床旁超声评估脓毒症患者膈肌和肢体骨骼肌的动态变化及其与血尿素/肌酐比值的相关性  

Dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis assessed by bedside ultrasound and their correlation with blood urea/creatinine ratio

作　　者：马金兰 夏羽菡[2] 王婷 陈静[4] 杨红晓[1] 丁欢[1] Ma Jinlan;Xia Yuhan;Wang Ting;Chen Jing;Yang Hongxiao;Ding Huan(Department of Critical Care Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Clinical Nutrition,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Ningxia Women and Children's Hospital,Peking University First Hospital,Yinchuan 750004,Ningxia Hui Autonomous Region,China;Department of Rehabilitation,General Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia Hui Autonomous Region,China)

机构地区：[1]宁夏医科大学总医院重症医学科,银川750004 [2]宁夏医科大学总医院临床营养科,银川750004 [3]北京大学第一医院宁夏妇女儿童医院,银川750004 [4]宁夏医科大学总医院康复科,银川750004

出　　处：《中华危重病急救医学》2024年第6期643-648,共6页Chinese Critical Care Medicine

基　　金：宁夏回族自治区重点研发计划项目(2022BEG03125)。

摘　　要：目的应用床旁超声探讨脓毒症患者入重症监护病房(ICU)7 d内膈肌和肢体骨骼肌的动态变化及其与血尿素/肌酐比值(UCR)的相关性。方法采用前瞻性观察性研究方法,选择2022年6月至2023年2月入住宁夏医科大学总医院ICU的55例脓毒症患者作为研究对象。观察患者的一般资料、入ICU第1、4、7天实验室检查指标〔血尿素、血肌酐(SCr)、UCR〕和预后指标;应用床旁超声动态评估患者入ICU第1、4、7天膈肌形态学动态变化〔包括膈肌移动度(DE)、吸气末膈肌厚度(DTei)、呼气末膈肌厚度(DTee)〕,以及肢体骨骼肌(股四头肌)形态学动态变化〔包括股直肌厚度(RF-MLT)、股中间肌厚度(VI-MLT)和股直肌横截面积(RF-CSA)〕。计算膈肌增厚分数(DTF)和RF-CSA萎缩率,并统计膈肌功能障碍和肢体骨骼肌功能障碍的发生率。采用Pearson相关性分析患者入ICU 7 d内各时间点膈肌和股四头肌超声形态学参数与UCR的相关性。结果共纳入55例脓毒症患者,其中29例为脓毒性休克。随入ICU时间延长,脓毒症患者膈肌功能障碍发生率呈先升高后下降趋势(入ICU第1、4、7天分别为63.6%、69.6%、58.6%),肢体骨骼肌功能障碍发生率呈升高趋势(入ICU第4天和第7天分别为54.3%、62.1%),入ICU第4天和第7天两者同时发生的概率分别为32.6%、34.5%。脓毒症患者入ICU第7天UCR明显高于第1天〔121.77(95.46,164.55)比97.00(70.26,130.50)〕,RF-CSA萎缩率明显高于第4天〔%:-39.7(-52.4,-22.1)比-26.5(-40.2,-16.4)〕,RF-CSA明显低于第1天〔cm2:1.3(1.0,2.5)比2.1(1.7,2.9)〕,差异均有统计学意义(均P<0.05)。Pearson相关性分析显示,脓毒症患者入ICU第7天RF-CSA与当日UCR呈显著负相关(r=-0.407,P=0.029)。结论脓毒症患者膈肌功能障碍发生早,可改善;肢体骨骼肌功能障碍发生相对滞后,呈进行性加重。入ICU第7天的RF-CSA可能是衡量脓毒症患者肢体骨骼肌功能障碍的可靠指标,能够成为早期识Objective To investigate the dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis by bedside ultrasound and their correlation with the ratio of blood urea/creatinine ratio(UCR)in 7 days after intensive care unit(ICU)admission.Methods A prospective observational study was conducted.A total of 55 patients with sepsis admitted to ICU of General Hospital of Ningxia Medical University from June 2022 to February 2023 were selected as the research objects.General information,laboratory indicators[urea,serum creatinine(SCr),and UCR]on days 1,4,and 7 of ICU admission,and prognostic indicators were observed.Bedside ultrasound was used to assess the dynamic changes of diaphragm morphology[including diaphragmatic excursion(DE),end-inspiratory diaphragm thickness(DTei),and end-expiratory diaphragm thickness(DTee)]on days 1,4,and 7 of ICU admission,as well as limb skeletal muscle(quadriceps femoris)morphology[including rectus femoris-muscle layer thickness(RF-MLT),vastus intermedius-muscle layer thickness(VI-MLT),and rectus femoris-cross sectional area(RF-CSA)].Diaphragm thickening fraction(DTF)and RF-CSA atrophy rate were calculated,and the incidence of diaphragm and limb skeletal muscle dysfunction was recorded.The correlation between ultrasound morphological parameters of diaphragm and quadriceps and UCR at each time points in 7 days after ICU admission was analyzed by Pearson correlation.Results A total of 55 patients with sepsis were included,of which 29 were in septic shock.As the duration of ICU admission increased,the incidence of diaphragm dysfunction in patients with sepsis increased first and then decreased(63.6%,69.6%,and 58.6%on days 1,4,and 7 of ICU admission,respectively),while the incidence of limb skeletal muscle dysfunction showed an increasing trend(54.3%and 62.1%on days 4 and 7 of ICU admission,respectively),with a probability of simultaneous occurrence on days 4 and 7 of ICU admission were 32.6%and 34.5%,respectively.The UCR on day 7 of ICU admission was significantly higher than t

关 键 词：脓毒症 床旁超声检查 膈肌 股四头肌 血尿素/肌酐比值 相关性 

分 类 号：R459.7[医药卫生—急诊医学]