甲状腺手术围手术期发生低钙血症的影响因素及处理方案

Influencing factors and treatment of hypocalcemia in perioperative period of thyroid surgery

目的探讨甲状腺手术围手术期继发性甲状旁腺功能减退致症状性低钙血症(SH)的影响因素以及处理方案。方法收集行甲状腺全切术后出现SH的患者120例作为SH组,同时期行甲状腺全切术后未发生SH的患者110例作为对照组,采用logistic回归分析术后发生SH及SH患者症状缓解所需补钙剂量的影响因素,并绘制ROC曲线分析术前、术后全段甲状旁腺激素(iPTH)对术后SH患者补钙剂量的预测效能。结果发生SH的单因素分析显示,女性、术后钙水平、术前iPTH、术后iPTH、术后维生素D水平、术后24 h尿钙水平、病变范围、手术时间、病理诊断是影响术后发生SH的主要因素(P<0.05);SH患者补钙剂量的单因素分析显示补钙量、手术时间、术前iPTH、术后iPTH、术后维生素D水平、术后24 h尿钙水平是影响术后SH患者症状缓解所需补钙剂量的主要因素(P<0.05);多因素分析显示,术前低iPTH、术后低iPTH是影响术后SH患者症状缓解所需补钙剂量的高危因素(P<0.05);Pearson相关性分析发现,术后SH患者症状缓解所需补钙剂量与术前iPTH、术后iPTH均呈负相关(P<0.05),ROC曲线提示术后iPTH<18.19 mmol/L时对预测术后SH患者静脉补充葡萄糖酸钙>4g最有价值。结论影响甲状腺全切术围手术期患者发生SH的相关因素较多,检测术后iPTH水平对预测患者发生SH及术后补钙量有一定价值。

Objective To investigate the related influencing factors and treatment plan of symptomatic hypocalcemia(SH)caused by secondary hypoparathyroidism during perioperative period of thyroid surgery.Methods A total of 120 patients who developed SH after total thyroidectomy were grouped as SH group,and 110 patients who did not develop SH after total thyroidectomy during the same period were grouped as control group.Logistic regression was used to analyze the influencing factors of postoperative symptomatic hypocalcemia and calcium supplement dose required for symptom relief in patients with SH;ROC curves were drawn to analyze the predictive efficacy of preoperative and postoperative full-segment parathyroid hormone(iPTH)on postoperative SH calcium supplement dose.Results Univariate analysis of SH showed that female,postoperative calcium level,preoperative iPTH,postoperative iPTH,postoperative vitamin D level,postoperative 24-hour urinary calcium level,lesion range,operation time,and pathological diagnosis were the main factors affecting SH after operation(P<0.05).univariate analysis of calcium supplement dose in SH patients showed that calcium supplement,operation time,preoperative iPTH,postoperative iPTH,postoperative vitamin D level and 24-hour urinary calcium level were the main factors affecting the calcium supplement dose required for symptom relief in SH patients after operation(P<0.05).Multivariate analysis showed that preoperative low iPTH and postoperative low iPTH were high risk factors affecting the calcium supplement dose required for symptom relief in patients with SH(P<0.05).Pearson correlation analysis showed that the calcium supplement dose required for symptom relief in postoperative SH patients was negatively correlated with preoperative iPTH and postoperative iPTH(P<0.05).ROC curve showed that postoperative iPTH<18.19 mmol/L was most significant for predicting postoperative SH patients with intravenous calcium gluconate>4 g.Conclusion There are many related factors affecting the occurrence of SH in perioperative period of total thyroidectomy.Postoperative iPTH level might serve to predict occurrence of SH and post-operative calcium supplementation.