【摘要】 目的 探讨超声联合低频重复电刺激在老年重症监护室(ICU)机械通气患者获得性肌无力中预测价值。方法 选取2018年5月至2021年5月ICU收治的85例老年机械通气患者进行前瞻性队列研究，均在入住ICU 24 h内行超声与低频重复电刺激检测，待患者意识清醒后依据美国医学研究委员会肌力评定量表(MRC)评估肌力，根据是否发生获得性肌无力分为发生组、未发生组，比较2组基线资料、四头肌厚度、肱二头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度、低频重复电刺激检测结果，应用Pearson分析股四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度与MRC评分关系，采用多因素Logistic回归方程分析获得性肌无力的相关影响因素，采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度、低频重复电刺激检测预测获得性肌无力的价值。结果 发生组机械通气时间、制动时间长于未发生组(P<0.05);发生组股四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度低于未发生组，低频重复电刺激阳性率高于未发生组(P<0.05);股四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度与MRC评分呈正相关(P<0.05);控制了机械通气时间、制动时间后，股四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度是获得性肌无力的相关保护因素，低频重复电刺激阳性是获得性肌无力的相关危险因素(P<0.05);股四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度联合低频重复电刺激阳性预测获得性肌无力的AUC最大。结论 超声检测股四头肌厚度、胫前屈肌厚度、桡侧腕屈肌厚度联合低频重复电刺激阳性均与老年ICU机械通气患者获得性肌无力发生有关，可作为预测获得性肌无力的一个方案，为临床预防提供参考。更多还原

【Abstract】 Objective To explore the predictive value of ultrasonography combined with low-frequency repetitive electrical stimulation on acquired weakness in mechanically ventilated elderly in intensive care unit(ICU).Methods A prospective cohort study of 85 mechanically ventilated elderly admitted to the ICU from May 2018 to May 2021 was performed.Ultrasonography and low-frequency repetitive electrical stimulation were conducted within 24 hours of ICU admission.The Medical Research Council(MRC) muscle strength score was followed to assess the muscle strength when patients were conscious, the patients were allocated to the occurrence group and non-occurrence group based on the occurrence of the acquired weakness.The baseline data and testing results of thickness of quadriceps, biceps, anterior tibia flexor, flexor carpi radialis combined with low-frequency repetitive electrical stimulation were compared between the two groups.The relationships between the thickness of quadriceps, anterior tibia flexor, flexor carpi radialis with MRC scores were analyzed by using Pearson.Multivariate Logistic regression equation was used to analyze the related influencing factors of acquired myasthenia.Receiver operating characteristic curve(ROC) and ROC curve(AUC) were used to analyze the predictive value of thickness of quadriceps, anterior tibia flexor, flexor carpi radialis combined with low frequency repetitive electrical stimulation for acquired weakness.Results The duration and immobilization duration of mechanical ventilation in the occurrence group were longer than those in the non-occurrence group(P<0.05); the thickness of quadriceps, anterior tibia flexor, flexor carpi radialis in the occurrence group was lower than that in the non-occurrence group, and the positive rate of low-frequency repetitive electrical stimulation was higher than that in the non-occurrence group(P<0.05).The thickness of quadriceps, anterior tibia flexor, flexor carpi radialis was positively correlated with MRC scores(P<0.05),which was related protective factor for acquired weakness after controlling duration and immobilization duration of mechanical ventilation.The positive low-frequency repetitive electrical stimulation was a related risk factor for the acquired weakness(P<0.05).The AUC of the thickness of quadriceps, anterior tibia flexor, flexor carpi radialis combined with low frequency repetitive electrical stimulation was maximum in predicting acquired weakness.Conclusion For ICU mechanically ventilated elderly, ultrasonography including thickness of quadriceps, anterior tibia flexor, flexor carpi radialis combined with low-frequency repetitive electrical stimulation is related to the occurrence of acquired weakness.It can be used as a scheme to predict acquired weakness and provide reference for clinical prevention.更多还原