监测甲状腺术后引流液和血清中甲状旁腺素及血钙的临床意义

目的：检测甲状腺术后患者引流液甲状旁腺素（ drainage fluid parathyroid hormone ，dPTH）、血清甲状旁腺素（ parathyroid hormone ，PTH）、血清钙的动态变化规律，以此来判断原位保留的甲状旁腺的存活、功能及预后情况。方法昆明医科大学第一附属医院甲状腺中心2012年4月至2012年8月期间，将90例甲状腺手术依手术方式分为4组，A组：甲状腺全切组；B组：甲状腺全切＋中央组淋巴结清扫组；C组：甲状腺全切＋功能性颈淋巴结清扫组；D组：甲状腺一侧叶切除组。记录术中甲状旁腺的保留情况，术后低钙血症的发生情况，术后第1、2、3、4天上午7点至8点抽血检测血清钙、PTH。术后留置引流管，抽取引流液测dPTH。对血清钙、PTH、dPTH进行统计学分析，采用重复测量方差分析。结果术后血钙平均水平D组最高，C组最低，A、B组血清钙水平差别不大，但随着时间推移，各组的血清钙都呈上升趋势。术后PTH平均水平B、C组最低，D组最高，与其他3组比较差异有统计学意义，但随着时间推移，各组的PTH都呈上升趋势。各组dPTH的对比差异无统计学意义，但随着时间推移，各组dPTH均呈下降趋势。术后发生低血钙22例，发生低钙血症13例。 A组发生术后低血钙12例，低钙血症4例；B组发生低血钙3例，低钙血症3例；C组发生低血钙4例，低钙血症1例；D组发生低血钙2例，低钙血症1例。结论监测甲状腺术后dPTH、PTH、血清钙水平可综合判断甲状腺术后原位保留的甲状旁腺是否存活及其功能情况，并能帮助判断其预后。术后dPTH维持在一个高水平是原位保留的甲状旁腺存活的直接证据。甲状腺术后低PTH，高dPTH说明大多数情况下手术只影响了PTH分泌入血的途径，原位保留的甲状旁腺仍能持续分泌大量的PTH。随着甲状旁腺周围微循环的重建恢复，PTH将逐渐恢复正常。术后持?

Prediction of the parathyroid gland function and prognosis after thyroid surgery by monitoring drainage fluid and serum parathyroid hormone and serum calcium

Objective To explore the dynamic variation rule of drainage fluid parathyroid hormone （ dPTH） , serum parathyroid hormone （ PTH） and serum calcium after thyroidectomy .According to the variation rule, the survival , function and prognosis of the parathyroid which retained at the original place can be predicted . Methods From Apr.2012 to Aug.2012, 90 patients who underwent thyroidectomy in Thyroid Surgery Center of the First Affiliated Hospital of Kunming Medical University were chosen as the research object .All of the objects＆#39;operations were performed by the same surgeon team and they were divided into four groups according to different surgical methods （ group A：bilateral thyroidectomy group , group B：bilateral thyroidectomy and central neck dis-section group , group C： bilateral thyroidectomy and functional neck dissection group , and group D： unilateral thyroidectomy group ） .Parathyroid retention situation during operation and the occurrence of hypocalcaemia after operation were recorded .Blood samples were taken between 7am and 8am in the 4 consecutive days after opera-tion to detect serum calcium and serum parathyroid hormone .All of the 90 patients had the drainage tube and their drainage fluid were taken for testing dPTH .The levels of serum calcium , PTH and dPTH were analyzed by＆amp;nbsp;statistical analysis of repetitive measure analysis of variance （ ANOVA） .Results The mean postoperative maxi-mum serum calcium was in group D and the minimum was in group C .There was no obvious difference in terms of serum calcium between group A and group B .However , the serum calcium showed an upward trend in each group.The mean postoperative maximum PTH was in group D and the difference has statistical significance com -pared to the other 3 surgical methods.The minimum was in group B and group C .However, it showed an upward trend with time in each group .The difference of dPTH in each group had no statistical significance and it showed a downward trend in all the 4 groups.Low seru