Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Crit Care Med. 2013 Jan;41(1):93-101. doi: 10.1097/CCM.0b013e31826a3f9e.
ICU admission is associated with decreased physical function for years after discharge. The underlying mechanisms responsible for this muscle function impairment are undescribed. The aim of this study was to describe the biomechanical properties of the quadriceps muscle in ICU survivors 12 months after ICU discharge.
Case-control study with consecutive inclusion of ICU survivors and age- and sex-matched controls.
Patients were treated at a mixed 18-bed ICU at a tertiary care university hospital and tested at a biomechanical university laboratory.
We included 16 male ICU patients (Acute Physiology and Chronic Health Evaluation II score 20 ± 7, mean ± SD), who had stayed in the ICU >72 hrs and survived to 12 months and 15 age- and sex-matched controls.
None.
An extensive battery of biomechanical tests, including maximum, fast, and endurance contractions, was administered during isometric knee extensions while simultaneously recording surface electromyography (quadriceps and hamstrings). Compared to controls, ICU survivors had reduced maximal voluntary torque (22%, 179 ± 64 Nm vs. 230 ± 57 Nm, p = 0.03), absolute rate of force development (50%, 868 ± 372 Nm/sec vs. 1739 ± 470 Nm/sec, p < 0.001) and relative rate of force development (32%, 512 ± 260% maximum voluntary contraction/sec vs. 754 ± 189% maximum voluntary contraction/sec, p < 0.01), and endurance time (40%, 136 ± 84 sec vs. 226 ± 111 sec, p < 0.02). Rate of force development, but not maximal voluntary torque, was significantly reduced after adjusting for muscle mass. Electromyography data indicated no impairment of motor activation strategy or central motor drive. Also, no difference in reaction time was found between patients and controls.
ICU survivors had reduced rate of force development and muscular endurance 1 yr after ICU discharge. Our data indicate that the functional deficits experienced by ICU survivors originate in muscle tissue rather than the nervous system. Also, increased attention to velocity-orientated exercise during rehabilitation of ICU patients may have the potential to better physical outcome after critical illness.
重症监护病房（ICU）入院与出院后数年身体机能下降有关。导致肌肉功能障碍的潜在机制尚不清楚。本研究旨在描述 ICU 出院后 12 个月 ICU 幸存者的股四头肌生物力学特性。
病例对照研究，连续纳入 ICU 幸存者和年龄及性别匹配的对照组。
患者在一所三级大学附属医院的混合 18 床 ICU 接受治疗，并在生物力学大学实验室进行测试。
我们纳入了 16 名男性 ICU 患者（急性生理学和慢性健康评估 II 评分 20 ± 7，平均值 ± 标准差），他们在 ICU 中停留时间超过 72 小时，存活至 12 个月，并与 15 名年龄和性别匹配的对照组进行了比较。
无。
在等长膝关节伸展过程中进行了广泛的生物力学测试，包括最大、快速和耐力收缩，同时记录表面肌电图（股四头肌和腘绳肌）。与对照组相比，ICU 幸存者的最大自主扭矩降低（22%，179 ± 64 Nm 与 230 ± 57 Nm，p = 0.03）、绝对肌力发展速度（50%，868 ± 372 Nm/sec 与 1739 ± 470 Nm/sec，p < 0.001）和相对肌力发展速度（32%，512 ± 260%最大自主收缩/sec 与 754 ± 189%最大自主收缩/sec，p < 0.01）和耐力时间（40%，136 ± 84 sec 与 226 ± 111 sec，p < 0.02）。在调整肌肉量后，肌力发展速度而不是最大自主扭矩显著降低。肌电图数据表明运动激活策略或中枢运动驱动无损伤。此外，患者和对照组之间的反应时间无差异。
ICU 幸存者在 ICU 出院后 1 年时肌力发展速度和肌肉耐力降低。我们的数据表明，ICU 幸存者的功能缺陷源于肌肉组织，而不是神经系统。此外，在 ICU 患者康复过程中增加对速度定向运动的关注，可能对危重病后身体恢复有潜在益处。
