目的 研究甲状腺结节切除术后发生低钙血症的风险因素。方法 回顾性收集124例甲状腺结节切除手术患者的临床数据,包括年龄,性别,肿块性质,病灶部位（单/双侧）,手术方式,淋巴结清扫,围手术期血钙（包括校正前、校正后）、甲状旁腺激素（PTH）、血镁水平等,根据术后血钙值分为有低血钙组和无低血钙组,以比较两组间差异,从而研究甲状腺结节切除术后发生低钙血症的风险因素。结果 甲状腺结节切除术后低钙血症发生率为9.7%（12/124）,平均血钙值为（2.10±0.08） mmol/L;对血钙值进行白蛋白校正后,低钙血症发生率为7.3%（9/124）,平均血钙值为（2.05±0.14） mmol/L。根据校正后血钙来进行分析,两组患者年龄、性别、肿块性质、是否行淋巴结清扫方面,差异均无统计学意义（P>0.05）;但是在病灶位置（单/双侧）、手术方式、术后平均PTH水平及是否发生术后低镁血症方面比较,差异均有统计学意义（P<0.05）。结论 对术后存在低蛋白血症的患者,应当使用校正后的血钙水平评估其是否需要额外钙剂补充。病灶切除手术方式为术后低钙血症高危因素;术后发生低镁血症及术后PTH水平降低对患者低钙血症的发生有预测价值。
Objective To study the risk factors of postoperative hypocalcemia after resection of thyroid nodules. Methods A retrospective study was conducted on 124 patients undergoing thyroid nodule resection surgery, including age, gender, mass nature, lesion location （unilateral/bilateral）, lymph node dissection, surgical approach, perioperative blood calcium （adjusted and un-adjusted）, parathyroid hormone （PTH）, and blood magnesium. Patients were divided into a hypocalcemia group and a non-hypocalcemia group based on their postoperative blood calcium levels, to compare the differences between the two groups and thereby investigate the risk factors for hypocalcemia after thyroid nodule resection. Results Of the 124 cases enrolled, 12 cases （9.7%） developed hypocalcemia after the operation, with an average blood calcium of （2.10±0.08） mmol/L. After albumin correction of blood calcium level, 9 cases （7.3%） had hypocalcemia, with an average blood calcium of （2.05±0.14） mmol/L. There were no statistically significant differences between the two groups stratified by corrected blood calcium levels in terms of age, gender, mass nature, and performance of lymph node dissection （P> 0.05）. However, significant differences were observed in lesion location （unilateral/bilateral）, surgical approach, average postoperative PTH level, and presence of postoperative hypomagnesemia （P<0.05）. Conclusion For patients with postoperative hypoproteinemia, corrected blood calcium levels should be used to evaluate whether the patient needs additional calcium supplementation. Surgical procedure is a high-risk factor for postoperative hypocalcemia, and postoperative hypomagnesemia and postoperative PTH reduction are associated with hypocalcemia.
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