From the Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.
Berlin Institute of Health (BIH), Berlin, Germany.
Anesth Analg. 2020 Feb;130(2):341-351. doi: 10.1213/ANE.0000000000004068.
Skeletal muscle failure in critical illness (intensive care unit-acquired weakness) is a well-known complication developing early during intensive care unit stay. However, muscle weakness during the perioperative setting has not yet been investigated.
We performed a subgroup investigation of a prospective observational trial to investigate perioperative muscle weakness. Eighty-nine patients aged 65 years or older were assessed for handgrip strength preoperatively, on the first postoperative day, at intensive care unit discharge, at hospital discharge, and at 3-month follow-up. Functional status was evaluated perioperatively via Barthel index, instrumental activities of daily living, Timed Up and Go test, and functional independence measure. After exclusion of patients with intensive care unit-acquired weakness or intensive care unit stay of ≥72 hours, 59 patients were included into our analyses. Of these, 14 patients had additional pulmonary function tests preoperatively and on postoperative day 1. Blood glucose was measured intraoperatively every 20 minutes.
Handgrip strength significantly decreased after surgery on postoperative day 1 by 16.4% (P < .001). Postoperative pulmonary function significantly decreased by 13.1% for vital capacity (P = .022) and 12.6% for forced expiratory volume in 1 second (P = .001) on postoperative day 1. Handgrip strength remained significantly reduced at hospital discharge (P = .016) and at the 3-month follow-up (P = .012). Perioperative glucose levels showed no statistically significant impact on muscle weakness. Instrumental activities of daily living (P < .001) and functional independence measure (P < .001) were decreased at hospital discharge, while instrumental activities of daily living remained decreased at the 3-month follow-up (P = .026) compared to preoperative assessments.
Perioperatively acquired weakness occurred, indicated by a postoperatively decreased handgrip strength, decreased respiratory muscle function, and impaired functional status, which partly remained up to 3 months.
危重病（重症监护病房获得性肌无力）中的骨骼肌衰竭是在重症监护病房住院期间早期发生的一种众所周知的并发症。然而，围手术期的肌肉无力尚未得到研究。
我们对一项前瞻性观察性试验进行了亚组研究，以调查围手术期肌肉无力。89 名年龄在 65 岁或以上的患者在术前、术后第 1 天、重症监护病房出院时、出院时和 3 个月随访时进行握力评估。围手术期通过巴氏指数、工具性日常生活活动、计时起立行走测试和功能独立性测量来评估功能状态。排除重症监护病房获得性肌无力或重症监护病房入住时间≥72 小时的患者后，59 名患者纳入我们的分析。其中，14 名患者在术前和术后第 1 天进行了额外的肺功能测试。术中每 20 分钟测量一次血糖。
术后第 1 天握力显著下降 16.4%（P<.001）。术后第 1 天肺活量显著下降 13.1%（P=.022），第 1 秒用力呼气量显著下降 12.6%（P=.001）。出院时（P=.016）和 3 个月随访时（P=.012）握力仍显著下降。围手术期血糖水平对肌肉无力无统计学显著影响。出院时日常生活活动工具性能力（P<.001）和功能独立性测量（P<.001）下降，而与术前评估相比，日常生活活动工具性能力在 3 个月随访时仍下降（P=.026）。
术后发生获得性肌无力，表现为术后握力下降、呼吸肌功能下降和功能状态受损，部分持续至 3 个月。
