Bentrem D J, Rademaker A, Angelos P
Division of Gastrointestinal and Endocrine Surgery, Northwestern University Medical School, Chicago, Illinois, USA.
Am Surg. 2001 Mar;67(3):249-51; discussion 251-2.
Hospital stays for thyroid and parathyroid surgery have decreased significantly with selected patients staying under 8 hours. Strategies to recognize hypocalcemia postoperatively vary. We examined timed postoperative calcium levels to determine how long one needs to monitor patients for hypoparathyroidism. We analyzed 120 consecutive patients having total/near-total thyroidectomy and/or parathyroidectomy between April 1998 and October 1999. Total and ionized serum calcium levels were obtained at 8, 16, and 22 hours postoperatively. Strict criteria for significant hypoparathyroidism were defined as a symptomatic patient, a total calcium value of less than 7.2 mg/dL, or an ionized calcium value of less than 1.0 mmol/L. Eighteen patients (15%) met criteria for hypocalcemia. The 8-hour ionized calcium level identified 40 per cent of those that needed supplementation. With the inclusion of the 16-hour ionized calcium value 94.5 per cent of patients who met criteria were identified. Of the 74 patients who had not previously received calcium at 22 hours after surgery only one patient with hypocalcemia was identified. Serial calcium values postoperatively add to the costs associated with an overnight hospital stay. In addition to clinical examination an ionized calcium level 16 hours postoperatively is sufficient to identify significant hypoparathyroidism in the majority of patients.
甲状腺和甲状旁腺手术后的住院时间显著缩短，部分患者住院时间不到8小时。术后识别低钙血症的策略各不相同。我们检查了术后定时血钙水平，以确定需要对患者进行多长时间的甲状旁腺功能减退监测。我们分析了1998年4月至1999年10月期间连续进行全甲状腺切除和/或甲状旁腺切除的120例患者。术后8小时、16小时和22小时测定血清总钙和离子钙水平。严重甲状旁腺功能减退的严格标准定义为有症状的患者、总钙值低于7.2mg/dL或离子钙值低于1.0mmol/L。18例患者（15%）符合低钙血症标准。8小时的离子钙水平可识别出40%需要补充钙剂的患者。纳入16小时的离子钙值后，94.5%符合标准的患者被识别出来。在术后22小时之前未接受钙剂治疗的74例患者中，仅识别出1例低钙血症患者。术后连续测定血钙值会增加与过夜住院相关的费用。除临床检查外，术后16小时的离子钙水平足以识别大多数患者的严重甲状旁腺功能减退。
