| 李 枝,王景刚,李庆云,贠国俊,曹建国.超声下股四头肌变化与儿童ICU获得性衰弱的关系[J].中国康复医学杂志,2025,(1):32~37 |
| 超声下股四头肌变化与儿童ICU获得性衰弱的关系 点此下载全文 |
| 李 枝 王景刚 李庆云 贠国俊 曹建国 |
| 深圳市儿童医院康复科，深圳市，518034 |
| 基金项目：广东省医学科学技术研究基金项目（A2022421）；广东省高水平医院建设财政资金项目（ynkt2021-zz036） |
| DOI：10.3969/j.issn.1001-1242.2025.01.006 |
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| 摘要： |
| 摘要
目的：探索儿童股四头肌变化与ICU获得性衰弱（ICU-AW）的关系。
方法：前瞻性收集2022年10月—2023年3月在深圳市儿童医院重症监护病房治疗的患儿，分别在入ICU后第1天、第4天、第7天使用超声仪测量股直肌厚度、股中间肌厚度及股直肌横截面积，以第一天为基线，计算各肌肉萎缩率，并于第7天，在患儿能遵嘱配合时进行医学研究委员会肌力评分（MRC评分）及危重症物理功能测试评分（PFIT-s评分）。根据MRC评分<48分，分为ICU-AW组与非ICU-AW组，分析儿童ICU-AW与股四头肌变化的关系。
结果：共纳入21例重症患儿，男11例，女10例，儿童ICU-AW发生率为41.2%（n=7/17，4例患儿因谵妄状态未行肌力评估）。入ICU后7天内股直肌横截面积萎缩率最大，达-8.00%±15.10%。两组间7天内均以股中间肌厚度变化率最大，且ICU-AW组主要以增厚为主，4天内平均增厚19.51%±16.51%，7天内平均增厚14.14%±28.13%；非ICU-AW组主要以萎缩为主，4天内平均萎缩率﹣16.07%±17.46%，7天内平均萎缩率为﹣15.55%±30.04%。ICU-AW组在入ICU7天内股直肌厚度平均增厚4.51%±8.38%，非ICU-AW组股直肌厚度平均萎缩率为﹣8.19%±11.79%。肌肉萎缩率与PFIT-s评分间无相关性（均P>0.05），4天内股直肌厚度萎缩率、股中间肌厚度萎缩率分别与MRC评分呈中度负相关（r=﹣0.541，P=0.025；r=﹣0.657，P=0.004）；7天内股直肌厚度萎缩率、股中间肌厚度萎缩率分别与MRC评分呈中度负相关（r=﹣0.664，P=0.004；r=﹣0.584，P=0.014）；股直肌横截面积萎缩率与MRC评分间无显著相关（P>0.05）。
结论：ICU-AW组较非ICU-AW组，肌肉厚度主要表现为增厚而非萎缩，超声可于入ICU后第4天早期识别，具体诊断临界值值得进一步研究。 |
| 关键词：ICU获得性衰弱 医学研究委员会肌力评分 超声评估 |
| Relationship between ultrasonic changes of quadriceps femoris and acquired weakness of ICU in children Download Fulltext |
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| Department of Rehabilitation， Shenzhen Children’s Hospital，518034 |
| Fund Project: |
| Abstract: |
| Abstract
Objective： To explore the relationship between the changes of quadriceps femoris and ICU acquired weakness （ICU-AW） in children.
Method： A prospective collection of pediatric patients treated in the intensive care unit of Shenzhen children's hospital from October 2022 to March 2023. The thickness and cross-sectional area of rectus femoris and the thickness of vastus intermedius were measured by ultrasound on the 1st， 4th and 7th day after ICU. The first day served as the baseline to calculate the atrophy rate for each muscle. On the 7th day， the Medical Research committee muscle strength score （MRC score） and critical physical function test score （PFIT-s score） were performed. According to the MRC score＜48， patients were divided into ICU-AW group and non-ICU-AW group to analyze the relationship between ICU-AW and the changes of quadriceps femoris.
Result： A total of 21 critically ill children were included， including 11 males and 10 females. The incidence of ICU-AW in children was 41.2% （4 cases were not evaluated because of delirium）. Within 7 days after entering ICU， the atrophy rate of cross-sectional area of rectus femoris was the highest， reaching ﹣8.00%±15.10%. Both groups showed the greatest rate of change in the vastus intermedius thickness over 7 days, with the ICU-AW group mainly showing an increase in thickness(19.51%±16.51% over 4 days, 14.14%±28.13% over 7 days)，while the non-ICU-AW group primarily showed atrophy(﹣16.07%±17.46% over 4 days，﹣15.55%±30.04% over 7 days). The ICU-AW group had an average increase in rectus femoris thickness of 4.51%±8.38% within 7 days of ICU admission, while the non-ICU-AW group had an average atrophy rate of ﹣8.19%±11.79%. There was no correlation between muscular atrophy rate and PFIT-s score (all P>0.05)， but there was a moderate negative correlation between rectus femoris thickness atrophy rate and femoral intermediate muscle thickness atrophy rate and MRC score within 4 days， respectively （ritual color 0.541 million 0.657 million 0.004）， and moderate negative correlation between MRC score and thickness atrophy rate of rectus femoris and vastus medius within 7 days. There was no significant correlation between the atrophy rate of cross-sectional area of rectus femoris and MRC score.
Conclusion： Compared with the non-ICU-AW group， the muscle thickness in the ICU-AW group is mainly thickened rather than atrophied， which can be identified by ultrasound on the 4th day after ICU. The specific diagnostic threshold is worthy of further study. |
| Keywords:intensive care unit acquired weakness Medical Research Committee muscle strength score ultrasonic evaluation |
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