机械通气患者膈肌和肋间肌厚度的变化：一项前瞻性观察性超声研究。
Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: a prospective observational ultrasonography study.
作者信息
Nakanishi Nobuto, Oto Jun, Ueno Yoshitoyo, Nakataki Emiko, Itagaki Taiga, Nishimura Masaji
机构信息
1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan.
2Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto, Tokushima, 770-8539 Japan.
出版信息
J Intensive Care. 2019 Dec 2;7:56. doi: 10.1186/s40560-019-0410-4. eCollection 2019.
BACKGROUND
Diaphragm atrophy is observed in mechanically ventilated patients. However, the atrophy is not investigated in other respiratory muscles. Therefore, we conducted a two-center prospective observational study to evaluate changes in diaphragm and intercostal muscle thickness in mechanically ventilated patients.
METHODS
Consecutive adult patients who were expected to be mechanically ventilated longer than 48 h in the ICU were enrolled. Diaphragm and intercostal muscle thickness were measured on days 1, 3, 5, and 7 with ultrasonography. The primary outcome was the direction of change in muscle thickness, and the secondary outcomes were the relationship of changes in muscle thickness with patient characteristics.
RESULTS
Eighty patients (54 males and 26 females; mean age, 68 ± 14 years) were enrolled. Diaphragm muscle thickness decreased, increased, and remained unchanged in 50 (63%), 15 (19%), and 15 (19%) patients, respectively. Intercostal muscle thickness decreased, increased, and remained unchanged in 48 (60%), 15 (19%), and 17 (21%) patients, respectively. Decreased diaphragm or intercostal muscle thickness was associated with prolonged mechanical ventilation (median difference (MD), 3 days; 95% CI (confidence interval), 1-7 and MD, 3 days; 95% CI, 1-7, respectively) and length of ICU stay (MD, 3 days; 95% CI, 1-7 and MD, 3 days; 95% CI, 1-7, respectively) compared with the unchanged group. After adjusting for sex, age, and APACHE II score, they were still associated with prolonged mechanical ventilation (hazard ratio (HR), 4.19; 95% CI, 2.14-7.93 and HR, 2.87; 95% CI, 1.53-5.21, respectively) and length of ICU stay (HR, 3.44; 95% CI, 1.77-6.45 and HR, 2.58; 95% CI, 1.39-4.63, respectively) compared with the unchanged group.
CONCLUSIONS
Decreased diaphragm and intercostal muscle thickness were frequently seen in patients under mechanical ventilation. They were associated with prolonged mechanical ventilation and length of ICU stay.
TRIAL REGISTRATION
UMIN000031316. Registered on 15 February 2018.
背景
在机械通气患者中观察到膈肌萎缩。然而，其他呼吸肌的萎缩情况尚未得到研究。因此，我们进行了一项双中心前瞻性观察研究，以评估机械通气患者膈肌和肋间肌厚度的变化。
方法
纳入预计在重症监护病房（ICU）接受机械通气超过48小时的成年连续患者。在第1、3、5和7天使用超声测量膈肌和肋间肌厚度。主要结局是肌肉厚度的变化方向，次要结局是肌肉厚度变化与患者特征的关系。
结果
共纳入80例患者（54例男性和26例女性；平均年龄68±14岁）。膈肌厚度减少、增加和保持不变的患者分别有50例（63%）、15例（19%）和15例（19%）。肋间肌厚度减少、增加和保持不变的患者分别有48例（60%）、15例（19%）和17例（21%）。与厚度保持不变的组相比，膈肌或肋间肌厚度减少与机械通气时间延长（中位数差异（MD）为3天；95%置信区间（CI）为1 - 7天，以及MD为3天；95%CI为1 - 7天）和ICU住院时间（MD为3天；95%CI为1 - 7天，以及MD为3天；95%CI为1 - 7天）相关。在调整性别、年龄和急性生理与慢性健康状况评分系统（APACHE II）评分后，与厚度保持不变的组相比，它们仍与机械通气时间延长（风险比（HR）为4.19；95%CI为2.14 - 7.93，以及HR为2.87；95%CI为1.53 - 5.21）和ICU住院时间（HR为3.44；95%CI为1.77 - 6.45，以及HR为2.58；95%CI为1.39 - 4.63）相关。
结论
机械通气患者中经常出现膈肌和肋间肌厚度减少的情况。它们与机械通气时间延长和ICU住院时间相关。
试验注册
UMIN000031316。于2018年2月15日注册。
Zotero 插件