甲状旁腺切除术联合前臂自体移植术对行MHD的SHPT患者生化指标及生活质量的影响

Effects of Parathyroidectomy Combined with Forearm Autograft on Biochemical Indexes and Quality of Life in SHPT Patients Undergoing MHD

【目的】探讨甲状旁腺切除术联合前臂自体移植术对维持性血液透析(MHD)伴继发性甲状旁腺功能亢进(SHPT)患者的生化指标水平及生活质量的影响。【方法】本院收治的MHD伴SHPT的96例患者,随机分为两组,每组48例。对照组行单纯的甲状旁腺全切切除术,观察组在对照组的基础上联合前臂自体移植术。比较两组术前、术后3个月血磷(P^(3-))、血钙(Ca^(2+))、甲状旁腺激素(iPTH)和血红蛋白(Hb)水平、生活质量以及不良反应发生情况。【结果】术后3个月,两组P^(3-)、Ca^(2+)和iPTH水平低于术前,Hb水平高于术前(P<0.05);且观察组P^(3-)、Ca^(2+)和iPTH水平低于对照组,Hb水平高于对照组(P<0.05)。术后3个月,两组总体健康、躯体疼痛、社会功能、机体活力等评分均高于术前(P<0.05),且观察组高于对照组(P<0.05)。术后3个月,观察组声音嘶哑、肌无力及喉返神经损伤发生率均低于对照组(P<0.05)。【结论】选择甲状旁腺切除联合前臂自体移植术治疗MHD伴SHPT患者能够更有效地改善患者临床症状,提高生存质量且安全性高。

【Objective】To investigate the effect of parathyroidectomy combined with forearm autotransplantation on biochemical indexes and quality of life in patients with maintenance hemodialysis(MHD)and secondary hyperparathyroidism(SHPT).【Methods】A total of 96 patients with MHD and SHPT were randomly divided into two groups with 48 cases in each group.The control group underwent simple total parathyroidectomy,and the observation group combined with forearm autograft on the basis of the control group.The levels of blood phosphorus(P^(3-)),blood calcium(Ca^(2+)),parathyroid hormone(iPTH)and hemoglobin(Hb),quality of life and adverse reactions were compared between the two groups before and 3 months after operation.【Results】Three months after operation,the levels of P^(3-),Ca^(2+)and iPTH in the two groups were lower than those before operation,and the level of Hb was higher than that before operation(P<0.05);The levels of P^(3-),Ca^(2+)and iPTH in the observation group were lower than those in the control group,and the level of Hb was higher than those in the control group(P<0.05).Three months after operation,the scores of overall health,physical pain,social function and body vitality in the two groups were higher than those before operation(P<0.05),and those in the observation group were higher than those in the control group(P<0.05).Three months after operation,the incidence of hoarseness,muscle weakness and recurrent laryngeal nerve injury in the observation group were lower than those in the control group(P<0.05).【Conclusion】Parathyroidectomy combined with forearm autograft in the treatment of MHD patients with SHPT can more effectively improve the clinical symptoms,improve the quality of life with high safety.