血浆皮质醇在重症患者病情评估中的价值  

The value of plasma cortisol in evaluating the severity of critical care patients

作　　者：姚建华[1] 陈晓燕[1] 汪国斌[1] 陈辉[1] 闫晓玲[1] 毕炯炯 翟点点 

机构地区：[1]安徽省黄山首康医院重症医学科,安徽黄山245000

出　　处：《中国现代医生》2016年第5期79-81,F0003,共4页China Modern Doctor

摘　　要：目的探讨血浆皮质醇水平在重症患者病情评估中的价值。方法前瞻性收集2015年1~10月在我院重症医学科住院的患者的临床资料。24 h内进行血浆皮质醇检测。按预后分为存活组和死亡组,比较两组患者的年龄、住ICU时间、血浆皮质醇及APACHEⅡ评分。结果 68例患者被纳入,其中男50例（73.53%）,女18例（26.47%）,年龄18~92岁,平均（64.1±16.6）岁,存活49例,死亡19例,APACHEⅡ评分平均（18.54±7.74）分。内科患者46例（67.65%）,创伤18例（26.47%）,急诊手术4例（5.88%）。存活组和死亡组的年龄、APACHEⅡ评分、住重症医学科时间和血清皮质醇浓度分别是（61.04±16.89）岁、（72.10±13.18）岁,（17.00±7.66）、（22.53±6.57）,6（4,14）d、4（3,5）d,（379.08±305.94）nmol/L、（588.21±405.78）nmol/L,两组比较差异有统计学意义（P均〈0.05）。血清皮质醇的ROC曲线下面积0.665（95%CI：0.525~0.806,P=0.035）,血清皮质醇397 nmol/L时Youden指数最大,为0.398。结论血浆皮质醇浓度与重症患者的病情严重程度有一定的相关性,浓度高者预后差,死亡风险高。Objective To explore the value of plasma cortisol in evaluating the severity of critical care patients. Methods All adult patients admitted to our ICU from January to October 2015 were prospectively analyzed. The severity in survivors and non-survivors was evaluated by plasma cortisol detected within 24 hours and APACHE Ⅱ score, then statistic analysis were performed. Results Of 68 patients were included,73.53%（n=50） were male,the minimum,maximum and（mean±SD） age were from 18 to 92 years and（64.1±16.6） years respectively. 19 patients was in non-survivors group and 49 patients were survivors group. The age, APACHE Ⅱ score, duration of ICU of survival group and non-survivors group were（61.04 ±16.89）years,（72.10 ±13.18）years,（17.00 ±7.66）,（22.53 ±6.57）,6（4,14）days、4（3,5）days,（379.08±305.94）nmol/L,（588.21±405.78）nmol/L respectively,there were significant difference in two groups（all P〈0.05）.The area under the ROC of plasma cortisol was 0.665（95%CI： 0.525-0.806,P=0.035）,the Youden index was biggest when plasma cortisol was 397 nmol/L. Conclusion Plasma cortisol concentrations were correlated with the severity of patients,patients with high cortisol concentrations were high risk of death.

关 键 词：血浆皮质醇 重症患者 病情评价 

分 类 号：R195[医药卫生—卫生统计学]