床旁超声测量肢体骨骼肌厚度对ICU获得性肌无力的诊断价值  

Diagnostic accuracy of bedside ultrasound measurement of limb skeletal muscle thickness for intensive care unit-acquired weakness

作　　者：支海君[1] 郭晋平[1] 赵雅宁 聂屾[1] 李石磊 王淑娟[1] 李勇[1] Zhi Haijun;Guo Jinping;Zhao Yaning;Nie Shen;Li Shilei;Wang Shujuan;Li Yong(Department of Emergency,Cangzhou Central Hospital,Cangzhou 061000,Hebei,China)

机构地区：[1]沧州市中心医院急诊医学部,河北沧州061000

出　　处：《中华危重病急救医学》2020年第4期494-497,共4页Chinese Critical Care Medicine

基　　金：河北省卫生和计划生育委员会科研基金项目(20191250)。

摘　　要：目的探讨床旁超声测量肢体骨骼肌厚度对机械通气患者发生ICU获得性肌无力(ICU-AW)的诊断价值。方法采用前瞻性观察性研究方法,纳入2018年6月至2020年3月入住沧州市中心医院急诊重症监护病房(ICU)接受机械通气的患者作为研究对象。记录患者一般资料,待患者清醒后采用医学研究委员会制定的评分法(MRC)评估肌力以判断是否发生ICU-AW,同时床旁超声测量肱二头肌、桡侧腕屈肌、股四头肌及胫前屈肌的厚度,比较非ICU-AW组与ICU-AW组之间各指标的差异;并绘制受试者工作特征曲线(ROC),分析骨骼肌厚度对ICU-AW的诊断价值。结果共纳入41例机械通气患者,其中ICU-AW 15例,非ICU-AW 26例。与非ICU-AW组比较,ICU-AW组患者MRC评分、桡侧腕屈肌厚度、股四头肌厚度及胫前屈肌厚度更低〔MRC评分(分):36(30,40)比60(56,60),桡侧腕屈肌厚度(cm):1.09±0.19比1.30±0.28,股四头肌厚度(cm):1.57±0.58比2.23±0.58,胫前屈肌厚度(cm):1.76±0.33比2.21±0.43,均P<0.05〕,而ICU住院时间更长〔d:15(9,26)比10(4,12),P<0.05〕;尽管肱二头肌厚度在ICU-AW组也较低,但两组间差异无统计学意义(cm:2.45±0.57比2.70±0.61,P=0.205)。ROC曲线分析显示,桡侧腕屈肌厚度、股四头肌厚度及胫前屈肌厚度对ICU-AW具有诊断价值〔ROC曲线下面积(AUC)和95%可信区间(95%CI)分别为0.742(0.582~0.866)、0.787(0.631~0.899)、0.817(0.665~0.920),均P<0.01〕,但肱二头肌厚度对ICU-AW无诊断价值(AUC=0.597,95%CI为0.433~0.747,P=0.296)。结论床旁超声测量桡侧腕屈肌、股四头肌及胫前屈肌的厚度对机械通气患者发生ICU-AW具有诊断价值,而肱二头肌厚度对ICU-AW无诊断价值。Objective To explore the diagnostic accuracy of bedside ultrasound measurement of limb skeletal muscle thickness for intensive care unit-acquired weakness(ICU-AW)in patients receiving mechanical ventilation.Methods A prospective observational study was conducted.Patients receiving mechanical ventilation admitted to the emergency ICU of Cangzhou Central Hospital from June 2018 to March 2020 were enrolled.The demographic data were collected.Medical Research Council(MRC)score was used to assess muscle strength and to determine the presence of ICU-AW once the patients were awake.The thicknesses of biceps brachii(BB),flexor carpi radialis(FCR),rectus femoris(RF)and tibialis anterior(TA)were measured by bedside ultrasound.The difference of each index was compared between the patients in ICU-AW group and in non-ICU-AW group.Receiver operator characteristic(ROC)curves were plotted to examine the values of the thicknesses of these four muscles in diagnosing ICU-AW.Results Forty-one patients receiving mechanical ventilation(15 patients with ICU-AW,26 patients without ICU-AW)were recruited.Compared with the non-ICU-AW group,the MRC score,the thicknesses of FCR,RF and TA were lower in the ICU-AW group[MRC score:36(30,40)vs.60(56,60),FCR(cm):1.09±0.19 vs.1.30±0.28,RF(cm):1.57±0.58 vs.2.23±0.58,TA(cm):1.76±0.33 vs.2.21±0.43,all P<0.05],and the length of ICU stay was longer[days:15(9,26)vs.10(4,12),P<0.05].Although the thickness of BB was also lower in the ICU-AW group,there was no statistical difference between the two groups(cm:2.45±0.57 vs.2.70±0.61,P=0.205).ROC curve showed that the thicknesses of FCR,RF and TA had diagnostic values for ICU-AW[area under ROC curve(AUC)and 95%confidence interval(95%CI)was 0.742(0.582-0.866),0.787(0.631-0.899),0.817(0.665-0.920),respectively,all P<0.01].The thicknesses of BB couldn't diagnose ICU-AW(AUC=0.597,95%CI was 0.433-0.747,P=0.296).Conclusion The thicknesses of FCR,RF and TA measured by bedside ultrasound in patients with mechanical ventilation had diagnostic values for ICU-AW

关 键 词：ICU获得性肌无力 床旁超声 骨骼肌厚度 

分 类 号：R746.1[医药卫生—神经病学与精神病学]