摘要
目的 了解继发性甲状旁腺功能亢进患者切除甲状旁腺并自体移植术后,早期的骨骼和关节疼痛缓解的程度及部位。方法 广东省人民医院耳鼻咽喉科2018年2—8月34例肾衰继发性甲状旁腺功能亢进患者参与研究,其中男15例,女17例,年龄31~70岁。所有患者采用甲状旁腺全切手术并自体移植。术后常规给予补钙,维持血钙在2.0~2.5 mmol/L之间。测试患者术前术后钙磷代谢指标甲状旁腺素、血清磷、血清碱性磷酸酶和血钙的变化。使用疼痛可视化量表让患者自评术前及术后48 h内各肌肉、骨骼和关节的疼痛变化情况。包括:脚跟脚趾、小腿骨、膝关节、髋关节、腰背部、上肢等部位。结果 甲状旁腺全切除术+自体移植术后甲状旁腺素、血清磷和血钙明显降低(P<0.05)。术后脚跟脚趾、小腿骨、膝关节、髋关节、腰背部、上肢等部位的疼痛较术前均明显缓解(P<0.05),上肢、膝关节和脚跟脚趾相较小腿和髋关节的疼痛最明显,同时术后缓解也最明显(P<0.05)。结论 甲状旁腺切除+自体移植术后并维持一定血钙浓度,可以明显改善继发性甲状旁腺功能亢进患者术后早期上肢及下肢以及躯干部的骨和关节疼痛。且骨关节是否负重并不同疼痛的缓解程度相关。
Objective To investigate the extent and location of early relief of bone and joint pain in patients with secondary hyperparathyroidism who underwent parathyroidectomy and autotransplantation.Methods A total of 34 patients with renal failure and secondary hyperparathyroidism were enrolled in the study from February to August 2018 in the Department of Otolaryngology Head&Neck Surgery at Guangdong Provincial People′s Hospital.Among them,15 were male and 17 were female,aged between 31 and 70 years.All patients underwent total parathyroidectomy with autotransplantation.Postoperatively,routine calcium supplementation was administered to maintain blood calcium levels between 2.0 and 2.5 mmol/L.Changes in calcium-phosphorus metabolism markers,including parathyroid hormone,serum phosphorus,serum alkaline phosphatase,and blood calcium,were measured preoperatively and postoperatively.Patients were asked to self-assess pain changes in various muscles,bones,and joints using a visual analog scale within 48 hours before and after surgery,including the heel and toes,lower leg bones,knee joints,hip joints,lower back,and upper limbs.Results Total parathyroidectomy with autotransplantation significantly reduced parathyroid hormone,serum phosphorus,and blood calcium levels postoperatively(P<0.05).Postoperatively,pain in the heel and toes,lower leg bones,knee joints,hip joints,lower back,and upper limbs significantly improved compared to preoperative levels(P<0.05).Pain relief in the upper limbs,knee joints,and heel and toes was more pronounced than in the lower legs and hip joints,and the relief was most significant postoperatively(P<0.05).Conclusion Parathyroidectomy with autotransplantation,while maintaining a certain blood calcium concentration,can significantly improve bone and joint pain in the upper and lower limbs and trunk in patients with secondary hyperparathyroidism in the early postoperative period.The degree of pain relief is not related to weight-bearing status in bones and joints.
作者
阮红娟
王利平
康竞
苏靖琳
张思毅
刘双信
葛平江
RUAN Hong-juan;WANG Li-ping;KANG Jing;SU Jing-ling;ZHANG Si-yi;LIU Shuang-xin;GE Ping-jiang(不详;Department of Otolaryngology Head&Neck Surgery,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences),Guangzhou 510180,Guangdong,China)
出处
《广东医学》
CAS
2023年第11期1440-1443,共4页
Guangdong Medical Journal
基金
广东省人民医院(广东省医学科学院)“登峰计划”(DFJH201901)。
