甲状腺手术后低钙血症的临床分析

摘要

目的 分析甲状腺手术后有症状低血钙与无症状低血钙患者的血钙水平及临床不同手术方法对血清钙及甲状旁腺素(PTH)水平的影响情况.方法 选取2008年1月至2012年1月在佛山市第一人民医院行甲状腺手术后出现低钙血症的患者188例进行分析,按照症状的情况分为有症状组84例、无症状组104例.比较两组患者末后1、2、3、5d血清钙及PTH水平的变化.同时探讨不同手术方式术后1、2、3、5d对血清钙水平的影响.结果 两组患者术后1、2、3、5d血清钙水平逐渐上升,有症状组血清钙水平显著高于无症状组(P＜0.05)；两组患者术后1、2、3、5 dPTH水平均逐渐降低,有症状组PTH水平显著低于无症状组(P＜0.05),4种手术方式血钙水平以单侧甲状腺次全切除术最高,其次为一侧甲状腺全切+对侧甲状腺次全切除术,再次为双侧甲状腺次全切除术,血清钙水平最低是双侧甲状腺全切除术.结论 甲状腺术后有症状低血钙与无症状低血钙患者的血钙水平均降低,监测血钙水平对低血钙的预防是必要的.%Objective To analyze the serum calcium level of hypocalcemia with and without symptoms after thyroid surgery,and the influence of different surgery methods on serum calcium level and parathyroid hormone (PTH).Methods We analyzed 188 cases who had thyroid surgery at the First People's Hospital of Foshan City 1 from January 2008 to January 2012.According to the situation of the symptoms they were divided into symptomatic group of 84 cases,and asymptomatic group of 104 cases.The preoperative and 1,2,3,5 d postoperative serum calcium levels and the thyroid gland element (PTH) levels of the two groups were compared.The different surgical procedures influence on the serum calcium level 1,2,3,5 d after surgery was also discussed.Results Serum calcium levels 1,2,3,5 d after surgery increased gradually,serum calcium level of the symptomatic group was higher than the asymptomatic group with statistically significant difference (P ＜ 0.05).PTH level 1,2,3,5 d after surgery of both groups was decreasing gradually,and the symptomatic group PTH level was lower than the asymptomatic group with statistically significant differnce(P ＜ 0.05).Among the 4 kinds of operation methods calcium level of unilateral subtotal thyroidectomy was the highest,followed by the side thyroid cut + contralateral subtotal thyroidectomy,bilateral subtotal thyroidectomy,serum calcium was the lowest in cases of bilateral thyroid total resection.Conclusion After thyroid surgery hypocalcemia with or without symptoms both have low blood calcium,therefore monitoring the blood calcium level is necessary for the prevention of hypocalcemia.