C.E. Baldwin, PhD, BPhysiotherapy (Hon), Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Physiotherapy Department, Flinders Medical Centre, Bedford Park, South Australia, Australia; and Faculty of Health Sciences, Department of Critical Care Medicine, School of Medicine, Flinders University, Bedford Park, South Australia, Australia. Mailing address: Division of Health Sciences, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, South Australia, Australia, 5001.
Phys Ther. 2014 Jan;94(1):68-82. doi: 10.2522/ptj.20130048. Epub 2013 Sep 5.
Skeletal muscle wasting and weakness are common in patients with sepsis in the intensive care unit, although less is known about deficits in diaphragm and limb muscles when mechanical ventilation also is required.
The objective of this study was to concurrently investigate relative differences in both thickness and strength of respiratory and peripheral muscles during routine care.
A prospective, cross-sectional study of 16 alert patients with sepsis and 16 people who were healthy (control group) was used.
Assessment was made of the diaphragm, upper arm, forearm, and thigh muscle thicknesses with the use of ultrasound; respiratory muscle strength by means of maximal inspiratory pressure; and isometric handgrip, elbow flexion, and knee extension forces with the use of portable dynamometry. To describe relative changes, data also were normalized to fat-free body mass (FFM) measured by bioelectrical impedance spectroscopy.
Patients (9 men, 7 women; mean age=62 years, SD=17) were assessed after a median of 16 days (interquartile range=11-29) of intensive care unit admission. Patients' diaphragm thickness did not differ from that of the control group, even for a given FFM. When normalized to FFM, only the difference in patients' mid-thigh muscle size significantly deviated from that of the control group. Within the patient sample, all peripheral muscle groups were thinner compared with the diaphragm. Patients were significantly weaker than were the control group participants in all muscle groups, including for a given FFM. Within the critically ill group, limb weakness was greater than the already-significant respiratory muscle weakness.
Volitional strength tests were applied such that successive measurements from earlier in the course of illness could not be reliably obtained.
When measured at bedside, survivors of sepsis and a period of mechanical ventilation may have respiratory muscle weakness without remarkable diaphragm wasting. Furthermore, deficits in peripheral muscle strength and size may exceed those in the diaphragm.
尽管在需要机械通气的情况下，有关膈肌和肢体肌肉的缺陷知之甚少，但 ICU 中脓毒症患者常出现骨骼肌减少和无力。
本研究旨在同时研究常规护理过程中呼吸肌和外周肌的厚度和力量的相对差异。
使用前瞻性、横断面研究，纳入 16 例脓毒症且意识清醒的患者和 16 例健康对照者。
使用超声评估膈肌、上臂、前臂和大腿肌肉厚度；使用最大吸气压力评估呼吸肌力量；使用便携式测力计评估握力、肘屈肌和膝伸肌等长力量。为了描述相对变化，数据还通过生物电阻抗谱法测量的去脂体重（FFM）进行了标准化。
患者（9 名男性，7 名女性；平均年龄 62 岁，标准差 17 岁）在 ICU 入住后中位数 16 天（四分位间距 11-29 天）进行评估。患者的膈肌厚度与对照组无差异，即使考虑到 FFM 也是如此。按 FFM 标准化后，只有患者中大腿中部肌肉大小的差异与对照组显著不同。在患者样本中，所有外周肌肉群均比膈肌薄。与对照组相比，患者在所有肌肉群中都明显较弱，即使考虑到 FFM 也是如此。在危重病患者组中，肢体无力比已经显著的呼吸肌无力更为严重。
应用了随意强度测试，因此无法可靠地获得疾病早期的连续测量值。
在床边测量时，脓毒症和机械通气一段时间的幸存者可能存在呼吸肌无力，而没有明显的膈肌消耗。此外，外周肌肉力量和大小的缺陷可能超过膈肌。
