【摘要】 目的探讨甲状腺全切术后血钙、血镁、血磷和血清甲状旁腺激素(parathyroid hormone,PTH)水平的变化及意义。方法选取甲状腺全切术患者129例(甲状腺乳头状癌82例,结节性甲状腺肿和甲状腺腺瘤47例),监测所有患者术前和术后30min、1d、3d的血钙、血镁、血磷和血PTH水平;并分析患者性别、年龄、术前促甲状腺激素(thyroid stimulating hormone,TSH)水平、术中识别甲状旁腺数和病理类型与术后甲状旁腺损伤所致低钙血症间的关系。结果不同甲状腺全切术组术后血钙、血镁和PTH水平均呈下降趋势,且血钙和血镁水平以术后1d下降最为明显,PTH水平在术后30min即出现明显下降。血钙水平在不同甲状腺全切术组组间、不同时点间差异有统计学意义(P<0.05),在组间·不同时点间交互作用差异无统计学意义(P>0.05)。血镁和PTH水平在不同甲状腺全切术组组间、不同时点间以及组间·不同时点间交互作用差异均有统计学意义(P<0.05)。血磷在不同甲状腺全切术组组间、不同时点间以及组间·不同时点间交互作用差异均无统计学意义(P>0.05)。129例甲状腺全切术患者中又分为血钙正常亚组77例(59.7%),低钙血症无症状亚组31例(24.0%),低钙血症有症状亚组21例(16.3%)。低钙血症有症状亚组和低钙血症无症状亚组乳头状癌检出率高于血钙正常亚组(P<0.05)。血钙正常亚组、低钙血症有症状亚组和低钙血症无症状亚组性别、年龄、术前TSH水平以及术中识别甲状旁腺数差异无统计学意义(P>0.05)。结论手术范围和甲状腺癌可能是术后甲状旁腺损伤的影响因素。甲状腺术后血PTH监测较血钙更敏感。甲状腺术后低钙血症多合并低镁血症,补钙同时应补镁。更多还原

【Abstract】 Objective To assess the variety and significance of serum calcium,magnesium,phosphorus,parathyroid hormone(PTH),and related clinical risk factors of parathyroid injury after total thyroidectomy. Methods One hundred and twenty-nine patients with total thyroidectomy,consisting of 82 cases with thyroid papillary carcinoma and 47 cases with Nodular goiter and thyroid adenoma,were retrospectively studied.Levels of serum calcium,magnesium,inorganic phosphorus and PTH before operation and 30 minutes,1d,3dafter operation were measured respectively,and age,gender,preoperative thyroid stimulating hormone(TSH),intraoperative identification of parathyroid glands,pathologic diagnosis were counted.And then the relationship between the above factors and hypocalcemia which affected by parathyroid injury after operation were analyzed respectively.Results Serum calcium,magnesium and PTH levels after operation in total thyroidectomy patients were all lower than those before operation,especially serum calcium and magnesium levels in 1day after operation decreased significantly,and serum PTH levels declined in 30 minutes after operation.There were statistically significantdifferences on serum calcium levels in different thyroidectomy groups or different time points(P<0.05),but there was no significant interaction between the two groups at the same time P>0.05).And there were also statistically significant differences on serum magnesium and PTH in different groups,different time points and the interaction between the two groups(P<0.05),while there was no significant difference in the interaction of serum phosphorus in different groups of all the groups,between different points,and between the two groups(P>0.05).Among 129 cases with total thyroidectomy,77cases(59.7%)were normal serum calcium,31cases(24.0%)were asymptomatic hypocalcemia,and 21 cases were symptomatic hypocalcemia.The risk of hypocalcemia thyroid cancer underwent total thyroidectomy group after surgery was significantly higher than that in benign thyroid disease group(P<0.05).The identification number and the age,gender,parathyroid surgery preoperative TSH level and postoperative hypocalcemia were not statistically significant(P>0.05).Conclusion The scope of operation and thyroid cancer may be the influencing factors of parathyroid injury after operation.After thyroid surgery,blood PTH monitoring is more sensitive than serum calcium monitoring.Low serum calcium after thyroid surgery is often accompany with low serum magnesium,so serum calcium supplement needs serum magnesium supplement at the same time.更多还原