Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium; Department of Intensive Care, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium.
J Crit Care. 2021 Apr;62:65-71. doi: 10.1016/j.jcrc.2020.11.018. Epub 2020 Nov 28.
To investigate the effect of Neuromuscular Electrical Stimulation (NMES) on muscle thickness, strength and morphological and molecular markers of the quadriceps.
Adult critically ill patients with an expected prolonged stay received unilateral quadriceps NMES sessions for 7 consecutive days. Before and after the intervention period, quadriceps thickness was measured with ultrasound. After the intervention period, strength was assessed in cooperative patients and muscle biopsies were taken. Multivariable regression was performed to identify factors affecting muscle thickness loss.
Muscle thickness decreased less in the stimulated leg (-6 ± 16% versus -12 ± 15%, p = 0.014, n = 47). Strength was comparable. Opioid administration, minimal muscle contraction and more muscle thickness loss in the non-stimulated muscle were independently associated with better muscle thickness preservation. Stimulated muscles showed a shift towards larger myofibers and higher MyHC-I gene expression. NMES did not affect gene expression of other myofibrillary proteins, MuRF-1 or atrogin-1. Signs of myofiber necrosis and inflammation were comparable for both muscles.
NMES attenuated the loss of muscle mass, but not of strength, in critically ill patients. Preservation of muscle mass was more likely in patients receiving opioids, patients with a minimal muscle contraction during NMES and patients more prone to lose muscle mass.
clinicaltrials.govNCT02133300.
研究神经肌肉电刺激（NMES）对股四头肌厚度、力量以及形态和分子标志物的影响。
预计需要长时间住院的成年危重症患者接受单侧股四头肌 NMES 治疗，连续 7 天。在干预前后，使用超声测量股四头肌厚度。干预后，对有合作能力的患者进行力量评估，并进行肌肉活检。采用多变量回归分析确定影响肌肉厚度损失的因素。
刺激侧的肌肉厚度减少较少（-6±16% 与-12±15%，p=0.014，n=47）。力量相当。阿片类药物的使用、最小肌肉收缩和非刺激肌肉的肌肉厚度损失更多与更好的肌肉厚度保留相关。刺激的肌肉表现出更大的肌纤维和更高的 MyHC-I 基因表达的转变。NMES 不影响其他肌原纤维蛋白、MuRF-1 或 Atrogin-1 的基因表达。两种肌肉的肌纤维坏死和炎症迹象相当。
NMES 可减轻危重症患者的肌肉质量损失，但不能减轻力量损失。在接受阿片类药物的患者、NMES 期间最小肌肉收缩的患者以及更容易失去肌肉质量的患者中，肌肉质量的保留更有可能。
clinicaltrials.govNCT02133300。
