目的 了解危重癥患者血清膽堿酯酶( CHE) 的變化情況, 探討血清CHE 水平下降的原因及對病情嚴(yán)重程度和預(yù)后判斷的作用。方法 觀察2007 年5 月至2008 年3 月入北京協(xié)和醫(yī)學(xué)院整形外科醫(yī)院ICU 病房的42 例危重癥患者。用APACHEⅡ評分系統(tǒng)評價病情的危重程度, 分析血清CHE 濃度變化與APACHEⅡ評分的相關(guān)性, 同時觀察患者肝功能的變化情況。結(jié)果 患者血清CHE 濃度較發(fā)病前降低[ ( 187. 83 ±78. 18) U/L 比( 270. 43 ±91. 66) U/L, P lt;0. 01] , 其中23 例低于正常參考值。死亡患者CHE 濃度顯著低于存活患者[ ( 140.26 ±54. 81) U/L 比( 208. 84 ±69. 96) U/L, P lt;0. 01] 。血清CHE 水平與APACHEⅡ評分呈顯著負(fù)相關(guān)( r = - 0. 43, P lt; 0. 01) 。血清總膽汁酸( TBA) 發(fā)病前后無顯著差異。死亡組與存活組丙氨酸轉(zhuǎn)氨酶與門冬氨酸轉(zhuǎn)氨酶無顯著差異。結(jié)論 ICU 中危重癥患者血清CHE 濃度下降明顯, APACHEⅡ評分越高, CHE 下降程度越大。患者CHE 下降不是由肝實質(zhì)損害引起。測定血清CHE 可作為判斷ICU 危重癥患者病情和預(yù)后的一個有意義的指標(biāo)。
引用本文： 熊軍,薛富善. 血清膽堿酯酶水平對危重癥病情判斷的意義. 中國呼吸與危重監(jiān)護(hù)雜志, 2009, 09(6): 585-587. doi: 復(fù)制
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| 17. | 劉大為. 危重癥醫(yī)學(xué). 北京: 中國協(xié)和醫(yī)科大學(xué)出版社, 2000,425. |
| 18. | Silvestre J, Póvoa P, Coelho L, et al. Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Med, 2009, 35:909-913. |
| 19. | Gonzales R, Aaggaard EM, Camargo CA, et al. C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. J Emerg Med, doi: 10. |
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| 21. | / j .jemermed. |
| 22. | . 06. 021. |
- 1. 陳麗峰, 吳琴. 膽堿酯酶在不同系統(tǒng)疾病中活性變化的觀察. 時珍國醫(yī)國藥, 2005, 16: 555-556.
- 2. 李淮安, 程愛國. 血清膽堿酯酶臨床研究進(jìn)展. 中國煤炭工業(yè)醫(yī)學(xué)雜志, 2008, 11: 119-121.
- 3. 黃濤, 梁廷波. 肝癌患者圍手術(shù)期血清膽堿酯酶水平評估手術(shù)預(yù)后的意義. 浙江醫(yī)學(xué), 2006, 28: 704-706.
- 4. 劉秀娟, 劉伯仁, 張謙, 等. 多器官功能障礙綜合征血清白蛋白及膽堿酯酶水平的意義和預(yù)后的關(guān)系. 陜西醫(yī)學(xué)雜志, 2008,37: 835-836.
- 5. 張寶臣, 白瑞軍. 稀釋后測定ALT、AST 值的臨床意義. 中國醫(yī)藥導(dǎo)刊, 2008, 10: 621.
- 6. 王鳳學(xué), 李樹仁, 歐陽旭紅. 血清丙氨酸氨基轉(zhuǎn)移酶和總膽汁酸聯(lián)合測定對肝病的診斷價值. 貴州醫(yī)藥, 2000, 24: 134-135.
- 7. 楊秀峰, 吉建民. 血清總膽汁酸與谷丙轉(zhuǎn)氨酶測定的臨床評價.山西職工醫(yī)學(xué)院學(xué)報, 1998, 8: 4.
- 8. 陳方帆. 聯(lián)合測定血清TBA 肝功能酶學(xué)在肝癌肝硬化診斷中的意義. 浙江中西醫(yī)結(jié)合雜志, 1998, 8: 209-210.
- 9. 陳浩, 何建軍, 屠士行. 血清總膽汁酸測定在慢性肝炎與肝炎后肝硬化的臨床意義. 浙江預(yù)防醫(yī)學(xué), 2002, 14: 13-14.
- 10. Borovikova LV, Ivanova S, Zhang M, et al. Vagus nerve stimulation attenuate the systemic inflammatory response to endotoxin. Nature,2000, 405: 458-462.
- 11. Bernik TR, Friedman SG, Ochani M, et al. Pharmacological stimulation of the cholinergic anti-inflammatory pathway. J Exp Med, 2002, 195: 781-788.
- 12. Wang H, Yu M, Ochani M, et al. Nicotinic acetylcholine receptor α7subunit is an essential regulator of inflammation. Nature, 2003 ,421: 384-388.
- 13. Hofer S, Eisenbach C, Lukic IK, et al. Pharmacologic cholinesterase inhibition improves survival in experimental sepsis. Crit Care Med,2008, 36: 404-408.
- 14. Fodale V, Santamaria LB. Cholinesterase inhibitors improve survival in experimental sepsis: A new way to activate the cholinergic antiinflammatory pathway. Crit Care Med, 2008 , 36 : 622-623.
- 15. Nizri E, Hamra-Amitay Y, Sicsic C, et al. Anti-inflammatory properties of cholinergic up-regulation: A new role for acetylcholinesterase inhibitors. Neuropharmacology, 2006, 50: 540-547.
- 16. Reale M, Iarlori C, Gambi F, et al. The acetylcholinesterase inhibitor, Donepezil, regulates a Th2 bias in Alzheimer′s disease patients. Neuropharmacology, 2006, 50: 606-613.
- 17. 劉大為. 危重癥醫(yī)學(xué). 北京: 中國協(xié)和醫(yī)科大學(xué)出版社, 2000,425.
- 18. Silvestre J, Póvoa P, Coelho L, et al. Is C-reactive protein a good prognostic marker in septic patients? Intensive Care Med, 2009, 35:909-913.
- 19. Gonzales R, Aaggaard EM, Camargo CA, et al. C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. J Emerg Med, doi: 10.
- 20. 曹衛(wèi)紅, 柴家科, 孫天駿, 等. 血清膽堿酯酶在大面積燒傷患者營養(yǎng)狀態(tài)評價中的意義. 中國臨床營養(yǎng)雜志, 2006, 14: 22-25.
- 21. / j .jemermed.
- 22. . 06. 021.