床旁超声测量肢体骨骼肌厚度对机械通气患者ICU获得性衰弱的预测价值

Predictive value of limb skeletal muscle thickness measured by bedside ultrasound in intensive care unit acquired weakness of the patients with mechanical ventilation

目的探讨应用床旁超声测量肱二头肌、桡侧腕屈肌、股四头肌及胫前屈肌厚度对机械通气患者发生重症监护病房(ICU)获得性衰弱(intensive care unit acquired weakness,ICUAW)的预测价值.方法采用前瞻性、观察性研究方法,纳入2018年6月至2020年3月于沧州市中心医院急诊ICU住院且接受机械通气的患者作为研究对象.记录患者一般资料,于开始机械通气最初24 h内应用床旁超声对肱二头肌、桡侧腕屈肌、股四头肌及胫前屈肌的厚度进行测量,待患者清醒后采用医学研究委员会(medical research council,MRC)评分进行肌力评估,判断是否发生ICUAW,比较ICUAW组及非ICUAW组四组骨骼肌厚度的差异,并绘制受试者工作特征(ROC)曲线,评估骨骼肌厚度对患者发生ICUAW的预测价值.结果共纳入40例接受机械通气患者(非ICUAW组26例,ICUAW组14例).非ICUAW组与ICUAW组比较,MRC评分[分:60(56,60)vs.36(30,40),P<0.05]、住ICU天数[d:10(4,12)vs.18(12,28),P<0.05]、桡侧腕屈肌厚度(cm:1.31±0.25 vs.1.09±0.18,P<0.05)、股四头肌厚度(cm:2.27±0.68 vs.1.77±0.68,P<0.05)及胫前屈肌(cm:2.36±0.36 vs.1.98±0.44,P<0.05)差异有统计学意义;而肱二头肌厚度(cm:2.76±0.58 vs.2.61±0.71,P=0.476)差异无统计学意义(P>0.05).桡侧腕屈肌厚度、股四头肌厚度及胫前屈肌厚度对ICUAW具有预测价值(桡侧腕屈肌:AUC=0.755,95%CI为0.594~0.877;股四头肌:AUC=0.721,95%CI为0.557~0.851,胫前屈肌:AUC=0.768,95%CI为0.608~0.886,均P<0.05),但肱二头肌厚度对ICUAW的预测价值较差(AUC=0.581,95%CI为0.415~0.735,P=0.426).结论接受机械通气患者最初24 h内通过床旁超声测量桡侧腕屈肌厚度、股四头肌厚度及胫前屈肌厚度对ICUAW具有预测价值.

Objective To explore the predictive accuracy of limb skeletal muscle thickness measured by bedside ultrasound for the diagnosis of intensive care unit acquired weakness(ICUAW)in the patients receiving mechanical ventilation.Methods This is a prospective,observational study including the patients receiving mechanical ventilation admitted to the emergency ICU of Cangzhou Central Hospital from June 2018 to March 2020.In addition to the demographic data,the thicknesses of biceps brachii(BB),flexor carpi radialis(FCR),rectus femoris(RF)and tibialis anterior(TA)were measured by medical ultrasonic instrument within 24 hours from receiving mechanical ventilation.Medical Research Couneil(MRC)scores were used to assess muscle strength to determine the presence of ICUAW when the patients were awake.The differences of the thicknesses of these four muscles were compared between the patients in ICUAW group and in non-ICUAW group.Receiver operator characteristie(ROC)curves were plotted to examine the values of the thicknesses of these four muscles in predicting ICUAW.Results Forty patients receiving mechanical ventilation(14 with ICUAW,26 without ICUAW)were recruited.The MRC scores[scores:60(56,60)vs.36(30,40),P<0.05],length of stay in ICU[d:10(4,12)vs.18(12,28),P<0.05],the thicknesses of FCR(scores:1.31±0.25 vs.1.09±0.18,P<0.05),RF(scores:2.27±0.68 vs.1.77±O.68,P<0.05)and TA(scores:2.36±0.36 vs.1.98±0.44,P<0.05)significantly differed between the non-ICUAW group and ICUAW group.The differences of the thicknesses of BB(scores:2.76±0.58 vs.2.61±0.71,P=0.476)between the two groups Iwas not statistically signifcant.The thicknesses of FCR[area under the curve(AUC)=0.755,95%confidence interval(CI)0.594-0.877.P<0.05],RF(AUC=0.721,95%CI0.557-0.851,P<0.05)and TA(AUC=0.768,95%CI0.608-0.886,P<0.05)were of predictive value for ICUAW.The predictive values of BB(AUC=0.58195%CI 0.415-0.735,P=0.426)for ICUA W were poor.Conclusion The thicknesses of FCR,RF and TA measured by medical ultrasonic instrument within 24 hours from receiving mechanical ventilation were of predictive value for ICUAW.