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

Q3 Medicine
Jinlan Ma, Yuhan Xia, Ting Wang, Jing Chen, Hongxiao Yang, Huan Ding
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引用次数: 0

Abstract

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 that on day 1 [121.77 (95.46, 164.55) vs. 97.00 (70.26, 130.50)], and RF-CSA atrophy rate on day 7 was significantly higher than that on day 4 [%: -39.7 (-52.4, -22.1) vs. -26.5 (-40.2, -16.4)]. RF-CSA was significantly lower on day 7 compared to day 1 [cm2: 1.3 (1.0, 2.5) vs. 2.1 (1.7, 2.9)], with all differences being statistically significant (all P < 0.05). Pearson correlation analysis showed that RF-CSA on day 7 of ICU admission was negatively associated with the UCR on the same day (r = -0.407, P = 0.029).

Conclusions: Diaphragmatic dysfunction in patients with sepsis occurred early and can be improved. Limb skeletal muscle dysfunction occurred relatively later and progresses progressively. The RF-CSA on day 7 of ICU admission may be a reliable measure of limb skeletal muscle dysfunction in patients with sepsis, can be an indicator of early identification and diagnosis of ICU-acquired weakness (ICU-AW). Continuous loss of muscle mass occurring in septic patients is mainly associated with persistent organismal catabolism, and undergoes significant changes around a week in ICU.

[床旁超声评估脓毒症患者膈肌和四肢骨骼肌的动态变化及其与血尿素/肌酐比值的相关性]。
目的通过床旁超声研究脓毒症患者膈肌和四肢骨骼肌的动态变化,以及它们与重症监护病房(ICU)入院 7 天后血尿素/肌酐比值(UCR)的相关性:方法:进行了一项前瞻性观察研究。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 例败血症患者作为研究对象。观察患者的一般资料、入ICU第1、4、7天的实验室指标[尿素、血清肌酐(SCr)和UCR]以及预后指标。床旁超声波用于评估膈肌形态的动态变化[包括膈肌偏移(DE)、吸气末膈肌厚度(DTei)和呼气末膈肌厚度(DTee)]、以及四肢骨骼肌(股四头肌)形态[包括股直肌肌层厚度 (RF-MLT)、股中肌肌层厚度 (VI-MLT) 和股直肌横截面积 (RF-CSA)]。计算膈肌增厚率(DTF)和RF-CSA萎缩率,并记录膈肌和四肢骨骼肌功能障碍的发生率。通过皮尔逊相关性分析入ICU 7天后各时间点的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。随着入住重症监护室时间的延长,脓毒症患者膈肌功能障碍的发生率先上升后下降(入住重症监护室第1天、第4天和第7天分别为63.6%、69.6%和58.6%),而四肢骨骼肌功能障碍的发生率呈上升趋势(入住重症监护室第4天和第7天分别为54.3%和62.1%),入住重症监护室第4天和第7天同时发生的概率分别为32.6%和34.5%。入住 ICU 第 7 天的 UCR 明显高于第 1 天 [121.77 (95.46, 164.55) vs. 97.00 (70.26, 130.50)],第 7 天的 RF-CSA 萎缩率明显高于第 4 天 [%: -39.7 (-52.4, -22.1) vs. -26.5 (-40.2, -16.4)]。与第 1 天相比,第 7 天的 RF-CSA 明显降低[平方厘米:1.3 (1.0, 2.5) vs. 2.1 (1.7, 2.9)],所有差异均有统计学意义(所有 P <0.05)。皮尔逊相关分析显示,ICU入院第7天的RF-CSA与同一天的UCR呈负相关(r = -0.407,P = 0.029):结论:脓毒症患者的膈肌功能障碍发生较早,可以得到改善。结论:脓毒症患者的膈肌功能障碍发生较早,并可得到改善,而肢体骨骼肌功能障碍发生相对较晚,并呈进行性发展。入ICU第7天的RF-CSA可能是脓毒症患者肢体骨骼肌功能障碍的可靠测量指标,可作为ICU获得性肌无力(ICU-AW)的早期识别和诊断指标。脓毒症患者肌肉质量的持续丧失主要与机体持续分解代谢有关,并在重症监护室一周左右发生显著变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Zhonghua wei zhong bing ji jiu yi xue
Zhonghua wei zhong bing ji jiu yi xue Medicine-Critical Care and Intensive Care Medicine
CiteScore
1.00
自引率
0.00%
发文量
42
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