Naoi Tameto, Morita Mitsuya, Koyama Kansuke, Katayama Shinshu, Tonai Ken, Sekine Toshie, Hamada Keisuke, Nunomiya Shin
Rehabilitation Center, Jichi Medical University, Tochigi, Japan.
Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Prog Rehabil Med. 2022 Jul 9;7:20220034. doi: 10.2490/prm.20220034. eCollection 2022.
This retrospective observational study investigated whether the degree of muscular echogenicity in patients admitted to the intensive care unit (ICU) could help with the early detection of ICU-acquired weakness (ICU-AW) and predict physical function at hospital discharge.
Twenty-five patients who were mechanically ventilated for more than 48 h in the ICU were enrolled. We also enrolled 23 outpatients with nonmuscular diseases as the control group. The target sites for measuring muscular echogenicity were the upper arm and lower leg. First, the muscular echogenicity was compared between surviving nonsurgical patients admitted to the ICU and stable outpatients with nonmuscular diseases. Second, we investigated the relationship between muscular echogenicity and clinical features, e.g., the manual muscle test (MMT), Medical Research Council (MRC) sum score, and Functional Independence Measure (FIM).
Muscular echogenicity in the upper arm in the ICU group was significantly higher than that in the control group. In the ICU group, the degree of muscular echogenicity of the upper arm was inversely correlated with the MMT of elbow flexion (P=0.006; r=-0.532) and the MRC sum score (P=0.002; r=-0.591). However, muscular echogenicity of the upper arm did not correlate with functional FIM (P=0.100; r=-0.344) at hospital discharge.
Critically ill patients can experience pathological muscle weakness associated with increased muscular echogenicity in the upper arm. Additionally, the degree of muscular echogenicity in the upper arm correlated with the MRC sum score and can facilitate early detection of ICU-AW. The relationship between echogenicity and functional outcome at discharge requires elucidation.
本回顾性观察性研究探讨了重症监护病房（ICU）患者的肌肉回声强度是否有助于早期发现ICU获得性肌无力（ICU-AW）并预测出院时的身体功能。
纳入25例在ICU接受机械通气超过48小时的患者。我们还纳入了23例非肌肉疾病门诊患者作为对照组。测量肌肉回声强度的目标部位是上臂和小腿。首先，比较入住ICU的存活非手术患者与患有非肌肉疾病的稳定门诊患者的肌肉回声强度。其次，我们研究了肌肉回声强度与临床特征之间的关系，例如徒手肌力测试（MMT）、医学研究委员会（MRC）总分和功能独立性测量（FIM）。
ICU组上臂的肌肉回声强度显著高于对照组。在ICU组中，上臂肌肉回声强度与肘屈曲的MMT（P=0.006；r=-0.532）和MRC总分（P=0.002；r=-0.591）呈负相关。然而，上臂肌肉回声强度与出院时的功能FIM无关（P=0.100；r=-0.344）。
危重症患者可出现与上臂肌肉回声增强相关的病理性肌无力。此外，上臂肌肉回声强度与MRC总分相关，可有助于早期发现ICU-AW。回声强度与出院时功能结局之间的关系有待阐明。
