摘要
目的探索重症患者股四头肌厚度(股直肌厚度、股中间肌厚度)、横截面积(股直肌横截面积)与医学研究委员会(MRC)手法肌力评分的相关性,及其随重症监护病房(ICU)住院时间的变化特点,并判断肌肉变化对ICU获得性衰弱(ICU-AW)的诊断价值。方法纳入2019年3至10月于北京协和医院重症医学科住院治疗预期≥5 d的患者,前瞻性收集患者入ICU第1天(D1)、第3天(D3)、第5天(D5)、第7天(D7)、出ICU时(D出ICU)超声测量下的股直肌横截面积、股直肌肌肉厚度、股中间肌肌肉厚度以及评价D出ICU时MRC肌力评分,分析其相关性以及股四头肌变化的规律。并以D出ICU时MRC>48分作为诊断ICU-AW阳性的标准,分析股四头肌肌肉变化与ICU-AW的关系。采用t检验或Mann-Whitney U检验进行统计分析。结果共纳入45例重症患者,男25例,女20例,年龄为(58±10)岁。患者的股直肌横截面积、股直肌厚度、股中间肌厚度随ICU住院时间的增长而减少。股直肌横截面积、厚度及股中间肌厚度与MRC评分呈正相关(r=0.452、0.411、0.402,均P<0.05),股直肌横截面积、厚度及股中间肌厚度的下降幅度均与MRC评分呈负相关(r=-0.682、-0.740、-0.734,均P<0.05)。入ICU第3天股直肌横截面积萎缩率预测ICU-AW阳性的临界值为6.0%,敏感度为66.7%,特异度为77.8%;第5天股直肌厚度萎缩率预测ICU-AW阳性的临界值为14.5%,敏感度为77.8%,特异度为66.7%;第7天股中间肌厚度萎缩率预测ICU-AW阳性的临界值为19.9%,敏感度为70.6%,特异度为87.5%。结论床旁超声测量股四头肌横截面积、厚度对ICU-AW有一定的诊断价值,能够早期识别ICU-AW患者。
Objective To explore the correlation between quadriceps thickness(thickness of rectus femoris and vastus intermedius),cross-sectional area(cross-sectional area of the rectus femoris)and the strength score of the Medical Research Council(MRC)in critically ill patients,and to explore the changes in the length of hospital stay in the intensive care unit(ICU),and to determine the diagnostic value of muscle changes in the ICU-acquired weakness(ICU-AW).Methods Patients admitted to the Department of Critical Care Medicine from March to October in 2019 who were expected to stay for more than five days were enrolled in this study.The cross-sectional area of the rectus femoris,the thickness of the rectus femoris,the thickness of the vastus intermedius on the first day of the ICU(D1),day 3(D3),and day 5(D5),day 7(D7),out of ICU(DICU),and the MRC muscle strength scores on the day of out of ICU prospectively were collected in all the patients,and the correlation and the regularity of quadriceps changes were analyzed.MRC>48 points on the day of dismiss of ICU were used as the standard for the diagnosis of ICU-AW,and the relationship between muscle changes of the quadriceps and ICU-AW was analyzed.The t test or the Mann-Whitney U test was used for data analysis.Results A total of 45 patients were included,including 25 males and 20 females,aged(58±10)years.The rectus femoris cross-sectional area,rectus femoris thickness,and vastus intermedius thickness decreased with the length of ICU hospital stay.The cross-sectional area,thickness of the rectus femoris muscle,and the vastus intermedius thickness were positively correlated with the MRC score(r=0.452,0.411,0.402,all P<0.05),and the changes were all negatively correlated with the MRC score(r=-0.682,-0.740,-0.734,all P<0.05).On the 3rd day after ICU admission,the best cutoff value of rectus muscle cross-sectional area atrophy rate for discrimination of ICU-AW was 6.0%,with a sensitivity of 66.7%and a specificity of 77.8%;on the 5th day,the best cutoff value of rectus femoris thic
作者
李若祎
何怀武
孙建华
李奇
隆云
刘华平
Li Ruoyi;He Huaiwu;Sun Jianhua;Li Qi;Long Yun;Liu Huaping(School of Nursing,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100144,China;Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第25期1967-1972,共6页
National Medical Journal of China
关键词
超声检查
ICU获得性衰弱
床旁超声
股四头肌
肌力
Ultrasonography
ICU-acquired weakness
Bedside ultrasound
Quadriceps femoris muscle
Muscle strength
