中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (11): 756-759.doi: 10.3969/j.issn.1671-4091.2020.11.009

• 临床研究 • 上一篇    下一篇

继发性甲状旁腺切除术后高钾血症的危险因素分析

邹芸1,周华1,张丽伟2,杨艳1,杨敏1, 狄佳1   

  1. 常州市第一人民医院1肾内科2感染管理科
  • 收稿日期:2020-06-30 修回日期:2020-08-11 出版日期:2020-11-12 发布日期:2020-11-05
  • 通讯作者: 狄佳 brightsea@163.com E-mail:brightsea@163.com
  • 基金资助:
    江苏省卫计委面上项目(KY2018105)；常州市卫计委重大科研项目(ZD201706)

Risk factors for hyperkalemia in secondary hyperparathyroidism after parathyroidectomy

  1. 1Department of Nephrology and 2Department of Infection Management, Changzhou First People’s Hospital, Changzhou 213003, China
  • Received:2020-06-30 Revised:2020-08-11 Online:2020-11-12 Published:2020-11-05

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摘要： 【摘要】目的研究继发性甲状旁腺功能亢进症(secondary hyperparathyroidism，SHPT)患者甲状旁腺切除术(parathyroidectomy，PTX)后高钾血症的危险因素，为减少术后高钾血症提供理论依据。方法回顾性分析2014 年1 月～2019 年10 月期间常州市第一人民医院因SHPT 行PTX 手术患者的临床资料，按照术后血钾水平分为高钾组及非高钾组，比较2 组患者PTX 围手术期血钾、钙、磷、全段甲状旁腺激素(intact parathyroid hormone，iPTH)等指标差异。结果PTX 患者术后血钾高于术前(t=-9.125，P＜0.001)，血钙、磷及iPTH 低于术前(t/Z 值分别为9.853，2.044，6.334；P 值分别为＜0.001，0.046，＜0.001)；有28/53(52.8%)的患者术后发生高钾血症，术前K+水平是SHPT 患者PTX 术后出现高钾血症的独立危险因素(β=-3.054，P=0.008)。根据ROC 曲线分析，术前K+的最佳截定值为4.30mmol/L。结论术前K+水平较高的SHPT 患者PTX 术后出现高钾血症风险较高，积极降低术前K+水平在4.30mmol/L 以下有助于减少术后高钾血症风险。

关键词: 甲状旁腺切除术, 高钾血症, 甲状旁腺功能亢进症, 血液透析

Abstract: 【Abstract】Objective Parathyroidectomy (PTX) is the main method to treat secondary hyperparathyroidism (SHPT). However, the risk factors for postoperative hyperkalemia are uncertain. This study was to investigate the risk factors for postoperative hyperkalemia after PTX for SHPT. Methods A total of 53 patients with SHPT undergoing PTX in Changzhou First People’s Hospital from January 2013 to August 2019 were involved in this study. Laboratory examinations including serum K+, Ca2+, alkaline phosphatase, phosphorus and intact parathyroid hormone were conducted before and after PTX. Results In PTX patients, postoperative serum K+ was higher than preoperative level (t=-9.125, P<0.001), and postoperative serum Ca2 + (t=-9.853, P<0.001), phosphorus (t=2.044, P=0.046) and iPTH (Z=-6.334, P<0.001) were lower than the preoperative levels. Postoperative hyperkalemia developed in 28 (52.8%) patients. Preoperative serum K+ level was the independent risk factor for hyperkalemia after PTX in SHPT patients (β=-3.054, P=0.008). The ROC curve showed that the optimal cut- off value for preoperative serum K+ was 4.3mmol/L. Conclusion SHPT patients with higher serum K+ before surgery have a higher risk of hyperkalemia after PTX, Lowering serum K+ below 4.3mmol/L before surgery is useful to reduce the risk of postoperative hyperkalemia.

Key words: Parathyroidectomy, Hyperkalemia, Hyperparathyroidism, Hemodialysis