Department of Intensive Care, the Section for Surgical Pathophysiology, Rigshospitalet, University Hospital of Copenhagen, and the Laboratory of Biological Anthropology, Institute of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark.
Crit Care Med. 2011 Mar;39(3):456-61. doi: 10.1097/CCM.0b013e318205c7bc.
Intensive care unit admission is associated with muscle wasting and impaired physical function. We investigated the effect of early transcutaneous electrical muscle stimulation on quadriceps muscle volume in patients with septic shock.
Randomized interventional study using a single-legged exercise design with the contralateral leg serving as a paired control.
A mixed 18-bed intensive care unit at a tertiary care university hospital.
Eight adult male intensive care unit patients with septic shock included within 72 hrs of diagnosis.
After randomization of the quadriceps muscles, transcutaneous electrical muscle stimulation was applied on the intervention side for 7 consecutive days and for 60 mins per day. All patients underwent computed tomographic scans of both thighs immediately before and after the 7-day treatment period. The quadriceps muscle was manually delineated on the computed tomography slices, and muscle volumes were calculated after three-dimensional reconstruction.
Median age and Acute Physiology and Chronic Health Evaluation II score were 67 years (interquartile range, 64-72 years) and 25 (interquartile range, 20-29), respectively. During the 7-day study period, the volume of the quadriceps muscle on the control thigh decreased by 16% (4-21%, p=.03) corresponding to a rate of 2.3% per day. The volume of the stimulated muscle decreased by 20% (3-25%, p=.04) corresponding to a rate of 2.9% per day (p=.12 for the difference in decrease). There was no difference in muscle volume between the stimulated and nonstimulated thigh at baseline (p=.10) or at day 7 (p=.12). The charge delivered to the muscle tissue per training session (0.82 [0.66-1.18] coulomb) correlated with the maximum sequential organ failure assessment score.
We observed a marked decrease in quadriceps volume within the first week of intensive care for septic shock. This loss of muscle mass was unaffected by transcutaneous electrical muscle stimulation applied for 60 mins per day for 7 days.
重症监护病房（ICU）入住与肌肉消耗和身体功能受损有关。我们研究了早期经皮电肌肉刺激对败血症性休克患者股四头肌体积的影响。
采用单侧运动设计的随机干预研究，对侧腿作为配对对照。
一家三级护理大学医院的混合 18 床重症监护病房。
8 名成年男性败血症性休克患者，在确诊后 72 小时内纳入研究。
股四头肌随机分组后，干预侧连续 7 天每天接受 60 分钟经皮电肌肉刺激。所有患者在 7 天治疗期前后立即进行双侧大腿计算机断层扫描。在计算机断层扫描切片上手动描绘股四头肌，在三维重建后计算肌肉体积。
中位年龄和急性生理学和慢性健康评估 II 评分分别为 67 岁（四分位间距，64-72 岁）和 25（四分位间距，20-29）。在 7 天的研究期间，对照腿的股四头肌体积减少了 16%（4-21%，p=.03），相当于每天减少 2.3%。受刺激肌肉的体积减少了 20%（3-25%，p=.04），相当于每天减少 2.9%（刺激与非刺激大腿之间的减少差异无统计学意义，p=.12）。刺激和非刺激大腿的肌肉体积在基线时（p=.10）或第 7 天（p=.12）均无差异。每次训练的肌肉组织输送电荷量（0.82[0.66-1.18]库仑）与最大连续器官衰竭评估评分相关。
我们观察到败血症性休克患者 ICU 入住后第一周股四头肌体积明显减少。这种肌肉质量的损失不受每天 60 分钟经皮电肌肉刺激治疗 7 天的影响。
