甲状腺全切术后预防性补钙对甲状旁腺功能的影响

目的探讨对甲状腺全切患者术后预防性补钙治疗，对甲状旁腺功能恢复的影响。方法将符合入选标准的232例随机分为A和B组，再根据术后3d内最低1d的甲状旁腺素（PrH）值，将A、B组再分为Al（87例，PTH≥8pg／ml）和A2（30例，WH〈8pg／ml）组；B1（83例，PTH≥8pg／m1）和B，（32例，PTH〈8pg/ml）组。术后A组给予静脉补钙6g／d，B组术后暂时不给予补钙；术后不论是否出现低钙血症，但PTH〈8pg/ml均给予静脉补钙6g／d。所有患者检测术前术后第1、2、3天、1周及1个月血钙及PTH的水平，发生甲状旁腺功能减退的患者增加监测术后2、3周血钙及PTH水平。观察并记录患者术后是否出现低血钙及低钙血症、甲状旁腺功能减退。结果①术后1周A．组PTH及术后第1、2、3天和术后1周血钙水平高于B1组（P〈0．05）。A，组低血钙及低钙血症的发生率明显低于B1组（P〈0．05）。②术后第1、2、3周A2组PTH水平高于B2组（P〈0．05），并较B2组PTH先恢复到正常范围；术后第1天至第3周，A2组血钙水平高于B2组（P〈0．05），并较B2组先恢复到正常范围；A2组低血钙及低钙血症的发生率明显低于B2组（P〈0．05）。结论甲状腺全切术后预防性补钙有利于甲状旁腺功能恢复。

The influence of preventive calcium supplementation on the function of parathyroid glands after total thyroidectomy

Objective To discuss the influence of preventive calcium supplementation on the recovery of parathyroid glands function after total thyroidectomy. Methods 232 patients meeting the selected criteria were randomly assigned to group A and B, and then divided into group A1 （87 cases, PTH≥8 pg/ml） and A2（30 cases, PTH 〈 8 pg/ml）, group B1 （83 cases, PTH ≥ 8 pg/ml）and B2 （32 cases, PTH 〈 8 ug/ml）based on the lowest parathyroid hormone（PTH） value within 3 days after surgery. All patients in group A were immediately supplemented 10% calcium gluconate intravenously 6 g/d after operation. For group B, post operative calcium supplementation was not given, however, anyone whose FFH 〈 8 pg/ml was supplemented 10% calcium gluconate intravenously 6 g/d no matter hypocalcemia occurred or not. The level of serum calcium and PTH of all patients were assayed before operation and at the 1st, 2nd, 3rd day, 1st week and 1st month after operation. In additon, patients with hypocalcemia received serum calcium and PTH detection at the 2nd and 3rd week. Whether hypocalcemia and hypoparathyroidism occurred or not was recorded. Results （ 1 ） The serum FFH was obviously higher in group A1 than in group B1 at the 1st week after operation（P 〈0. 05）. The serum calcium was obviously higher in group A1 than in group B1 at the 1st, 2nd, 3rd day and 1st week after operation（P 〉0. 05）. The hypocalcaemia and symptomatic hypocalcaemia incidence were obviously lower in group A1 than in group B1 （P 〈 0. 05）. （2） （1） Group A2 had obviously higher level of serum PTH than group B2 at the 1st, 2nd, and 3rd week after operation （ P 〈 0. 05 ） and returned to normal level of serum PTH earlier than group B2. （2） Group A2had obviously higher lev- el of serum calcium than group B2 from the 1 st day to the 3rd week after operation （P 〈 0. 05 ）and returned to normal level of serum calcium earlier than group B2. （3） The hypocalcaemia and symptomaic hypocalcaemia incidence ware obviously lower in group A2 than in group B2 （P 〈 0. 05）. Conclusion The preventive calcium supplementation is beneficial for the recovery of the function of parathyroid glands after total thyroidectomy.