Effect of Electrical Muscle Stimulation on Upper and Lower Limb Muscles in Critically Ill Patients: A Two-Center Randomized Controlled Trial
Effect of Electrical Muscle Stimulation on Upper and Lower Limb Muscles in Critically Ill Patients: A Two-Center Randomized Controlled Trial
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DOI：
10.1097/ccm.0000000000004522
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发表时间：
2020-11-01
影响因子：
8.8
通讯作者：
Nishimura, Masaji
中科院分区：
文献类型：
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作者：
Nakanishi, Nobuto;Oto, Jun;Nishimura, Masaji
目的：肌肉电刺激广泛用于增强下肢活动度。尽管上肢肌肉萎缩在危重患者中很常见，但上肢肌肉电刺激的应用却鲜有报道。本研究的目的是调查肌肉电刺激是否可以预防上肢和下肢肌肉萎缩并改善身体功能。设计：随机对照试验。设置：两中心、混合内科/外科 ICU。患者：预计机械通气时间超过 48 小时且在 ICU 停留时间超过 5 天的成年患者。干预措施：42 名患者被随机分配至肌肉电刺激组 (n=17) 或对照组 (n=19)。测量和主要结果：主要结果是第 1 天至第 5 天肱二头肌和股直肌的肌肉厚度和横截面积的变化。次要结果包括 ICU 获得性无力的发生、ICU 活动度、住院时间和氨基酸水平。肌肉电刺激组和对照组（p=0.007）的肱二头肌厚度变化分别为-1.9%和-11.2%，横截面积的变化分别为-2.7%和-10.0%（p=0.03）。股直肌厚度的变化分别为-0.9% 与-14.7% (p= 0.003)，横截面积变化为-1.7% 与-10.4% (p= 0.04)。各组之间 ICU 获得性无力（13% vs 40%；p= 0.20）和 ICU 活动量表（3 vs 2；p= 0.42）没有显着差异。肌肉电刺激组的住院时间较短（23 天 [19-34 天] vs 40 天 [26-64 天]）（p = 0.04）。第 3 天，肌肉电刺激组支链氨基酸水平的变化较低（40.5% vs 71.5%；p=0.04）。结论：在危重患者中，肌肉电刺激可防止上肢和下肢肌肉萎缩，减弱蛋白水解作用，并缩短住院时间。
Objectives: Electrical muscle stimulation is widely used to enhance lower limb mobilization. Although upper limb muscle atrophy is common in critically ill patients, electrical muscle stimulation application for the upper limbs has been rarely reported. The purpose of this study was to investigate whether electrical muscle stimulation prevents upper and lower limb muscle atrophy and improves physical function. Design: Randomized controlled trial. Setting: Two-center, mixed medical/surgical ICU. Patients: Adult patients who were expected to be mechanically ventilated for greater than 48 hours and stay in the ICU for greater than 5 days. Interventions: Forty-two patients were randomly assigned to the electrical muscle stimulation (n= 17) or control group (n= 19). Measurements and Main Results: Primary outcomes were change in muscle thickness and cross-sectional area of the biceps brachii and rectus femoris from day 1 to 5. Secondary outcomes included occurrence of ICU-acquired weakness, ICU mobility scale, length of hospitalization, and amino acid levels. The change in biceps brachii muscle thickness was -1.9% versus -11.2% in the electrical muscle stimulation and control (p= 0.007) groups, and the change in cross-sectional area was -2.7% versus -10.0% (p= 0.03). The change in rectus femoris muscle thickness was -0.9% versus -14.7% (p= 0.003) and cross-sectional area was -1.7% versus -10.4% (p= 0.04). No significant difference was found in ICU-acquired weakness (13% vs 40%;p= 0.20) and ICU mobility scale (3 vs 2;p= 0.42) between the groups. The length of hospitalization was shorter in the electrical muscle stimulation group (23 d [19-34 d] vs 40 d [26-64 d]) (p= 0.04). On day 3, the change in the branched-chain amino acid level was lower in the electrical muscle stimulation group (40.5% vs 71.5%;p= 0.04). Conclusions: In critically ill patients, electrical muscle stimulation prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization.