甲状腺全切术后早期低钙血症发生的影响因素分析

Clinical analysis of risk factors of early hypocalcemia after total thyroidectomy

目的探讨甲状腺全切除术后早期低钙血症的危险因素。方法选取2016年1月到2019年6月因甲状腺癌行甲状腺全切除术的715例患者病例进行回顾性研究。采用SPSS 24.0软件进行分析,影响术后血钙水平单因素差异比较采用χ^2检验、t检验或非参数检验,Logistic模型进行多因素分析。以P<0.05为差异有统计学意义。结果术后低钙血症297例(41.5%),其中228例(76.8%)诊断为无症状低钙血症,69例(23.2%)出现临床症状。其中性别、体重指数(BMI)、术后第1天血清钙、术后第1天PTH、术后第3天PTH、癌灶数量、CLND数量及范围是术后早期发生低钙血症的危险因素(P<0.05)。在多变量分析中,性别(P=0.003)、BMI(P=0.005)、CLND清扫范围(P=0.019)、术后第1天PTH(P=0.033)、癌灶数量(P=0.011)是独立危险因素。结论女性、低体重、行单侧或双侧中央区淋巴结清扫、术后第1天PTH明显下降、癌灶数量两个以上是早期发生低钙血症的独立危险因素。

Objective To investigate the risk factors of early hypocalcemia after total thyroidectomy.Methods A retrospective study was conducted in 715 patients who underwent total thyroidectomy for thyroid cancer from January 2016 to June 2019.Statistical analysis were performed by using SPSS 24.0 software.Risk factors of early hypocalcemia were analyzed by using chi-square test,t test or nonparametric test.Logistic model were employed for multiple factors analysis.A P value of<0.05 was considered as statistically significant difference.Results There were 297 cases(41.5%)of postoperative hypocalcemia,including 228 cases(76.8%)of asymptomatic hypocalcemia,and 69 cases(23.2%)with clinical symptoms.Among them,gender,BMI(body mass index),serum calcium on the 1st day after surgery,PTH on the 1st day after surgery,PTH on the 3rd day after surgery,number of cancer lesions,number and range of CLND were risk factors for early postoperative hypocalcemia(P<0.05).In the multivariate analysis,gender(P=0.003),BMI(P=0.005),CLND sweep range(P=0.019),PTH on the 1st day after surgery(P=0.033),and number of cancer lesions(P=0.011)were independent risk factors.Conclusion Women,low body weight,unilateral or bilateral central lymph node dissection,significant decrease of PTH on the first day after surgery,and more than two cancer lesions are independent risk factors for early hypocalcemia.