Aoki K, Nishino N, Konno H, Maruo H, Tanaka T, Baba S
Second Department of Surgery, Hamamatsu University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1993 Feb;94(2):97-103.
Postoperative phosphate dynamics were studied in 30 patients who underwent radical surgery for thoracic esophageal cancer and who were postoperatively nourished by total parenteral nutrition. There was a significant fall in the serum phosphate level on the 2nd and 3rd postoperative days in all patients. Postoperative hypophosphatemia was due to an increase in urinary phosphate excretion which was indicated by the fall in TRP% and TmPO4/GFR. A highly significant positive correlation was observed between the increase in urinary phosphate loss and the enhanced secretion of parathyroid hormone which was possibly triggered by surgical stress, a decrease in the serum level of calcium, the action of phosphate buffer or diuretics. All the patients except for those with postoperative pulmonary complications responded to the drop in serum phosphate by renal conservation of phosphate. A slight decrease in the serum level of phosphate was also found on the 6th postoperative day in most patients who were receiving parenteral hyperalimentation. The second fall in phosphate was due to transcellular shifts of phosphate. It is concluded that patients with postoperative pulmonary complications develop severe hypophosphatemia which should be prevented by replacement therapy with phosphate in the immediate postoperative period.
对30例行胸段食管癌根治术且术后接受全胃肠外营养的患者的术后磷酸盐动态变化进行了研究。所有患者术后第2天和第3天血清磷酸盐水平均显著下降。术后低磷血症是由于尿磷酸盐排泄增加所致，这可通过TRP%和TmPO4/GFR的下降来表明。尿磷酸盐丢失增加与甲状旁腺激素分泌增强之间存在高度显著的正相关，甲状旁腺激素分泌增强可能是由手术应激、血清钙水平降低、磷酸盐缓冲剂或利尿剂的作用引发的。除术后有肺部并发症的患者外，所有患者均通过肾脏对磷酸盐的保留来应对血清磷酸盐的下降。在接受胃肠外高营养的大多数患者术后第6天也发现血清磷酸盐水平略有下降。磷酸盐的第二次下降是由于磷酸盐的跨细胞转移。结论是，术后有肺部并发症的患者会出现严重的低磷血症，应在术后立即用磷酸盐替代疗法进行预防。
