本文關(guān)鍵詞：分化型甲狀腺癌圍手術(shù)期甲狀旁腺功能監(jiān)測與基于危險分層的個體化預(yù)防性補鈣策略探討　出處：《廣西醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 分化型甲狀腺癌 功能監(jiān)測 低鈣血癥 鈣劑支持 危險分層

【摘要】：目的：分析低鈣血癥潛在危險因素對分化型甲狀腺癌(differentiated thyroid carcinoma, DTC)術(shù)后各階段甲狀旁腺激素(parathyroid hormone, PTH)與血鈣的影響。探討以不同危險分層為依據(jù)的對DTC患者術(shù)后有效的預(yù)防性補鈣策略,為分層個體化預(yù)防性補鈣提供臨床證據(jù)支持。方法：對2015年3月至2016年2月期間診治的117例DTC患者進行前瞻性研究。按危險分層評分高低將其分為低危組(A組)及高危組(B組及C組)。其中A組不予補鈣,B組予以靜脈補鈣2g qd,C組予以靜脈補鈣2g bid,對各組低鈣癥狀及低鈣血癥發(fā)生率進行比較。監(jiān)測圍手術(shù)期第0至第4階段(術(shù)前、術(shù)后1-3天、術(shù)后4-6天、術(shù)后第7天、術(shù)后第14天后)血PTH及血鈣水平,分析性別、甲狀腺處理方式、中央?yún)^(qū)淋巴結(jié)清掃范圍、甲狀旁腺自體移植數(shù)以及鈣劑支持對血PTH及血鈣的影響。結(jié)果： 血PTH水平在第1階段下降至最低點,其后逐漸上升,在第4階段仍低于術(shù)前水平。第2階段血鈣水平數(shù)值最低,但各階段間差異無統(tǒng)計學(xué)意義。0階段女性PTH水平高于男性(46.75±17.3 pg/ml VS 38.08±14.78 pg/mlχ2=5.518, P=0.02)。行甲狀腺腺葉及峽葉切除(unilateral lobectomy plus isthmectomy, ULI)患者第1-3階段血PTH及血鈣明顯高于甲狀腺全切(totalthyroidectomy, TT)忠者(P0.01)。雙側(cè)中央?yún)^(qū)淋巴結(jié)清掃(bilateral central neck dissection, BCND)組血PTH明顯低于單側(cè)中央?yún)^(qū)淋巴結(jié)清掃(unilateral central neck dissection, UCND)組(χ2=-4.83,P0.05),尤其在第1-3階段(P0.01),但兩組間血鈣水平無顯著差異。甲狀旁腺白體移植(parathyroid autotransplantation, PAT)2枚組血PTH及血鈣較PAT 1枚組和未移植組低,而PAT 1枚組和未移植組間差異無統(tǒng)計學(xué)意義。A組術(shù)后各階段血PTH均高于其余兩組, B組與C組之間則無統(tǒng)計學(xué)差異(P=0.28)。三組中B組低鈣血癥發(fā)生率最高,其次為C組,A組最低(47.9%； 31.2%；17.2%P0.05)。B組低鈣癥狀發(fā)生率(25.5%)高于其余兩組,A、C組間發(fā)生率無統(tǒng)計學(xué)差異(4.1%；5.2%P=0.65)。癥狀組血鈣值95%置信區(qū)間CI[1.74,1.80]。結(jié)論：①圍手術(shù)期血PTH經(jīng)歷先降后升的過程,最低水平出現(xiàn)在術(shù)后1-3天,但恢復(fù)至術(shù)前水平需要2周以上。②女性血PTH基礎(chǔ)水平高于男性。③較之于ULI及UCND,TT及BCND更易導(dǎo)致較低的PTH水平。④TT更易導(dǎo)致患者出現(xiàn)低鈣血癥。⑤2枚甲狀旁腺自體移植對于DTC術(shù)后血PTH及血鈣水平無顯著影響。⑥予以低鈣血癥高�；颊�2g bid靜脈輸注10%葡萄糖酸鈣有利于減少低鈣癥狀的發(fā)生率,并且維持適宜的血鈣水平。⑦當(dāng)血鈣1.8mmol/L時應(yīng)高度警惕低鈣癥狀的發(fā)生。
[Abstract]:Objective: to analyze the potential risk factors of hypocalcemia for differentiated thyroid carcinoma in differentiated thyroid carcinoma. After operation, parathyroid hormone was used in all stages. To explore effective preventive calcium supplementation strategies based on different risk stratification for DTC patients. To provide clinical evidence for individualized and stratified prophylactic calcium supplementation. Methods:. A prospective study was conducted in 117 patients with DTC from March 2015 to February 2016. The patients were divided into low risk group according to their risk stratification scores (P < 0.05). Group A) and high risk group, group B and group C. among them, group A did not receive calcium supplementation. Group B was given 2g QDX by intravenous calcium supplementation. The incidence of hypocalcemia and hypocalcemia were compared. The perioperative stages 0 to 4 (preoperative) were monitored. Serum PTH and calcium levels, sex, thyroid management, and the extent of central lymph node dissection were analyzed 1-3 days, 4-6 days, 7 days and 14 days after operation. Effect of autotransplantation of parathyroid gland and calcium on blood PTH and calcium. Results: the level of serum PTH decreased to its lowest level in stage 1 and then increased gradually. The level of serum calcium in stage 4 was still lower than that before operation, and the level of serum calcium in stage 2 was the lowest. However, there was no significant difference between different stages. The level of PTH in females was higher than that in males at stage 0 (P < 0.05). 46.75 鹵17.3 pg/ml vs 38.08 鹵14.78 pg/ml 蠂 2 5.518. The thyroid gland lobe and isthmus lobectomy were performed with unilateral lobectomy plus isthmectomy. The levels of serum PTH and serum calcium in patients with uli were significantly higher than those in total thyroidectomy. The bilateral central neck dissection were dissected in bilateral central area. The serum PTH in BCND group was significantly lower than that in unilateral central neck dissection. UCND group (蠂 ~ 2 ~ (-4.83) P _ (0.05) P ~ (0.05)), especially in stage 1-3 (P _ (0.01)). But there was no significant difference in serum calcium level between the two groups. Parathyroid autotransplantation was transplanted into parathyroid white body. The levels of PTH and calcium in PAT)2 group were lower than those in PAT group and untransplanted group. There was no significant difference between the PAT group and the untransplanted group. The blood PTH in group A was higher than that in the other two groups. There was no statistical difference between group B and group C. among the three groups, the incidence of hypocalcemia in group B was the highest, and the lowest in group A was 47.9. 31.2. 17.2 the incidence of hypocalcemia symptoms was 25.5in group B (P 0.05), which was higher than that in group C (P 0.05). There was no significant difference between group C and group C (4. 1). The serum calcium value of the symptom group was 95% CI. [Conclusion during the perioperative period of 1: 1, the level of PTH decreased first and then increased, and the lowest level appeared at 1-3 days after operation. However, it took more than 2 weeks to recover to the preoperative level. The basic level of PTH in women was higher than that in men (3. 3 vs ULI and UCND). TT and BCND are more likely to lead to lower PTH levels. 4TT is more likely to cause hypocalcemia. 52 autografts of parathyroid glands have no significant effect on blood PTH and serum calcium levels after DTC. 2 g for high risk patients with hypocalcemia. Bid intravenous infusion of calcium gluconate 10% was helpful to reduce the incidence of hypocalcemia. And maintain the appropriate level of blood calcium at 1.8 mmol / L of blood calcium should be highly alert to the occurrence of hypocalcemia symptoms.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R736.1

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