尿毒症伴难治性继发性甲状旁腺功能亢进患者术前心电图的改变

Preoperative Electrocardiogram in Uremia Patients with Refractory Secondary Hyperparathyroidism

目的分析尿毒症伴难治性继发性甲状旁腺功能亢进(SHPT)患者拟行甲状旁腺次全切除术前的心电图改变特征。方法收集尿毒症维持血液透析伴难治性SHPT拟行甲状旁腺次全切除术治疗患者52例的临床资料,观察其心电图的改变情况。同时进行心电图正常组(n=12)和心电图异常组(n=40)相关指标[年龄、透析龄、血清钙、磷、钠、碱性磷酸酶(ALP)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、血红蛋白(Hb)]的比较。结果难治性SHPT进患者术前的心电图异常率为76.92%,心电改变以左心室高电压、ST-T改变、T波高耸为主。心电图异常组中透析龄、血磷和钙磷乘积水平较心电图正常组高(P<0.05)。结论难治性SHPT进患者术前心电图异常的发生率高,心电图改变类型多样化,应重视心电图的常规检查。透析龄、血磷和钙磷乘积与心电图异常检出率有关,应积极控制血磷、钙磷乘积水平。

Objective To analyze the characteristics of electrocardiogram（ECG）in uremia patients with refractory secondary hyperparathyroidism before subtotal parathyroidectomy（SPT）.Methods Clinical data of 52 uremia patients with refractory secondary hyperparathyroidism scheduled for SPT were collected,and changes in ECG were analyzed.The age,dialysis age,serum calcium,phosphorus,sodium,alkaline phosphatase（ALP）,triacylglycerol（TG）,high-density lipoprotein（HDL）,low-density lipoprotein（LDL）and hemoglobin（Hb）were compared between normal ECG group（n=12）and abnormal ECG group（n=40）.Results There was a high prevalence of ECG abnormalities（76.92%）in uremia patients with refractory secondary hyperparathyroidism,which mainly showed left ventricular high voltage,ST-T changes and T wave alteration.Compared with normal ECG group,the dialysis age,serum phosphorus and calcium-phosphorus product significantly increased in abnormal ECG group（P〈0.05）.Conclusion The prevalence of ECG abnormalities is high and the types of ECG changes vary in uremia patients with refractory secondary hyperparathyroidism.Therefore,attention should be paid to the routine ECG examination.In addition,serum phosphorus and calcium-phosphorus product should be actively controlled because dialysis age,serum phosphorus and calcium-phosphorus product are related to the abnormal rate of ECG.