机械通气重症患者腹部呼气肌厚度降低的危险因素——mNUTRIC评分是一个独立预测指标。
Risk Factors of Decreased Abdominal Expiratory Muscle Thickness in Mechanically Ventilated Critically Ill Patients-The mNUTRIC Score is an Independent Predictor.
作者信息
Vishwas P, Amara Vedaghosh, Maddani Sagar Shanmukhappa, Chaudhuri Souvik, Podder Suvajit
机构信息
Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
出版信息
Indian J Crit Care Med. 2023 Jan;27(1):8-15. doi: 10.5005/jp-journals-10071-24375.
BACKGROUND
The expiratory abdominal skeletal muscles are an important component of the respiratory muscle pump, and their reduced thickness has been associated with difficult weaning. There is no objective score that may help clinicians to predict expiratory abdominal muscle thinning.
PATIENTS AND METHODS
This was a single-center retrospective study on 81 patients undergoing weaning from mechanical ventilation. The thickness of the four abdominal expiratory muscles-rectus abdominis (RA), internal oblique (IO), external oblique (EO), and transversus abdominis (TA) on the day of the first spontaneous breathing trial (SBT), was obtained. The various parameters of the patients with thinner RA, IO, EO, and TA below the determined thickness cut-off values, predicting difficult weaning was analyzed.
RESULTS
Modified nutritional risk in critically ill (mNUTRIC) score was found to be an independent predictor of thinner IO muscle after logistic regression analysis [ = 0.001, adjusted OR 2.33, 95% CI (1.394-3.892)]. The mNUTRIC score was also an independent predictor of thinner EO ( = 0.014, adjusted OR 1.57) and RA muscle ( = 0.002, adjusted OR 1.69). The mNUTRIC cutoff score ≥4 predicted thinner IO (AUC 0.813, < 0.001 sensitivity 71%, specificity 77%) and thinner EO (AUC 0.738, < 0.001, 71% sensitivity, 67% specificity). The mNUTRIC score ≥3 predicted that at least one out of the four abdominal expiratory muscles will be thin (AUC 0.849, < 0.001, 95% CI [0.763-0.935], sensitivity 87.5%, specificity 59%).
CONCLUSION
The mNUTRIC score is an independent predictor of thinner abdominal expiratory muscles in mechanically ventilated critically ill patients.
HOW TO CITE THIS ARTICLE
Vishwas P, Amara V, Maddani SS, Chaudhuri S, Podder S. Risk Factors of Decreased Abdominal Expiratory Muscle Thickness in Mechanically Ventilated Critically Ill Patients-The mNUTRIC Score is an Independent Predictor. Indian J Crit Care Med 2023;27(1):8-15.
背景
呼气时腹部骨骼肌是呼吸肌泵的重要组成部分，其厚度减小与脱机困难有关。目前尚无客观评分可帮助临床医生预测呼气时腹部肌肉变薄情况。
患者与方法
这是一项针对81例接受机械通气撤机患者的单中心回顾性研究。获取首次自主呼吸试验（SBT）当天四块腹部呼气肌（腹直肌（RA）、腹内斜肌（IO）、腹外斜肌（EO）和腹横肌（TA））的厚度。分析RA、IO、EO和TA厚度低于确定厚度临界值的患者的各项参数，以预测脱机困难情况。
结果
经逻辑回归分析发现，危重症患者改良营养风险（mNUTRIC）评分是IO肌变薄的独立预测因素[P = 0.001，调整后OR为2.33，95%CI（1.394 - 3.892）]。mNUTRIC评分也是EO肌变薄（P = 0.014，调整后OR为1.57）和RA肌变薄（P = 0.002，调整后OR为1.69）的独立预测因素。mNUTRIC临界评分≥4可预测IO肌变薄（AUC为0.813，P < 0.001，敏感性71%，特异性77%）和EO肌变薄（AUC为0.738，P < 0.001，敏感性71%，特异性67%）。mNUTRIC评分≥3可预测四块腹部呼气肌中至少有一块会变薄（AUC为0.849，P < 0.001，95%CI[0.763 - 0.935]，敏感性87.5%，特异性59%）。
结论
mNUTRIC评分是机械通气危重症患者腹部呼气肌变薄的独立预测因素。
如何引用本文
Vishwas P, Amara V, Maddani SS, Chaudhuri S, Podder S. 机械通气危重症患者腹部呼气肌厚度降低的危险因素——mNUTRIC评分是独立预测因素。《印度重症医学杂志》2023；27(1):8 - 15。
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