本文選題：繼發(fā)性甲旁亢 + 血鈣�。� 參考：《皖南醫(yī)學(xué)院》2015年碩士論文

【摘要】：目的:通過(guò)分析繼發(fā)性甲旁亢患者圍手術(shù)期血鈣變化的曲線,從中尋找規(guī)律,并進(jìn)一步分析患者術(shù)前與術(shù)后一月血鈣磷乘積及i PTH水平變化趨勢(shì),回訪患者術(shù)后服用鈣劑量,以此評(píng)估手術(shù)效果。方法:回顧性分析皖南醫(yī)學(xué)院第一附屬醫(yī)院血透中心自2012年6月至2015年1月的31例因內(nèi)科治療失效而選擇外科手術(shù)治療的繼發(fā)性甲狀旁腺功能亢進(jìn)患者的資料,患者年齡在18-56歲(平均43.2歲),主要統(tǒng)計(jì)患者術(shù)前血鈣值、術(shù)中血鈣值、術(shù)后第1天的血鈣值、術(shù)后第3天的血鈣值、術(shù)后第7天的血鈣值及術(shù)后1月的血鈣值,患者術(shù)前術(shù)后的血鈣磷乘積,并統(tǒng)計(jì)患者術(shù)前外周血i PTH值及術(shù)后1月外周血i PTH值,通過(guò)比較術(shù)前術(shù)后外周血i PTH值評(píng)估手術(shù)效果,并繪制血鈣變化的曲線,結(jié)合術(shù)后隨訪,為患者制定合適的補(bǔ)鈣方案,進(jìn)一步改善患者的生活質(zhì)量。結(jié)果:31例患者均順利完成手術(shù),其中1例患者行甲狀旁腺全切術(shù)+自體移植術(shù)(total PTX with autotransplantation,TPTX+AT)、14例患者行甲狀旁腺全切除不移植術(shù)(total PTX without autotransplantation,TPTX)、16例患者行甲狀旁腺次全切除術(shù)(subtotal parathyroidectomy,SPTX),術(shù)前31例患者血鈣平均(2.57±0.23)mmol/L,術(shù)中血鈣平均(2.28±0.19)mmol/L,術(shù)后第1天血鈣平均(1.94±0.26)mmol/L,術(shù)后第3天血鈣平均(1.75±0.21)mmol/L,術(shù)后第7天血鈣平均(1.93±0.20)mmol/L,術(shù)后1月血鈣平均(2.30±0.31)mmol/L,術(shù)前血鈣磷乘積平均(66.34±15.74)mmol2/L2,術(shù)后血鈣磷乘積平均(34.79±13.08)mmol2/L2,術(shù)前i PTH平均(1795.40±512.61)pg/ml,術(shù)后1月的i PTH平均(37.27±86.67)pg/ml。通過(guò)統(tǒng)計(jì)學(xué)分析比較得出31例患者術(shù)后血鈣、鈣磷乘積均較術(shù)前降低,29例患者術(shù)后i PTH較術(shù)前降低明顯,2例患者術(shù)后i PTH100pg/ml,其中1例鈣磷尚正常,1例鈣稍偏高,但較術(shù)前有所降低;手術(shù)共切除旁腺116枚,其中有23例患者有4枚旁腺(占74%),有8例患者有3枚旁腺(占26%),術(shù)后病理示:7枚呈彌漫性增生(6.03%),96枚呈結(jié)節(jié)狀增生(82.76%),13枚呈增生伴腺瘤形成(11.21%),其中有3枚旁腺增生伴鈣化,還有2例伴有甲狀腺乳頭狀癌,術(shù)后均未出現(xiàn)聲音嘶啞、飲水嗆咳等并發(fā)癥,術(shù)后有7例患者出現(xiàn)明顯低血鈣的臨床表現(xiàn),4例患者出現(xiàn)明顯低血壓,術(shù)后皮膚瘙癢、骨痛等癥狀消失。結(jié)論:1、患者術(shù)后有一血鈣降低期,血液中鈣轉(zhuǎn)移入骨,有效改善了骨骼缺鈣狀態(tài),延緩了相關(guān)并發(fā)癥的發(fā)生;2、患者鈣磷乘積較術(shù)前明顯減少,降低了鈣化防御的風(fēng)險(xiǎn);3、骨骼缺鈣狀態(tài)改善后血鈣升高,患者服鈣量較術(shù)前減少,停用沖擊治療;4、患者術(shù)后PTH較術(shù)前明顯減少,手術(shù)是治療SHPT的有效手段。
[Abstract]:Objective: to analyze the changes of serum calcium in patients with secondary hyperparathyroidism during perioperative period, to find out the regularity, and to further analyze the change trend of serum calcium and phosphorus product and the level of I PTH in patients with secondary hyperparathyroidism before and after operation. To evaluate the effect of the operation. Methods: the data of 31 patients with secondary hyperparathyroidism who were selected for surgical treatment due to the failure of medical treatment from June 2012 to January 2015 in the Hemodialysis Center of the first affiliated Hospital of Southern Anhui Medical College were retrospectively analyzed. The patients were aged 18-56 years (mean 43.2 years). The preoperative calcium values, intraoperative calcium values, blood calcium values on the first day after operation, blood calcium values on the third day, blood calcium values on the 7th day and the serum calcium values at 1 month after operation were calculated. The preoperative and postoperative calcium and phosphorus products were calculated, and the values of I PTH in peripheral blood and I PTH in peripheral blood 1 month after operation were counted. The results of operation were evaluated by comparing the preoperative and postoperative I PTH values of peripheral blood, and the curves of changes of serum calcium were plotted, combined with postoperative follow-up. Develop appropriate calcium supplementation programs for patients to further improve their quality of life. Results all 31 patients successfully completed the operation. One patient underwent total with autotransplantation (TPTX AT) and 14 patients underwent total PTX without autotransplantation (TPTX) and 16 patients underwent subtotal parathyroid subtotal resection (subtotal parathyroid subtotal resection). The mean serum calcium was (2.57 鹵0.23) mmol / L in 31 patients before operation. The mean blood calcium was (2.28 鹵0.19) mmol / L during the operation, (1.94 鹵0.26) mmol / L on the first day after operation, (1.75 鹵0.21) mmol / L on the third day after operation, (1.93 鹵0.20) mmol / L on the 7th day after operation, (2.30 鹵0.31) mmol / L on the first month after operation, (66.34 鹵15.74) mmol / r / L, (34.79 鹵13.08) mmol / 2L / L on the third day after operation, and (3.79 鹵13.08) mmol / L 路L ~ (2) on the seventh day after operation, and (2.30 鹵0.31) mmol / L on the first month after operation. The mean value of I PTH was (1795.40 鹵512.61) PG / ml and (37.27 鹵86.67) PG / ml at 1 month postoperatively. The results of statistical analysis showed that the postoperative serum calcium, calcium and phosphorus product in 31 patients were significantly lower than those before operation in 29 patients, and the postoperative I PTH 100pg / ml in 2 patients was significantly lower than that in 2 patients. Among them, 1 patient had normal calcium and phosphorus, and 1 patient had a slightly higher calcium. The total number of paracentral glands was 116. Of the 23 patients, 4 were accessory glands (74%), 8 had 3 accessory glands (26%), 7 were diffuse hyperplasia (6.03%), 96 were nodular hyperplasia (82.76%), 13 were hyperplasia with adenoma (11.21%), 3 were paraspinal hyperplasia with calcification. There were also 2 patients with papillary thyroid carcinoma. There were no postoperative complications such as hoarseness, drinking water choking and coughing. There were 7 cases with obvious hypocalcemia, 4 cases with obvious hypotension and postoperative skin itching. Symptoms such as bone pain have disappeared. Conclusion: there is a period of decrease of blood calcium after operation, which can effectively improve the status of bone calcium deficiency, delay the occurrence of related complications, and decrease the product of calcium and phosphorus. The risk of calcification defense was reduced, the blood calcium level was increased after bone calcium deficiency was improved, the calcium consumption of patients was decreased compared with that before operation, and the PTH was significantly reduced after discontinuation of shock therapy. Surgery is an effective method in the treatment of SHPT.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R653

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相關(guān)碩士學(xué)位論文 前2條

1 孫達(dá);慢性腎臟病致繼發(fā)性甲狀旁腺功能亢進(jìn)（SHPT）的臨床分析[D];中國(guó)醫(yī)科大學(xué);2010年

2 陳旭;探討SHPT圍手術(shù)期血鈣變化的臨床意義[D];皖南醫(yī)學(xué)院;2015年

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本文編號(hào)：2065373