危重症患者血清胆碱酯酶水平及APACHE II评分相关性.docVIP

危重症患者血清胆碱酯酶水平及APACHE II评分相关性 　王 辰，朱宇清，曾 庆，孙洪涛，支力大，吴健敏 【摘要】 目的 探讨危重症人群血清胆碱酯酶（ChE）水平与APACHE Ⅱ评分的关系。方法 对116例收入EICU 24h内的危重患者的血清胆碱酯酶水平进行测定，并测定30例正常人的血清胆碱酯酶水平对照分析，比较两组间的差异。同时对这116例患者进行APACHEⅡ评分，按照APACHEⅡ评分分值的高低分成3组（lt;15分组、15～20分组、gt;20分组），比较不同组别间血清胆碱酯酶水平的差异。将本组116例危重症患者按照是否死亡分为死亡组和存活组，比较两组间血清胆碱酯酶水平的差异。结果 （1） 危重症患者的血清胆碱酯酶平均水平较正常人明显降低（P＜0.01）。（2）危重症患者的血清胆碱酯酶水平与其APACHEⅡ评分的分值成负相关（r=-0.2251，P＜0.01），病情越危重，APACHEII评分分值越高，死亡率越高，相应血清胆碱酯酶水平越低下（P＜0.01）。结论 血清胆碱酯酶水平是反映危重症病情及评价预后的一项重要参考指标。 【关键词】 危重症患者；血清胆碱酯酶；APACHE Ⅱ；评分 【Abstract】 Objective To study the relationships between serum cholinesterase measurement of critical care patients and acute physiological and chronic health evaluationⅡ. Methods The levels of serum cholinesterase in 116 critical care patients and 30 normal people were detected with colorimetric method to find their difference. A severity of illness score （APACHE Ⅱ） was determined for each patient during the first 24 h in the EICU，at the same time，serum cholinesterase were measured. First，these patients were divided into three groups based on their different scores and then were divided into two groups based on their prognosis： survival group and death group. Results （1） The serum cholinesterase levels in critical care patients were markedly lower than those in normal people （P＜0.01）.（2） The serum cholinesterase levels in critical care patients were reverse correlated with APACHEⅡscore（r=-0.2251，P＜0.01）.Conclusion The serum cholinesterase level might be an important index reflecting the critical care patient’s condition，and an index for estimation of the prognosis. 【Key words】 critical care patient; serum cholinesterase; APACHE Ⅱ scores 血清胆碱酯酶是一类糖蛋白，主要存在于脑、肝、血及胆碱能神经末梢的突触间隙中。在目前临床中，测定血清胆碱酯酶活性是协助诊断有机磷中毒和评估肝实质细胞损害的重要手段。由美国学者Knaus发明的APACHE Ⅱ（acute physiological and chronic health evaluation Ⅱ）评分系统［8］目前广泛应用于临床，对入院患者的病情危重程度及病死率的判断具有很高的实际操作意义。在临床工作中笔者发现大部分危重症患者血清胆碱酯酶水平明显降低，为了探讨危重症患者血清胆碱酯酶水平变化与APACHE Ⅱ评分关系的意义，笔者检测了本院EICU病房自2003年2月～2005年2月间所收治的116例患者血清中的胆碱酯酶水平，并用APAC