强化胰岛素治疗在老年重症急性胰腺炎患者中的临床作用

目的探讨强化胰岛素治疗控制血糖对于老年重症急性胰腺炎患者的临床意义。方法将40例〉70岁老年重症急性胰腺炎患者分成强化胰岛素治疗组（I组）和非强化治疗组（N组）,I组通过胰岛素静脉泵将空腹血糖（FBG）控制在4.4～6.1 mmol/L。N组当FBG〉11.1 mmol/L时使用胰岛素治疗并将FBG控制在10.0～11.1 mmol/L。观察2组血糖变化情况、APACHEⅡ评分变化情况、并发症发生情况、住院时间。结果（1）I组在治疗后1 d血糖降至正常水平,且较入院时明显下降,N组在治疗后3 d才较入院时明显下降;（2）I组在治疗后3 d APACHEⅡ评分较入院时明显下降,N组APACHEⅡ评分在治疗后7 d较入院时明显下降（P均〈0.05）;（3）I组住院时间明显短于N组（P〈0.01）;（4）I组与N组总体并发症发生情况无明显差异,但I组手术病人的并发症发生显著低于对照组（P〈0.05）。结论强化胰岛素治疗控制血糖对于改善老年重症急性胰腺炎患者的预后具有积极意义,并可减少手术患者并发症的发生。     

胰岛素强化治疗危重症患者应激性高血糖临床疗效分析

目的探讨胰岛素强化治疗危重症患者应激性高血糖的临床疗效。方法选取该科2014年3月—2016年3月收治的危重症患者108例,随机将其分为观察组与对照组,每组各54例。对照组采用胰岛素强化治疗方案将血糖控制在4.0~6.1 mmol/L。对照组应用常规胰岛素降糖治疗,将晨起空腹血糖控制在6.9~11.1 mmol/L。比较两组患者出ICU时生理学与慢性健康状况评分(APACHEⅡ)、机械通气时间、ICU入住天数、不良反应发生率、死亡率、低血糖的发生率及胰岛素的用量。结果出ICU时对照组的APACHEⅡ评分低于观察组,对照组机械通气时间、ICU入住天数明显高于观察组,其差异有统计学意义(P0.05);对照组的不良反应发生率、死亡率高于观察组,但差异无统计学意义(P0.05)。观察组的低血糖发生率高于对照组,差异有统计学意义(P0.05),对照组胰岛素用量明显高于观察组,但差异无统计学意义(P0.05)。结论胰岛素强化治疗能明显能改善危重症患者病情,有利于患者愈后,但应该防止低血糖。     

门冬胰岛素和人胰岛素强化治疗内科危重症高血糖疗效比较

目的 比较门冬胰岛素和人胰岛素强化治疗内科危重症高血糖的有效性和安全性.方法 选取中南大学湘雅二医院老年病科符合全身炎症反应综合征诊断标准的内科危重患者186例,入组时空腹血糖水平为(10.8±2.3)mmoL/L,根据患者入组时恢复进食情况分为多次皮下注射胰岛素组(MDI,n=90)和持续皮下注射胰岛素组(CSⅡ,n=96),2组均随机分为门冬胰岛素和人胰岛素亚组.MDI组中门冬胰岛素和人胰岛素亚组分别为44、46例,CSⅡ组分别为46、50例.MDI组餐前大剂量采用门冬胰岛素或人胰岛素,基础量均采用甘精胰岛素,CSⅡ组餐前大剂量及基础量均采用门冬胰岛素或人胰岛素.根据多点指尖血糖监测结果调整胰岛素用量,强化胰岛素治疗疗程7 d,使血糖控制在4.4～8.3 mmol/L,7 d后改为常规胰岛素治疗,使血糖控制在4.4～11.1 mmol/L,观察各哑组患者基线及第7天日内平均血糖水平、日内血糖标准差、日内血糖极差(最高和最低血糖之差)、血清C反应蛋白(CRP)水平、急性生理与慢性疾病评分(APACHE Ⅱ),统计7 d内低血糖发生率、严重低血糖发生率、日平均胰岛素用量及28 d内各组死亡率.统计学分析采用t检验和x~2检验.结果 (1)MDI及CSⅡ组的门冬胰岛素亚组和人胰岛素亚组强化治疗各项指标差异无统计学意义.(2)强化治疗后第7天门冬胰岛素哑组较人胰岛素组日内平均血糖水平更低,MDI组:(6.2±1.3)mmol/L比(7.6±1.6)mmol/L;CSⅡ组:(6.0±1.2)mmol/L比(7.4±2.5)mmol/L,均P＜0.05.(3)门冬胰岛素亚组血糖标准差更小,MDI组:(1.54±0.27)mmol/L比(1.92±0.38)mmol/L;CSⅡ组:(1.24±0.27)mmol/L比(1.83±0.45)mmol/L,均P＜0.05.(4)门冬胰岛素亚组极差更小,MDI组:(3.0±0.5)mmoL/L vs(3.9±1.1)mmoL/L;CSⅡ组:(3.1±0.6)mmol/L vs(3.9±1.0)mmol/L,均P＜0.05.(5)门冬胰岛素业组7 d内日平均胰岛素用量更少,低血糖发生率及严重低血糖发生率更低.同时,门冬胰岛素亚组7 d内血清CRP?     

108例2型糖尿病3种短期胰岛素强化治疗方法的临床研究

目的观察3种不同短期胰岛素强化治疗方法对2列糖尿病的降糖作用和评价常规人胰岛素和胰岛素Aspart应用于胰岛素泵的特点.方法对108例空腹血糖大于11.1mmol/L的2型糖尿病患者随机分为常规人胰岛素强化治疗组(MSII组)、胰岛素泵持续人胰岛素输注强化治疗组(CSII-R组)和胰岛素泵持续胰岛素Aspart输注强化治疗组(CSII-A组),比较血糖治疗达标所需天数、日均胰岛素用量、低血糖频率、泵应用的餐前大剂量和基础量及血糖控制水平.结果CSII-R组和CSII-A组血糖达标天数分别为4.7±1.6,4.8±1.2)比MSII组缩短13.8天(P＜0.0001),胰岛素用量比MSII组显著减少(均P＜0.05),CSII-R组和CSII-A组未发生低血糖,MSII组低血糖发生19人次.血糖治疗达标后至停止泵治疗时,CSII-A组胰岛素基础剂量比CSII-R组显著增多(均数增加14.2%,P＜0.05),餐前大剂量显著减少(均数减小17.4%,P＜0.05);CSII-A组餐后血糖较CSII-R组显著降低(均数降低1.3mmol/L,P＜0.01),前者发生低血糖1人次,后者6人次.结论胰岛素泵CSII强化治疗2型糖尿病具有快速、稳定、理想地控制血糖的作用,胰岛素Aspart具有更好的有效性和安全性.     

门冬胰岛素30/70治疗2型糖尿病的有效性和安全性观察

目的 探讨门冬胰岛素30/70治疗2型糖尿病(T2DM)的有效性及安全性.方法 选择T2DM患者70例,随机分为观察组36例、对照组34例.观察组给予门冬胰岛素30/70强化降糖治疗方案治疗,对照组给予生物合成人胰岛素、精蛋白生物合成人胰岛素治疗.连续治疗2周后,比较两组血糖控制情况及低血糖发生率、住院天数、胰岛素用量.结果 两组治疗后空腹、三餐后2h血糖水平均明显低于治疗前(P均＜0.05),两组治疗后空腹、三餐后2h血糖水平比较无统计学意义.观察组低血糖发生率明显低于对照组(P＜0.05),住院天数、胰岛素用量两组无统计学差异.结论 门冬胰岛素30/70治疗T2DM安全、有效.     

胰岛素泵联合连续血糖监测系统强化治疗老年脆性糖尿病临床研究

目的:探讨胰岛素泵联合连续血糖监测系统(双"C")强化治疗老年脆性糖尿病临床疗效差异。方法:选取我院2011年1月至2014年10月收治的老年脆性糖尿病患者共120例,采用随机区组法分为对照组(60例)和联合组(60例),分别采用联合胰岛素方案和在此基础上加用双"C"强化辅助治疗。比较2组患者血糖达标率、血糖达标时间、胰岛素用量、治疗前后血糖指标水平及低血糖发生率等。结果:联合组患者血糖达标率明显优于对照组,差异具有统计学意义[97%(58/60)比80%(48/60),P0.05],血糖达标时间和胰岛素用量均明显优于对照组,差异具有显著意义[(3.46±0.95)d比(6.50±1.82)d,(31.55±4.61)U/d比(40.12±5.94)U/d,P0.05],治疗后血糖指标水平明显低于对照组、治疗前,差异具有统计学意义[(5.15±0.51)mmol/L比(7.37±0.91)mmol/L,(5.48±1.55)mmol/L比(8.20±2.04)mmol/L,(5.33±1.48)mmol/L比(7.96±2.20)mmol/L,(4.90±1.46)mmol/L比(7.70±2.07)mmol/L,(4.75±1.22)mmol/L比(6.70±1.98)mmol/L,P0.05]。联合组患者低血糖发生率明显低于对照组,差异具有统计学意义[2%(1/60)比12%(7/60),P0.05]。结论:双"C"强化辅助联合胰岛素方案治疗老年脆性糖尿病可有效改善血糖控制效果,缩短血糖达标时间,减少胰岛素用量,且有助于降低低血糖发生风险。     

严重脓毒症合并高血糖的强化胰岛素治疗

目的:探讨强化胰岛素治疗方案对严重脓毒症患者预后的影响。方法:将102例严重脓毒症呼吸衰竭并高血糖患者随机分为强化胰岛素治疗组(将随机血糖控制在4.4~6.1mmol/L之间)和常规治疗组(当随机血糖超过12mmol/L开始应用胰岛素,将血糖控制在10~11.1mmol/L之间)。观察ICU病死率、住院病死率、ICU住院天数、总住院天数、呼吸机治疗时间和继发肝、肾功能异常情况。结果:与常规治疗组比较,强化胰岛素治疗组的ICU住院天数、总住院天数和呼吸机治疗时间均明显缩短(P<0.01),继发性肾损害减少(P<0.05),ICU病死率和住院病死率虽然均有降低,但无统计学意义(P>0.05)。结论:强化胰岛素治疗可以减少严重脓毒症并发高血糖患者的ICU住院时间和总住院时间,缩短呼吸机带机时间,降低继发性肾损害的发生率。     

目标血糖控制在老年重症肺炎集束化治疗中的应用分析

目的探讨目标血糖控制在老年重症肺炎集束化治疗中的临床意义。方法选取60例既往无糖尿病病史的老年重症肺炎患者为研究对象,收住呼吸重症医学科(RICU)时患者平均血糖为(12.6±5.9)mmol/L。将患者随机分为对照组和观察组,每组30例。两组患者均给予氧疗、抗感染、化痰、纠正酸碱失衡及水电解质紊乱、营养支持等治疗。在此基础上,对照组患者采用强化血糖控制治疗,使血糖水平控制在4.0~6.1 mmol/L,观察组患者实施目标血糖控制治疗,使血糖水平控制在6.1~10.0 mmol/L。比较两组患者治疗后低血糖发生率、住RICU天数、病死率。结果观察组患者治疗后低血糖发生率、病死率低于对照组患者,但差异无统计学意义(P0.05);观察组患者住RICU天数显著短于对照组患者,差异有统计学意义(P0.01)。结论目标血糖控制在老年重症肺炎的集束化治疗中,能在一定程度上降低患者的低血糖发生率及病死率,显著缩短患者住RICU时间。     

胰岛素泵强化血糖控制临床价值分析

56例初发型2型糖尿病患者,分为实验组(实施胰岛素泵强化治疗,30例)、对照组(实施静脉滴注胰岛素治疗,26例)。结果实验组患者血糖达标时间[(2.46±0.56) d]、治疗后空腹血糖[(5.52±1.23) mmol/L]、餐后2h血糖[(8.26±1.32) mmol/L]低于对照组[(4.12±0.78) d、(6.65±1.36) mmol/L、(10.02±1.36) mmol/L],(P 0.05);实验组低血糖发生率(16.67%)低于对照组(38.46%),(P 0.05)。结论胰岛素泵强化有助于控制血糖水平,预防低血糖发生。     

胰岛素泵与多次胰岛素皮下注射治疗2型糖尿病疗效对比分析

目的比较短期胰岛素泵(CSII)与多次皮下胰岛素(MSII)注射强化控制2型糖尿病(T2DM)的有效性和安全性。方法对解放军总院内分泌科2006年6月至2007年5月收治住院的96例糖化血红蛋白(HbA1c)>7.5%的T2DM患者随机分为2组,分别给予CSII和MSII进行短期强化达标治疗,比较两组治疗前后的多时点血糖、糖化血清蛋白(GSP)、血糖达标天数、达标时胰岛素总剂量及低血糖事件发生的差异。结果治疗后CSII组与MSII组静脉血空腹血糖(FBG)分别由(13.53±5.01)mmol/L和(12.25±3.49)mmol/L下降到(5.56±0.76)mmol/L和(6.07±0.97)mmol/L,CSII组FBG下降程度更大(P=0.005)。静脉血餐后2h血糖(2hPG)分别由(19.56±5.82)mmol/L和(18.69±3.98)mmol/L下降到(6.93±1.07)mmol/L和(7.28±1.54)mmol/L,两组间比较差异无统计学意义(P>0.05)。两组的7个时点指血血糖均显著降低,两组间差异无统计学意义(P>0.05)。但达标时最高与最低血糖差值CSII组明显小于MSII组(P=0.029),血糖曲线下面积CSII组明显小于MSII组(P=0.017)。CSII组与MSII组GSP分别由(407±79)μmol/L和(410±100)μmol/L下降到(266±74)μmol/L和(297±83)μmol/L,均有显著改善(P均<0.01),两组治疗后绝对下降值CSII组更显著(P<0.05)。CSII组血糖达标时间平均为(3.66±1.41)d,显著短于MSII组的(5.83±1.77)d(P<0.05)。CSII组在达标时和治疗第7天的胰岛素剂量分别是(40.23±7.47)U/d和(36.06±9.71)U/d,均显著少于MSII组的(47.71±17.74)U/d和(45.63±11.91)U/d(P均<0.05)。两组有症状性低血糖事件共35例次,CSII组与MSII组分别有15例次和20例次,其中CSII组血糖≤3.9mmol/L和≤2.8mmol/L的分别为7和0例次,MSII组分别为19和8例次,前者均少于后者。结论两种胰岛素强化治疗均能有效控制尚未胰岛素治疗的T2DM患者的血糖,促进短期血糖达标。但与MSII相比,CSII治疗在降低FBG、缩小血糖波动和整体血糖控制方面更显著,并能够缩短血糖达标时间,减少胰岛素用量和降低低血糖的发生率。     

Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fiber supplementation versus standard enteral solution： A prospective randomized double-blind study

AIM: To compare the benefi cial effects of early enteral nutrition (EN) with prebiotic fiber supplementation in patients with severe acute pancreatitis (AP).METHODS: Thirty consecutive patients with severe AP, who required stoppage of oral feeding for 48 h, were randomly assigned to nasojejunal EN with or without prebiotics. APACHE Ⅱ score, Balthazar’s CT score and CRP were assessed daily during the study period.RESULTS: The median duration of hospital stay was shorter in the study group [10 ± 4 (8-14) d vs 15 ± 6 (7-26) d] (P < 0.05). The median value of days in intensive care unit was also similar in both groups [6 ± 2 (5-8) d vs 6 ± 2 (5-7) d]. The median duration of EN was 8 ± 4 (6-12) d vs 10 ± 4 (6-13) d in the study and control groups, respectively (P > 0.05). Deaths occurred in 6 patients (20%), 2 in the study group and 4 in the control group. The mean duration of APACHE Ⅱ normalization (APACHE Ⅱ score < 8) was shorter in the study group than in the control group (4 ± 2 d vs 6.5 ± 3 d, P < 0.05). The mean duration of CRP normalization was also shorter in the study group than in the control group (7 ± 2 d vs 10 ± 3 d, P < 0.05).CONCLUSION: Nasojejunal EN with prebiotic fiber supplementation in severe AP improves hospital stay, duration nutrition therapy, acute phase response and overall complications compared to standard EN therapy.     

舒血宁治疗高脂血症性重症急性胰腺炎的临床研究

目的观察舒血宁治疗高脂血症性重症急性胰腺炎(hyperlipidemic severe acute pancreatitis,HL-SAP)的作用。方法将50例HL-SAP患者随机分为A组(25例)和B组(25例),同时以健康志愿者25例作为正常对照组。A组采用常规治疗,B组采用常规治疗+舒血宁注射液治疗,以全自动血液黏度计测定全血高切黏度及全血低切黏度,以全自动生化分析仪测定血清甘油三酯(TG)水平,测定A、B两组胰腺Balthazar CT分级评分和APACHEⅡ评分。结果 B组治疗第15天全血高切黏度、全血低切黏度、血清甘油三酯、胰腺Balthazar CT分级评分及APACHEⅡ评分与入院时比较,降低程度均高于A组(P<0.01)。结论舒血宁对HL-SAP有较好的治疗作用。     

两类达标血糖控制对急危重患者预后的影响

目的 观察两类达标血糖控制对急危重患者预后的影响. 方法 选取2011年1月至2013年9月我院急诊重症监护室（EICU）急性生理学与慢性健康评分（APACHEⅡ）＞15分且合并高血糖的危重患者200例,分为胰岛素强化治疗（IIT）组和常规控制（CIT）组,比较两组近期死亡率、3d及7d后APACHEⅡ、严重并发症、低血糖、院内感染发生率、住院时间和费用等指标. 结果 IIT组住院时间和费用、院内感染发生率、呼吸衰竭、心功能不全、3d及7d后APACHEⅡ较CIT组低（P＜0.05）.两组低血糖总发生率比较差异有统计学意义（29％ vs 13％,P＜0.01）,严重低血糖发生率、死亡率比较差异无统计学意义. 结论 IIT可能为临床带来较多益处,但增加急危重患者低血糖风险,对降低总死亡率可能无明显影响.     

内科危重病患者胰岛素抵抗相关因素研究

目的目的通过观察危重病患者早期血糖、胰岛素浓度及胰岛素抵抗(IR)的变化,这些指标与疾病。方法选取本院ICU内科危重病患者52例,于入院24h内进行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,次日清晨抽取空腹静脉血测血糖(FBG)和胰岛素(FINS)浓度,使用稳态模式法(HOMA)计算胰岛素抵抗指数(HOMA-IR)。52例中入ICU28d后仍存活者划入存活组,余为死亡组。另选择健康体检者30人为对照组,检测FBG、FINS及计算HO-MA-IR。结果内科危重病组FBG、FINS浓度及HOMA-IR均高于对照组(P均0.01)。死亡组FBG浓度、HOMA-IR及A-PACHEⅡ评分均高于存活组(P0.05);而FINS浓度两组比较差异无统计学意义。按APACHEⅡ评分分值≤10分、11～20分、≥21分3组,表现为随评分增加,各组FBG、FINS均显著增加(P0.05)。结论危重病应激状态下存在胰岛素抵抗。FBG及HOMA-IR可反映危重病严重程度及预后,部分患者表现为高胰岛素血症,但FINS不能准确反映危重病的病情及预后。     

Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis

AIM: To investigate a formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis (HL-SAP).METHODS: Thirty-two consecutive patients with severe acute pancreatitis were included in the clinical trial. All of them met the following five criteria for admission to the study, namely the Atlanta classification and stratification system for the clinical diagnosis of SAP, APACHEII score more than 8, time interval for therapeutic intervention less than 72 hours after onset of the disease, serum triglyceride (TG) level 6.8 mmol/l or over, and exdusion of other etiologies.They were divided into severe acute pancreatitis group (SAP,22 patients) and fulminant severe acute pancreatitis group (FSAP, 10 patients). Besides the conventional therapeutic measures, Penta-association therapywas also applied in the two groups, which consisted of blood purification (adsorption of triglyceride and hemofiltration), antihyperlipidemic agents (fluvastatin or lipanthyl), low molecular weight heparin (fragmin), insulin, topical application of Pixiao (a traditional Chinese medicine) over the whole abdomen, serum triglyceride,pro-inflammatory cytokines and anti-inflammatory cytokines were determined before blood purification (PF), at the end of blood purification (AFE) and on the 7th day after onset of the disease (AF7) respectively. Simultaneously, severity of the diseases was assessed by the APACHE Ⅱ system.Prognosis was evaluated by non-operation cure rate,absorption rate of pseudocyst, time interval pseudocyst absorption, hospital stay and survival rate.RESULTS: Serum triglyceride level (mmol/L), TNFα (U/mi) concentration and APACHE Ⅱ score were significantly decreased (P＜0.05) at AFE and AF7, as compared with PF.However, serum IL-10 concentration (pg/ml) was increased significantly (P＜0.001) at AFE, and decreased significantly (P＜0.05) at AF7 when compared with PF. Operations: The First surgical intervention time was 55.8±42.6 days in SAP group (5 patients) and 12.2±6.6 days in FSAP group (7 patients),there was a significant difference between the two groups (P=0.02). The number of operations in the two groups was 1.33±0.5 vs3.5±1.2 (P=0.0037), respectively. Prognosis: Nonoperation cure rate, absorption rate of pseudocyst, hospital stay and survival rate in SAP group and FSAP group were 100 % (22/22) vs11.1% (1/9), 77.3 % (17/22) vs 11.1%(1/9), 54.2±35.9 vs99.1±49.5 days (P=0.008) and 100 %(22/22) vs66.7 % (6/9) (P=0.0044). The time for absorption of pseudocyst was 135.1±137.5 days in SAP group.CONCLUSION: Penta-association therapy is an effective guideline in the treatment of hyperlipidemic severe acute pancreatitis at its early stage (within 72 hours).     

Adjunctive continuous high-volume hemofiltration in acute severe pancreatitis patients: A retrospective study

Abstract

Objective. To evaluate the efficacy of continuous high-volume hemofiltration for the treatment of severe acute pancreatitis patients and the impact of acute physiology and chronic health evaluation (APACHE) II score on the efficacy of high-volume hemofiltration. Material and methods. A total of 63 patients diagnosed with severe acute pancreatitis between January 2005 and July 2007 were retrospectively analyzed: 34 accepted adjunctive continuous high-volume hemofiltration (HVHF group); and 29 only accepted conventional recommended treatments (control group). Results. There were no differences in physiological characteristics between the two groups when entering the intensive care unit. After treatment, the percentages of patients successfully weaned from mechanical ventilation (p = 0.004) and who experienced renal function recovery (p = 0.046) were significantly higher in the HVHF group than in the control group. The 28-day survival rate was 91.2% in the HVHF group, compared with 65.5% in the control group (p = 0.014). For patients with APACHE II scores > 15, survival was significant higher in the HVHF group than in the control group (87.5% vs 50%; p = 0.044). No difference in survival was found in patients with APACHE II scores ≤ 15 between the two groups (94.4% vs 76.5%; p = 0.177). After HVHF therapy, APACHE II score, body temperature, urine volume and laboratory indices, including serum creatinine, base excess and blood calcium, were significantly improved. Conclusions. Adjunctive continuous HVHF was beneficial for the survival of severe acute pancreatitis patients. Survival improvement was significant in patients with APACHE II score > 15.     

LT3S与急性心力衰竭患者病情的相关性及其对短期预后的预测价值

目的:观察和分析低三碘甲状腺原氨酸综合征（LT3S）对判断急性心力衰竭（AHF）患者病情危重程度和预测短期内死亡风险的临床价值。方法: 入选240例AHF患者,对其进行疾病严重程度指数APACHE II评分,检测其脑钠尿肽（BNP）水平、甲状腺功能。统计患者住院期间病死率,电话随访患者出院6个月后的生存情况。结果: 入选240例AHF患者中,并发的患者70例,发生率为29.2%;并发LT3S与并发非LT3S AHF患者间APACHE II评分、BNP水平、住院期间病死率和随访期间病死率差异均有统计学意义［(24±6) vs.(20±6);(784±188) mg/L vs.(697±200) mg/L;17.1% vs. 7.6%;11.3% vs. 3.4%,均P<0.05］。Cox回归风险比例模型分析:游离三碘甲状腺原氨酸(FT3)水平、APACHE II评分和BNP水平是AHF患者短期内死亡的影响因素(标准偏回归系数=-0.872,HR=0.683,95%CI:0.536-0.847,P<0.05;标准偏回归系数=1.531,HR=1.257,95%CI:1.317-1.864,P<0.05;标准偏回归系数=0.417,HR=0.997, 95%CI:0.922-1,P<0.05)。受试者工作特征曲线(ROC)下面积(AUC)分析:APACHE II评分的AUC大于BNP水平和FT3水平的AUC;而BNP水平和FT3水平的AUC间的差异无统计学意义(0.893,95%CI:0.831-0.965;0.720, 95%CI:0.640-0.806;0.698,95%CI:0.586-0.751)。结论: AHF患者伴LT3S的诊断,对预测患者的病情危重程度和预后有重要价值。