尿毒症血液透析患者行甲状腺全切术围手术期护理要点研究进展

尿毒症血液透析患者合并继发性甲状旁腺功能亢进在临床上是极为常见的,长期血液透析患者常出现甲状旁腺功能亢进,表现为血甲状旁腺激素明显升高,血钙持续升高,骨质脱钙和血管及软组织的异位钙化。出现甲旁亢,可采取的治疗方法有药物治疗和外科手术。药物治疗对轻型甲旁亢有效,中重度甲旁亢常需要外科手术治疗。当出现:(1)明显临床症状,如骨关节痛、肌无力、皮肤搔痒等;(2)持续性高钙血症、高磷血症或钙磷乘积大于70;(3) i PTH大于800 pg/m L,并且对活性维生素D药物治疗抵抗;(4)颈部彩色超声显示:至少一个甲状旁腺增大,直径大于1 cm并且有丰富的血流是需要外科手术。甲状腺全切术在此病治疗中较为常用,围手术期精心、完善、正确的护理模式对患者术后的康复以及并发症的发生等具有重大的意义。

Research Progress of Perioperative Nursing for Uremic Hemodialysis Patients Undergoing Total Thyroidectomy

Secondary hyperparathyroidism in uremic hemodialysis patients is very common in clinical practice. Hyperparathyroidism often occurs in long-term hemodialysis patients,which is manifested as the obvious increase of blood parathyroid hormone,the continuous increase of blood calcium,bone decalcification and ectopic calcification of blood vessels and soft tissues.The treatment methods for hyperparathyroidism can be medication and surgery. Drug therapy is effective for mild hyperparathyroidism,and surgery is often needed for moderate to severe hyperparathyroidism. When there are:( 1) obvious clinical symptoms,such as bone and joint pain,myasthenia,skin itching,etc.;( 2) persistent hypercalcemia,hyperphosphatemia or calcium phosphorus product more than 70;( 3) IPH greater than 800 pg/ml,and resistance to active vitamin D drug treatment;( 4) neck color ultrasound shows: at least a parathyroid gland enlargement,diameter greater than 1 cm and rich blood flow,it needs surgery. Total thyroidectomy is commonly used in the treatment of this disease. Careful,perfect and correct nursing mode during the perioperative period is of great significance to the rehabilitation of patients and the occurrence of complications.