Özdemir Uğur, Özdemir Merve, Aygencel Gulbin, Kaya Burcu, Türkoğlu Melda
Internal Medicine specialist, Fellow of Critical Care Medicine. Division of Critical Care Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Nutrition and Dietetics, Başkent University Faculty of Health Sciences, Ankara, Turkey.
Rev Assoc Med Bras (1992). 2019 Aug 5;65(7):952-958. doi: 10.1590/1806-9282.65.7.952.
In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status.
55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected.
There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04).
Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.
在这项前瞻性观察性研究中，我们旨在探讨通过超声检查（USG）测量的股四头肌最大压缩厚度（MC）和未压缩厚度（UC）在检测不同容量状态的重症监护患者（ICP）营养风险中的作用。
纳入55例患者。在入住ICU后的头48小时内，使用标准USG设备测量右、左以及双侧的未压缩股四头肌厚度（ucQFMT）和最大压缩股四头肌厚度（mcQFMT）。通过临床检查和USG设备确定患者的容量状态。收集序贯器官衰竭评估（SOFA）、急性生理与慢性健康状况评分系统II（APACHE II）、改良营养风险评分（NUTRIC）以及人口统计学数据。
在左侧、右侧以及双侧mcQFMT测量方面，患者的营养风险存在显著差异（分别为p = 0.025、p = 0.039；p = 0.028），机械通气需求（p = 0.014）、感染存在情况（p = 0.019）以及脓毒症（p = 0.006）方面也存在显著差异。在mcQFMT测量方面，不同容量状态之间无显著差异。在多变量分析中，发现mcQFMT测量与高营养风险独立相关（改良NUTRIC评分≥5时，p = 0.019，Exp(B)=0.256，95%CI = 0.082 - 0.800），以及更高的营养风险（改良NUTRIC评分≥6时，p = 0.009，Exp(B)=0.144，95%CI = 0.033 - 0.620）。总mcQFMT值低于1.36 cm是更高营养风险的预测指标，灵敏度为79%，特异度为70%（AUC = 0.749，p = 0.002，似然比 = 2.04）。
超声测量双侧mcQFMT可作为不同容量状态的重症监护医学患者新的营养风险评估参数。因此，在这些患者群体中，可以轻松识别出可能从积极营养治疗中获益的患者。
