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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy.
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A safe and cost-effective short hospital stay protocol to identify patients at low risk for the development of significant hypocalcemia after total thyroidectomy.

机译：一种安全且具有成本效益的短期住院方案，可确定全甲状腺切除术后发生严重低钙血症的风险较低的患者。

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OBJECTIVE: The objective of this retrospective chart review was to determine if serial postoperative serum calcium levels early after total thyroidectomy can be used to develop an algorithm that identifies patients who are unlikely to develop significant hypocalcemia and can be safely discharged within 24 hours after surgery. METHODS: Records of 135 consecutive patients who underwent total/completion thyroidectomy and were operated on by the senior author from 2001 to 2005 have been reviewed. For the entire study group, reports of the early postoperative serum calcium levels (6 hours and 12 hours postoperatively), final thyroid pathology, preoperative examination, inpatient course, and postoperative follow up were reviewed. An endocrine medicine consultation was obtained for all patients while in the hospital after surgery. For patients who developed significant hypocalcemia, reports of their management and the need for readmission or permanent medications for hypoparathyroidism were reviewed. According to the change in serum calcium levels between 6 hours and 12 hours postoperatively, patients were divided into two groups: 1) positive slope (increasing) and 2) nonpositive (nonchanging/decreasing). RESULTS: All patients with a positive slope (50/50) did not develop significant hypocalcemia in contrast to only 59 of 85 patients (69.4%) with a nonpositive slope (P < .001, positive predictive value of positive slope in predicting freedom from significant hypocalcemia = 100%, 95% confidence interval = 92.9-100). In the nonpositive slope group, 61 patients had a serum calcium level > or =8 mg/dL at 12 hours postoperatively (< or =0.5 mg/dL below the low end of normal), and 53 (87%) of these patients remained free of significant hypocalcemia in contrast to only 6 (25%) of 24 patients with serum calcium level <8 mg/dL at 12 hours postoperatively (sensitivity = 90%, positive predictive value = 87%). In addition, of the eight patients who developed significant hypocalcemia in the nonpositive slope group with a serum calcium level > or =8 mg/dL at 12 hours postoperatively, 7 (88%) patients developed the signs and symptoms during the first 24 hours after total thyroidectomy. Readmission and permanent need for calcium supplementation happened in two patients, respectively, all with serum calcium levels <8 mg/dL at 12 hours after total thyroidectomy. The compressive and/or symptomatic large multinodular goiter as an indication for thyroidectomy was associated with developing significant hypocalcemia (P < .05). There was no statistically significant correlation between the development of significant hypocalcemia and gender, age, thyroid pathology other than goiter, or neck dissection. CONCLUSION: Patients with a positive serum calcium slope (t = 6 and 12 hours) after total thyroidectomy are safe to discharge within 24 hours after surgery with patient education with or without calcium supplementation. In addition, patients with a nonpositive slope and a serum calcium level > or =8 mg/dL at 12 hours postoperatively(< or =0.5 mg/dL below the low end of normal) are unlikely to develop significant hypocalcemia, especially beyond 24 hours postoperatively, and therefore can be safely discharged within 24 hours after total thyroidectomy with patient education and oral calcium supplementation. Our management algorithm identifies those patients at low risk of developing significant hypocalcemia early in the postoperative course after total thyroidectomy to allow for a short hospital stay and safe discharge.
机译：目的：本回顾性图表回顾的目的是确定是否可以在全甲状腺切除术后早期使用连续的术后血清钙水平来开发一种算法，以识别不太可能发生严重低钙血症并且可以在手术后24小时内安全出院的患者。方法：回顾性分析了2001年至2005年由资深作者进行的135例接受全/全甲状腺切除术的连续患者的病历。对于整个研究组，回顾了术后早期血清钙水平（术后6小时和12小时），最终甲状腺病理，术前检查，住院过程以及术后随访的报告。手术后在医院中对所有患者进行了内分泌医学咨询。对于发生严重低钙血症的患者，对他们的治疗方法以及甲状旁腺功能减退需要重新入院或永久性药物治疗的报告进行了回顾。根据术后6小时至12小时血清钙水平的变化，将患者分为两组：1）正斜率（增加）和2）非阳性（不变/减少）。结果：所有具有正斜率（50/50）的患者均未发生明显的低钙血症，相比之下，非斜率为85的患者中只有59例（69.4％）（P <.001，正斜率对从以下角度预测自由度具有积极的预测价值）低血钙= 100％，95％置信区间= 92.9-100）。在非阳性斜率组中，有61例患者在术后12小时的血清钙水平>或= 8 mg / dL（低于正常低端以下<或= 0.5 mg / dL），其中53例（87％）仍然存在术后12小时血清钙水平<8 mg / dL的24例患者中只有6例（25％）没有明显的低钙血症（敏感性= 90％，阳性预测值= 87％）。此外，在非阳性斜率组中有8名在术后12小时血清钙水平≥8 mg / dL发生严重低钙血症的患者中，有7名（88％）患者在术后第一个24小时内出现了体征和症状全甲状腺切除术。两名患者分别在全甲状腺切除术后12小时出现再次入院和永久需要补充钙的情况，所有患者的血钙水平均<8 mg / dL。压迫性和/或有症状的多结节性甲状腺肿是甲状腺切除术的指征，与发生明显的低钙血症有关（P <.05）。低血钙症的发展与性别，年龄，甲状腺疾病（除甲状腺肿或颈淋巴结清扫）之间无统计学意义的相关性。结论：全甲状腺切除术后血清钙斜率（t = 6和12小时）为正的患者在接受或不补充钙的患者教育后的手术后24小时内可以安全出院。此外，术后12小时非阳性斜率且血清钙水平>或= 8 mg / dL（低于正常低端以下<或= 0.5 mg / dL）的患者不太可能发生严重的低钙血症，尤其是在24小时后术后，因此可以在接受患者教育和口服钙补充剂的全甲状腺切除术后24小时内安全排出。我们的管理算法可识别出那些在全甲状腺切除术后的早期过程中发生严重低钙血症的风险较低的患者，以确保短暂住院和安全出院。

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