新型冠状病毒肺炎患者的重症监护病房获得性肌无力：发生率及相关因素
Intensive Care Unit-Acquired Weakness in Patients With COVID-19: Occurrence and Associated Factors.
作者信息
Schmidt Débora, Piva Taila Cristina, Glaeser Sheila Suzana, Piekala Daniele Martins, Berto Paula Pinheiro, Friedman Gilberto, Sbruzzi Graciele
机构信息
Serviço de Fisioterapia, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
Postgraduate Program in Human Movement Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
出版信息
Phys Ther. 2022 May 5;102(5). doi: 10.1093/ptj/pzac028.
OBJECTIVE
The primary objective of this study was to identify the occurrence and factors associated with intensive care unit (ICU)-acquired weakness (ICUAW) in patients with COVID-19. Secondarily, we monitored the evolution of muscle strength and mobility among individuals with ICUAW and those without ICUAW and the association of these variables with length of stay, mechanical ventilation (MV), and other clinical variables.
METHODS
In this prospective observational study, individuals admitted to the ICU for >72 hours with COVID-19 were evaluated for muscle strength and mobility at 3 times: when being weaned from ventilatory support, discharged from the ICU, and discharged from the hospital. Risk factors for ICUAW were monitored.
RESULTS
The occurrences of ICUAW at the 3 times evaluated among the 75 patients included were 52%, 38%, and 13%. The length of the ICU stay (29.5 [IQR = 16.3-42.5] vs 11 [IQR = 6.5-16] days), the length of the hospital stay (43.5 [IQR = 22.8-55.3] vs 16 [IQR = 12.5-24] days), and time on MV (25.5 [IQR = 13.8-41.3] vs 10 [IQR = 5-22.5] days) were greater in patients with ICUAW. Muscle strength and mobility were lower at all times assessed in patients with ICUAW. Bed rest time for all patients (relative risk = 1.14; 95% CI = 1.02 to 1.28) and use of corticosteroids (relative risk = 1.01; 95% CI = 1.00 to 1.03) for those who required MV were factors independently associated with ICUAW. Muscle strength was found to have a positive correlation with mobility and a negative correlation with lengths of stay in the ICU and hospital and time on MV.
CONCLUSION
The occurrence of ICUAW was high on patients' awakening in the ICU but decreased throughout hospitalization; however, strength and mobility remained compromised at hospital discharge. Bed rest time and use of corticosteroids (for those who needed MV) were factors independently associated with ICUAW in patients with COVID-19.
IMPACT
Patients who had COVID-19 and developed ICUAW had longer periods of ICU stay, hospital stay, and MV. Bed rest time and use of corticosteroids (for those who required MV) were factors independently associated with ICUAW.
目的
本研究的主要目的是确定新型冠状病毒肺炎（COVID-19）患者中重症监护病房（ICU）获得性肌无力（ICUAW）的发生率及相关因素。其次，我们监测了发生ICUAW和未发生ICUAW患者的肌肉力量和活动能力的变化，以及这些变量与住院时间、机械通气（MV）和其他临床变量之间的关联。
方法
在这项前瞻性观察研究中，对因COVID-19入住ICU超过72小时的患者在3个时间点进行肌肉力量和活动能力评估：撤机时、从ICU出院时和从医院出院时。监测ICUAW的危险因素。
结果
纳入的75例患者在3个评估时间点的ICUAW发生率分别为52%、38%和13%。发生ICUAW的患者ICU住院时间（29.5[四分位间距（IQR）=16.3 - 42.5]天 vs 11[IQR = 6.5 - 16]天）、住院时间（43.5[IQR = 22.8 - 55.3]天 vs 16[IQR = 12.5 - 24]天）和MV时间（25.5[IQR = 13.8 - 41.3]天 vs 10[IQR = 5 - 22.5]天）更长。在所有评估时间点，发生ICUAW的患者肌肉力量和活动能力均较低。所有患者的卧床休息时间（相对危险度=1.14；95%置信区间[CI]=1.02至1.28）以及需要MV的患者使用皮质类固醇（相对危险度=1.01；95%CI = 1.00至1.03）是与ICUAW独立相关的因素。发现肌肉力量与活动能力呈正相关，与ICU和医院住院时间以及MV时间呈负相关。
结论
患者在ICU苏醒时ICUAW发生率较高，但在整个住院期间有所下降；然而，出院时力量和活动能力仍受损。卧床休息时间和皮质类固醇的使用（对于需要MV的患者）是COVID-19患者中与ICUAW独立相关的因素。
影响
发生COVID-19并出现ICUAW的患者ICU住院时间、住院时间和MV时间更长。卧床休息时间和皮质类固醇的使用（对于需要MV的患者）是与ICUAW独立相关的因素。
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