ASSOCIATION BETWEEN MUSCLE WASTING AND MUSCLE STRENGTH IN PATIENTS WHO DEVELOPED SEVERE SEPSIS AND SEPTIC SHOCK
ASSOCIATION BETWEEN MUSCLE WASTING AND MUSCLE STRENGTH IN PATIENTS WHO DEVELOPED SEVERE SEPSIS AND SEPTIC SHOCK
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DOI：
10.1097/shk.0000000000001183
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发表时间：
2019-03-01
期刊：
影响因子：
3.1
通讯作者：
Soriano, Francisco Garcia
中科院分区：
文献类型：
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作者：
Borges, Rodrigo Cerqueira;Soriano, Francisco Garcia
目的：评价因严重脓毒症和脓毒性休克转入重症监护室（ICU）的患者的股直肌横截面积（RFCSA）与床边获得的肌力之间的相关性。方法：前瞻性队列观察研究。在ICU入院的第二天通过超声评估RFCSA，并在住院期间进行监测。当患者能够理解检查者的口头命令时，他们进行了肌肉力量的临床测试（医学研究理事会（MRC）量表和握力测定法）。结果如下：在37例因败血症住院的患者中，RFCSA在ICU的第二天显著下降5.18（4.49-5.96）cm（2），出院时为4.37（3.71-5.02）cm（2）。然而，握力显示从觉醒的12.00（7.00-20.00）Kgf增加到19.00（14.00-26.00）Kgf，直到出院。与未接受机械通气的患者相比，接受机械通气的患者RFCSA下降的趋势更大，但不具有显著性（P = 0.08）。RFCSA δ（ICU-ICU出院第2天）与握力呈负相关（r = 0.51，P < 0.05），男性和脓毒症相关器官衰竭评估评分与RFCSA δ呈正相关。结论：RFCSA与临床肌力测试相关。此外，已经表明败血症可以导致短期肌肉退化，无论他们是否接受机械通气。
Purpose: To evaluate the association between the rectus femoris cross-sectional area (RFCSA) and the muscular strength obtained at the bedside in patients forwarded to the intensive care unit (ICU) for severe sepsis and septic shock. Methods: An observational study of prospective cohort. RFCSA was assessed by ultrasound on the following day of the ICU admission and monitored during hospitalization. The patients performed clinical tests of muscle strength (Medical Research Council (MRC) scale and handgrip dynamometry), when they could understand the verbal commands of the examiners. Results: In 37 patients hospitalized for sepsis there was a significant decline in RFCSA of 5.18 (4.49-5.96) cm(2) on the 2nd day of ICU for 4.37 (3.71-5.02) cm(2) at hospital discharge. Differently, the handgrip strength showed an increase from the awakening of 12.00 (7.00-20.00) Kgf to 19.00 (14.00-26.00) Kgf until hospital discharge. Patients in mechanical ventilation had a greater tendency to decline in the RFCSA compared with patients who did not receive mechanical ventilation, however without being significant (P = 0.08). There was a negative association between RFCSA delta (2nd day of ICU-ICU discharge) and handgrip strength (r = 0.51, P < 0.05), and a male and Sepsis-related Organ Failure Assessment score positive association with the RFCSA delta. Conclusion: There was an association of RFCSA with clinical muscle strength tests. In addition, it has been shown that sepsis can lead to short-term muscle degradation, regardless of whether they are submitted to mechanical ventilation or not.