Universiti Putra Malaysia, Selangor, Malaysia.
Ann Acad Med Singap. 2009 Dec;38(12):1074-80.
Intravenous calcium gluconate has been used to prevent postoperative hypocalcaemia (POH) following parathyroidectomy for secondary hyperparathyroidism in chronic kidney disease (CKD).
Retrospective data were obtained for 36 patients with CKD stage 4 and 5 after parathyroid surgery, correlating albumin-corrected serum calcium with the infusion rate of calcium gluconate. Calcium flux was characterised along with excursions out of the target calcium range of 2 to 3 mmol/L. With this data, an improved titration regimen was constructed.
Mean peak efflux rate (PER) from the extracellular calcium pool was 2.97 mmol/h occurring 26.6 hours postoperatively. Peak calcium efflux tended to occur later in cases of severe POH. Eighty-one per cent of patients had excursions outside of the target calcium range of 2 to 3 mmol/L. Mean time of onset for hypocalcaemia was 2 days postoperatively. Hypocalcaemia was transient in 25% and persistent in 11% of patients.
A simple titration regimen was constructed in which a 10% calcium gluconate infusion was started at 4.5 mL/h when serum calcium was <2 mmol/L, then increased to 6.5 mL/h and finally to 9.0 mL/h if calcium continued falling. Preoperative oral calcium and calcitriol doses were maintained. Blood testing was done 6-hourly, but when a higher infusion rate was needed, 4-hourly blood testing was preferred. Monitoring was discontinued if no hypocalcaemia developed in the fi rst 4 days after surgery. If hypocalcaemia persisted 6 days after surgery, then the infusion was stopped with further monitoring for 24 hours.
在慢性肾脏病（CKD）继发甲状旁腺功能亢进症患者甲状旁腺切除术后，静脉滴注葡萄糖酸钙已被用于预防术后低钙血症（POH）。
回顾性分析了 36 例 CKD 4 期和 5 期患者的术后数据，将白蛋白校正后的血清钙与葡萄糖酸钙的输注率相关联。描述了钙通量以及钙浓度超出 2 至 3mmol/L 目标范围的波动情况。根据这些数据，构建了一种改进的滴定方案。
细胞外钙池的平均峰值外排率（PER）为 2.97mmol/h，发生在术后 26.6 小时。严重 POH 病例中，PER 峰值往往出现较晚。81%的患者钙浓度超出 2 至 3mmol/L 的目标范围。低钙血症的发病时间平均为术后 2 天。25%的患者低钙血症为一过性，11%的患者为持续性。
构建了一种简单的滴定方案，当血清钙<2mmol/L 时，以 4.5mL/h 的速度开始输注 10%葡萄糖酸钙，然后增加至 6.5mL/h，如果钙继续下降，则增加至 9.0mL/h。维持术前口服钙和骨化三醇剂量。每 6 小时进行一次血液检测，但如果需要更高的输注率，则每 4 小时进行一次血液检测。如果术后 4 天内没有发生低钙血症，则停止监测。如果术后 6 天仍存在低钙血症，则停止输注，并进一步监测 24 小时。
