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目的 探讨甲状腺手术病人甲状旁腺素（PTH）测定与术后低钙血症发生率的关系，总结术后低钙血症的预防和治疗经验。方法 2004年1月至2007年8月对南京医科大学附属无锡市第二人民医院收治的592例甲状腺病人分别于术前．术中切除标本后10min、术后第1、2天测血清门H值，术前、术后第1、2、3天动态监测血清钙离子变化。结果 甲状腺手术后出现低钙血症86例，术中切除标本10min后PTH≤15ng／L（14．19％）及术后第1天≤10ng／L（8．28％）者低钙血症发生率与〉15ng／L（0．34％）、〉10ng／L（6．25％）者相比差异有统计学意义；将切除后10min PTH下降〉75％做为预测术后低钙血症的指标。其敏感性、特异度分别为100％、94．51％。结论 术中切除标本后10min门H下降〉75％时可做为预测术后低钙血症的指标；甲状腺手术后3d内血钙变化最显著；一侧甲状腺全切除＋对侧次全切除及切除范围更大的病人，应常规行术中门H测定，并据情况适当补充钙剂，可以防止低钙症状的发生。

Prediction of parathyroid hormone assay for hypocalcemia in patients after thyroidectomy: a report of 592 cases

??Objective:To investigate the relationship between hypocalcemia and parathyroid hormone(PTH) level during thyroidectomy,and discuss the prevention and treatment of hypocalcemia after thyroidectomy. Methods:The clinical data of 592 cases performed thyroidectomy bdtween January 2004 and August 2007 were analyzed and serum calcium level was observed closely.PTH was checked before,during and after the operation. Results:Hypocalcemia occurred in 86 cases during the postoperative period.The morbidity of hypocalcemia of the patients with serum PTH level less than 15 ng/L (10 minutes after the thyroidectomy) was 14??19%,which was significant different with that of patients with serum PTH level more than 15 ng/L (0.34%).The morbidity of hypocalcemia of the patients with serum PTH level less than 10 ng/L(1 day after the operation) was 8.28%,which was significant different with that of patients with,serum PTH level more than 10 ng/L(6.25%).The PTH level reduced more than 75% 10 min after the ectomy was a predictor of hypocalcemia with the sensitivity and specificity of 100% and 94??51%. Conclusion:The PTH level reduced more than 75% 10 min after the ectomy,as a predictor,was reliable.The serum calcium level changed significantly within the first 3 days after the operation.The PTH level should be observed during the operation for the patients accepted unilateral lobectomy with contralateral subtotal lobectomy or even larger lobectomy,Which is useful for preventing hypocalcemia.