黄素玉 龚穗清 王利平 吴小琴 陈玉微 刘映文 徐贤贞 葛平江 刘涛

[摘要] 目的 探讨继发性甲状旁腺功能亢进患者术前一天末次血液透析至手术间隔时间长短对电解质的影响及护理。 方法 选取2017年1月～2018年2月我科收治的接受甲状旁腺全切联合自体移植术的尿毒症患者40例，患者均接受甲状旁腺全切联合自体移植术，计时对比手术前一天末次透析结束至手术当天早上7：00所间隔时间长短对患者体内血钾水平的影响程度。 结果 40例患者中，19例透析后到手术时间<21 h，21例≥21 h。透析后到手术间隔≥21 h患者手术结束即刻血钾（简称术后血钾）水平均高于透析到手术间隔时间<21 h（P<0.05），两者术前血钾水平差异具有统计学意义（P<0.05）。手术后患者血钾水平高于术晨（P<0.05）。术后血钾与术前末次血透到手术结束时间为中等相关（相关系数r=0.409），术后血钾与术前末次血透到术晨时间为中等相关（相关系数r=0.318）。 结论 缩短继发性甲状旁腺功能亢进患者术前一天末次血液透析至手术的间隔时间有利于减少患者术后高血钾的发生率，加强护理有利于更好控制患者术后恢复期的血钾，可行性程度較高。

[关键词] 继发性甲状旁腺功能亢进；血液透析；血钾；护理

[中图分类号] R473.5 [文献标识码] B [文章编号] 1673-9701（2018）30-0159-03

[Abstract] Objective To investigate the effects of the interval between the last hemodialysis one day before surgery and the day of surgery on the electrolyte in the patients with secondary hyperparathyroidism and their nursing. Methods A total of 40 patients with uremia who were admitted to our department and were given total parathyroidectomy combined with autologous transplantation from January 2017 to February 2018 were selected. All patients were given total parathyroidectomy combined with autologous transplantation. The interval between the end of the last hemodialysis on the day before the surgery and the time at 7：00 am on the day of surgery was timed， and the degree of influence of the interval on the blood potassium level in the patient was compared. Results Of the 40 patients， there were 19 patients with the interval from hemodialysis to surgery of <21 h， and 21 patients with the interval of ≥ 21 h. For the patients with the interval of ≥21 h， the immediate blood potassium after operation（postoperative blood potassium） was higher than that in the patients with the interval of <21 h （P<0.05）. The difference in blood potassium levels between the two groups was statistically significant （P<0.05）. The blood potassium level of the patients after surgery was higher than that in the morning（P<0.05）. Postoperative blood potassium was moderately correlated with the time from the last hemodialysis before surgery until the end of surgery （correlation coefficient r=0.409）. Postoperative blood potassium was moderately correlated with the time from the last hemodialysis before surgery to the morning on the day of surgery（correlation coefficient r=0.318）. Conclusion Shortening the interval between the last hemodialysis one day before surgery and the day of surgery in the patients with secondary hyperparathyroidism is beneficial to reducing the incidence rate of postoperative hyperkalemia in patients. Strengthening the nursing is beneficial to better controlling the blood potassium of the patients during the recovery period， and the feasibility is higher.

[Key words] Secondary hyperparathyroidism； Hemodialysis； Blood potassium； Nursing

随着社会的发展以及科技水平的进步，血液净化技术在肾衰竭等肾脏类疾病中的应用范围也呈现扩大的趋势，但由此引起的并发症也呈现不断上升的趋势，继发性甲状旁腺功能亢进（secondary hyperparathyroidism，SHTP），属于透析的主要并发症，患者体内钙磷元素含量的失衡、皮肤出现瘙痒甚至疼痛等炎症反应是此类疾病的主要临床病症，严重影响患者的生活质量和自信心[1]。通过甲状旁腺全切除及自体移植手术能够起到很好的治疗效果，但术前一天末次透析与手术之间的间隔时间与治疗的安全性存在直接的相关性，一定的护理能够改善患者的状态[2]。对此我科分析继发性甲状旁腺功能亢进患者术前一天末次血液透析至手术间隔时间长短对钾的影响及护理效果，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年1月～2018年2月我科收治的接受甲状旁腺全切联合自体移植术的尿毒症患者40例，纳入标准：所有患者均接受维持性血液透析治疗，均经保守治疗无效，并有不同程度并发症，如骨痛和瘙痒。……