AECOPD机械通气患者并发ICU获得性衰弱与CT评估胸肌指数的关系

Relationship between ICU-acquired weakness in AECOPD patients with mechanical ventilation and the value of CT in evaluating chest muscle index

目的探讨慢性阻塞性肺疾病急性加重(AECOPD)机械通气患者并发ICU获得性衰弱(ICU-AW)与CT评估胸肌指数(PMI)的关系。方法本研究为病例对照研究。采用目的抽样法选取2021年9月至2023年7月期间临汾市人民医院收治的行机械通气的AECOPD患者93例为研究对象,按照英国医学研究理事会(MRC)肌力评分结果分为ICU-AW组(34例)和非ICU-AW组(59例)。比较2组临床资料和PMI水平,多因素logistic回归分析AECOPD患者发生ICU-AW的独立危险因素。绘制受试者操作特征(ROC)曲线分析PMI对AECOPD患者ICU-AW的预测价值。结果ICU-AW组34例,男21例,女13例,年龄(72.32±6.37)岁;非ICU-AW组59例,男39例,女20例,年龄(71.54±7.12)岁。2组间性别、年龄、吸烟史、糖尿病、高血压、BMI、PaCO_(2)、PaO_(2)、pH、ALB和CRP、用镇痛剂次数、肝功能GOLD分级差异均无统计学意义(均P>0.05)。ICU-AW组APACHEⅡ评分高于非ICU-AW组,分别为[(21.32±1.54)分比(16.89±1.88)分,t=11.66,P<0.001];PMI低于非ICU-AW组,分别为[(9.84±0.89)cm^(2)/m比(10.95±0.42)cm^(2)/m,t=8.15,P<0.001],ICU-AW组用镇静剂次数、用糖皮质激素和2种以上缩血管药物的比例高于非ICU-AW组,分别为(3.84±0.97)次比(2.76±0.59)次、24例(70.6%)比16例(27.1%)和5例(14.7%)比2例(27.1%),差异均有统计学意义(t=6.68,χ^(2)=3.97、16.63,均P<0.05)。多因素logistic回归分析结果显示:使用糖皮质激素、镇静次数、APACHEⅡ评分、PMI是AECOPD患者发生ICU-AW的独立危险因素(P<0.05)。ROC曲线分析结果显示:PMI预测AECOPD患者发生ICU-AW的曲线下面积为0.880,最佳截断值为9.28 cm^(2)/m^(2)时敏感度为82.61%,特异度为66.67%。结论使用糖皮质激素、镇静次数、APACHEⅡ评分、PMI是AECOPD患者发生ICU-AW的危险因素,且PMI对AECOPD患者发生ICU-AW具有较好的预测效能。

Objective To investigate the relationship between ICU-acquired weakness(ICU-AW)and chest muscle index(PMI)assessed by CT in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)undergoing mechanical ventilation.Methods This was a case-control study.A simple random sampling method was used.A total of 93 patients with AECOPD who underwent mechanical ventilation in Linfen People′s Hospital from September 2021 to July 2023 were selected as the study subjects.According to the British Medical Research Council(MRC)muscle strength score,the patients were divided into ICU-AW group(n=34)and non-ICU-AW group(n=59).The clinical data and PMI were compared between the two groups.Multivariate Logistic regression was used to analyze the independent risk factors of ICU-AW in AECOPD patients.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of PMI for ICU-AW in AECOPD patients.Results There were 34 cases(21 male and 13 female)in the ICU-AW group,with the age of(72.32±6.37)years;there were 59 cases(39 male and 20 female)in the non-ICU-AW group,with the age of(71.54±7.12)years.There were no significant differences in sex,age,smoking history,diabetes mellitus,hypertension,BMI,PaCO_(2),PaO_(2),pH,ALB,CRP,frequency of using analgesics,and GOLD grade of liver function between the two groups(all P>0.05).The APACHEⅡscore of the ICU-AW group was significantly higher than that of the non-ICU-AW group,(21.32±1.54)score vs(16.89±1.88)score(t=11.66,P<0.001);the PMI was significantly lower than that of the non-ICU-AW group,(9.84±0.89)cm^(2)/m vs(10.95±0.42)cm^(2)/m(t=8.15,P<0.001).There were significant differences in the times of sedation using,the use of glucocorticoids,and the use of>2 kinds of vasoconstrictors between the two groups.They were(3.84±0.97)times vs(2.76±0.59)times,24 cases(70.6%)vs 16 cases(27.1%)and 5 cases(14.7%)vs 2 cases(27.1%),with significant differences(t=6.68,χ^(2)=3.97,16.63,all P<0.05).Multivariate logistic regression analysis showed that the use of glucocorticoids,the times of sedation using,APACHEⅡscore,and PMI were independent risk factors for ICU-AW in AECOPD patients(P<0.05).ROC curve analysis showed that the area under curve(AUC)of PMI in predicting ICU-AW in AECOPD patients was 0.880,and the optimal cut-off value was 9.28 cm^(2)/m^(2).At this point,the sensitivity was 82.61%and the specificity was 66.67%.Conclusions The use of glucocorticoids,the times of sedation using,APACHEⅡscore,and PMI are risk factors for ICU-AW in AECOPD patients,and PMI shows a good predictive effect on ICU-AW in AECOPD patients.