甲状旁腺切除术对伴有严重继发性甲状旁腺功能亢进的维持性血液透析患者睡眠质量的影响

摘要

目的 通过对行甲状旁腺切除术的维持性血液透析患者进行随访,探讨甲状旁腺切除术对该类患者睡眠质量的影响.方法 选取因继发性甲状旁腺功能亢进行甲状旁腺切除术的维持性血液透析患者16例,对其术前1个月及术后1年进行随访.观察手术前后钙、磷、甲状旁腺激素的变化,应用匹兹堡睡眠指数(PSIQ),评估患者手术前后睡眠质量.结果 行甲状旁腺切除术后1年,患者睡眠质量得到显著改善(PSQI评分17.48±5.13 vs 3.17±2.63,P<0.05),伴有骨痛及瘙痒症状的患者的数量也显著减少,术后1年,患者血钙、血磷及全段甲状旁腺激素(iPTH)水平也明显下降.结论 甲状旁腺激素水平在维持性血液透析患者的睡眠问题中起着至关重要的作用,甲状旁腺切除术可以明显改善患者的睡眠质量及预后,促进尿毒症患者回归社会.%Objective The maintenance hemodialysis patients with parathyroidectomy were followed up to investigate the effects of parathyroid adenectomy on the quality of sleep.Methods Sixteen hemodialysis patients were selected for parathyroidectomy due to secondary hyperparathyroidism.Follow-up was performed one month before and one year after surgery.The changes in Ca,P,and parathyroid hormone were observed before and after surgery. Pittsburgh Sleep Index (PSIQ)was used to assess the quality of sleep before and after surgery.Results One year after parathyroidectomy,the quality of sleep was significantly improved(PSQI 17.48±5.13 vs 3.17±2.63,P <0.05).The number of patients with bone pain and itchy symptoms also decreased significantly.Blood calcium,phosphorus and iPTH levels also decreased significantly.Conclusion Parathyroid hormone level plays a critical role in the sleep problems of patients with maintenance hemodialysis.Parathyroidectomy can significantly improve the quality of sleep in maintenance hemodialysis patients.It could improve the sleep quality and prognosis of patients,and promote the reintegration of patients with uremia.