目的 探讨脓毒症患者血清胆碱酯酶(ChE)、碱性磷酸酶(ALP)及前清蛋白的变化及其临床意义.方法 选取2010年7月-2012年7月我院ICU收治的脓毒症患者72例,根据急性生理学及慢性健康状况评分系统Ⅱ (APACHE Ⅱ评分)将患者分为A组(APACHE Ⅱ评分＜20分)33例和B组(APACHE Ⅱ评分≥20分)39例,分析多器官功能障碍综合征(MODS)发生率和病死率.根据是否发生MODS将患者分为MODS组21例及非MODS组51例,并根据转归将患者分为存活组45例和死亡组27例,比较各组患者血清ChE、ALP及前清蛋白水平.结果 A组与B组患者MODS发生率及病死率比较,差异均有统计学意义(P＜0.05).MODS组与非MODS组患者入院24 h和入院第3天血清ChE及前清蛋白水平比较,差异均有统计学意义(P＜0.05);两组患者入院24 h和入院第3天血清ALP水平比较,差异均无统计学意义(P＞0.05).存活组与死亡组患者入院24 h和入院第3天血清ChE及前清蛋白水平比较,差异均有统计学意义(P＜0.05);两组患者入院24 h和入院第3天血清ALP水平比较,差异均无统计学意义(P＞0.05).结论 动态监测血清ChE及前清蛋白水平有助于评估脓毒症患者病情的危重程度及预后.%Objective To explore the clinical significance of changes of serum cholinesteruse ( ChE ), alkaline phosphatase ( ALP ) and prealbumin ( PAB ) in patients with sepsis. Methods A total of 72 patients with sepsis in our hospital from July 2010 to July 2012 were selected and APACHE II score was calcumulated. The fasting serum level of cholinesterase, alkaline phosphatase and prealbumin were detected in 24 hours at the admission day and the 3rd day. Then the patients were divided into group A ( APACHE II score < 20, n = 33 ) and group B ( APACHE II score≥20, n = 39 ), with the incidence of multiple organ dysfunction syndrome ( MODS ) and mortality rate compared. The patients were divided into non - MODS group ( n = 51 ) and MODS group ( n =21 ) .In addition, the patients were divided into survival group ( n =45 ) and death group ( n =27 ) according to the prognosis. ChE, ALP and PAB in each group were compared. Results The incidence of MODS and mortality rate in group B were significantly higher than those in group A ( P < 0. 05 ) . ChE and PAB of the patients in MODS group in 24 hours at the admission day and the 3rd day were significantly lower than those in non - MODS group ( P <0. 05 ); The same results were got in death group and survival group ( P < 0. 05 ); There was no significant difference of ALP ( P > 0. 05 ) . Conclusion The measurement of cholinesterase and prealbumin is useful to evaluate the severity of illness and the prognosis of the patients with sepsis.
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