多器官功能障碍综合征患者血清胆碱酯酶变化的临床意义

Clinical significance of the change of serum cholinesterase in the MODS patients

目的动态观察多器官功能障碍综合征(MODS)患者血清胆碱酯酶变化,探讨血清胆碱酯酶与MODS患者病情严重程度的关系及其对预后的判断价值。方法以收住急诊重症监护病房92例MODS患者(年龄22～92岁)和30例非MODS患者(年龄20～87岁)为观察对象,分别检测入院时与入院第24小时的血清胆碱酯酶,并计算24h内血清胆碱酯酶变化值。根据入院28d生存情况,将MODS患者分成存活组和死亡组,比较两组患者胆碱酯酶变化值,并进行Logistic回归分析。结果入院时与入院24hMODS组血清胆碱酯酶下降明显,与非MODS组患者比较有统计学意义(P<0.05)。且MODS死亡组患者血清胆碱酯酶持续下降。多因素Logistic回归分析显示,血清胆碱酯酶变化值、功能不全器官数目、APACHEⅡ评分是判断MODS预后的独立危险因素。结论 MODS患者入院时、入院24h外周血清胆碱酯酶水平及其变化值,与MODS患者病情严重程度相关,其中动态变化值是MODS患者预后的独立危险因素。

Objective To observe the trend of serum cholinesterase change in the MODS patients,discuss the relationgship between the level of the serum cholinesterase and the severity of MODS patients,also evaluate the value of serum cholinesterase level while judging the prognosis of MODS. Methods All the observe subjects were selected from the admission patients of the EICU of Tianjin medical university general hospital. 92 MODS patients aged 22～92 years were included while 30 non-MODS patients aged 20～87 years included as control group. Detect the serum cholinesterase level respectively at admission and in the 24 th hour of admission. Calculate the value change of serum cholinesterase. The MODS patients were divided into two groups based on their prognosis：survival group and death group. Results Compared with the control group,the MODS patients had a decreased level of serum cholinesterase which had a statistic significance（P〈0.05）. The serum cholinesterase level of the MODS which dead in day 28 was decreased persistently as comparing with the survival group. Using multinomial Logistic regression analysis,the change value of serum cholinesterase level,APACHEⅡ scores and the number of dysfunction organ were independent risk factors for judging the prognosis in the MODS patients. Conclusions The serum cholinesterase level at admission,in the 24 th hour of admission and the change value of serum cholinesterase level have a close ralationship with the severity of MODS. And the change value of serum cholinesterase is an independent risk factor for judging the prognosis in the MODS patients.