The Perioperative Change Of Parathyroid Hormone And Ionized Calcium In Primary Hyperparathyroidism

primary hyperparathyroidism is a kind of disease that caused by parathyroid adenoma,hyperplasia or carcinoma with calcium phosphorus metabolism irregularity.the parathyroid hormone autonomy over secretion . the incidence rate is inferiority,in our country ,the total case of illness is relatively less. nearly recent twenty years,adopt blood calcium screen look up ,the incidence rate for 0.1%～0.25% of the PHPT,compare formerly increase four times, approximate with abroad incidence rate. because of the low incidence rate and specific pathology physiological effect,clinical feature ordinary atypical. easy engender misdiagnosis ,error control. therefore ,we take venous blood from preoperative,intraoperative and postoperative for thirteen case PHPT that suffering operative,adopt electrochemical luminescence farad detect complete segment parathyroid hormone, at the same time monitor blood calcium level. by the look of serum PTH and Ca2+ 's variation in perioperative,in order to advance the realization for PHPT.with the result that all the PTH value above the reference value's scope, the serum Ca2+ above the reference value's scope except 2 case. the group 2 (tumour excision aback 5 min) by comparision to group 1 (anaesthesia inure aback operate front) PTH fell off clearly 59.42%,serum calcium fell off clearly 0.32%。the group 3 (tumour excision aback 30 min) by comparision to group 1 (anaesthesia inure aback operate front) PTH fell off clearly 91.62%,serum calcium fell off clearly 6.7%. the group 2 comparison to group 1 PTH fell > 50% have got eight case (61.54%),serum calcium recover normal range have got two case(15.38%). the group 3 comparison to group 1 PTH fell > 50% have got thirteen case (100%),serum calcium recover normal range have got four case(30.77%). the PTH change quite calm ,without evident fluctuate in the postoperative, the serum calcium undermost in 3 or 5 group of postoperative compare to other groups. the average PTH and Ca2+ at the range of normal value in the group 7 of postoperative.we proceed track and follwo-up survey for thirteen case, the time from eight month to five years disparity. in the follow-up survey period ,the symptom of much drunk,diuresis,fatigue,nausea,vomit all disappear.bone joint ache three case disappear,five case get better, without fracture occur, deformity of spinal column case not aggravate, kidney concretion symptom two case get better ,three case not aggravate. all case check PTH and Ca2+ per three month after operation, ten case change quite calm and fluctuate in the reference value . for two case ,the PTH value gradualness heighten and beyond reference value scope after one year of postoperative ,the serum Ca fluctuate in the under line of reference value. for one case ,the PTH value gradualness heighten and beyond reference value scope after two year of postoperative, serum Ca2+ under reference value.this three case all have renal inadequacy in preoperative and the renal function improve indefiniteness in postoperative. analyses that the main reason of PTH raise and serum Ca2+ depress is because the calcium phosphorus metabolism imbalance that caused by renal inadequacy. the hypocalcemia is the major factor of urge parathyroid secretion PTH. therefore,we observe these three case closely and fill calcium expectant treatment in order to decrease the stimulation to parathyroid andagainst the occurance of secondary hyperparathyroidism.We can make a conclusion : (1) the serum PTH and Ca2+ is the main indicator that reflect the function of parathyroid in PHPT and changed between them possess relativity.(2) monitoring PTH fell down whether adequacy is the standard that evaluate the operation successful or not because the PTH changes quite swiftness when the function of parathyroid changes..(3) PTH decline very markable in 30 min after the tumer be out.(4) the serum Ca2+ changes slightly tardiness compared to PTH in perioperative and generally descend on undermost in three or five day after operation, in this period we should monitor Ca2+ closely.(5) the person's state is also the main factor that impact the changes of serum Ca2+.(6) we should supply the calcium propriety according to the level of serum calcium after operation of PHPT in order to the appearance of hypocalcemia.