机械通气患者肌肉减少症的诊断及其对预后的影响  

Diagnosis of sarcopenia in mechanically ventilated patients and its impact on prognosis

作　　者：刘春峰 徐朝晖 施红伟 陈瑢 马腾飞 李鹏飞 袁蓉 陈建荣[2] 徐爱明 Liu Chunfeng;Xu Zhaohui;Shi Hongwei;Chen Rong;Ma Tengfei;Li Pengfei;Yuan Rong;Chen Jianrong;Xu Aiming(Intensive Care Unit,Rudong Hospital Affiliated to Xinglin College,Nantong University,Nantong 226400,China;Emergency Medicine Department,Rudong Hospital Affiliated to Xinglin College,Nantong University,Nantong 226400,China;Emergency Medicine Department,the Second Affiliated Hospital of Nantong University,Nantong 226000,China)

机构地区：[1]南通大学杏林学院附属如东医院重症医学科,江苏南通226400 [2]南通大学第二附属医院急诊科,江苏南通226400 [3]南通大学杏林学院附属如东医院急诊科,江苏南通226400

出　　处：《中华临床医师杂志(电子版)》2024年第9期820-825,共6页Chinese Journal of Clinicians(Electronic Edition)

基　　金：南通市卫生健康委员会面上科研项目(MB2021090)

摘　　要：目的探讨重症监护病房(ICU)患者肌肉减少症(肌少症)的诊断方法,分析其在机械通气患者中的患病率及预后的影响。方法本研究纳入了2021年1月至2023年12月期间在南通大学杏林学院附属如东医院ICU因呼吸衰竭接受机械通气治疗的62例患者。通过SARC-F量表和CT-胸部骨骼肌肌肉指数(SMI)评估患者肌少症的发生,并根据诊断结果将患者分为肌少症组和非肌少症组。对比分析2组患者在入ICU后24 h与72 h的急性生理与慢性健康评分(APACHE-II)、序贯器官衰竭估计(SOFA)评分,入ICU时的营养风险筛查评分(NRS-2002)、入ICU后7 d的胃肠内营养达标率、机械通气时间、ICU住院时间和28 d病死率的变化。结果在62例患者中,24例被诊断为肌少症,患病率为38.7%。肌少症患者的NRS-2002评分、72 h APACHE-II评分和72 h SOFA评分均显著高于非肌少症患者,且其机械通气时间和ICU住院时间明显延长。此外,肌少症组患者的7 d胃肠内营养达标率低于非肌少症组,差异均具有统计学意义(P<0.05)。结论结合SARC-F量表与胸部CT-SMI指标对接受机械通气治疗的ICU患者进行肌少症评估的一种有效方法。肌少症会显著影响机械通气患者的康复过程和整体健康状态,因此应尽早进行诊断、评估和治疗,以最大限度提高患者的临床获益。Objective To explore effective diagnostic methods for sarcopenia,its prevalence,and its impact on the prognosis of intensive care unit(ICU)patients receiving mechanical ventilation.Methods This study included 62 patients with respiratory failure who received mechanical ventilation in the ICU of Rudong Hospital Affiliated to Xinglin College,Nantong University between January 2021 and December 2023.The SARC-F questionnaire and the thoracic skeletal muscle index(SMI)to diagnose sarcopenia.Patients were divided into sarcopenia and non-sarcopenia groups based on the diagnosis results.Key variables,including age,gender,APACHE-II and SOFA scores at 24 and 72 hours after admission,NRS-2002 score at admission,7-day gastrointestinal nutrition compliance rate,mechanical ventilation duration,ICU stay,and 28-day mortality rate,were compared between the two groups.Results Of the 62 patients,24 were diagnosed with sarcopenia,resulting in a prevalence rate of 38.7%.The sarcopenia group had significantly higher NRS-2002 score,72-hour APACHE-II and SOFA scores,longer mechanical ventilation duration,extended ICU stay,and lower 7-day gastrointestinal nutrition compliance rate compared to the nonsarcopenia group(P<0.05).Conclusion The combination of the SARC-F questionnaire and thoracic SMI may help effectively diagnose sarcopenia in mechanically ventilated ICU patients.Sarcopenia is prevalent in this population and is associated with a poor prognosis,highlighting the need for early diagnosis,evaluation,and treatment to optimize patient outcomes.

关 键 词：SARC-F量表 胸部骨骼肌肌肉指数 肌肉减少症 机械通气 重症监护 

分 类 号：R459.7[医药卫生—急诊医学]