广西医学

目的了解高原地区ICU患者住院期间四肢肢体围的动态变化趋势及其肌肉衰减情况。方法选取在青海省人民医院ICU住院的109例患者作为研究对象，收集其基本信息、营养风险筛查2002（NRS2002）评分及急性生理学与慢性健康状况评价系统Ⅱ（APACHEⅡ）评分。采用软皮尺结合测量标记定位技术，分别于患者入住ICU 24 h、48 h、72 h、5 d、7 d、10 d测量患者双侧上臂围、大腿围、小腿围。结果（1）109例患者的NRS2002评分为（5.63±2.36）分，APACHEⅡ评分为（20.19±6.75）分。（2）109例患者入住ICU 72 h的四肢肢体围均较入住ICU 24 h及48 h减小，且入住ICU 48 h的右侧上臂围、左侧大腿围、右侧小腿围小于入住ICU 24 h（P<0.05）。（3）81例患者入住ICU 5 d时的四肢肢体围较入住ICU 24 h、48 h、72 h减小（P<0.05）。（4）54例患者入住ICU 7 d时的四肢肢体围较入住ICU 24 h、48 h、72 h及5 d减小（P<0.05）。（5）39例患者入住ICU 10 d时的四肢肢体围较入住ICU 24 h、48 h、72 h、5 d及7 d减小（P<0.05）。结论高原地区ICU患者存在较高的营养风险且病情较重，入住ICU 48 h开始出现肌肉衰减现象，且随着住院时间的延长肌肉衰减逐渐加重。

Objective To understand the dynamic variation trend of limb circumference and its muscle attenuation of ICU patients in plateau area during hospitalization. Methods A total of 109 ICU patients who were hospitalized in Qinghai Provincial People's Hospital were selected as the research subjects. Their general data, Nutritional Risk Screening 2002 (NRS2002) score, and Acute Psychology and Chronic Health Evaluation Ⅱ (APACHEⅡ ) score were collected. Patients' bilateral circumferences of upper arm, thigh, and calf were measured 24 hours after ICU admission, and 48 and 72 hours after ICU admission, as well as 5, 7, and 10 days after ICU admission by employing flexible tape measure combined with measurement mark positioning technique, respectively. Results (1) NRS2002 score among 109 patients was 5.63±2.36, and APACHEⅡ score was 20.19±6.75. (2) Limb circumference among 109 patients at 72 hours after ICU admission was reduced as compared with at 24 and 48 hours after ICU admission, and circumferences of right upper arm, left thigh, and right calf at 48 hours after ICU admission were smaller as compared with at 24 hours after ICU admission (P<0.05). (3) Limb circumference among 81 patients on 5 days after ICU admission was reduced as compared with at 24, 48 and 72 hours after ICU admission (P<0.05). (4) Limb circumference among 54 patients on 7 days after ICU admission was reduced as compared with at 24, 48 and 72 hours, and on 5 days after ICU admission (P<0.05). (5) Limb circumference among 39 patients on 10 days after ICU admission was reduced as compared with at 24, 48 and 72 hours, and on 5 and 7 days after ICU admission (P<0.05). Conclusion ICU patients in plateau area were at a relatively high nutritional risk and have more serious condition. Muscle attenuation begins at 48 hours of ICU admission, and it gradually increases with the extension of length of hospital stays.

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