Ariyan Charlotte Eielson, Sosa Julie Ann
Yale University School of Medicine, Department of Surgery, New Haven, CT, USA.
Crit Care Med. 2004 Apr;32(4 Suppl):S146-54. doi: 10.1097/01.ccm.0000117172.51403.af.
Calcium is essential for homeostasis, and normocalcemia should be maintained strictly during the perioperative period. The biochemistry of calcium equilibrium results from the calcium-sensing receptors on the parathyroid glands, which detect changes in calcium concentrations and initiate the proper response. Asymptomatic hypercalcemia is a common metabolic derangement that is often discovered on routine serum screening. The most common etiologies are primary hyperparathyroidism and cancer. Increasingly, parathyroidectomy is the preferred therapy for primary hyperparathyroidism. Severe hypercalcemia ("hypercalcemic crisis") should be managed aggressively with a combination of intravenous fluids, steroids, bisphosphonates, and calcitonin. Some of these patients may require an urgent parathyroidectomy for calcium control. Hypocalcemia needs to be verified, as many cases of hypocalcemia are the artifact of hypoalbuminemia. Severe hypocalcemia occurs after subtotal or total parathyroidectomy with auto transplantation as well as after massive resuscitation or blood transfusion. Strategies aimed at correcting calcium concentrations depend on the severity of symptomatology. If symptoms are mild, oral calcium supplementation can be given; otherwise, intravenous calcium should be administered.
钙对于体内平衡至关重要，围手术期应严格维持血钙正常。钙平衡的生物化学过程源于甲状旁腺上的钙敏感受体，这些受体可检测钙浓度的变化并引发适当反应。无症状高钙血症是一种常见的代谢紊乱，常在常规血清筛查中被发现。最常见的病因是原发性甲状旁腺功能亢进和癌症。越来越多的人认为，甲状旁腺切除术是原发性甲状旁腺功能亢进的首选治疗方法。严重高钙血症（“高钙血症危象”）应积极采用静脉补液、类固醇、双膦酸盐和降钙素联合治疗。其中一些患者可能需要紧急进行甲状旁腺切除术以控制血钙。低钙血症需要进行核实，因为许多低钙血症病例是低白蛋白血症的假象。严重低钙血症发生在甲状旁腺次全切除术或全切除术后自体移植以及大量复苏或输血之后。旨在纠正血钙浓度的策略取决于症状的严重程度。如果症状较轻，可给予口服补钙；否则，应静脉注射钙剂。
