血皮质醇、危重病评分与老年外伤危重患者预后的相关性

Relationship of blood cortisol and critical illness score with the prognosis of elderly patients with critical injury

目的:研究老年外伤危重患者血皮质醇(Blood Cortisol)浓度、危重病评分的变化,并分析其相关影响因素与预后的关系。方法:回顾性分析126例老年外伤危重患者入院24h内记录的APACHEⅡ评分和测定Blood Cortisol、血糖(BS)、三碘甲腺原氨酸(T3)和甲状腺素(T4)浓度的变化。结果:(1)老年外伤危重患者组Blood Cortisol、T3和T4[(396.79±126.68)nmol/L,(1.37±0.62)pmol/L,(108.2±12.1)pmol/L]明显低于非老年组[(447.05±131.32)nmol/L,(2.14±1.07)pmol/L,(114.5±21.7)pmol/L],而BS浓度(12.36±6.17)明显高于非老年组(9.27±2.36)mmol/L,且均有统计学意义(P<0.01)。(2)老年外伤危重患者随APACHEⅡ评分的上升,BloodCortisol浓度先升后降,BS浓度逐步上升,且不同APACHEⅡ评分组间BloodCortisol、BS、T3和T4浓度的变化均有统计学意义(P<0.05或P<0.01)。(3)死亡组的老年外伤危重患者APACHEⅡ评分与BS浓度明显增高,BloodCortisol浓度(278.06±66.39)nmol/L比存活组(401.21±112.40)nmol/L明显下降,且两组差异有统计学意义(P<0.01)。(4)经多元逐步回归分析,老年外伤危重患者的APACHEⅡ评分与BloodCortisol、T3和T4浓度呈负相关,与BS呈正相关。结论:老年外伤危重患者BloodCortisol与BS浓度有明显变化并呈分离现象且与APACHEⅡ均可提示病情严重程度,三者结合可作为评估老年外伤危重患者预后的可靠指标。

Objective To determine the changes of plasma cortisol and critical illness score and their relationship with the prognosis of elderly patients with critical injury. Methods APACHE- Ⅱscoring value of 120 critically injured elderly patients were recorded, and levels of blood cortisol, blood sugar （BS）, T3 and T4 were determined in the first 24 h. Results The levels of blood cortisol, T3 and T4 in critically injured elderly patients were significantly lower than those in critically injured non-elderly patients [396.79 ± 126.68, 1.37 ± 0.62, 108.2 ± 12.1 vs. 447.05 ± 131.32,2.14 ± 1.07,114.5 ± 21.7, respectively, P 〈 0.01 ], and that of BS was significantly higher （12.36 ± 6.17vs. 9.27 ± 2.36）. With the increase of APACHE-Ⅱ scoring value, the level of blood cortisol was increased at first and then decreased later, BS was increased. There were significant differences of the levels of blood cortisol, BS, T3 and T4 in different APACHE- Ⅱscoring value groups. The APACHE- Ⅱ scoring value and level of BS in death group were significantly increased as compared to survival group, but the level of blood cortisol was significantly decreased （278.06 ± 66.39 vs. 401.21± 112.40, P 〈 0.01）. Multivariate regression analysis revealed that the APACHE- Ⅱ scoring value was negatively correlated with the levels of blood cortisol, T3 and T4, but was positively correlated with BS. Conclusion The levels of blood cortisol and BS had obvious changes in critically injured elderly patients, and in combination with APACHE Ⅱ scoring value, they are associated with the severity and can be used to evaluate the prognosis of these patients.