摘要
目的探讨甲状腺术后血钙变化情况及低钙血症发生的高危因素。方法回顾性分析2018年1-12月在台山市人民医院行甲状腺手术的80例患者资料。收集包括患者年龄、性别、后仰颈长(胸骨柄上缘至甲状软骨切迹)、最大病灶直径、手术入路(开放或腔镜手术)、手术范围(单侧或双侧)是否再次手术,术中出血量、术前、术后第1、2、3、5天的血钙值等。统计所有患者临床数据并进行数据分析。结果①80例患者中,33例(41.3%)患者术后第1天血钙低于正常值,47例(58.8%)患者术后第2天血钙低于正常值,27例(33.8%)患者术后第3天血钙低于正常值,13例(16.3%)患者术后第5天血钙低于正常值。②在所有手术方式中,术后血钙均较术前有所下降,其中以术后第2天最为明显,术后第3天开始出现回升趋势。在开放手术(t=26.968)及双侧甲状腺切除(t=18.734)中,二者差异有统计学意义(P<0.05),但在腔镜手术(t=0.666)及单侧甲状腺切除(t=0.949)中,术后第2天血钙水平与术前相比差异无统计学意义(P>0.05)。③年龄(t=1.723)、性别(χ^2=1.805)、最大病灶直径(t=-1.223)、术中出血量(t=1.103)、手术入路方式(χ^2=0.446)与患者术后低钙血症的发生差异无统计学意义(P>0.05),而后仰颈长(t=-8.008)、手术范围(χ^2=8.822)、是否再次手术(χ^2=5.386)与术后低钙血症的发生差异有统计学意义(P<0.05)。结论所有甲状腺术后,血钙值水平均较术前有所下降,以术后第2天最为明显,存在一个先下降后回升的过程。甲状腺术后低钙血症的危险因素是双侧甲状腺切除、再次手术、后仰颈长。在存在低钙血症发生的危险因素时,术前谈话时可提前着重强调低钙血症发生机会,术后可预防性补钙治疗。
Objective To investigate the changes of blood calcium and the high-risk factors of hypocalcemia after thyroid surgery.Methods The data of 80 patients who underwent thyroid surgery at the People's Hospital of Taishan City from January to December 2018 were retrospectively analyzed.The collection included patient age,gender,back neck length(upper edge of sternal stem to thyroid cartilage notch),maximum lesion diameter,surgical approach(open or laparoscopic surgery),and surgical range(unilateral or bilateral)whether surgery was performed again,intraoperative blood loss,blood calcium values before and after surgery,1,2,3,and 5 days.Statistics and analysis of clinical data of all patients.Results 1.Of the 80 patients,33(41.3%)patients had lower-than-normal blood calcium on the first day after operation,and 47(58.8%)patients had lower-than-normal blood calcium on the second day after operation,27(33.8%)patients had serum calcium lower than normal on the third day after operation,and 13 patients(16.3%)had calcium lower than normal on the fifth day after operation.2.In all surgical methods,the postoperative blood calcium decreased compared with that before operation,and the most obvious was the second day after operation,and the recovery began on the third day after operation.In open surgery(t=26.968)and bilateral thyroidectomy(t=18.734),the difference was statistically significant(P<0.05),but in laparoscopic surgery(t=0.666)and unilateral thyroidectomy(t=0.949),the blood calcium level on the second day after surgery was not statistically significant compared with that before surgery(P>0.05).3.Age(t=1.723),gender(χ^2=1.805),maximum lesion diameter(t=-1.223),intraoperative blood loss(t=1.103),surgical approach(χ^2=0.446)and postoperative incidence of hypocalcemia was not statistically significant(P>0.05),and the length of the back neck(t=-8.008),the scope of the operation(χ^2=8.822),whether to undergo surgery again(χ^2=5.386)and postoperative hypocalcemia had a statistical difference in the occurrence(P<0.05).Conclusion After all thyroid surgery,the blood calcium level has decreased compared with that before surgery, and it is most obvious on the second day after surgery. There is a process of decreasing first and then rising.The risk factors for hypocalcemia after thyroid surgery are bilateral thyroidectomy, reoperation, and long neck back.In the presence of risk factors for the occurrence of hypocalcemia, during the preoperative conversation, the opportunity for hypocalcemia can be emphasized in advance, and postoperative preventive calcium supplementation can be used.
作者
吴卫文
陈文晓
程健
WU Wei-wen;CHEN Wen-xiao;CHENG Jian(Department of General Surgery,People's Hospital of Taishan City,Taishan,Guangdong Province,529200 China)
出处
《中外医疗》
2020年第13期58-60,64,共4页
China & Foreign Medical Treatment
关键词
低钙血症
甲状腺术后
高危因素
Hypocalcemia
Thyroid surgery
High risk factors
