1920例危重患儿血淀粉酶水平分析

摘要

ObjectiveTo explore the value of elevated amylase in assessment of severity of the disease and its inlfuencing factors in critically ill children.MethodThe clinical data from critically ill children hospitalized in pediatric intensive care unit were retrospectively analyzed from November 2009 to June 2014. According to levels of serum amylase, the critically ill children were divided into normal serum amylase group (≤103 IU/L) and elevated serum amylase group (>103 IU/L). The differences between two groups were compared.ResultsA total of 1920 critically ill children were enrolled, most of whom had primary respiratory and neurological diseases. Among them, 1470 children had normal serum amylase (76.6%) and 450 children had ele-vated serum amylase (23.4%). The elevated serum amylase group had signiifcantly higher rate of organs failure (≥4), lower rate of PCIS (<70), higher rate of invasive mechanical ventilation and mortality than those in normal serum amylase group (P<0.001). The correlation of serum amylase with lipase blood, urine amylase, blood urea nitrogen and creatinine were signiifcant (r=0.246 to 0.683,P<0.001). Blood amylase was positively correlated with shock index (r=0.111,P=0.002) and negatively correlated with respiratory failure index (r=0.133,P<0.001).ConclusionsSerum amylase could be used to assess the severity of disease. The elevated amylase was closely related to pancreatic exocrine function, renal function, ischemia, and hypoxia. The elevated serum amylase in critically ill children is a warning sign.%目的：探讨危重患儿血淀粉酶升高对病情评估的意义及影响因素。方法回顾性分析2009年11月至2014年6月入住儿童重症监护病房(PICU)危重患儿临床资料，根据入PICU时的血淀粉酶水平，分为血淀粉酶正常组(≤103 IU/L)、血淀粉酶升高组(>103 IU/L)，比较两组间的差异。结果共1920例危重患儿入选，初发疾病以呼吸系统疾病、神经系统疾病为主；血淀粉酶正常1470例(76.6%)、升高450例(23.4%)。血淀粉酶正常组与升高组之间器官衰竭个数和小儿危重病例评分(PCIS)分布，以及有创机械通气率和病死率的差异均有统计学意义(P均＜0.001)，血淀粉酶升高组中器官衰竭个数≥4、有创机械通气、PCIS评分<70以及死亡的比例均较高。血淀粉酶与血脂肪酶、尿淀粉酶、尿素氮和肌酐水平相关性较大(r=0.246~0.683，P均＜0.001)。血淀粉酶与休克指数呈正相关(r=0.111，P=0.002)，与呼吸衰竭指数呈负相关(r=−0.133，P＜0.001)。结论血淀粉酶水平可评估危重患儿病情，血淀粉酶升高与胰腺外分泌功能、肾功能、缺血缺氧密切相关，对危重患儿血淀粉酶升高需警惕。