甲状旁腺素测定联合预防性补钙对防治甲状腺全切除术后低钙血症的价值

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1h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3g/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 hPTH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.

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

Objective To discuss the application value of parathyroid hormone （PTH）measurement and preventive calcium supplementation on the preservation of hypoealcaemia 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 glueonate 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 hypoealeemia 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 （Psignificance 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 hypoealcaemia in group A and 6 cases （9.5%） in group B, the difference of symptomatic hypocalcaemia incidence rate had no statistical significance betwe