CT图像定量分析竖脊肌横截面积减少率在机械通气患者中的临床价值

Clinical value of reduction rate of cross sectional area of the erector spinae muscle measured by quantitative analysis of CT images on patients with mechanical ventilation

目的:应用CT图像定量分析技术测量机械通气患者双侧竖脊肌横截面积(ESMCSA)的减少率,分析其与患者危重程度、预后、肌力及营养的关系,研究其在机械通气患者中的意义。方法:回顾性统计机械通气患者入院时和入院7~10 d的CT胸12椎体水平ESMCSA之和的减少率。按照减少率<10%、10%~20%、>20%分为3组,分析3组患者之间病情危重程度、预后、肌力评分、营养水平的差异。结果:研究共纳入111例患者,其中A组47例,B组46例,C组18例。ESMCSA减少率与患者的危重程度、肌力评分有密切关系,3组患者MRC评分、APACHEⅡ评分、SOFA评分的差异均有统计学意义(P<0.05)。APACHEⅡ评分、SOFA评分、ESMCSA减少率与死亡之间的ROC曲线下面积分别为0.759、0.737、0.778,ESMCSA减少率界值10.01%,敏感度为0.828、特异度为0.512。3组患者ICU获得性肌无力(ICU-AW)发生率、脱机成功率、28 d病死率及90 d存活天数、ICU住院天数的差异均有统计学意义(P<0.05)。ESMCSA减少率越高,机械通气天数、ICU住院天数增多,病死率增加。3组间的总住院天数、血清前白蛋白的组间差异无统计学意义。结论:CT测量胸12椎体水平ESMCSA在7~10 d内的减少率,可以准确评估机械通气患者肌肉损耗程度和疾病的严重程度,预测ICU-AW和脱机困难的概率,预测机械通气患者的预后。

Objective:CT image quantitative analysis technique was used to measure the reduction rate of cross sectional area of bilateral vertical spinal muscle(ESMCSA)in patients with mechanical ventilation,and to analyze the relationship between the reduction rate of ESMCSAand the critical degree,prognosis,muscle strength and nutrition of the patients,and to study its significance in patients with mechanical ventilation.Method:The reduction rate of the sum of ESMCSA at the 12 th thoracic vertebrae of patients with mechanical ventilation at admission and 7-10 days after admission were retrospectively analyzed.According to the reduction rate of ESMCSA<10%,10%-20%,and>20%,the patients were divided into three groups,and the difference of severity of the disease,prognosis,muscle strength score and nutritional level among the three groups were analyzed.Result:There duction rate of ESMCSA was closely related to the severity of the disease and muscle strength scores of the patients.The differences in MRC scores,APACHEII scores and SOFA scores among the three groups were statistically significant(P<0.05).The areas under the ROC curve between the APACHEII score,SOFA score,ESMCSA reduction rate and death were 0.759,0.737,and 0.778,respectively,and the threshold value of ESMCSA reduction rate was 10.01,the sensitivity was 0.828,and specificity was 0.512.There were statistically significant differences in ICU acquired muscle weakness(ICUAW)incidence,success rate of weaning,28-day mortality rate,90-day survival days,and length of stay in ICU among the three groups(P<0.05).With the increase of ESMCSA,the mechanical ventilation days and ICU stays increased,and the mortality rate also increased.There were no statistically differences in the hospital stays and serum prealbumin between the three groups.Conclusion:The reduction rate of the ESMCSA at thoracic 12 vertebral by CT images within 7-10 days can accurately assess the degree of muscle loss and severity of the disease in patients with mechanical ventilation,predict the probability of ICU-AW and difficulty in ventilation weaning,and predict the prognosis of patients with mechanical ventilation.