胆碱酯酶与APACHEⅢ评分在急诊危重症监护室患者病情及预后评估的研究
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摘要
目的：探讨血清胆碱酯酶(CHE)和急性生理学与慢性健康状况评分(APACHEⅢ评分)在急诊危重症监护室(EICU)患者的病情危重程度和预后评估的意义。
方法：对EICU98例患者进行血清CHE浓度测定,并进行APACHEⅢ评分。按照APACHEⅢ评分将患者分为各个计分段,比较各计分段之间病死率的差异性。以APACHEⅢ评分60分为界线,将患者分为两组比较两组之间的病死率。将患者按预后分为存活组与死亡组进行组内比较,分析血清CHE浓度变化与APACHEⅢ评分的变化情况。分析患者血清CHE浓度和APACHEⅢ评分与病情及预后的关系。
结果：APACHEⅢ评分以每30分作一个计分段,各计分段之间的病死率均有差异(P<0.05)。以60分为界线,APACHEⅢ评分(>60分)组的病死率明显高于APACHEⅢ评分(0-60分)组。死亡组的血清CHE浓度明显低于存活组(P<0.01),APACHEⅢ评分明显高于存活组(P<0.01)。血清CHE浓度与APACHEⅢ评分呈负相关(r=一0.983,P=0.003)。随着APACHEⅢ评分升高,血清CHE浓度降低,且病死率上升。
结论：EICU患者血清CHE浓度和APACHEⅢ评分呈负相关。APACHEⅢ评分得分为60分可以作为一个较好地划分患者病情危重程度的分界线。测定血清CHE浓度和进行APACHEⅢ评分可作为EICU中患者病情危重程度和预后评估有意义的两项指标。
Objective:
To explore the relationship between cholinesterase in blood and acute physiology and chronic health evaluation III(APACHEⅢ) scores,evalua-tion of disease severity and prognosis of patients admitted to Emergency Intensive Care Unit (EICU).
Methods:
The APACHE Ⅲ scores of the patients of EICU were assessed, and the CHE concentrations were determinded in98patients. Patients were divided into various meter segmented according to the APACHEⅢscores. Compare the difference of fatality rate of each scoring segment. By the boundary of APACHEⅢscores score60points, all patients were divided into two group. Compare these group's mortality rate. According to their prognosis, all patients were divided into two groups:survival group and death group, and the relationship between APACHE Ⅲ scores and the CHE concentration,prognosis were analyzed. Analysis of the relationship bet-ween changes in serum CHE, APACHE Ⅲ scores and the condition pro-gnosis.
Results:
The APACHE Ⅲ scores were taken every30points as a scoring seg ment. The fatality rate of the every group have no difference (P>0.05).APACHE Ⅲ scores60is divided into the boundaries. APACHE Ⅲ s-core (>60points) group, mortality was significantly higher than to the APACHE Ⅲ scores (0to60points) group (P<0.05). Death group serum CHE concentration was significantly lower in the survival group (P<0.01), APACHE Ⅲ scores was significantly higher in the survival group (P <0.01). Serum concentration of CHE and APACHE Ⅲ scores negatively correlated (r=0.983, P=0.003). With the APACHE Ⅲ scores increased, the concentration of CHE became lower, while mortality rate were raised (P<0.01)
Conclusion:
Serum CHE concentration and APACHE Ⅲ scores of EICU patients were negatively related. The score of APACHE III scores of60points as a better division of the severity of illness in patients with the dividing line. Determination of serum concentration of CHE and APACHE Ⅲscores c-an be used as EICU in patients with disease severity and prognosis asses- sment of meaningful two indicators.
方法：对EICU98例患者进行血清CHE浓度测定,并进行APACHEⅢ评分。按照APACHEⅢ评分将患者分为各个计分段,比较各计分段之间病死率的差异性。以APACHEⅢ评分60分为界线,将患者分为两组比较两组之间的病死率。将患者按预后分为存活组与死亡组进行组内比较,分析血清CHE浓度变化与APACHEⅢ评分的变化情况。分析患者血清CHE浓度和APACHEⅢ评分与病情及预后的关系。
结果：APACHEⅢ评分以每30分作一个计分段,各计分段之间的病死率均有差异(P<0.05)。以60分为界线,APACHEⅢ评分(>60分)组的病死率明显高于APACHEⅢ评分(0-60分)组。死亡组的血清CHE浓度明显低于存活组(P<0.01),APACHEⅢ评分明显高于存活组(P<0.01)。血清CHE浓度与APACHEⅢ评分呈负相关(r=一0.983,P=0.003)。随着APACHEⅢ评分升高,血清CHE浓度降低,且病死率上升。
结论：EICU患者血清CHE浓度和APACHEⅢ评分呈负相关。APACHEⅢ评分得分为60分可以作为一个较好地划分患者病情危重程度的分界线。测定血清CHE浓度和进行APACHEⅢ评分可作为EICU中患者病情危重程度和预后评估有意义的两项指标。
Objective:
To explore the relationship between cholinesterase in blood and acute physiology and chronic health evaluation III(APACHEⅢ) scores,evalua-tion of disease severity and prognosis of patients admitted to Emergency Intensive Care Unit (EICU).
Methods:
The APACHE Ⅲ scores of the patients of EICU were assessed, and the CHE concentrations were determinded in98patients. Patients were divided into various meter segmented according to the APACHEⅢscores. Compare the difference of fatality rate of each scoring segment. By the boundary of APACHEⅢscores score60points, all patients were divided into two group. Compare these group's mortality rate. According to their prognosis, all patients were divided into two groups:survival group and death group, and the relationship between APACHE Ⅲ scores and the CHE concentration,prognosis were analyzed. Analysis of the relationship bet-ween changes in serum CHE, APACHE Ⅲ scores and the condition pro-gnosis.
Results:
The APACHE Ⅲ scores were taken every30points as a scoring seg ment. The fatality rate of the every group have no difference (P>0.05).APACHE Ⅲ scores60is divided into the boundaries. APACHE Ⅲ s-core (>60points) group, mortality was significantly higher than to the APACHE Ⅲ scores (0to60points) group (P<0.05). Death group serum CHE concentration was significantly lower in the survival group (P<0.01), APACHE Ⅲ scores was significantly higher in the survival group (P <0.01). Serum concentration of CHE and APACHE Ⅲ scores negatively correlated (r=0.983, P=0.003). With the APACHE Ⅲ scores increased, the concentration of CHE became lower, while mortality rate were raised (P<0.01)
Conclusion:
Serum CHE concentration and APACHE Ⅲ scores of EICU patients were negatively related. The score of APACHE III scores of60points as a better division of the severity of illness in patients with the dividing line. Determination of serum concentration of CHE and APACHE Ⅲscores c-an be used as EICU in patients with disease severity and prognosis asses- sment of meaningful two indicators.
引文
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[1]Knaus wA,zimmerman JE,wagnerDP,et al.APACHE—acute phys-iology and chronic health evaluation:a physiologically based classificati-on system.Crit Care Med,1981,9(8):591-597.
[2]ZimmerInan JE,Kramer AA.Outcome prediction in critical care the acute physiology and chronic health evaluation model.Curropin Crit Car-e,2008,14(5):491-497.
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[2]ZimmerInan JE, Kramer AA.Outcome prediction in critical care the acute physiology and chronic health evaluation model.Curropin Crit Car-e,2008,14(5):491-497.
[3]Knaus wA, Draper EA, wagner DP, et al.AP ACHE I:a severity of diseaseclassification system.Crit Care Med,1985,13(10)1818-829.
[4]黄斌,王导新,程远.APACHE Ⅱ评分系统在SICU中MODS患者病情评估的应用.重庆医学2010,39(10)：1193-1195.
[5]谢铎文,潘景业.急性生理学与慢性健康状况评分系统：1978—2010.中国中西医结合急救杂志,2010,6(25)：67-69.
[6]王春波,李建国,谭泽龙.尿蛋白定性与APACHEⅢ评分和ICU危重患者预后关系的可行性研究.急诊医学杂志,2009,10(4)：89-92.
[7]胡金兰,诸葛毅.APACHEⅢ评分用于重症监护病房脑损伤病人的临床评价.护理研究,2006,1(20)：21-23.
[8]陈衡华.APACHEⅢ评分对COPD急性加重期并呼吸衰竭患者病情评估的价值.中国实用医药,2008,4(10)：123-125.
[9]陈劲峰,唐小平,蔡卫平.艾滋病并肺炎患者的急性生理学和慢性健康状况评分系统Ⅲ评分分析.中国呼吸与危重监护杂志,2005,7(4)：278-281.
[10]纪大伟,何贵金,顾玺,等.不同APACHEⅢ评分的急性重症胆管 炎患者手术及介入治疗病死率对比观察.山东医药,2008,48(43)：37-39.
[11]蒋超钟,玉兵,周苏君.APACHEⅢ评分系统与急性重症胰腺炎预后的关系.中国现代医生,2009,10(47)：9-11.
[12]王吉耀.内科学[M],北京：北京人民卫生出版社,2001,1193-1143.
[13]单丽沈,刘春峰,袁壮.感染性休克患儿血清C反应蛋白及部分酶学指标动态变化及临床意义.中国实用儿科学杂志,2004,19(8)：494-497.
[14]熊军,薛富善,廖旭,等.血清胆碱酯酶水平对危重症病情判断的意义.中国呼吸与重症监护杂志,2009,11(8)：586-589.
[15]李淮安,王景梅.血清胆碱酯酶变化与病危程度及愈后预测价值.中国疗养医学,2008,9(12)：549-550.
[16]王辰,朱字清.胆碱酯酶在危重症患者病情预判中的应用及与APA CHE Ⅱ的相关性.医学临床研究,2004,27(2)：579-581.
[17]许榕椿,王梅华.危重病患者C-反应蛋白与APACHEⅢ评分相关性的回顾性分析.山东医科大学学报,2009,12(20)：34-36.
[18]杜晓冬,陈瑶,邹利群.血清胆碱酯酶对急性有机磷中毒患者病情评估的意义.临床与预防,2007,9(12)：31-34.
[19]石亚玲,周素琼,林俐红,等.病毒性肝炎患者总胆汁酸、胆碱酯酶、前白蛋白及凝血酶原时间的检测意义.实用医学杂志,2006,22(14)：124-126.
[20]张卫卫,王学清,李岩.血清前白蛋白、胆碱酯酶对判断肝硬化患者肝储备功能及预后的临床价值.中国实用内科杂志,2002,11(02)45-47.
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