Graff Adam T, Miller Frank R, Roehm Corrie E, Prihoda Thomas J
Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
Ear Nose Throat J. 2010 Sep;89(9):462-5.
A 24- to 48-hour in-hospital observation period to monitor for hypocalcemia is common after total thyroidectomy. Because most thyroidectomy patients do not experience this potentially serious complication, investigators have searched for methods and clinical indicators that may help stratify thyroidectomy patients according to their risk of developing hypocalcemia and identify those who can be safely discharged earlier. We conducted a retrospective study to compare the value of an immediate postoperative intact parathyroid hormone (PTH) level and serial calcium levels in predicting the development of hypocalcemia following total thyroidectomy. Our study population was made up of 69 consecutive patients who had undergone total thyroidectomy from January 2004 through March 2005. These patients were divided into two groups on the basis of their postoperative calcium levels; 11 patients (16%) had developed transient hypocalcemia (serum calcium level: <7.5 mg/dl) and 58 (84%) had remained normocalcemic. A model was developed to assess the relationship between early (<60 min) postoperative PTH levels and serial (6 and 18 hr) calcium levels, and the two-sample Student t test was used to identify differences between the two groups. Analysis showed that hypocalcemia was associated with a postoperative PTH level of less than 14 pg/ml and a negative serum calcium slope between 6 and 18 hours postoperatively. A single early postoperative intact PTH measurement may be the most cost-effective screening tool for hypocalcemia, but even greater specificity can be achieved by combining those findings with a serum calcium measurement taken 6 hours postoperatively. The combination of the two measurements represents the safest method of assessing risk and identifying those patients who can be discharged on the day of surgery.
全甲状腺切除术后，进行24至48小时的住院观察以监测低钙血症很常见。由于大多数甲状腺切除患者不会出现这种潜在的严重并发症，研究人员一直在寻找方法和临床指标，以帮助根据甲状腺切除患者发生低钙血症的风险进行分层，并识别出那些可以更早安全出院的患者。我们进行了一项回顾性研究，比较术后即刻完整甲状旁腺激素（PTH）水平和连续血钙水平在预测全甲状腺切除术后低钙血症发生方面的价值。我们的研究对象为2004年1月至2005年3月期间连续接受全甲状腺切除术的69例患者。这些患者根据术后血钙水平分为两组；11例患者（16%）发生了短暂性低钙血症（血清钙水平：<7.5mg/dl），58例（84%）血钙维持正常。建立了一个模型来评估术后早期（<60分钟）PTH水平与连续（6小时和18小时）血钙水平之间的关系，并使用两样本Student t检验来确定两组之间的差异。分析表明，低钙血症与术后PTH水平低于14pg/ml以及术后6至18小时血清钙斜率为负相关。术后早期单次完整PTH测量可能是筛查低钙血症最具成本效益的工具，但将这些结果与术后6小时的血钙测量结果相结合可实现更高的特异性。这两项测量的组合是评估风险和识别那些可以在手术当天出院的患者的最安全方法。
