甲状腺围术期血清甲状旁腺素的变化及其与甲状腺术后低钙血症的关系研究

Change of Parathyroid Hormone and Its Relationship with Postoperative Hypocalcemia in Peri-operation of Thyroidectomy

目的探讨甲状腺围术期血清甲状旁腺素(PTH)的变化及其与甲状腺术后低钙血症的关系。方法选择2008年3月—2010年8月在我院住院治疗的甲状腺手术患者共437例作为研究对象,分别检测术前、术后第1、2、3天的血清钙离子水平,术前、术中切除标本10 m in后、术后第1、2天的血清PTH水平。结果本组共63例患者术后发生低钙血症,发生率为14.4%;其中接受双侧腺叶全切除术的患者术后低钙血症发生率最高,接受单侧腺叶次全切除术的患者术后低钙血症发生率最低。术后低钙血症组在术中切除标本10 m in后、术后第1天及第2天的血清PTH水平均显著低于术后正常血钙组,差异有统计学意义(P<0.05)。术中切除标本10 m in后PTH<15 ng/L时,术后低钙血症的发生率为91.04%,显著高于PTH≥15ng/L时;而术后第1天PTH<10 ng/L时,术后低钙血症的发生率为23.35%,显著高于PTH≥10 ng/L时,差异亦有统计学意义(P<0.05)。结论甲状腺手术对甲状旁腺分泌PTH会造成一定的影响,引起术后低钙血症的发生。在甲状腺手术时,应常规行术中PTH测定,以指导及时合理的治疗。

Objective To investigate the change of parathyroid hormone（PTH） and its relationship with postoperative hypocalcemia in peri-operation of thyroidectomy.Methods Totally 437 inpatients who received thyroid surgery in our hospital from March 2008 to August 2010 were chosen as subjects.The serum calcium levels before and 1st,2nd,and 3rd day after surgery were detected;and serum PTH levels before and during the operation,10 min after the removal of specimen,and 1st,2nd,and 3rd day after surgery were also detected.Results Among all the subjects there were 63 who had postoperative hypocalcemia,with an incidence of 14.4%,of which patients underwent bilateral resection of the whole gland had the highest incidence,while patients underwent unilateral subtotal gland surgery had the lowest incidence.PTH levels 10 min the removal of specimen,and 1st,2nd day after surgery were significantly lower in the postoperative hypocalcemia group than in the normal postoperative calcium group（P0.05）.When PTH15 ng/L 10 min after the removal of specimen,the incidence rate of postoperative hypocalcemia was 91.04%,which was significantly higher than that when PTH≥15 ng/L.When PTH10 ng/L 1st day after surgery,the incidence rate of postoperative hypocalcemia was 23.35%,which was significantly higher than that when PTH≥10 ng/L（P0.05）.Conclusion Thyroid surgery may affect the secretion of PTH and thus cause the postoperative hypocalcemia.Measurement of intraoperative PTH should be routinely conducted so as to guide the timely and reasonable treatment.