目标:在危重患者中,肌肉质量的数量和质量都有早期的变化。找到能够及时识别这种肌肉质量损失的工具是至关重要的。这项研究的目的是比较股四头肌的超声检查与金标准,大腿计算机断层扫描(CT)用于评估患有创伤性脑损伤的不同体重指数的重症患者的肌肉组织。
方法:这是一项专门针对创伤护理的重症监护病房(ICU)的前瞻性验证研究,位于三级教学医院。我们的研究涉及一个方便的患者样本。在三个不同的时间间隔进行了序贯超声和CT扫描:入院时,在入院后24到96小时之间,最后,在入学后96到168小时之间。对于所有超声波测量,我们同时进行了股四头肌CT测量。分析了超声和计算机断层扫描在三个不同时间和三个BMI范围内获得的测量值之间的相关性,在体重正常的个体中,超重和肥胖。
结果:结果:我们分析了时间1的49例患者的252张图像,时间2的40例患者和时间3的37例患者的图像,以比较使用US和CT的股四头肌厚度。其中,18例患者BMI≤24.9kg/m2(正常体重),18名患者从25到29.9kg/m2(超重),8例患者的BMI≥30kg/m2(肥胖)。平均年龄是37岁,大多数(94%)是男性,主要合并症是:高血压12%,糖尿病4%和14%吸烟。结果表明,通过两种方法获得的测量结果之间存在微小差异,这些变化不受体重指数的影响,这些变化在临床应用中实际上是微不足道的。因此,所获得的值之间的相关性和一致性发现与良好的一致性范围存在很强的正相关。对于正常体重,在T1,T2和T3处获得的Spearman相关系数分别为r=0.89,0.91和0.88,p<0.01,对于超重,r=0.91、0.80和0.81,分别在T1、T2和T3时p<0.01,对于肥胖,r=0.89、0.94和0.84,分别在T1、T2和T3时p<0.01。除了正相关,我们观察到方法之间有很高的一致性。Bland&Altman在时间1的分析显示,分别,偏差为1.46、2.03和0.76。在时间2,偏差为0.42、3.11和2.12。在时间3,偏差为2.26、3.38和2.11mm。
结论:我们的研究结果表明,基于超声测量股四头肌厚度具有与大腿CT相当的性能。这一结论源于超声和CT之间观察到的极好的相关性和良好的一致性,这被认为是危重患者肌肉评估的黄金标准。
背景:该临床试验已在REBEChttps://ensaiosclinicos.gov注册。br/标识符:RBR-2bzspnz。协议获得批准,2019年7月30日,由dasClínicas医院研究伦理委员会,科学学院-试验登记号:3,475,851。
Among critical patients, there is an early onset of changes in both the quantity and quality of muscle mass. It is essential to find tools that promptly identify this muscle mass loss. The aim of this study was to compare the ultrasonography of the quadriceps femoris to the gold standard, thigh computed tomography (CT) for assessing the musculature of critically ill patients with different body mass index who have suffered traumatic brain injury.
This is a prospective validation study in an Intensive Care Unit (ICU) specialized in trauma care, located at a tertiary teaching hospital. Our study involved a convenience sample of patients. Sequential ultrasound and CT scans were performed at three distinct time intervals: upon admission, between 24 and 96 h\' post-admission, and finally, between 96 and 168 h\' post-admission. For all ultrasound measurements, we conducted simultaneous quadriceps CT measurements. The correlation between measurements obtained by ultrasound and computed tomography at three different times and in three BMI ranges was analyzed, in individuals with normal weight, overweight and obese.
Results: We analyzed 252 images in 49 patients in time 1, 40 patients in time 2, and 37 in time 3 to compare the thickness quadriceps muscle using US and CT. Of these, 18 patients had a BMI ≤ 24.9 kg/m2 (normal weight), 18 patients from 25 to 29.9 kg/m2 (overweight), and 8 patients had a BMI ≥ 30 kg/m2 (obese). The mean age was 37 years, the majority (94%) were male and the main comorbidities were: hypertension 12%, diabetes 4% and 14% smoking. The results revealed minor discrepancies between measurements obtained through the two methods, these changes were not influenced by the body mass index, with these variations being practically insignificant in the context of clinical application. Thus, the correlation and concordance between the values obtained found a strong positive correlation with good limits of agreement. The Spearman\'s correlation coefficients obtained were r = 0.89, 0.91 and 0.88, p < 0.01 at T1, T2 and T3 respectively for normal weight, r = 0.91, 0.80 and 0.81, p < 0.01 at T1, T2 and T3 respectively for overweight and r = 0.89, 0.94 and 0.84, p < 0.01 at T1, T2 and T3 respectively for obesity. In addition to a positive correlation, we observed a high agreement between the methods. The Bland & Altman analysis at time 1 showed, respectively, the bias of 1.46, 2.03 and 0.76. At time 2, the bias was 0.42, 3.11 and 2.12. At time 3, the bias was 2.26, 3.38 and 2.11 mm.
Our findings suggest that measure femoral quadriceps muscle thickness ultrasound-based exhibits a comparable performance to thigh CT. This conclusion stems from the excellent correlation and good agreement observed between ultrasound and CT, which is considered the gold standard for muscle assessment in critically ill patients.
This clinical trial is registered at REBEC https://ensaiosclinicos.gov.br/ identifier: RBR-2bzspnz. The protocol was approved, on July 30, 2019, by the Research Ethics Committee of the Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto - Trial Registration Number: 3,475,851.