高钙危象的初步诊治经验（附23例临床分析）

The Preliminary Experiences of Diagnosis and Treatment for Hypercalcemia Crisis──Clinical Analysis of 23 Cases

本文报告２３例高钙危象患者原发病有原发性甲状旁腺功能亢进症（甲旁亢）１８例、恶性肿瘤４例及维生素Ｄ中毒１例。危象临床表现主要有消化系、精神神经系症状和心律紊乱等。诸症的发生和程度随血钙值增高呈加重趋向。治疗首先应补充生理盐水以扩充血容量，采用速尿利尿等以降低血钙水平，同时针对病因治疗。甲旁亢应急诊定位立即手术。介绍了５例患者应用降钙素作手术前准备的经验。

This article report a study of 23 cases of hypercalcemia crisis resulting from primary hyperparathyroidism(18 cases),carcinoma(4 cases)and vitamin D intoxication(1 case).In addition to the symptoms of primary diseases,the patients with hypercalcemia crisis often had anorexia,nausea,vomiting,polydipsia,polyuria,psychoneurotic symptoms,arrhthmia.The severity of the symptoms was proportional to the degree of hypercalcimia.Serum calcium concentration of patients in hypercalcemia crisis should be equal or higher than 3.75 mmol/L(15 mg/dl)or serum ionized calcium higher than 1.88 mmol/L.Treatment hypercalcemia crisis consisted of rapidly lowering the serum calcium level by various measures while actively treating the primary diseases.Our experience is to supply normal saline intravenously or orally to increase the extracellular fluid and to enhance excretion of the urine calcium by administrating furosemide.In this paper,serum calcium concentration of 5 patients with hypercalcemia crisis treated with salmen calcitonin was reduced in varying degrees.The above mentioned treatment would be beneficial to the alleviation of the crisis and the preparation for operative treatment.