Ultrasound Image Analysis Of Quadriceps Of Different TCM Syndrome Types In Patients With ICU Sepsis-induced Myopathy

ObjectiveTo analyze the ultrasound images of the quadriceps of different syndrome types in patients with ICU sepsis,and to seek the relationship between the syndrome and the characteristics of the ultrasound images.MethodsFrom August 2018 to February 2019,the ICU sepsis patients who were treated in the Department of Critical Care Medicine,the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine,were eligible for inclusion in 39 patients.According to the dialectical of TCM,it was divided into spleen and stomach weak group(P group),syndrome of lung heat with yin deficiency(F group),liver and kidney loss group(G group).Collecting basic patient information,including gender,age,height,weight,BMI index,mechanical ventilation time.The pictures of ultrasound examination of the left quadriceps mu,scle on the oth,4th,and 7th day of admission,which were analyzed to obtain image characteristics by using Photoshop.The characteristics are:Vastus Intermedius thickness(Vlt),RF thickness(RFt),subcutaneous tissue thickness(Subcutaneous tissue thickness,St),Rectus femoris cross-sectional area(RFcsa),RF Echo intensity(RF).ResultsThere were 16 patients with spleen and stomach weakness,13 patients with lung heat and injury group,and 10 patients with liver and kidney loss group.The gender,age,height,weight,BMI index,mechanical ventilation time,and procalcitonin difference,s between three groups were not statistically meaningful.The characteristics of each group of ultrasound are as follows:The P group had the highest RF area when entering the ICU(2.39±0.66cm2,P=0.005,0.003),which decreased the fastest with time,but on the 7th day,the difference was not obvious with the three groups;the RF thickness was also the highest when entering the ICU.And on the 4th and 7th days,there was no significant difference with the other 2 groups of patients.In group F,the intensity of RF ultrasound increased the fastest with time,and the difference reached the maximum on the 7th day(11.59,9.86 with P group and G group,respectively,P was less than 0.05).In the G group,no difference was found between the two groups.Among the ultrasound indicators,the overall decline trend is:rectus rectus area,thickness,femoral intermediate muscle thickness;the upward trend is:subcutaneous tissue thickness,rectus muscle ultrasound intensity.There was no statistically significant difference in the trend of changes in the thickness of the median and subcutaneous tissue between the three groups.ConclusionThe musculoskeletal weak syndrome patients may have normal muscle mass at the initial stage of ICU,but the muscle loss with time is faster than the other two groups,suggesting that spleen and stomach weakness may be the main pathogenesis of sepsis muscle reduction.In the lung heat-induced group,the intensity of the rectus femoris muscle increased with time,which may be related to muscle fibrosis,fat infiltration and muscle inflammation.The study suggests that ultrasound can help early detection of ICU sepsis in patients with symptoms of myasthenia gravis,and also contribute to the TCM syndrome differentiation of these patients.