动脉血乳酸水平与血清组织释放酶在危重病患者中的变化  

The Changes of Arterial Blood Lactate and Serum Tissue Release Enzymes (LDH,AKP,CK)in the Critical Illeness and Their Correlation

作　　者：曹相原[1] 马少林[1] 段风梅[1] 杨晓军[1] 柳明[1] 马希刚[1] 杨勇[1] 马晓薇[1] 

机构地区：[1]宁夏医学院附属医院,宁夏银川750004

出　　处：《中国医师杂志》2001年第4期248-250,共3页Journal of Chinese Physician

摘　　要：目的　研究与观测危重病阶段动脉血乳酸水平与血清组织释放酶的变化及其相关性。方法　 6 4例危重病患者在入ICU之即、2 4h、4 8h和 72h进行动脉血乳酸 (ABL)、血清碱性磷酸酶 (AKP)、乳酸脱氢酶(LDH)和肌酸激酶 (CK)水平监测。结果　 6 4例分良好、存活与死亡三组 ,入ICU时平均ABL水平分别为 (3 9± 2 5、2 9± 1 3和 3 8± 2 3)mmol/L。 2 4～ 4 8h后良好与存活组降至正常 ,而死亡组呈持续升高状态。死亡组与良好、存活组比较差异显著 (P <0 0 5)或非常显著性 (P <0 0 1)。组织释放酶AKP的死亡组与良好组 2 4～72h存在着显著差异 (P <0 0 5)或非常显著差异 (P <0 0 1) ;LDH和CK的均值在危重病期均升高 ,由高到低依次排列为死亡组、存活组和良好组。死亡组与良好组之间从入ICU初期到 72h ,存在着统计学意义 (P <0 0 5或P <0 0 1)。ABL与组织释放酶AKP、LDH、CK释放的相关性显示 :ABL与AKP在 4 8h～ 72h呈正相关 ;ABL与LDH在 2 4h～ 4 8h呈正相关 ;ABL与CK2 4～ 72h均呈负相关。结论　ABL水平对预后判断意义主要取决于治疗后ABL清除及利用下降的速度。ABL水平清除越滞缓、或继续增高 ,组织释放酶LDH和CK的释放水平则越高 ,病情越重 ,预后亦越差 ,死亡率也越高。也是死亡组MODS或MOF多发的原因?Objective To study the changes of arterial blood lactate(ABL) and serum enzymes activities and thier correlation.Method Lactate dehydrogenase(LDH),alkaline phosphatase(AKP) and creatine kinase(CK) in serum were determined in sixty-four critical patients in the intensive care unit(ICU) at admission immediately,following 24h,48h and 72h,respectively.The patients was divided into three groups:favorable,survival and death groups.Results Before treatment,ABL level was(3.9±2.5,2.9±1.3 and 3.8±2.3)mmol/L in favorable,survival and death groups respectively.Although ABL in favorable and survival groups were decreased gradually to normal level during 24～72h,the death group showed that the decline was very slowly it still persistent elevated in 72h.There was significanct difference between the death group and the favorable and survival groups(P<0.05 or P<0.01).AKP had significant difference between favorable and death groups(P<0.05 or P<0.01) in 24～72h.LDH and CK increased in three groups and there was significantly difference between the death group and the favorable and/or survival group(P<0.05 or P<0.01).The relationship of ABL to AKP in 48～72h,ABL to LDH in 24～48h was positive correlation,and ABL to CK in 24～72h was negative correlation.Conclusions We conclude that the significance of ABL for prognosis in critical illness dependent on the rapid of ABL' elimination.The ABL is slowly eliminated,or increased continually,and the LDH,AKP,CK the more are release,the more worse the patients' condition and prognosis.So it is that more multiple organ disorder syndrome(MODS) or multiple organ failure(MOF) occurred easily in the death group.The high ABL level with the high tissue release enzymes has better clinic value to judge the degree and prognosis of critical illness.

关 键 词：乳酸 碱性磷酸酶 乳酸脱氢酶 肌酸激酶 动脉血 

分 类 号：R446.112[医药卫生—诊断学]