SUY TUYEN PHO GIAP SAU PHAU THUAT CAT GIAP: chan oan ieu tr va theo doi

nh ngha1. Suy tuyen pho giap: PTH

Sinh ly benhHa canxi mau thoang qua: + Sang chan tuyen giap va pho giap trong phau thuat + Ton thng mach mau nuoi tuyen pho giap + Mat nhiet tuyen pho giap Thieu mau nuoi tuyen pho giap, co kha nang hoi phuc

Suy tuyen pho giap vnh vien: +Cat t mach mau nuoi tuyen pho giap +Cat bo tuyen pho giap Ton thng khong hoi phuc sau 6 thang/1 nam

Ha canxi mau xay ra trong cat thuy tuyen giap: Endothelin 1

Cac yeu to nguy c suy tuyen pho giap sau phau thuat cat giap:

o rong phau thuatPhau thuat tuyen giap lan 2N giiTuoiBenh ly tuyen giap: Graves, ung thSo lng ca phau thuat cua benh vien (hospital operative volume)So lng tuyen pho giap bao ton

Bieu hien lam sang ha canxi mau

Te au chi, quanh moi, lo auKch thch than kinh c: co c nhai, c ban tay, cang chanCn tetanyCn co giatCo that thanh quanDau Chvostek: (+) gi : 25%, (-) gi: 29%Dau Trouseau: nhy: 94% , (+) gi:1%

Dau Trousseauiem A- B: iem go tren than kinh mat e thay dau co c : Dau Schvostek I va II

Cac xet nghiem can lam sang:Ca mau: la yeu to chan oan, theo doi ieu tr khong la yeu to d oan- Ca toan phan/ ca ion hoa ?- Thi iem th?+ POD 1, POD 2 + 24 gi sau ieu tr canxi uong+ 6-12 gi sau canxi tiem tnh mach+/- POD 3, POD4, POD5-Ch nh: +Thng qui cho oi tng co nguy c : cat giap toan phan, cat giap gan tron, nao hach co ben, nao hach co nhom VI, phau thuat tuyen giap nhieu lan) +Khi co trieu chng lam sang nghi ng-Yeu to d oan: Mc o thay oi Ca

Pasty S.H Soon nghien cu nong o canxi trong d oan ha canxi co trieu chng Stewart R Walsh: nghien cu mc o thay oi ca mau trong d on ha canxi mau Thay oi (+): khong bao gi ha canxi mauThay oi (-):mot t le benh nhan ha canxi mau Ha Ca(-) Ha Ca (+)Ca (6g POD)-Ca (trc mo) : -0,01mmol/h >< -0,004 mmol/h (P=0,009)6Ca (24g POD)-Ca (trc mo) :- 0,007mmol/h >< -0,001 (P=0,0001) 24

Predicting symptomatic hypocalcemiaSensitivitySpecificityCa POD1

PTH: thi gian ban huy 2-3 phut yeu to d oan tnh trang ha canxi mau ? Khong la yeu to n thuan d oan chnh xac-Muc ch?-Thi iem? trc mo, trong mo(tien me, sau cat tuyen giap 1g, ong da), sau mo ( 30p,1g, 2g, 4g, 6g, 24g,48g)-Chon iem cat ? Giam 50%, giam 75% so vi trc mo,

Gia tr tien oan cua PTH trong mot vai nghien cu:

AuthorsNo of patientValue of PTHSensitivitySpecificityAccuracyAvi Khafif(30PO)40

Marco Raffaelli : tien cu 523 benh nhan 4h PTH

Ca < 7,7mg/dL: yeu to d oan ha canxi sap co tetany

Francois Pattou: 1 trong 4 tieu chuan sau: -Co t hn 3 tuyen pho giap khong c bao ton -PTH trc ieu tr Ca +vit D

ieu tr ha Canxi mau do suy tuyen pho giap:Muc ch: a Ca mau ve ngng thap cua gia tr bnh thng hay thap hn mc bnh thng chut t

Lieu ieu tr c ieu chnh tuy theo nong o Ca mau

Ngng ieu tr 1-2 tuan, Ca trong gii han bnh thng Chc nang tuyen pho giap phuc hoi

Lu y ieu tr suy giap sau phau thuat

-Ca thng qui/ khi Ca giam/ khi co trieu chng lam sang?Khuyet iem khi ieu tr thng qui:+ieu tr cho tat ca nhng ch 1 so t can+Khong theo doi c bien chng nay+Chi ph ieu tr cao+Cham tre hay ngan nga kha nang hoi phuc chc nang tuyen pho giap neu qua lieuNghien cu: bo sung Ca khi Ca giamTextbook: bo sung Ca khi co trieu chng lam sang hay khi Ca

-Vit D t u / khi ha Ca keo dai, kem ap ng?-Calcitriol hay Ergocalciferol? -Vit D: c che chc nang pho giap ? Rocco bellantone : +/- Francesco Tartaglia: -Ngng dung Vit D khi PTH co khuynh hng hoi phuc

ieu tr ha Canxi mau do suy tuyen pho giap: (tt)Cac van e ieu tr cha c thong nhat:

Ca IV: calcium gluconate10%/10ml , calcium chloride 10ml Ch nh:Ha canxi co tetany, ong kinhHa canxi khong ap ng vi Ca va vit D uongCa 7mg/dL, het TCLS

Ca uong: Calcium sandoz( calcium carbonat + calcium glucunolactate ), Calcium Vit D(calcium carbonat + Vit D)

Ch nh: Ha canxi co trieu chng khong nang Duy tr sau Ca IV trong ieu tr ha Ca nang Ca

Cac che pham thuoc Canxi:

CompoundBrand nameIon contentCalcium carbonateCalcium glucunolactateCalcium sandoz 500mgCal cium carbonate(600mg)Vit D2 400 IUCal D Vit240mgCalcium carbonate(1250mg)Calcium Fort Corbiere500mgCalcium citrate (950mg)Calcium glucoheptonate(1.1g)Vit C, Vit PPCalMed/Calcivita290mgCalcium glucoheptonate Vit C, NicotinamideCalcium corbiere45mgCalcium gluconate IVCalcium gluceptate IVCalcium chloride IV93mg/10ml90mg/5ml273mg/10ml

Vit D:Calcitriol; 0,25-1microgram/ ngay chia la 2- 3 lan hay Ergocalciferol 50000-100000U/ ngayMagnie: ch nh khi Mg giam cung cap ng tiem bap, han che uongPTH: khong ung hoXuat vien hay ngoai tru khi Ca trong 24 gi at muc tieu ieu tr

Cac xet nghiem can lam trong nghien cu:

Trc mo: PTH, Ca, Mg, Phosphat, va AlbuminSau mo:+PTH 4 g sau khi ket thuc phau thuat+Ca, Phospho POD1, POD2+Albumin, Mg POD1+Ca sau ieu tr neu co: 24 gi sau uong hay 6-12g sau IV+o thanh thai Ca trong nc tieu 24g sau ieu tr Ca 4 tuan+ECG neu ha canxi nang

Cac xet nghiem th cac thi iem:PTHDuyet mo4 g POKet thuc ieu trXNTPPOD 1POD 2POD 14POD 28Sau ngng thuoc 1 tuanMoi ngay neu Ca con giamCa mau, Phospho mau6 thang neu con ieu trMoi thang en 6 thang

Cac tnh huong xay ra:

PTH, Ca POD1, POD 2 bt XV hay ngoai truPTH giam, Ca POD1,POD2 bt T/doi Ca moi ngayCa van bt XV POD 5, o lai PTH POD 5? PTH giam, Ca POD1 giam : ieu tr theo nong o CaNeu khong ieu tr T/doi Ca moi ngayNeu ieu tr th lai Ca sau oNeu Ca sau ieu tr at muc tieu: XV hay ngoai truHen tk 1- 4 tuan, ieu tr tuy theo ket qua, cho en khi ngng ieu tr.

D kien:Neu can giam lieu : 1-2 vien Calcium sandoz/ tuan

Cac van e kho khan: PTH, Albumin, o thanh thai nc tieu 24g BV cha co!!!Ket qua Ca mau toan phan khong chnh xac bang Ca ion hoa???Bn XV theo doi tai khoa: BHYT, xet nghiem, nhan lc?X tr ha Ca khong ong bo

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