为(8.14±3.07)年,2组比较差异有统计学意义,t=2.172,P=0.036;观察组术后泵钙调节时间为(5.19±1.12)d,对照组为(10.62±2.40)d,2组比较差异有统计学意义,t=9.395,P<0.001;术前观察组服用钙剂18例(85.71%),对照组服用钙剂2例(9.52%),2组比较差异有统计学意义,χ^(2)=21.477,P<0.001;术前血钙值观察组为(2.76±0.34)mmol/L,对照组为(2.45±0.45)mmol/L,2组比较差异有统计学意义,t=2.519,P=0.016;术前甲状旁腺激素(PTH)值观察组为(1443.23±385.45)ng/L,对照组为(3074.59±1202.41)ng/L,2组比较差异有统计学意义,t=5.921,P<0.001;术前碱性磷酸酶(ALP)值观察组为(366.95±94.93)U/L,对照组为(727.76±103.56)U/L,2组比较差异有统计学意义,t=11.769,P<0.001。单因素分析显示,年龄,术前透析时间,术前口服钙剂,术前血钙值,术前PTH值,术前ALP值与其密切相关,2组间比较差异有统计学意义。多因素分析显示,年龄、术前血钙、术前PTH值、术前ALP值为独立危险因素。结论TPTX+AT术后,持续低剂量的泵钙方案能避免严重并发症,对于年轻、术前血钙值低、术前PTH值及ALP值较高的患者,合理地调整泵钙方案以免出现低钙血症。
Objective To summarize the perioperative calcium regulation strategy for patients with secondary hyperparathyroidism undergoing total parathyroidectomy combined with autologous transplantation(TPTX+AT)and to statistically analyze the relevant influencing factors to guide clinical management and assessment of prognosis.Methods The perioperative clinical data of 42 patients diagnosed with secondary hyperparathyroidism who received TPTX+AT and admitted in Jinzhou Central Hospital between January 1,2020 and December 31,2021 were collected and grouped into observation group(21 cases)and control group(21 cases)according to the median time of postoperative calcium pump adjustment.The postoperative calcium pump dose and duration of the two groups of patients were recorded.The preoperative related indexes of the two groups were conducted univariate and multivariate analysis to assess the factors affecting the time of postoperative calcium pump adjustment.Results The median time of intraoperative calcium pump adjustment was(7.67±2.82)days.The mean age of the observation group was(55.33±11.06)years old,and that of the control group was(40.62±10.34)years old,and the difference was statistically significant(t=4.452,P<0.001);The duration of continuous dialysis before operation was(6.29±2.41)years in the observation group and(8.14±3.07)years in the control group,and the difference was statistically significant(t=2.172,P=0.036).The postoperative calcium pump regulation time in the observation group was(5.19±1.12)d,and that in the control group was(10.62±2.40)d,and the difference was statistically significant(t=9.395,P<0.001).Before operation,18cases(85.71%)in the observation group took calcium,and 2cases(9.52%)in the control group took calcium,the difference was statistically significant,χ^(2)=21.477,P<0.001;Preoperative serum calcium was(2.76±0.34)mmol/L in the observation group and(2.45±0.45)mmol/L in the control group,and the difference was statistically significant(t=2.519,P=0.016).Preoperative parathyroid hormone(PTH)value was(1443.23±385.45)ng/L in the observation group and(3074.59±1202.41)ng/L in the control group,and the difference was statistically significant(t=5.921,P<0.001).The preoperative alkaline phosphatase(ALP)value was(366.95±94.93)U/L in the observation group and(727.76±103.56)U/L in the control group,and the difference was statistically significant(t=11.769,P<0.001).Univariate analysis showed that age,preoperative dialysis time,preoperative oral calcium,preoperative blood calcium value,preoperative PTH value,preoperative ALP value were closely related to the two groups,and the differences were statistically significant.Multivariate analysis showed that age,preoperative serum calcium,preoperative PTH value and preoperative ALP value were independent risk factors.Conclusions After TPTX+AT,a continuous low-dose calcium pumping regimen can avoid serious complications.For young patients with low preoperative calcium values and high preoperative PTH and ALP values,it is reasonable to adjust the pumping regimen to avoid hypocalcaemia.
作者
张卫彬
董佳
佟爽
武云飞
马艳
戴晋
ZHANG Wei-bin;DONG Jia;TONG Shuang;WU Yun-fei;MA Yan;DAI Jin(Department of General Surgery,Jinzhou Central Hospital,Jinzhou 121000,Jingzhou,China;Jinzhou Women and Infants Hospital,Jinzhou 121000,China)
出处
《社区医学杂志》
CAS
2022年第22期1275-1279,1284,共6页
Journal Of Community Medicine
基金
锦州市科技计划项目(JZ2022B037)
关键词
甲状旁腺全切、自体移植术
调整泵钙方案
低钙血症
total parathyroidectomy,autotransplantation
adjustment of calcium pump scheme
hypocalcemia
