重症患者股四头肌超声测量的信度分析

Reliability for ultrasound measurements of quadriceps muscle in ICU: a prospective study

目的分析床旁超声在重症患者股四头肌数据测量中的信度,评估其对ICU获得性肌无力的临床诊断价值。方法研究对象为2015年10月到2016年3月入住重症医学中心时间≥4天的重症患者29例,用超声诊断仪记录患者下肢股直肌面积、股直肌厚度及股中间肌厚度的数据,并于第4天重复测量,根据组内相关系数(ICC)评价相关指标的信度价值。结果在患者收入ICU首日和第4天测量下肢股直肌横截面面积、股直肌横截面厚度及股中间肌厚度的ICC为=0.84~0.99;不同测试者间测量值的ICC为0.93~0.99。结论超声测量重症患者下肢股直肌横截面面积、股直肌厚度及股中间肌厚度的信度好,有助于临床诊断ICU获得性肌无力。

Objective This study aimed to evaluate the reliability of measuring quadriceps muscle layer thickness of critically ill patients using bedside ultrasound,which can be utilized to help the clinical diagnosis of intensive care unit-acquired weakness. Methods Twenty-nine adults admitted for more than 4 days were included. Ultrasound images of cross sectional area of rectus femoris、cross sectional thickness of rectus femoris and cross sectional area of vastus intermedius were obtained in 1th day and 4th day. The ICC were calculated to evaluate the reliability of each index. Results We collected cross sectional area of rectus femoris、cross sectional area of vastus intermedius and cross sectional thickness of rectus femoris of within operator measurements with an ICC of 0. 84 ~ 0. 99 in the 1th day and 4th day. There were statistically significant differences between the trainer and trainee results in the left cross sectional area of vastus intermedius stata of the first day and left cross sectional area of rectus femoris and right rectus femoris thickness stata of the 4th day（ trainer and trainee mean =-0. 028 cm,95% CI =-0. 067 to-0. 011,P = 0. 1607） Conclusion Excellent intra-and interrater reliability for ultrasound measurements of cross sectional area of rectus femoris、cross sectional thickness of rectus femoris and cross sectional area of vastus intermedius in critically ill patients was observed.