超声在早期诊断ICU获得性肌无力中的临床应用价值

Clinical application value of ultrasound in early diagnosis of ICU acquired myasthenia

目的探讨超声在机械通气患者ICU获得性肌无力(ICU-AW)早期诊断中的临床应用价值。方法以2021年6月~2023年6月在我院ICU接受有创机械通气治疗的患者为研究对象。机械通气第1天记录患者的基本信息,并使用床旁超声检查股四头肌的横截面积和厚度,特别是选择较大的股直肌和股中间肌进行检查。机械通气第7天对患者进行MRC评分,根据MRC评分将患者分为ICU-AW组和非ICU-AW组;比较两组各项指标的差异,探讨骨骼肌体积的变化对ICU-AW诊断的应用价值。结果最终82例患者纳入本研究,其中ICU-AW组31例,ICU-AW的发生率为37.8%;相比于非ICU-AW组,ICU-AW组患者的MRC评分明显降低,机械通气持续时间、住ICU时长及总住院时长均显著增加(P<0.05);机械通气第7天ICU-AW组的骨骼肌各项指标均较第1天明显下降(P<0.05),而非ICU-AW组第7天和第1天骨骼肌的各项指标比较差异无统计学意义((P>0.05));第7天时ICU-AW组和非ICU-AW组的骨骼肌指标比较差异有统计学意义(P<0.05);ROC曲线分析显示,股直肌横截面面积、厚度与股中间肌厚度均能够作出准确的ICU-AW诊断结果。结论通过床旁B超测量股直肌横截面面积和厚度以及股中间肌厚度,能及早发现ICU-AW,从而及早干预,且股直肌横截面面积对ICU-AW的诊断价值最高。

Objective To explore the clinical application value of ultrasound in the early diagnosis of ICU acquired weakness(ICU-AW)in patients with mechanical ventilation.Methods The study subjects were patients who received invasive mechanical ventilation treatment in our hospital from Jun 2021 to Jun 2023.On the first day of mechanical ventilation,recorded the patient's basic information and used bedside ultrasound to examine the crosssectional area and thickness of the quadriceps femoris muscle,especially selecting larger rectus femoris and medial femoris muscles for examination.On the 7th day of mechanical ventilation,the patients were scored with MRC and divided into ICU-AW group and non ICU-AW group.Compared the differences in various indicators between the two groups,and explored the value of changes in skeletal muscle volume in the diagnosis of ICU-AW.Results The final 82 patients were included in this study,of which 31 were in the ICU-AW group,and the incidence of ICU-AW was 37.8%.Compared to the non ICU-AW group,the MRC score in the ICU-AW group was significantly reduced,duration of mechanical ventilation,length of stay in the ICU,and total length of hospitalization in the ICU-AW group were significantly increased(P<0.05).On the 7th day of mechanical ventilation,the skeletal muscle indicators in the ICU-AW group were significantly decreased compared to the 1st day of mechanical ventilation(P<0.05),while there was no significant difference in the skeletal muscle indicators between the non ICU-AW group on the 7th day and the 1st day of mechanical ventilation(P>0.05).On the 7th day of mechanical ventilation,there were significant differences in skeletal muscle indicators between the two groups(P<0.05).The area and thickness of the rectus femoris muscle and thickness of the middle femoral muscle could provide accurate ICU-AW diagnostic results.Conclusion By measuring the cross-sectional area and thickness of the rectus femoris muscle and the thickness of the middle femoral muscle through bedside ultrasound,ICU-AW can be early detected and intervened.The crosssectional area of the rectus femoris muscle has the highest diagnostic value for ICU-AW.