| [Objective] The secondary hyperparathyroidism,mineral metabolism disorder is one of the common complications of hemodialysis patients,and high blood pressure is the most common complications in patients receiving hemodialysis,cardiovascular disease is the main complication of chronic kidney disease(CKD),as well as the important cause of death.Many studies has found that hyperparathyroidism,calcium and phosphorus metabolism disorders can cause vascular calcification,so as to increase the risk of cardiovascular events.In dialysis patients,it is associated with increased mortality.Early studies in hypertension has proved to be a major risk factor for cardiovascular disease.Existing research shows that the dangers of blood pressure variation than itself with increased blood pressure,cardiovascular events in chronic kidney disease(CKD)population,blood pressure variation is the independent risk factors.Lines of hemodialysis patients with end-stage kidney replacement therapy,often merge secondary hyperparathyroidism and high blood pressure,this research mainly through the parathyroid gland resection treatment of 42 patients with secondary hyperparathyroidism were observed before and after operation,follow-up monitoring blood pressure variation situation,discuss parathyroidectomy in dialysis patients with secondary hyperparathyroidism effect of blood pressure variability.[Methods](1)Cases chosen: Between January 2015 and September 2016 in our hospital patients with kidney disease center of new,to prepare parathyroid gland resection of maintenance hemodialysis patients with SHPT;Men for 22 cases and 20 cases in women,average age was 41 ±9(26-62)years;All 42 patients in maintenance hemodialysis(HD)patients,and dialysis age 6 ±3.1 years on average.(2)Research methods: During the preoperative preparation,all the blood dialysis patients choose non-dialysis-day to do the 24 hours ambulatory blood pressure detection during 24 hours.In order to accurately observe patients BPV,from the first day after dialysis 8 am when measuring,until the end of second day 8 am(total 24h).Set to monitoring blood pressure and pulse per hour.For all patients to guide monitoring blood pressure,told the matters needing attention,to ensure that monitoring results is effective.Postoperative 4 weeks,12 weeks visit measuring blood pressure monitoring again,all the same choice of 24 hours ambulatory blood pressure detection.Blood pressure monitoring using a portable dynamic blood pressure monitor.Record the dynamic blood pressure value of preoperative,postoperative patients with 4 weeks and postoperative 12 weeks of ambulatory blood pressure value,check blood calcium,blood phosphorus and i PTH of all patients in preoperative,postoperative patients with 4 weeks and postoperative 12 weeks,evaluate with the change of the main symptoms such as itchy skin,bone pain before and after operation.(3)Curative effect judgment: According to the postoperative i PTH value evaluation curative effect.Cure: i PTH < 150 pg/ml;Marked effect: i PTH for treatment in 150 ~ 300 pg/ml;Effective treatment: i PTH in 301 ~ 500 pg/ml;Invalid treatment i PTH > 500 pg/ml.Treatment of marked effect,valid and invalid were markedly improved is still the parathyroid gland residual or ectopic parathyroid gland after surgery.i PTH lasting more than 150 pg/ml after 1 week is defined as a persistent SHPT;IPTH within 2 weeks < 100 pg/ml,but follow-up i PTH gradually rose to more than 150 pg/ml is defined as the SHPT relapse.[Results](1)The surgeries was performed on 42 cases while included in the standard.All patients were resect all parathyroid glands that can be found in the parathyroid glands(among them 37 cases were resected 4 parathyroid glands,5 cases were resected 3 parathyroid glands).17 cases underwent complete parathyroidectomy and thymus lingular lobe resection,15 cases underwent complete parathyroidectomy with forearm autograft.Healing in 2 cases,accounting for 5%;Treatment of 21 cases were markedly improved(50%),Effective treatment in 16 cases,accounting for 38%;Treatment is invalid in 3 cases(i PTH among 515.4 and 620.7 mg/ml),accounting for 7%.Treatment success rate was 92.8%,among them 3 cases of success,there are 2 cases belong to intraoperative only found 3 parathyroid glands,considering to ectopic parathyroid glands,and 1 case is considered to be not complete resection or implant proliferate to adenomatous and secreted.(2)39 patients symptoms improved significantly: the bone pain,itchy skin,such as apparent ease,without repeatedly during the follow-up period.Anemia indicators improved significantly within 4 weeks.(3)Preoperative systolic pressure BPV was 8.99 ±1.62%,diastolic pressure BPV was 10.15±2.10%.Systolic blood pressure 4 weeks postoperatively BPV was 8.46±1.55%,Diastolic pressure BPV was 12.08±18.2%.No statistical difference was found between two groups contrast(systolic blood pressure BPV: t = 1.729,P = 0.091;Diastolic pressure BPV: t = 0.687,P = 0.496).12 weeks after surgery and preoperative contrast: Systolic blood pressure 4 weeks postoperatively BPV was 8.045±1.71%,Diastolic pressure BPV was 8.74 ± 2.11%.Systolic blood pressure variation and diastolic blood pressure variation contrast were statistically significant(systolic blood pressure BPV: t = 2.239,P = 0.031;the diastolic pressure BPV: t = 2.98,P = 0.005).[Conclusion](1)Parathyroiectomy is a safe and effective treatment of refractory secondary hyperparathyroidism,with definite curative effects.(2)Parathyroiectomy can improve blood pressure rhythm in patients with dialysis,for both systolic pressure BPV and diastolic pressure BPV can be significantly reduced.(3)A few patients may encounter persistent severe hypocalcemia after surgery,Blood calcium can slowly rise to normal levels by strengthening vein filling calcium,combined oral calcium supplements and after treatment of calcitrio. |
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