尿毒症患者甲状旁腺全切除加前臂移植术后钙的补充

目的研究尿毒症患者甲状旁腺全切除加前臂移植术后的补钙方法。方法 15例接受甲状旁腺全切除加前臂移植术的尿毒症患者,根据其术后血钙浓度调整补钙剂量,使血钙浓度维持在1.8～2.5mmol/L之间。结果术后2周内平均血钙浓度是(2.235±0.082)mmol/L。术后2周内累计元素钙补充量(CaSUM)为(48.2±17.9)g。术后两周内平均每天、每千克体质量、每维持1mmol/L血钙所需元素钙的量(CaAVG)为(29.1±14.9)mg。CaSUM与甲状旁腺的质量显著相关(r=0.910,P=0.038),但是与甲状旁腺功能亢进持续时间、体质量、碱性磷酸酶(alkaline phosphatase,AKP)水平、标准蛋白分解率(normalized protein catabolic rate,nPCR)、术后第一日血清全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平不相关。CaAVG与甲状旁腺功能亢进持续时间正相关(r=1.000,P=0.041),与术后第1日iPTH水平负相关(r=-1.000,P=0.002)。结论甲状旁腺全切除加前臂移植术后的补钙量大小与甲状旁腺的质量、甲状旁腺功能亢进持续时间、术后第1日iPTH水平有关。

Calcium supplement after parathyroidectomy with forearm autograft in uremic patients

Objective To resolve the problems of calcium supplement after parathyroidectomy with forearm autograft in uremic patients. Methodology Fifteen uremic patients who received the operation had their serum concentration of calcium monitored, and the amount of calcium supplement was adjusted based on serum calcium to maintain the serum calcium within the range of 1.8 to 2.5mmol/L. Results The average serum calcium was （2.235±0.082）mmol/L within the 2 weeks after the operation. The cumulative amount of calcium supplement within the 2 weeks after the operation （CaSUM） was （48.2±17.9）g. To maintain 1mmol/L serum calcium, the average calcium supplement in the 2 weeks after the operation （CaAVG） was （29.1±14.9） mg/d·kg. CaSUM positively correlated to the weight of parathyroid （r =0.910, P =0.038）, but did not relate to the duration time of hyperparathyroidism （T）, body weight, serum alkaline phosphatase （AKP）, normalized protein catabolic rate （nPCR）, and the first day serum intact PTH （iPTH） after the operation. CaAVG positively related to the T （r =1.000, P =0.041）, but negatively related to the first day serum iPTH after the operation （r = -1.000, P =0.002）. Conclusion The amount of calcium supplement after parathyroidectomy with forearm autograft correlates to parathyroid weight, the duration time of hyperparathyroidism, and the first day serum iPTH after the operation.