床旁超声定量评估下肢肌肉诊断重症监护病房获得性衰弱  

Bedside ultrasound quantitative evaluation of lower extremity muscle for diagnosing intensive care unit acquired weakness

作　　者：曾欣 叶鸣[1] 周鸿[1] 黄煜[2] 周洋[1] ZENG Xin;YE Ming;ZHOU Hong;HUANG Yu;ZHOU Yang(Department of Ultrasound,the Third People's Hospital of Chengdu,Chengdu 610000,China;Department of Critical Care Medicine,the Third People's Hospital of Chengdu,Chengdu 610000,China)

机构地区：[1]成都市第三人民医院超声科,四川成都610000 [2]成都市第三人民医院重症监护室,四川成都610000

出　　处：《中国介入影像与治疗学》2023年第3期166-170,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：四川省医学科研课题计划项目(S18068)。

摘　　要：目的观察床旁超声定量评估下肢肌肉用于诊断重症监护病房(ICU)获得性衰弱(AW)的价值。方法纳入40例ICU重症患者,根据医学研究委员会(MRC)评分判断ICU-AW。分别于进入ICU第1、4、7日以床旁超声定量评估右下肢肌肉,测量股直肌、股中间肌及胫骨前肌厚度,以及羽状角和股直肌横截面积,以首日为基线数据,计算第4、7日各肌肉萎缩率;对比ICU-AW与非ICU-AW患者之间上述参数的差异;绘制受试者工作特征(ROC)曲线,评估下肢肌肉参数对ICU-AW的诊断效能。结果40例中,21例ICU-AW(ICU-AW组),19例非ICU-AW(非ICUAW组)。进入ICU首日各肌肉参数组间差异均无统计学意义(P均>0.05);第4日ICU-AW组股直肌厚度及横截面积的萎缩率均高于非ICU-AW组(P均<0.05);在第7日,除胫骨前肌羽状角外,ICU-AW组其余肌肉参数萎缩率均高于非ICU-AW组(P均<0.05)。根据第4日股直肌横截面积及厚度萎缩率诊断ICU-AW的曲线下面积(AUC)分别为0.708、0.684;以第7日股直肌厚度萎缩率诊断ICU-AW的AUC为0.844。结论床旁超声定量评估下肢肌肉有助于早期诊断ICU-AW;进入ICU第7日股直肌厚度萎缩率对于ICU-AW的诊断价值较高。Objective To explore the value of bedside ultrasound quantitative evaluation of lower extremity muscle for diagnosing intensive care unit(ICU)acquired weakness(ICU-AW).Methods Forty critically patients in ICU were enrolled,and ICU-AW was judged according to medical research council(MRC)scores.The muscles of the right lower limb were examined with bedside ultrasound on the 1st,4th and 7th day of admission to ICU.The thickness and pinniate angle of rectus femoris,vastus intermedius,as well as anterior tibial muscle and the cross-sectional area of the rectus femoris were measured.Taken the measuring results of the 1st day as baseline data,the atrophy rate of the muscles at 4th and 7th day were calculated,and the above parameters were compared between ICU-AW and no ICU-AW patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of lower limb muscle parameters obtained with bedside ultrasound for ICU-AW.Results Twenty-one patients were found with ICU-AW(ICU-AW group),while 19 patients not with ICU-AW(non ICU-AW group).On the first day of ICU,no significant difference of the above parameters of right lower limb muscles between groups(all P>0.05).On the 4th day,the atrophy rate of rectus femoris thickness and cross-sectional area in ICU-AW group were higher than those in non ICU-AW group(both P<0.05).On the 7th day,besides of pinna angle of anterior tibial muscle,the atrophy rate of other muscle parameters in ICU-AW group were higher than those in non ICU-AW group(all P<0.05).On the 4th day of ICU,the area under the curve(AUC)of the atrophy rate of rectus femoris cross-sectional area and thickness for diagnosing ICU-AW was 0.708 and 0.684,respectively.On the 7th day,the AUC of atrophy rate of rectus femoris thickness for diagnosing ICU-AW was 0.844.Conclusion Bedside ultrasound quantitative evaluation of lower extremity muscles was helpful for early diagnosis of ICU-AW.The atrophy rate of rectus femoris thickness on the 7th day of ICU was valuable for diagnosing ICU-AW.

关 键 词：下肢 肌肉 超声检查 重症监护病房获得性衰弱 

分 类 号：R685[医药卫生—骨科学] R445.1[医药卫生—外科学]