难治性继发性甲状旁腺功能亢进患者甲状旁腺切除术围术期应用枸橼酸钠抗凝的临床观察

目的 观察枸橼酸钠溶液体外局部抗凝法(RCA)在难治性继发性甲状旁腺功能亢进(R-SHPT)患者行甲状旁腺切除术(PTX)围术期的疗效及安全性.方法 选择行PTX术围术期的R-SHPT患者42例,随机分成两组.RCA组采用4％的枸橼酸钠溶液体外局部抗凝;另一组采用无肝素抗凝透析.观察两组透析器及管路凝血情况、出血情况,测定尿素清除指数(Kt/V)、尿素氮下降率(URR)及超滤量.另外,RCA组于透析前、透析2h及透后0.5 h分别查血气分析及游离血钙,于透析2h同时查滤器后静脉端游离血钙,并于透析前、后查凝血指标,比较治疗前后参数变化.结果 RCA组的URR、Kt/、超滤量均明显高于无肝素抗凝组(P＜0.05),且其透析器及管路凝血发生率及凝血严重程度均明显低于无肝素抗凝组(P＜0.01).PTX术后RCA透析,常规于管路静脉端泵入10％葡萄糖酸钙溶液(20 ml/h×4 h)补钙,治疗后血钙浓度较治疗前升高(P=0.01),而治疗前后凝血指标比较差异无统计学意义.RCA组治疗中均未发生低钙血症.结论 作为R-SHPT患者PTX术围术期血液透析抗凝方式,局部体外枸橼酸钠溶液抗凝较无抗凝剂法抗凝效果肯定,安全性好.

Efficacy and safety on extracorporal sodium citrate anticoagulation during perioperative period of parathyroidectomy in patients with refractory secondary hyperparathyroidism

Objective To observe the peri-operative efficacy and safety of local sodium citrate solution(RCA) anticoagulant in vitro for patients with refractory secondary hyperparathyroidism (R-SHPT) resection.Methods A total of 42 patients who had received parathyroidectomy and treated with perioperative R-SHPT were included and randomly divided into two groups:the RCA group with 4％ sodium citrate solution in vitro local anticoagulation and the nonheparin anticoagulant group with no heparin anticoagulation hemodialysis.The dialyzer and pipeline coagulation and bleeding;calculated Kt/V、URR and ultrafiltration volume of the two groups were compared.For the RCA group,blood gas analysis and free blood calcium were checked before dialysis,at the end of the second hour during hemodialysis and half an hour after hemodialysis respectively;at the same time,hemodialysis filter vein end free blood calcium were checked at the end of the second hour during hemodialysis;and coagulation indexes were checked before and after dialysis;eventually,parameter variations were compared before and after the treatment.Results The RCA group was significantly higher than that of the non-heparin anticoagulation group in URR,Kt/V and ultrafiltration volume.Dialyzer and incidence rate of blood coagulation and pipeline coagulation of the RCA group was significantly lower than that of the nonanticoagulant heparin group (P＜ 0.01).RCA dialysis after PTX for the RCA group,20ml/h×4h 10％ calcium gluconate solution was regularly pumped into through tube vein end for calcium supplement;after the treatment,blood calcium concentration increased than that of before treatment (P=0.01).Before and after RCA treatment,there was no significant difference in coagulation parameters.In the RCA group,no hypocalcemia was reported.Conclusion For patients with PTX perioperative R-SHPT,RCA shows a positive efficacy and safety compared with no heparin anticoagulation hemodialysis.