Investigation Of Muscle Health In Intensive Care Unit Patients And Its Influence Factors

Objective The present study aimed at investigating muscle health condition in Intensive Care Unit?ICU?patients by measuring muscle mass and strength,and analyzing its influence factors.Method A total of 119 Patients in ICU of the First Affiliate Hospital of Soochow University were enrolled from Jan.to Aug.2017.General demographic and clinic characteristics,Modified Early Warning Score?MEWS?and Activity of Daily Living?ADL?score were collected in the patients.Limb circumference?upper arm circumference,thigh circumference,calf circumference?was measured using a tape and peripheral muscle strength?handgrip,elbow flexion,both upper limb abduction,hip flexion?was evaluated using handgrip and handheld dynamometer.All of which were recorded within 24 h after admission to ICU?24H?,4 days?D4?,7 days?D7?,14 days?D14?,and continue to test once a week if patients stay longer and until patients were transferred,discharged or dead.Results There were 79 males and 40 females among the 119 patients enrolled with a mean age of 60.9±16.3 years old.Patients' length of ICU stay was 8?5,13?[median(P₂₅,P₇₅)]days,tracheal intubation stay was 6?4,13?days.MEWS and ADL significantly improved at discharge compared with at admission?24H??P?0.01?.Patients' upper arm circumference,thigh circumference and calf circumference at 24 H were 28.4±3.8 cm,42.9±5.3 cm and31.5±3.6 cm respectively.Significant differences were found between left and right upper arm circumference at 24 H,D4?left<right,P?0.01?,the right thigh and calf circumferences were bigger than left at D14?P?0.05?.Handgrip strength,pulling strength of elbow flexion,both upper limb abduction and hip flexion were 15?0,22.1?kg,8?0,13.7?kg,3.9?0,8.4?kg and 10.5?0,14.3?kg respectively,and the handgrip strength of right side was larger than the left side.There was significant reduction in upper arm and calf circumferences from 24 H to other time points and discharge day?P?0.05?.The thigh circumference was reduced at D14,D28 and discharge?P?0.05?and both upper limbs abduction was decreased at D21?P?0.05?when compared with 24 H.Generally,limb circumferences showed a downward trend and muscle strength showed three different trends?rising,down,irregular?in different patients.The main influence factors included age,hormone application,consciousness,sex,ADL score,length of ICU stay and tracheal tube intubation stay.Positive correlation was found between upper arm circumference and handgrip?r=0.22,P=0.037?as well as calf circumference and hip flexion?r=0.32,P=0.001?.Conclusion1.The upper arm circumference,thigh circumference,calf circumference of ICU patients were about 28 cm,42 cm,31 cm,respectively;The handgrip strength,elbow flexion,both upper limb abduction and hip flexion of ICU patients were about 13.3 kg,7.5kg,3.7 kg,9.4 kg.Positive correlation was found between limb circumference and strength.2.Muscle mass was reduced after 4 days admission to ICU and showed a general downtrend with longer ICU stay.The change of strength with time has a large individual difference.3.The main influence factors of muscle mass included age and hormone application,and the ones of muscle strength included consciousness,sex,ADL score,disease type,ICU stay and tracheal tube intubation stay.