血乳酸、胆碱脂酶与APACHEⅡ评分在评估危重症患者病情预后中的研究

目的探讨危重症患者血乳酸、血清胆碱酯酶水平与APACHEⅡ评分的相关性及指导预后的意义。方法回顾性分析65例人住笔者医院ICU中危重症患者的临床资料，根据其预后将患者分为存活组和死亡组，比较血乳酸、血清胆碱酯酶水平与不同APACHEⅡ分值组之间的关系，分析上述指标与患者预后的关系。结果死亡组患者的血乳酸、血清胆碱酯酶水平及APACHEⅡ评分明显高于存活组（P〈0．05）；APACHEⅡ评分21-30分组血乳酸及血清胆碱酯酶水平明显高于≤10分及11-20分组（P〈0．05），APACHEⅡ评分〉30分组血乳酸及血清胆碱酯酶水平明显高于21-30分组（P〈0．05）；血乳酸水平与APACHEⅡ分值的相关性呈显著正相关（r：0．909，P〈0．01），血清胆碱酯酶水平与APACHEⅡ评分密切相关，呈现负相关（r=-0．795，P〈0．05），血清胆碱酯酶与血乳酸的变化呈现负相关（r=-0．783，P〈0．05）。结论血乳酸、血清胆碱酯酶水平与APACHEⅡ评分均与病情严重程度相关，在危重症患者预后判断中具有一定临床指导意义。

Application of Blood Lactic Acid,Cholinesterase and APACHE II Score in Evaluation of Prognosis of Critically Ill Patients.

Objective To investigate the correlation between the blood lactic acid, serum cholinesterase and APACHE II score and the prognostic value in critically ill patients. Methods The clinical data of 65 critically ill patients, admitted in intensive care unit （ICU） , were retrospectively analyzed. Patients were divided into two groups ： the survival group and the death group according to progno- sis. Grouped according to APACHE Ⅱ score comparison among all groups of blood lactic acid and serum cholinesterase of the differences. Its correlation with the progonosis of patients was analyzed. Results Blood lactic acid, serum cholinesterase and APACHE Ⅱ score in thedeath group respectively,were significantly higher than those in the survival group （P 〈 0.01 ）. The blood lactic acid and serum cholines- terase in patients with APACHE II score 21 -30 group were significantly higher than ≤ 10 group and 11 -20 group（ P 〈 0.05 ）. Theses in- dexes in patients with APACHE II score 〉 30 group were significantly higher than 21 -30 group（ P 〈 O. 05 ）. The blood lactic acid level was positive correlated with APACHE I1 score （ r = 0. 909, P 〈 0.05 ） , negatively correlated with serum cholinesterase and APACHE Ⅱ score （ r = - 0. 795, P 〈 0.05）. Serum cholinesterase level was negative correlated with APACHE Ⅱ score （ r = - 0. 783, P 〈 0.05 ）. Conclusion The blood lactic acid, serum cholinesterase and APACHE N score were associated with the disease severity,and show clini- cal value in predicting the prognosis of critical illness.