比较两种评估重症监护病房住院期间肌肉质量损失的技术：肌肉超声与生物电阻抗分析。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Nutrition Pub Date : 2024-10-24 DOI:10.1016/j.nut.2024.112607

Gintarė Šostakaitė , Martyna Jauniškytė , Dominykas Budrys , Kastytis Budrevičius , Erika Šalčiūtė-Šimėnė , Marija Svetikienė , Tomas Jovaiša , Tadas Žvirblis , Andrius Klimašauskas , Jūratė Šipylaitė

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引用次数: 0

摘要

背景和目的：肌肉萎缩是长期重症患者中普遍存在的问题，并与不良临床结果有关。由于缺乏一致的方法以及 ICU 患者体液平衡范围的显著影响，ICU 患者肌肉质量的评估面临挑战。这项前瞻性研究旨在比较生物电阻抗分析法（BIA）和超声波法（US）在监测重症患者最初七天的肌肉萎缩方面的效用：研究在一家三级教学医院的混合重症监护室进行，包括在重症监护室住院超过七天的成年患者。在第 1 天（入院 24 小时内）、第 5 天和第 7 天进行测量：在 101 名入选患者中，74 人为男性，平均年龄为 55.3 岁（标准差为 14.8 岁）。平均 APACHE II 评分为 18.2（标清 7.2），第 1 天 SOFA 评分为 7.9（标清 3.2）。重症监护室存活率为 65%，重症监护室平均住院时间为 19.2 天（标准差 19.2 天）。通过 US 测量发现了统计意义上的明显肌肉质量损失，显示了一般肌肉厚度的相对变化：第 5 天为 -2.5%（标清 11.8），第 7 天为 -6.5%（标清 12.4）（P < 0.001）。BIA显示相位角无明显变化，第5天的相对变化为-3.3%（标准差19.9），第7天为-1.9%（标准差21.9），无明显差异（P = 0.374）：结论：超声波是评估和监测重症监护病房住院期间肌肉萎缩的一种更合适的方法，而生物电阻抗分析在第 5 天和第 7 天未能显示出可比的肌肉萎缩程度。这项研究强调了根据具体临床情况选择合适评估方法的重要性，并强调了超声波在评估重症患者肌肉萎缩方面的可靠性。

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Comparison of Two Techniques to Assess Muscle Mass Loss During ICU Stay: Muscle Ultrasound vs Bioelectrical Impedance Analysis

Background and aims

Muscle wasting is a prevalent issue among long-term critically ill patients and is associated with adverse clinical outcomes. Evaluating muscle mass in the ICU presents challenges due to the lack of a consistent methodology and the significant impact of fluid balance range in ICU patients. This prospective study aimed to compare the utility of bioelectrical impedance analysis (BIA) and ultrasound (US) for monitoring muscle wasting in critically ill patients over an initial seven-day period of critical illness.

Methods

Conducted in a tertiary teaching hospital's mixed ICU, the study included adult patients with ICU stays exceeding seven days. Measurements were taken on Day 1 (within 24 hours of ICU admission), Day 5, and Day 7.

Results

Out of 101 enrolled patients, 74 were male, with a mean age of 55.3 (SD 14.8) years. The mean APACHE II score was 18.2 (SD 7.2), and the Day 1 SOFA score was 7.9 (SD 3.2). The ICU survival rate was 65%, and the mean ICU length of stay was 19.2 (SD 19.2) days. Statistically significant muscle mass loss was detected by US measurement, demonstrating the relative change in general muscle thickness: -2.5% (SD 11.8) by Day 5 and -6.5% (SD 12.4) by Day 7 (P < 0.001). BIA demonstrated no significant change in phase angle, as the relative change by Day 5 was -3.3% (SD 19.9) and by Day 7 it was -1.9% (SD 21.9), with no significant difference (P = 0.374).

Conclusions

Ultrasound was a more suitable method for assessing and monitoring muscle wasting during ICU stays, while bioelectrical impedance analysis failed to demonstrate a comparable degree of muscle loss at Days 5 and 7. This study highlights the importance of selecting an appropriate assessment method based on the specific clinical context, emphasizing the reliability of US in evaluating muscle wasting among critically ill patients.

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来源期刊

Nutrition 医学-营养学

CiteScore

7.80

自引率

2.30%

发文量

300

审稿时长

60 days

期刊介绍： Nutrition has an open access mirror journal Nutrition: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. Founded by Michael M. Meguid in the early 1980''s, Nutrition presents advances in nutrition research and science, informs its readers on new and advancing technologies and data in clinical nutrition practice, encourages the application of outcomes research and meta-analyses to problems in patient-related nutrition; and seeks to help clarify and set the research, policy and practice agenda for nutrition science to enhance human well-being in the years ahead.