Sepsis Is Associated with a Preferential Diaphragmatic Atrophy A Critically Ill Patient Study Using Tridimensional Computed Tomography
Sepsis Is Associated with a Preferential Diaphragmatic Atrophy A Critically Ill Patient Study Using Tridimensional Computed Tomography
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DOI：
10.1097/aln.0000000000000201
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发表时间：
2014-05-01
期刊：
影响因子：
8.8
通讯作者：
Jaber, Samir
中科院分区：
文献类型：
--
作者：
Jung, Boris;Nougaret, Stephanie;Jaber, Samir
背景：在脓毒症动物模型中，膈肌和腰大肌受到影响。是否隔膜或四肢肌肉是优先受影响的败血症在critical illustrate.Methods：回顾性二次分析研究，包括40例患者，比较对照组（n = 17）和重症患者，（n = 14）或无败血症（n = 9）。在重症监护室（ICU）住院期间，使用三维计算机断层扫描体积测定法测量膈肌体积、腰肌体积和第三腰椎骨骼肌横截面积。膈肌强度采用磁膈神经刺激进行评价。主要终点是重症患者（有或无败血症）在ICU期间膈肌和外周肌容积动力学的比较。在ICU入院时，重症患者和对照组患者之间的膈肌和腰大肌体积均无显著差异（横膈膜163 53 cm（3）vs. 197 +/- 82 cm（3），P = 0.36;腰大肌272 +/- 116 cm（3）vs. 329 +/- 166 cm（3），P = 0.31）。入院后25天（15 - 36天），非脓毒症患者的膈肌容积减少了11 +/- 13%，脓毒症患者减少了27 +/- 12%，P = 0.01。非脓毒症患者腰肌体积减少11 +/- 10%，脓毒症患者减少19 +/- 13%，P = 0.09。ICU入院时，膈肌强度与膈肌容量相关，脓毒症患者膈肌强度（6.2 cm H2O [5.6 ~ 9.3]）低于非脓毒症患者（13.2 cm H2O [12.3 ~ 15.6]），P = 0.01。在脓毒症患者中，作者首次报告了人类与外周肌肉相比优先发生膈肌萎缩。
Background: Diaphragm and psoas are affected during sepsis in animal models. Whether diaphragm or limb muscle is preferentially affected during sepsis in the critically ill remains unclear.Methods: Retrospective secondary analysis study including 40 patients, comparing control (n = 17) and critically ill patients, with (n = 14) or without sepsis (n = 9). Diaphragm volume, psoas volume, and cross-sectional area of the skeletal muscles at the third lumbar vertebra were measured during intensive care unit (ICU) stay using tridimensional computed tomography scan volumetry. Diaphragm strength was evaluated using magnetic phrenic nerve stimulation. The primary endpoint was the comparison between diaphragm and peripheral muscle volume kinetics during the ICU stay among critically ill patients, with or without sepsis.Results: Upon ICU admission, neither diaphragm nor psoas muscle volumes were significantly different between critically ill and control patients (163 53 cm(3)vs. 197 +/- 82 cm(3) for the diaphragm, P = 0.36, and 272 +/- 116 cm(3)vs. to 329 +/- 166 cm(3) for the psoas, P = 0.31). Twenty-five (15 to 36) days after admission, diaphragm volume decreased by 11 +/- 13% in nonseptic and by 27 +/- 12% in septic patients, P = 0.01. Psoas volume decreased by 11 +/- 10% in nonseptic and by 19 +/- 13% in septic patients, P = 0.09. Upon ICU admission, diaphragm strength was correlated with diaphragm volume and was lower in septic (6.2 cm H2O [5.6 to 9.3]) than that in nonseptic patients (13.2 cm H2O [12.3 to 15.6]), P = 0.01.Conclusions: During the ICU stay, both diaphragm and psoas volumes decreased. In septic patients, the authors report for the first time in humans preferential diaphragm atrophy compared with peripheral muscles.