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新型冠状病毒肺炎危重症患者肌肉质量、力量和活动能力的特征:按性别、年龄、机械通气天数和肌肉无力情况分布

Characterization of muscle mass, strength and mobility of critically ill patients with SARS-CoV-2 pneumonia: Distribution by sex, age, days on mechanical ventilation, and muscle weakness.

作者信息

Silva-Gutiérrez Alexis, Artigas-Arias Macarena, Alegría-Molina Andrea, Guerra-Vega Pablo, Navarrete Pablo, Venegas Ángela, Montecinos Carlos, Vásquez Lorena, Moraga Karen, Rubilar César, Villagrán Germán, Parada Rodrigo, Vitzel Kaio Fernando, Marzuca-Nassr Gabriel Nasri

机构信息

Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile.

Doctorado en Ciencias mención Biología Celular y Molecular Aplicada, Universidad de La Frontera, Temuco, Chile.

出版信息

Front Physiol. 2023 Feb 10;14:1095228. doi: 10.3389/fphys.2023.1095228. eCollection 2023.

Abstract

Quantify and categorize by sex, age, and time spent on mechanical ventilation (MV), the decline in skeletal muscle mass, strength and mobility in critically ill patients infected with SARS-CoV-2 and requiring mechanical ventilation while at intensive care unit (ICU). Prospective observational study including participants recruited between June 2020 and February 2021 at Hospital Clínico Herminda Martin (HCHM), Chillán, Chile. The thickness of the quadriceps muscle was evaluated by ultrasonography (US) at intensive care unit admission and awakening. Muscle strength and mobility were assessed, respectively, through the Medical Research Council Sum Score (MRC-SS) and the Functional Status Score for the Intensive Care Unit Scale (FSS-ICU) both at awakening and at ICU discharge. Results were categorized by sex (female or male), age (<60 years old or ≥60 years old) and time spent on MV (≤10 days or >10 days). Intensive care unit in a public hospital. 132 participants aged 18 years old or above (women n = 49, 60 ± 13 years; men n = 85, 59 ± 12 years) admitted to intensive care unit with a confirmed diagnosis of severe SARS-CoV-2 and requiring MV for more than 48 h were included in the study. Patients with previous physical and or cognitive disorders were excluded. Not applicable. Muscle thickness have significantly decreased during intensive care unit stay, vastus intermedius (-11%; = 0.025), rectus femoris (-20%; < 0.001) and total quadriceps (-16%; < 0.001). Muscle strength and mobility were improved at intensive care unit discharge when compared with measurements at awakening in intensive care unit (time effect, < 0.001). Patients ≥60 years old or on MV for >10 days presented greater muscle loss, alongside with lower muscle strength and mobility. Critically ill patients infected with SARS-CoV-2 and requiring MV presented decreased muscle mass, strength, and mobility during their intensive care unit stay. Factors associated with muscle mass, such as age >60 years and >10 days of MV, exacerbated the critical condition and impaired recovery.

摘要

按性别、年龄和机械通气(MV)时长,对感染新型冠状病毒肺炎(SARS-CoV-2)且在重症监护病房(ICU)需要机械通气的危重症患者的骨骼肌质量、力量和活动能力下降情况进行量化和分类。前瞻性观察性研究,纳入2020年6月至2021年2月期间在智利奇廉市埃尔明达·马丁临床医院(HCHM)招募的参与者。在重症监护病房入院时和苏醒时,通过超声检查(US)评估股四头肌厚度。在苏醒时和重症监护病房出院时,分别通过医学研究委员会总评分(MRC-SS)和重症监护病房功能状态评分量表(FSS-ICU)评估肌肉力量和活动能力。结果按性别(女性或男性)、年龄(<60岁或≥60岁)和机械通气时长(≤10天或>10天)进行分类。一家公立医院的重症监护病房。本研究纳入132名18岁及以上的参与者(女性n = 49,60±13岁;男性n = 85,59±12岁),他们因确诊为重症SARS-CoV-2而入住重症监护病房且需要机械通气超过48小时。排除既往有身体和/或认知障碍的患者。不适用。在重症监护病房住院期间,肌肉厚度显著下降,股中间肌(-11%;P = 0.025)、股直肌(-20%;P < 0.001)和股四头肌总体厚度(-16%;P < 0.001)。与在重症监护病房苏醒时的测量结果相比,重症监护病房出院时肌肉力量和活动能力有所改善(时间效应,P < 0.001)。年龄≥60岁或机械通气>10天的患者肌肉损失更大,同时肌肉力量和活动能力更低。感染SARS-CoV-2且需要机械通气的危重症患者在重症监护病房住院期间肌肉质量、力量和活动能力下降。与肌肉质量相关的因素,如年龄>60岁和机械通气>10天,会加重病情并阻碍恢复。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a93c/9950093/2fc66f94aa53/fphys-14-1095228-g001.jpg

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