To Explore The Diagnostic Value Of Handgrip Dynamometer Combined With Diaphragm Ultrasound In The Diagnosis Of ICU Acquired Weakness

Objective: To explore the diagnostic value of handgrip dynamometer combined with diaphragm ultrasound in the diagnosis of ICU acquired weakness(ICU-AW).Methods: We enrolled the mechanically ventilated patients who were screened to meet the requirements in the Department of Intensive Care Medicine of the Fourth Hospital of Hebei Medical University from July 2020 to December 2020,and collected general patient data.After the patient is awake,use the Medical Research Committee(MRC)score to evaluate muscle strength to determine whether ICU-AW occurs.At the same time,a handgrip dynamometer is performed at the bedside to evaluate the patient’s muscle strength and ultrasound to evaluate the patient’s diaphragmatic excursion(DE)and diaphragm thickening rate(DTF).Patients who do not meet the diagnostic criteria based on the MRC score will receive daily arousal assessment and MRC score,handgrip dynamometer,and ultrasound assessment of the severe diaphragm until they are diagnosed as ICU-AW or transferred out of the ICU.Compare the differences in various indicators between the non-ICU-AW group and the ICU-AW group.And draw the receiver operating curve(ROC),analyze the diagnostic value of handgrid dynamometer,DE and DTF to ICU-AW,and explore the risk factors that affect ICU-AW.Results: A total of 95 mechanically ventilated patients were included in this study,except for 20 cases of incomplete data collection after enrollment.75 cases were finally enrolled,of which 35 cases(46.7%)were diagnosed as ICU-AW according to the MRC scoring standard,and 40 cases(53.3%)were non-ICU-AW.Compared with the non-ICU-AW group,the Handgrip dynamometer,DE and DTF of ICU-AW patients were lower(P<0.05).The results of further subgroup analysis according to gender showed that in male patients,the Handgrip dynamometer,DE and DTF of patients in the ICU-AW group were significantly lower than those in the non-ICU-AW group(P<0.05);among female patients,the ICU-AW group the Handgrip dynamometer and DTF of the patients were significantly lower than those in the non-ICU-AW group(P<0.05),but there was no significant difference in DE between the two groups in female patients(P=0.281).ROC curve analysis showed that the value of handgrip dynamometer,DE,DTF,and handgrip dynamometer combined with diaphragm ultrasound were all statistically significant for ICU-AW(P<0.01);and handgrip dynamometer combined with diaphragm ultrasound could significantly improve the ICU-AW diagnostic value in severely ill patients.Multivariate logistic regression analysis showed that mechanical ventilation time longer is a risk factor for ICU-AW in mechanically ventilated patients ﹝OR=1.156,95%CI1.061-1.260,P=0.001﹞.Conclusions: Handgrip dynamometer,DE,DTF and Handgrip dynamometer combined with diaphragm ultrasound have diagnostic value for ICU-AW.In contrast,the combination of handgrip dynamometer and diaphragm ultrasound significantly improves the diagnostic value of ICU-AW in critically ill patients.