Qualitative Ultrasound in Acute Critical Illness Muscle Wasting
Qualitative Ultrasound in Acute Critical Illness Muscle Wasting
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DOI：
10.1097/ccm.0000000000001016
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发表时间：
2015-08-01
影响因子：
8.8
通讯作者：
Montgomery, Hugh E.
中科院分区：
文献类型：
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作者：
Puthucheary, Zudin A.;Phadke, Rahul;Montgomery, Hugh E.
目的：骨骼肌质量的快速和早期损失是危重病幸存者常见的身体残疾的基础。然而，骨骼肌的功能不仅取决于其数量，还取决于其质量，这可能会受到不利影响。我们着手研究危重病早期发生的宏观肌肉回声和筋膜特征的变化，并将其与微观组织学定义的肌纤维坏死和筋膜病理学联系起来。设计和设置：前瞻性两中心观察性研究。患者：30名受试者组成危重病肌肉骨骼超声招募的患者亚组：纵向评估（肌肉）研究。测量和主要结果：比较股外侧肌组织学标本和股直肌回声的超声评估。发生肌肉坏死的患者（n = 15）的肌肉回声变化大于未发生肌肉坏死的患者（8.2% [95% CI，-5.3至21.7] vs -15.0% [95% CI，-28.9至-1.09]; p = 0.016）。超声回声预测肌纤维坏死的受试者操作曲线下面积为0.74（95% CI，0.565至0.919; p = 0.024），去除潜在医源性肌肉损伤后增加至0.85（95% CI，0.703至-0.995; p = 0.003）。30例活检中有18例（60%）观察到筋膜炎。结论：在危重患者中，超声可以无创地检测肌纤维坏死和筋膜炎症。筋膜炎先于并经常伴随肌肉坏死。这些发现可能对危重病幸存者的功能有影响。
Objectives: A rapid and early loss of skeletal muscle mass underlies the physical disability common amongst survivors of critical illness. However, skeletal muscle function depends not only on its quantity but its quality, which may be adversely affected. We set out to characterise the changes in macroscopic muscle echogenicity and fascial characteristics that occur early in critical illness, and to relate these to microscopic histologically defined myofibre necrosis and fascial pathology.Design and Setting: Prospective two center observational study.Patients: Thirty subjects comprising a subgroup of patients recruited to the Musculoskeletal Ultrasound in Critical Illness: Longitudinal Evaluation (MUSCLE) study.Measurements and Main Results: Comparisons were made between sequential Vastus Lateralis histological specimens and ultrasound assessment of Rectus Femoris echogenicity. Change in muscle echogenicity was greater in patients who developed muscle necrosis (n = 15) than in those who did not (8.2% [95% CI, -5.3 to 21.7] vs -15.0% [95% CI, -28.9 to -1.09]; p = 0.016). The area under receiver operator curve for ultrasound echogenicity's prediction of myofiber necrosis was 0.74 (95% CI, 0.565 to 0.919; p = 0.024) increasing to 0.85 (95% CI, 0.703 to -0.995; p = 0.003) with the removal of those with potential iatrogenic muscle damage. Fasciitis was observed in 18 of 30 biopsies (60%).Conclusions: Myofiber necrosis and fascial inflammation can be detected noninvasively using ultrasound in the critically ill. Fasciitis precedes and frequently accompanies muscle necrosis. These findings may have functional implications for survivors of critical illness.