维持性透析患者甲状旁腺切除术后低钙血症相关因素分析

The related factors of hypocalcemia after parathyroidectomy in maintenance dialysis patients

目的探讨维持性透析患者甲状旁腺切除术后发生低钙血症影响因素,为术后防治低钙血症提供临床依据。方法回顾性调查2010年4月~2014年11月45例维持性透析行甲状旁腺切除术患者,收集患者手术前后临床资料,单因素多重线性回归分析确定术后低钙血症的影响因素。结果 45例患者术后均有低钙血症,其中43例需静脉补充钙剂;以静脉补钙时间为因变量,多重回归分析筛选出年龄(β=-0.104,P=0.049)、术前血钙水平(β=-9.923,P=0.018)、术前碱性磷酸酶(β=0.003,P=0.010)和(术后1周碱性磷酸酶―术前碱性磷酸酶)/术前碱性磷酸酶比值(β=2.015,P=0.028)等4个指标为术后低钙血症影响因素。结论年龄、术前血钙水平、术前碱性磷酸酶和碱性磷酸酶比值为甲状旁腺切除术后低钙血症程度影响因素,高危患者需术后严密监测血钙水平并予静脉补钙。

Objective To investigate the related factors of hypocalcemia after parathyroidectomy in maintenance dialysis patients. Methods Forty-five patients treated with parathyroidectomy in the period from April, 2010 to November, 2014 were retrospectively studied. Clinical data of the patients before and after the operation were collected. Multivariate regression was conducted to confirm the factors influencing postoperative hypocalcemia. Results Hypocalcemia presented in all cases （100%） after the operation, and 43 cases of them had to treat with intravenous calcium. Using the length of intravenous calcium as the degree of hypocalcemia, univariate reggression showed that age （β=-0.104, P=-0.049）, preoperative serum calcium （β=-9.923, P=0.018）, preoperative alkaline phosphate （ALP） （β=0.003, P=0.010）, and the ratio of （postoperative ALP-preoperative ALP）/preoperative ALP （β=2.015, P=0.028） were the factors affecting postoperative hypocalcemia. Conelusions Age, preoperative serum calcium, preoperative ALP and the ratio of （postoperative ALP-preoperative ALP）/preoperative ALP are the factors influencing the hypocalcemia after parathyroidectomy.