Objective: To explore the influencing factors for serum potassium >4.4 mmol/L in the morning of parathyroidectomy in hemodialysis patients with secondary hyperparathyroidism (SHPT). Methods: The clinical data of 72 patients with SHPT who received regular hemodialysis and underwent parathyroidectomy in Guangdong Provincial People's Hospital from January 2012 to December 2018 were analyzed retrospectively. There were 37 males and 35 females, aged from 25 to 69 years, and the dialysis timespan was from 0.5 to 11 years. The levels of parathyroid hormone, serum potassium and serum calcium before hemodialysis were examined one day before operation, and hemodialysis time and dewatering volume after hemodialysis without heparin were recorded, and also the level of serum potassium in the morning of parathyroidectomy was detected. The occurrences of hyperkalemia during and after operation were studied. The factors related to hyperkalemia in the morning of parathyroidectomy were evaluated by Pearson or Spearman correlation analysis, and the cut-off values of risk factors were calculated by receiver operating characteristic (ROC) curve. Results: Serum potassium >4.4 mmol/L in the morning of parathyroidectomy existed in 23 of 72 patients. Correlation analysis showed that serum potassium one day before operation ((4.93±0.56)mmol/L, r=0.656, P<0.001) and dehydration volume ((2.37±0.75)L, r=0.261, P=0.027) were positively correlated with serum potassium in the morning of parathyroidectomy((4.16±0.54)mmol/L). Serum potassium before hemodialysis one day before operation was a main predictor for serum potassium in the morning of parathyroidectomy (AUC=0.791, P<0.001). The cut-off value of serum potassium before hemodialysis one day before operation was 5.0 mmol/L. Conclusion: Serum potassium before hemodialysis one day before operation in patients with SHPT can predict serum potassium in the morning of parathyroidectomy, offering imformation for the safety of operation.
目的： 探讨继发性甲状旁腺功能亢进（SHPT）患者围手术期引起术晨血钾>4.4 mmol/L的影响因素。 方法： 回顾性分析广东省人民医院2012年1月至2018年12月期间收治，接受维持性血液透析治疗且需要行甲状旁腺切除术的72例SHPT患者的临床资料，其中男性37例，女性35例，年龄25~69岁，透析时间0.5~11年。统计患者术前1 d血透前甲状旁腺激素、血钾、血钙等指标，检测后无肝素血透治疗的血透时间及脱水量以及术晨血钾水平。并总结完成手术的病例以及术中术后发生高钾血症的情况。采用Pearson或Spearman相关分析计算引起术晨血钾高的相关因素，并使用受试者工作特征曲线（receiver operating characteristic curve，简称ROC曲线）计算危险因素的临界值。 结果： 72例患者有23例术晨血钾>4.4 mmol/L。相关分析证实术前1 d血透前血钾［（4.93±0.56）mmol/L，r=0.656，P<0.001］和血透脱水量［（2.37±0.75）L，r=0.261，P=0.027］与术晨血钾［（4.16±0.54）mmol/L］呈显著正相关。且术前1 d血透前血钾是术晨血钾的主要预测因素（AUC=0.791，P<0.001）。根据ROC曲线的约登指数计算得出术前1 d血透前血钾的临界值为5.0 mmol/L。 结论： SHPT患者术前1 d血透前血钾可以预测术晨血钾从而提高甲状旁腺切除手术的安全性。.