周元等

[摘要] 目的 探讨甲状腺全切除术患者甲状旁腺素（PTH）测定联合预防性补钙对防治术后低钙血症的临床价值。 方法 选取2011年1月～2014年1月在嘉兴市第一医院行甲状腺全切除术的患者102例，根据术后1 h测定的PTH水平分为A组（39例，PTH < 15 ng/L）和B组（63例，PTH≥15 ng/L）。术后A组予以静脉补钙3 g/d，连续补钙5 d；B组予以常规补液，不予以补钙。检测术前及术后第1、2、3、7、30天的血钙及PTH水平，观察并记录术后是否出现症状性低钙血症，两组间进行统计学比较分析。 结果 A组术后第1、2、3、7、30天的血钙水平分别为（2.09±0.05）、（2.02±0.04）、（2.12±0.04）、（2.22±0.07）、（2.35±0.06）mmol/L，B组分别为（2.07±0.05）、（2.03±0.04）、（2.14±0.04）、（2.22±0.06）、（2.34±0.04）mmol/L，两组比较差异无统计学意义（P > 0.05）；A组术后第1、2、3天的PTH水平分别为（11.92±2.17）、（5.80±1.69）、（9.73±2.31）ng/L，B组分别为（19.92±5.37）、（12.84±2.43）、（15.93±5.17）ng/L，A组第1、2、3天的PTH水平均明显低于B组（P < 0.01）；A组术后第7、30天的PTH水平分别为（23.98±7.31）、（46.07±5.62）ng/L，B组分别为（24.90±6.45）、（45.22±7.42）ng/L，两组比较差异无统计学意义（P > 0.05）；A、B两组发生术后症状性低钙血症的例数分别为5例（12.8%）及6例（9.5%），两组间比较差异无统计学意义（P > 0.05）。 结论 对于甲状腺全切除术后1 h PTH水平低下的患者早期予以预防性补钙有利于防治术后低钙血症，有助于甲状旁腺功能恢复，值得临床推广应用。

[关键词] 甲状旁腺素；预防性补钙；甲状腺全切除术；低钙血症

[中图分类号] R653.2 [文献标识码] A [文章编号] 1673-7210（2014）11（c）-0020-05

Value of parathyroid hormone measurement and preventive calcium supplementation on the preservation of hypocalcaemia after total thyroidectomy

ZHOU Yuan JIANG Honggang LU Bohao CHEN Zhiheng LI Jin XU Luping

Department of Surgical Oncology， the First Hospital of Jiaxing City， Zhejiang Province， Jiaxing 314000， China

[Abstract] Objective To discuss the application value of parathyroid hormone（PTH）measurement and preventive calcium supplementation on the preservation of hypocalcaemia after total thyroidectomy. Methods Total 102 patients with thyroidectomy from January 2011 to January 2014 in the First Hospital of Jiaxing City were selected and divided into group A and group B， according to the level of PTH 1 hour after surgery， group A （39 cases， PTH<15 ng/L） and group B （63 cases， PTH≥15 ng/L）. All the patients in group A were supplemented calcium gluconate intravenously 3 g/d after surgery， continue 5 days. For group B， post operative calcium supplementation was not given， only routine fluid replacement was given. The level of serum calcium and PTH of all patients were assayed before operation and at the 1st， 2nd， 3rd day， 1st week and 1st month after operation. Whether hypocalcemia occured or not was recorded. Results The level of serum calcium at the 1st， 2nd， 3rd day， 1st week and 1st month after operation were （2.09±0.05）， （2.02±0.04）， （2.12±0.04）， （2.22±0.07）， （2.35±0.06） mmol/L in group A， and （2.07±0.05）， （2.03±0.04）， （2.14±0.04）， （2.22±0.06）， （2.34±0.04） mmol/L in group B， the differences were not statistically significant between group A and group B at the 1st， 2nd， 3rd day， 1st week and 1st month after operation （P > 0.05）. The level of PTH at the 1st， 2nd， 3rd day after operation were （11.92±2.17）， （5.80±1.69 ）， （9.73±2.31） ng/L in group A and （19.92±5.37）， （12.84±2.43）， （15.93±5.17） ng/L were in group B， the level of PTH in group A were obviously lower than those in group B at the 1st， 2nd， 3rd day after operation （P < 0.01）. The level of PTH at the 1st week and 1st month after operation were （23.98±7.31）， （46.07±5.62） ng/L in group A， and （24.90±6.45）， （45.22±7.42） ng/L were in group B， the difference of the level of PTH had no statistical significance between group A and group B at the 1st week and 1st month after operation （P > 0.05）. There were 5 cases （12.8%） of symptomatic hypocalcaemia in group A and 6 cases （9.5%） in group B， the difference of symptomatic hypocalcaemia incidence rate had no statistical significance between group A and group B （P > 0.05）. Conclusion The preventive calcium supplementation to the low level of PTH 1 hour after total thyroidectomy patients is beneficial for the preservation of hypocalcaemia and the recovery of the function of parathyroid glands. It is worth to be further promoted in clinic.

[Key words] Parathyroid hormone； Preventive calcium supplementation； Total thyroidectomy； Hypocalcaemia

甲状腺全切除术目前已经成为甲状腺癌及双侧结节性甲状腺肿手术治疗的标准术式[1]。甲状旁腺素（parathyroid hormone，PTH）是由甲状旁腺分泌的调节血钙水平的重要激素。甲状旁腺与甲状腺关系紧密，由于其位置与甲状腺被膜非常贴近，进行甲状腺手术时容易受到损伤而导致甲状旁腺功能低下，使其分泌的PTH水平下降，进而引起血钙水平降低，引起症状性低钙血症发生，特别在甲状腺全切除术患者人群中表现得尤为显著。甲状旁腺功能减退表现为一过性或永久性的低钙血症，严重会导致抽搐，甚至会出现喉和膈肌痉挛等进而引起窒息危及生命，是甲状腺全切除术术后常见的并发症[2]。对于永久性甲状旁腺功能减退，目前治疗方面没有确切……