The Clinical Study About The Evaluation Of Skeletal Muscle Mass In Critically Ill Patients By Ultrasound

Objectives:To explore the feasibility of evaluating the muscle mass of critically ill patients by the ultrasonic correlation index,and the diagnostic value of ICUAW,and its correlation with the condition and prognosis.Methods:Ten patients with non-sepsis and fifteen patients with sepsis and septic shock who were admitted to the second affiliated Hospital of Kunming Medical University from October 2017 to February 2018 were selected..The cross sectional area of rectus femoris muscle was measured by ultrasound at different time points(D1,D3,D5,D7).Using the diagnostic criteria of MRC muscle strength scoring method to diagnose ICUAW;evaluating muscle quality using the bedside portable Ultrasonic Device(M-turbo or Edge,the Sonosite Company of USA)and linear ultrasonic probe(Model L38,ultrasonic frequency 5-10MHz),to measure the cross-sectional area of lower extremity rectus femoris muscle;Using SPSS 19.0 software to analyze the collection data.Results:1、The age of patients with sepsis was greater than that of non sepsis,and the difference was statistically significant(P<0.05).2、To compare the change rate of the cross sectional area of right and left rectus muscle between sepsis and non-sepsis patients at different time points(D1,D3,D5,D7),the results showed that there was a decrease in cross sectional area of rectus femoris in both sepsis group and non-sepsis group.The difference of the left △13CSA was statistically significant(P<0.05),but there was no significant difference in left△15CSA,left △17CSA,right △13CSA,right △15CSA and right △17CSA between the two groups(P>0.05).3、The IL-6 of the patients with sepsis at different time points(D1,D3,D5,D7)was higher than that of non-sepsis patients,and the difference was statistically significant(P<0.05),and the IL-6 level of patients with ICU-AW on day 1 and day 3 was higher than that of patients without ICU-AW.,the difference was statistically significant(P<0.05),but there was no significant difference in IL-6 level on the day 5 and day 7(P>0.05).4、In sepsis patients,we divided the patients into two groups:the ICU-AW group and the non-occurrence group,we found that myoglobin in the first day、the fifth day and the the seventh day,and the Interleukin-6 in the first day and third day,and the left△13CSA、the right △15CSA and the right △17CSA,and vasoactive drug use time,mechanical ventilation time and ICU residence time were significant differences(P<0.05).There was no significant difference in myoglobin in the third a day and Interleukin-6 in the firth day and in the seventh day,and the right△13CSA,the left △15CSA and the right △17CSA between the two groups(P>0.05).The inpatient mortality of ICU-AW group was higher than that of non-occurrence group(P<0.05).5、ROC curve analysis showed that left △13CSA,left △17CSA,right △15CSA and right △17CSA had diagnostic significance in prognostic.The sensitivity of left△13CSA,left △17CSA and right △17CSA were 100%.Conclusion:The indicators of the quantitative Ultrasound examination are effective and reliable clinical tool,which can be used to judge the changes of muscle content in critically ill patients,and to assist the diagnosis of ICU-AW and the judgement of prognosis;The incidence of ICU-AW in sepsis patients is 26.67%,and the incidence of ICU-AW was increased in patients with obvious loss of muscle mass;In sepsis patients,the patients with ICU-AW have poor clinical prognosis;In critically ill patients,the first three days in the ICU admission,the cross sectional area of rectus femoris was obviously decreased,especially in sepsis patients;The loss of muscle mass in sepsis patients could increase the incidence of ICU-AW.