原发性甲状旁腺功能亢进术后合并急性肾功能衰竭患者护理.doc

原发性甲状旁腺功能亢进术后合并急性肾功能衰竭患者护理[摘要] 目的 总结8例甲状旁腺功能亢进患者术后合并急性肾功能衰竭的护理措施。方法 回顾性分析8例甲状旁腺功能亢进患者术后合并急性肾功能衰竭的资料。结果 急性肾功能衰竭出现在术后1~3d，术后密切观察生命体征，严密观察尿量及尿比重，监测肾功能，1例患者行透析治疗，7例对症处理后均痊愈。结论 加强甲状旁腺功能亢进患者术后护理是保证手术成功的关键。 [关键词]原发性甲状旁腺功能亢进；急性肾功能衰竭；护理 [中图分类号] R582.1；R692.5 [文献标识码] B[文章编号] 1673-9701（2011）27-124-02 Nursing Care of Patients with Primary Hyperparathyroidism Complicated with Acute Renal Failure in Postoperative Period WANG Junxia Department of Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China [Abstract] Objective To investigate the proper methods and summarize the experience in nursing care of 8 patients with primary hyperparathyroidism complicated with acute renal failure in postoperative period. Methods A retrospective analysis of 8 cases were studied. Results Acute renal failure was observed 1 ~ 3 days after surgery. Vital signs, urine output, urine specific gravity and renal function were observed and monitored closely. 1 patient was received dialysis treatment, and the other 7 patients were cured after symptomatic treatment. Conclusion Strengthening postoperative care in patients with hyperparathyroidism is the key point for successful operation. [Key words] Hyperparathyroidism；Acute renal failure；Nursing care 原发性甲状旁腺功能亢进症（primary hyperparathyroidism，PHPT）是由甲状旁腺本身病变引起的甲状旁腺素（parathyroid gland，PTH）合成与分泌过多，通过对骨与肾的作用，导致高钙血症和低磷血症[1]。临床上分为肾型、骨型和混合型3种。临床最常见进行性高钙血症导致的骨骼系统病变、泌尿系统结石等，部分表现为消化道症状、精神症状等，肾功能受损往往在长期钙质沉着或肾结石堵塞尿路时发生[2]。2004年9月~2009年10月我院共收治甲状旁腺功能亢进症患者36例，其中8例于术后出现急性肾功能衰竭，经过精心护理，患者痊愈出院，现将护理体会介绍如下。 1临床资料 本组共8例，男2例，女6例，年龄在28~62岁，病程1~6年。实验室检查：血钙（2.5~5.5 ）mmol/L，血磷（0.17~1.3） mmol/L，血甲状旁腺素（PTH）（75~1217）pmol/L。5例彩超显示甲状腺后方实性占位，考虑甲状旁腺占位可能性大，3例彩超未发现异常，行99mTc甲氧基异丁基异睛（99mTc-MIBI）甲状旁腺扫描确诊。术前合并肾及输尿管结石5例，均在全麻下行甲状旁腺肿瘤切除术。术中快速病理检查为甲状旁腺腺瘤5例，甲状旁腺癌3例，术后常规病理与术中病理相符。术后1~3d出现急性肾功能衰竭，经系统治疗和护理后，8例患者均痊愈。 2护理 2.1 生命体征的观察 原发性甲状旁腺功能亢进症的典型症状是高血钙，血钙升高可使心肌收缩力增强，心室排出量增多，心室舒张期容积过大，最终导致心肌收缩力减弱，引起心跳骤停。本组患者术后进入观察室，给予24h持续心电监护，密切监测生命体