Tan Jih Huei, Tan Henry Chor Lip, Loke Seng Cheong, Arulanantham Sarojah A/P
Department of Surgery, Hospital Sultan Ismail, Malaysia.
Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia.
Nephrology (Carlton). 2017 Apr;22(4):308-315. doi: 10.1111/nep.12761.
Calcium infusion is used after parathyroid surgery for renal hyperparathyroidism to treat postoperative hypocalcaemia. We compared a new infusion regimen to one commonly used in Malaysia based on 2003 K/DOQI guidelines.
Retrospective data on serum calcium and infusion rates was collected from 2011-2015. The relationship between peak calcium efflux (PER) and time was determined using a scatterplot and linear regression. A comparison between regimens was made based on treatment efficacy (hypocalcaemia duration, total infusion amount and time) and calcium excursions (outside target range, peak and trough calcium) using bar charts and an unpaired t-test.
Fifty-one and 34 patients on the original and new regimens respectively were included. Mean PER was lower (2.16 vs 2.56 mmol/h; P = 0.03) and occurred earlier (17.6 vs 23.2 h; P = 0.13) for the new regimen. Both scatterplot and regression showed a large correlation between PER and time (R-square 0.64, SE 1.53, P < 0.001). The new regimen had shorter period of hypocalcaemia (28.9 vs 66.4 h, P = 0.04), and required less calcium infusion (67.7 vs 127.2 mmol, P = 0.02) for a shorter duration (57.3 vs 102.9 h, P = 0.001). Calcium excursions, peak and trough calcium were not significantly different between regimens. Early postoperative high excursions occurred when the infusion was started in spite of elevated peri-operative calcium levels.
The new infusion regimen was superior to the original in that it required a shorter treatment period and resulted in less hypocalcaemia. We found that early aggressive calcium replacement is unnecessary and raises the risk of rebound hypercalcemia.
肾性甲状旁腺功能亢进症患者接受甲状旁腺手术后，会采用钙剂输注来治疗术后低钙血症。我们基于2003年的《肾脏病预后质量倡议》（K/DOQI）指南，将一种新的输注方案与马来西亚常用的一种方案进行了比较。
收集了2011年至2015年期间血清钙和输注速率的回顾性数据。使用散点图和线性回归确定钙峰值流出率（PER）与时间之间的关系。基于治疗效果（低钙血症持续时间、总输注量和时间）以及钙波动情况（超出目标范围、钙峰值和谷值），采用柱状图和非配对t检验对两种方案进行比较。
分别纳入了采用原方案和新方案的51例和34例患者。新方案的平均PER较低（2.16对2.56 mmol/h；P = 0.03）且出现时间更早（17.6对23.2 h；P = 0.13）。散点图和回归分析均显示PER与时间之间存在高度相关性（决定系数0.64，标准误1.53，P < 0.001）。新方案的低钙血症持续时间更短（28.9对66.4 h，P = 0.04），且在更短的时间内（57.3对102.9 h，P = 0.001）所需的钙剂输注量更少（67.7对127.2 mmol，P = 0.02）。两种方案之间的钙波动、钙峰值和谷值无显著差异。尽管围手术期钙水平升高，但在开始输注时仍出现了术后早期的高钙波动。
新的输注方案优于原方案，因为它所需的治疗时间更短，且导致的低钙血症更少。我们发现早期积极补钙并无必要，反而会增加反弹性高钙血症的风险。
