Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Katholieke Universiteit Leuven, Herestraat 49, B3000 Leuven, Belgium.
Muscle Nerve. 2012 Jan;45(1):18-25. doi: 10.1002/mus.22219.
Muscle weakness often complicates critical illness and is associated with devastating short- and long-term consequences. For interventional studies, reliable measurements of muscle force in the intensive care unit (ICU) are needed.
To examine interobserver agreement, two observers independently measured Medical Research Council (MRC) sum-score (n = 75) and handgrip strength (n = 46) in a cross-sectional ICU sample.
The intraclass correlation coefficient (ICC) for MRC sum-score was 0.95 (0.92-0.97). The kappa coefficient for identifying "significant weakness" (MRC sum-score <48, MRC subtotal upper limbs <24) and "severe weakness" (MRC sum-score <36) was 0.68 ± 0.09, 0.88 ± 0.07, and 0.93 ± 0.07, respectively. The ICC for left and right handgrip strength was 0.97 (0.94-0.98) and 0.93 (0.86-0.97), respectively.
Interobserver agreement on MRC sum-score and handgrip strength in the ICU was very good. Agreement on "severe weakness" (MRC sum-score <36) was excellent and supports its use in interventional studies. Agreement on "significant weakness" (MRC sum-score <48) was good, but even better using the equivalent cut-off in the upper limbs. It remains to be determined whether this may serve as a substitute.
肌肉无力常常使危重病复杂化，并与毁灭性的短期和长期后果相关。对于介入性研究，需要在重症监护病房（ICU）中可靠地测量肌肉力量。
为了检验观察者间的一致性，两位观察者独立测量了 75 例 ICU 患者的英国医学研究理事会（MRC）总和评分（n=75）和握力（n=46）。
MRC 总和评分的组内相关系数（ICC）为 0.95（0.92-0.97）。用于识别“明显无力”（MRC 总和评分<48，MRC 上肢总分<24）和“严重无力”（MRC 总和评分<36）的 Kappa 系数分别为 0.68±0.09、0.88±0.07 和 0.93±0.07。左手和右手握力的 ICC 分别为 0.97（0.94-0.98）和 0.93（0.86-0.97）。
ICU 中 MRC 总和评分和握力的观察者间一致性非常好。对于“严重无力”（MRC 总和评分<36）的一致性为优，并支持其在介入性研究中的应用。对于“明显无力”（MRC 总和评分<48）的一致性为好，但使用上肢的等效截断值更好。尚需确定其是否可作为替代。
