目的: 探讨急性期神经元特异性烯醇化酶( NSE) 升高对 ICU 继发性脑损伤病人预后的评估价值。 方法: 分析我院 ICU 2017－04～ 2018－12 期间收治的 68 例、无原发性脑部病变或脑外伤( 且排除肿瘤) 病人的临 床资料，根据入科时病人血压及神志分为: A 组－血压降低或神志变化者、42 例，B 组－术后复苏、无低血压或神 志改变者、26 例; 选取 2 组病人入科后第 2 d 7 AM 抽血化验的 NSE 并停镇静剂，10 AM 行 BIS、GCS 及 APACHE Ⅱ评分并记录 MAP，记录所有病人住 ICU 时间( d) 及呼吸机使用时间( h) ，运用 SPSS 21．0软件独立样本 t 检验进 行统计分析，探讨急性期 NSE 与 2 组病人住 ICU 及呼吸机使用时间等的关系。结果: 2 组病人 Hb、HCT、NSE、 MAP、BIS、GCS 评分、APACHEⅡ评分、住 ICU 及呼吸机使用时间相比，具有显著性差异( P≤0．01) ; A 组 NSE 比 B 组明显升高( P≤0．001) ，住 ICU 及呼吸机使用时间比 B 组明显延长( P= 0．000) ，死亡 9 例，其中 1 例住 ICU 时 间超过 28 d; B 组 NSE 无明显变化，7 d 内均好转离开 ICU．结论: 急性期 NSE 升高，可作为评估 ICU 继发性脑损 伤病人预后的检测指标。

Objective: To evaluate the prognostic value of acute neuron－specific enolase( NSE) ele- vation in patients with secondary brain injury in ICU．Methods: The clinical data of 68 patientswithout primary brain lesions or traumatic brain injury( excluding tumors) admitted to ICU of our hospital from April 2017 to December 2018 were analyzed．According to the patients’ blood pressure and conscious- ness at the time of admission，the patients were divided into: group A－42 patients with decreased blood pressure or altered consciousness; group B－26 patients with postoperative resuscitation without hypoten- sion and altered consciousness．The NSEof 7 am blood sampling on the second day after admission of the two groups of patients were selected，and the sedatives were stopped at the same time，10 amBISmoni- toring，GCSandAPACHE Ⅱscores were made and recorded MAPat the time，the duration of ICU stay ( days) and ventilator use( hours) of all patients were recorded，the datawere statistically analyzed using SPSS 21．0software independent－samples T testto investigate the relationship between NSE of the acute stage and ICU stay and ventilator use time in 2 groups． Ｒesults: There were significant differences inHb，HCT，NSE，MAP，BIS，GCS scores，APACHEⅡ scores，duration of ICU stay andventilator use between the two groups( P≤0．01) ; NSE of group A significant increasecompared with group B( P≤ 0．001) ，duration of ICU stayand ventilator use was significantly longer than that of group B ( P = 0．000) ，9 cases of group A died and 1 cases in ICU more than 28 days; the patients of group B were improved whose NSE has no significant change，within 7 days leaving ICU．Conclusion: Elevated NSE in acute stage can be used as a prognostic indicator for patients with secondary brain injury in ICU．

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收稿日期: 2019－01－05; 修回日期: 2019－03－10 基金项目: 深圳市龙岗区科技发展资金医疗卫生扶持类( 2017040510493883) 作者简介: 王美霞( 1972－) ，女，广东省深圳市龙岗中心医院重症医学科副主任医师，医学硕士。